76
|
Alexy T, Morris A, Flattery M, Ortega-Legaspi J, Devore A, Shah P, Sinha S, Cole R. Universal CMV Prophylaxis Mitigates the Risks of Basiliximab Induction in Heart Transplant Recipients at Intermediate Risk (R+) for Post-Transplant CMV Complications. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
77
|
Genovese L, Yin M, Michaels A, Singh R, Tang D, Indaram M, Kanwar M, Cowger J, Drakos S, Shah P. Multicenter Study of Favorable Patient Characteristics Associated with Cardiac Reverse Remodeling in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
78
|
Morris A, Flattery M, Ortega-Legaspi J, Devore A, Alexy T, Shah P, Nair K, Cole R. The Risk of Leukopenia with Universal vs. Preemptive Prophylaxis Strategies in Heart Transplant Recipients at Intermediate Risk for CMV Complications. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
79
|
Charya A, Jang M, Sun J, Mutebi C, Luikart H, Shah P, Matthews J, Brown A, Kong H, Tunc I, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Racial Differences in Immunosuppression and Lung Transplant Outcomes. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
80
|
Timofte I, Keller M, Varghese A, Levine D, Aryal S, Shah P, Vesselinov R, Ross D, Woodward R, Dale B, Terrin M, Iacono A, Agbor-Enoh S. Cell Free DNA Levels in Patients with Acute Rejection after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
81
|
Schneeberger P, Zhang C, Santilli J, Wijesinha Z, Levy L, Chen B, Xu W, Lee Y, Huszti E, Ahmed M, Boonstra K, Moshkelgosha S, Weigt S, Shah P, Budev M, Frankel C, Todd J, Snyder L, Palmer S, Yeung J, Keshavjee S, Singer L, Coburn B, Martinu T. The Pulmonary Microbiome after Lung Transplantation is Associated with Gastroesophageal Reflux Disease, Inflammation, and Allograft Dysfunction. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
82
|
Mutebi C, Ponor L, Cochrane A, Levine D, Jang M, Luikart H, Shah P, Mathew J, Brown A, Kong H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Impact of AMR Treatment: Responders vs Non-Responders Characteristics. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
83
|
Charya A, Jang M, Mutebi C, Luikart H, Shah P, Matthews J, Brown A, Kong H, Tunc I, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Valantine H, Agbor-Enoh S. Cell-Free DNA to Monitor Immunosuppression Adequacy in Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
84
|
Keller M, Mutebi C, Shah P, Levine D, Aryal S, Timofte I, Mathew J, Varghese A, Giner C, Ross D, Dale B, Woodward R, Agbor-Enoh S. Performance of Donor Derived Cell-Free DNA in Routine Clinical Care of Lung Transplant Recipients, a Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
85
|
Levy L, Ahmed M, Huszti E, Zhang C, Hunter S, Boonstra K, Sage A, Ghany R, Budev M, Shah P, Reynolds J, Snyder L, Belperio J, Singer L, Palmer S, Keshavjee S, Todd J, Weigt S, Martinu T. Bronchoalveolar Bile Acids are Associated with Acute Rejection, Inflammation, and Allograft Survival: A Multi-Center Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
86
|
Yang Y, Agbor-Enoh S, Ilker T, Hsu S, Russell S, Feller E, Shah K, Rodrigo M, Najjar S, Kong H, Pirooznia M, Jang M, Marboe C, Berry G, Shah P, Valantine H. Cardiac Allograft Injury in Patients of African Ancestry: Trends of Donor-Derived Cell-Free DNA Based on Genetic Ancestry. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
87
|
Teuteberg J, Kobashigawa J, Shah P, Ghosh S, Ross D, DePasquale E, Khush K. Donor-Derived Cell-Free DNA Predicts De Novo DSA after Heart Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
88
|
Shah P, Svigos K, Yin L, Soter N, Lo Sicco K, Adotama P. Differences in the clinical presentation of bullous pemphigoid in patients with skin of colour and patients with white skin. Br J Dermatol 2021; 185:430-432. [PMID: 33735455 DOI: 10.1111/bjd.20068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/27/2022]
|
89
|
Iwata Y, Nakajima S, Plitman E, Truong P, Bani-Fatemi A, Caravaggio F, Kim J, Shah P, Mar W, Chavez S, Remington G, Gerretsen P, De Luca V, Sailasuta N, Graff-Guerrero A. Glutathione Levels and Glutathione-Glutamate Correlation in Patients With Treatment-Resistant Schizophrenia. ACTA ACUST UNITED AC 2021; 2:sgab006. [PMID: 33969302 PMCID: PMC8086698 DOI: 10.1093/schizbullopen/sgab006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Treatment-resistant schizophrenia (TRS) has been suggested to involve glutamatergic dysfunction. Glutathione (GSH), a dominant antioxidant, is known to be involved in glutamatergic neurotransmission. To date, no study has examined GSH levels in patients with TRS. The aim of this study was to examine GSH levels in the dorsal anterior cingulate cortex (dACC) of patients with TRS. Patients with schizophrenia were categorized into 3 groups with respect to their antipsychotic response: (1) clozapine (CLZ) nonresponders, (2) CLZ responders, and (3) first-line responders (FLR). GSH and glutamine + glutamate (Glx) levels were measured using 3T proton magnetic resonance spectroscopy. Firstly, dACC GSH levels were compared among the patient groups and healthy controls (HCs). Further, relationships between GSH and Glx levels were compared between the groups and GSH levels were explored stratifying the patient groups based on the glutamate-cysteine ligase catalytic (GCLC) subunit polymorphism. There was no difference in GSH levels between the groups. FLR showed a more negative relationship between GSH and Glx levels in the dACC compared to HCs. There were no effects of GCLC genotype on the GSH levels. However, CLZ responders had a higher ratio of high-risk GCLC genotype compared to CLZ nonresponders. This study demonstrated different relationships between GSH and Glx in the dACC between groups. In addition, the results suggest a potential link between CLZ response and GCLC genotype. However, it still remains unclear how these differences are related to the underlying pathophysiology of schizophrenia subtypes or the mechanisms of action of CLZ.
Collapse
|
90
|
Baldwin DS, Dang M, Farquharson L, Fitzpatrick N, Lindsay N, Quirk A, Rhodes E, Shah P, Williams R, Crawford MJ. Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression. Compr Psychiatry 2021; 104:152212. [PMID: 33160123 DOI: 10.1016/j.comppsych.2020.152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/04/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. CONCLUSIONS There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.
Collapse
|
91
|
McClymont E, Fell D, Albert A, Alton G, Barrett J, El-Chaar D, Harrold J, Krajden M, Lipsky N, Maan E, Malinowski A, Othman M, Raeside A, Ray J, Roberts A, Ryan G, Sadarangani M, Sauve L, van Schalkwyk J, Shah P, Snelgrove J, Sprague A, Ting J, Walker M, Whittle W, Williams C, Yudin M, Zipursky J, Abenhaim H, Boucoiran I, Castillo E, Crane J, Elwood C, Joynt C, Kotaska A, Martel J, Murphy-Kaulbeck L, Poliquin V, Ryan S, Saunders S, Scott H, Money D. Canadian surveillance of COVID-19 in pregnancy: Epidemiology and maternal and infant outcomes. Am J Obstet Gynecol 2020. [PMCID: PMC7683302 DOI: 10.1016/j.ajog.2020.08.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
92
|
Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.
Collapse
|
93
|
Basu T, Ambulkar I, Nayek D, Karpe A, Gawde S, Kamwal B, Shah S, Shah P, Behera N, Saldanha V, Sakhare P, Onchineyan S. Outcome and Quality of Life among Geriatric Head and Neck Cancer Patients Treated with Intensity Modulated Radiotherapy: Importance of Comprehensive Geriatric Head and Neck Cancer Clinic. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
94
|
Nauffal V, Bay C, Shah P, Sobieszczyk P, Kaneko T, O'Gara P, Nohria A. Outcomes of transcatheter vs. isolated surgical aortic valve replacement in mediastinal radiation-associated severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Mediastinal radiation can lead to long-term cardiac sequelae, including aortic valve disease. Surgical aortic valve replacement (SAVR) is associated with poor outcomes in this population. Transcatheter aortic valve replacement (TAVR) now provides an alternative treatment strategy that may improve outcomes.
Purpose
To compare 30-day outcomes after TAVR vs. isolated SAVR for radiation-associated severe symptomatic aortic stenosis using the Society of Thoracic Surgery (STS) National Adult Cardiac Surgery Database.
Methods
We evaluated 1,668 TAVR and 2,611 isolated SAVR patients enrolled in the STS national database from July 2011 through December 2018. A propensity score for TAVR vs. SAVR was derived using a non-parsimonious logistic regression model that included 29 pre-operative variables and was used to generate a 1:1 matched cohort (NTotal=1,560). 30-day outcomes in TAVR vs. SAVR patients were compared in the matched cohort using conditional logistic regression. We also tested for temporal trends in 30-day mortality separately for TAVR and SAVR in the matched cohort, adjusted for potential confounders, to see if outcomes varied across the study period.
Results
In the propensity-matched cohort, baseline demographics, comorbidities and preoperative characteristics were balanced between the TAVR and SAVR groups. The mean age was 73.3 years and 75% were females in each group. In the propensity-matched cohort, TAVR was associated with significantly reduced 30-day all-cause [OR=0.50 (0.30–0.84), p=0.01] and cardiovascular mortality as compared to SAVR [OR=0.33 (0.14–0.78), p=0.01]. Similarly, post-operative complications occurred less in the TAVR group except for stroke/transient ischemic attack (TIA) [OR=3.17 (1.27–7.93), p=0.01] and pacemaker implantation [OR=1.71 (1.21–2.44), p=0.003] which were significantly higher with TAVR (Figure 1A). While, 30-day mortality associated with both procedures improved over the course of the study, the trend was only statistically significant in the TAVR group following adjustment for potential confounders. TAVR was consistently associated with better survival than SAVR in the matched cohort across the study period (Figure 1B).
Conclusion
Our findings suggest that TAVR is a safe alternative to SAVR for radiation-associated severe symptomatic aortic stenosis and is associated with lower 30-day mortality and post-operative complications. The risk of stroke/TIA and pacemaker implantation is higher with TAVR and should be considered when choosing therapy. Additional prospective studies to validate our findings and evaluate long-term outcomes are needed to further guide clinical decision making in this population.
Figure 1
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Funding to support acquisition of the data from the Society of Thoracic Surgery was obtained from discretionary funds available to Dr. Anju Nohria from the Cardiovascular Medicine Division.
Collapse
|
95
|
Ospina M, Soileau M, Brillman S, Reed C, Shah P, Jones S. Impact of Levodopa/Carbidopa Intestinal Gel Delivery on CarePartner Burden and Quality of Life: Survey by Parkinson & Movement disorder alliance. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
96
|
Todd B, Patel K, Chen N, Prewitt N, Shah P. 260 Risk Factors for Mortality in Emergency Medicine Morbidity and Mortality Cases. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
97
|
Subbiah V, Nastke M, Miller G, Shah P, Gesta S, Rodrigues L, Granger E, Narain N, Kiebish M, Sarangarajan R, Kundranda M. 1551P Validation of response and survival biomarkers in a phase II trial of BPM 31510-IV in advanced refractory pancreatic ductal adenocarcinoma (PDAC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
98
|
Embleton L, Shah P, Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. Int J Equity Health 2020; 19:147. [PMID: 32859193 PMCID: PMC7455900 DOI: 10.1186/s12939-020-01255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
Collapse
|
99
|
Shah J, Dubb S, Agar S, Shah P, Mirza T. Computed tomographic indications for occult skull fractures in paediatric head trauma diagnosed at the time of wound closure under general anaesthesia. Br J Oral Maxillofac Surg 2020; 59:35-38. [PMID: 32747033 DOI: 10.1016/j.bjoms.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/02/2020] [Indexed: 11/18/2022]
Abstract
Children with head injuries commonly present to the emergency department with forehead lacerations, and are frequently referred to the oral and maxillofacial team. Assessing the Glasgow coma scale (GCS) and neurological status of these patients is particularly challenging and there remains marked ambiguity regarding the use of computed tomographic (CT) imaging in children who have no obvious signs of traumatic brain injury. We present a case series of three patients who presented to our unit with forehead lacerations following a fall. All had a normal GCS, no obvious neurological signs, and all were listed for wound closure under general anaesthesia. Intraoperatively they were found to have underlying skull fractures that necessitated emergency CT whilst under general anaesthesia. Retrospective analysis was performed. Current guidelines and the literature were reviewed to identify factors that may help to identify occult skull fractures in the context of paediatric head trauma. Despite the subsequent discovery of skull fractures under general anaesthesia, none of our patients would have satisfied the present absolute indications for CT in the current guidelines. A number of helpful factors are not common in the UK guidelines but are present in others, including the presence of an appreciable haematoma and lacerations greater than 5 cm, amongst others. The assessment of paediatric patients with head trauma often remains a challenge when assessing for features such as headache, focal neurology, and amnesia. A high index of suspicion, formal examination under anaesthesia, and communication with the radiology department, are imperative if we are to avoid missing an occult injury that could potentially result in brain injury.
Collapse
|
100
|
Shah P, Bajaj S, Polsky D. 646 Late-stage melanoma diagnosis in New York State (NYS). J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|