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Kolla A, Fried L, Shah P, Liebman T, Stein J, Polsky D. 536 Impact of electrical impedance spectroscopy on diagnostic accuracy and clinician confidence in a survey-based evaluation of melanocytic skin lesions suspicious for melanoma. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.562] [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]
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77
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Rangel LK, Adotama P, Shah P, Lo Sicco K, Femia AN. Evaluating the contributions of dermatologists in the management of systemic sclerosis: a retrospective analysis. J Eur Acad Dermatol Venereol 2021; 35:e654-e656. [PMID: 33866612 DOI: 10.1111/jdv.17288] [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]
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78
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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
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79
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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
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80
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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
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81
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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
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82
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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
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83
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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
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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
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85
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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
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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
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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
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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
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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
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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]
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Kenerly MJ, Shah P, Patel H, Racine R, Jani Y, Owens C, George V, Linder D, Owens J, Hess DC. Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients. Ir J Med Sci 2021; 191:21-26. [PMID: 33566314 PMCID: PMC7872880 DOI: 10.1007/s11845-021-02515-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/12/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS Limited data exists on the outcomes of COVID-19 patients presenting with altered mental status (AMS). Hence, we studied the characteristics and outcomes of hospitalized COVID-19 patients who presented with AMS at our hospital in rural southwest Georgia. METHODS Data from electronic medical records of all hospitalized COVID-19 patients from March 2, 2020, to June 17, 2020, were analyzed. Patients were divided in 2 groups, those presenting with and without AMS. Primary outcome of interest was in-hospital mortality. Secondary outcomes were needed for mechanical ventilation, need for intensive care unit (ICU) care, need for dialysis, and length of stay. All analyses were performed using SAS 9.4 and R 3.6.0. RESULTS Out of 710 patients, 73 (10.3%) presented with AMS. Majority of the population was African American (83.4%). Patients with AMS were older and more likely to have hypertension, chronic kidney disease (CKD), cerebrovascular disease, and dementia. Patients with AMS were less likely to present with typical COVID-19 symptoms, including dyspnea, cough, fever, and gastrointestinal symptoms. Predictors of AMS included age ≥ 70 years, CKD, cerebrovascular disease, and dementia. After multivariable adjustment, patients with AMS had higher rates of in-hospital mortality (30.1% vs 14.8%, odds ratio (OR) 2.139, p = 0.019), ICU admission (43.8% vs 40.2%, OR 2.59, p < 0.001), and need for mechanical ventilation (27.4% vs 18.5%, OR 2.06, p = 0.023). Patients presenting with AMS had increased length of stay. CONCLUSIONS Patients with COVID-19 presenting with AMS are less likely to have typical COVID-19 symptoms, and AMS is an independent predictor of in-hospital mortality, need for ICU admission, and need for mechanical ventilation.
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Shende P, Shah P. Carbohydrate-based magnetic nanocomposites for effective cancer treatment. Int J Biol Macromol 2021; 175:281-293. [PMID: 33571584 DOI: 10.1016/j.ijbiomac.2021.02.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022]
Abstract
The treatment of cancer includes several conventional therapies like surgery, radiation, chemotherapy, etc. but mostly associated with limitations like off-targeted action, fatigue and organ toxicity. The emergence of nanotechnology-enabled drug delivery systems shows revolutionary development to overcome the limitations of such therapies. Magnetic nanocomposites are the new area of research that consists of nanoscale magnetic materials for triggering the release of active in response to an external magnetic field. For targeted drug delivery and enhancing the biocompatibility, effective functionalization of magnetic nanocomposites is required. Therefore, several biological molecules like carbohydrate polymers, proteins, nucleic acids, antibodies, etc. are used. This review article focuses on the insights of advances in the development of carbohydrate-based magnetic nanocomposites for safe and effective cancer treatment. Carbohydrate-based magnetic nanocomposites offer significant advantages like greater stability, higher biocompatibility and lower toxicity with better physicochemical properties such as higher magnetic moments and anisotropy, larger heating properties, etc. Magnetic nanocomposites explore in almost all the areas of cancer therapeutics for drug delivery carrier, as antineoplastic and MRI contrast agents and in photothermal, photodynamic and in combinational therapies for the development of safer nanocarriers. Such progressive trend of carbohydrate-based magnetic nanocomposites will encourage the researchers for better site-specific delivery with higher safety profile in cancer therapy.
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Shimpi RK, Patel DN, Raval K, Shah P, Shah B. Study of modified technique of ileal neobladder-Frog neobladder. Urol Ann 2021; 13:19-23. [PMID: 33897159 PMCID: PMC8052909 DOI: 10.4103/ua.ua_119_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: Orthotopic neobladder is a well-established technique for continent urinary diversion after radical cystectomy. In this study, we evaluated a new Frog ileal neobladder technique. Since the reconstructed neobladder appears like a frog, the name Frog Neobladder was given to it. We have used two isoperistaltic ileal segments and implanted ureters in the nondetubularized proximal end of the ileal segment. Subjects and Methods: This was a prospective, single-center (tertiary care hospital) study conducted from February 2008 to January 2018. Study patients were aged 39–94 years with biopsy-proven muscle-invasive localized bladder carcinoma. One hundred and twenty patients were included in the study, who had undergone Radical Cystectomy and were offered “FROG BLADDER”– a type of neobladder. Evaluation of complications, renal function, urodynamic parameters, post-void residual urine (PVR), continence, and need for clean intermittent catheterization was done in all patients with neobladder. Results: A total of 120 patients were included in the study, the average age of the patients was 62 years. The operative mean time was 280 ± 29.8 min. There was no perioperative death, and perioperative or early and late complication rates were 31.2% and 18.7%, respectively. Six patients had uretero-enteric anastomosis stricture, of which two were managed by retrograde ureteroscopic dilatation, another three strictures were treated with antegrade approach, and one patient underwent open surgery. All patients were able to void urine, except for three patients who required self-catheterization. The mean capacity was increased to average of 398 ± 220 ml at 12 months in all patients. The mean PVR at 1 year was 46 ± 54.4 ml. Conclusion: The Frog neobladder has similar outcome similar to other neobladder technique, with added advantage of ability to accommodate shorter ureteric length and the ease of accessing ureter by retrograde approach for intervention.
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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.
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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]
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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.
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Shah P, Doshi R, Chenna A, Owens R, Cobb A, Ivey H, Newton S, Mccarley K. Prognostic Value of Elevated Cardiac Troponin I in Hospitalized Covid-19 Patients. Am J Cardiol 2020; 135:150-153. [PMID: 32861733 PMCID: PMC7452835 DOI: 10.1016/j.amjcard.2020.08.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
Myocardial injury is common in hospitalized Covid-19 patients. Myocardial injury as assessed by elevated cardiac troponin I is an independent predictor of mortality in Covid-19 patients. Higher troponin I is associated with further increase in mortality and other adverse clinical outcomes. Levels of cardiac troponin I have prognostic value in hospitalized Covid-19 patients.
This study aimed to determine if cardiac troponin I (cTnI) is an independent predictor of clinical outcomes and whether higher values are associated with worse clinical outcomes in Covid-19 patients. This case-series study was conducted at Phoebe Putney Health System. Participants were confirmed Covid-19 patients admitted to our health system between March 2, 2020 and June 7, 2020. Data were collected from electronic medical records. Patients were divided into 2 groups: with and without elevated cTnI. The cTnI were further divided in 4 tertiles. Multivariable logistic regression analysis was performed to adjust for demographics, baseline comorbidities, and laboratory parameters including D-dimer, ferritin, lactate dehydrogenase, procalcitonin and C-reactive protein. Out of 309 patients, 116 (37.5%) had elevated cTnI. Those with elevated cTnI were older (59.9 vs. 68.2 years, p <0.001), and more likely to be males (53.5% vs. 36.3%, p = 0.003). Elevated cTnI group had higher baseline comorbidities. After multivariable adjustment, overall mortality was significantly higher in elevated cTnI group (37.9% vs. 11.4%, odds ratio:4.45; confidence interval:1.78 to 11.14, p <0.001). Need for intubation, dialysis, and intensive care unit (ICU) transfer was higher in elevated cTnI group. Among those with elevated cTnI, mortality was 23.2% for 50th percentile, 48.4% for 75th percentile, and 55.2% for 100th percentile. Similarly, further increase in cTnI was associated with a higher need for intubation, dialysis, and ICU transfer. In conclusion, myocardial injury occurs in significant proportion of hospitalized Covid-19 patients and is an independent predictor of clinical outcomes, with higher values associated with worse outcomes.
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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]
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Shah P, Owens J, Franklin J, Mehta A, Heymann W, Sewell W, Hill J, Barfield K, Doshi R. Demographics, comorbidities and outcomes in hospitalized Covid-19 patients in rural southwest Georgia. Ann Med 2020; 52:354-360. [PMID: 32620056 PMCID: PMC7877969 DOI: 10.1080/07853890.2020.1791356] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is limited data on outcomes in patients with coronavirus disease 2019 (Covid-19) in rural United States (US). This study aimed to describe the demographics, and outcomes of hospitalized Covid-19 patients in rural Southwest Georgia. METHODS Using electronic medical records, we analyzed data from all hospitalized Covid-19 patients who either died or survived to discharge between 2 March 2020 and 6 May 2020. RESULTS Of the 522 patients, 92 died in hospital (17.6%). Median age was 63 years, 58% were females, and 87% African-Americans. Hypertension (79.7%), obesity (66.5%) and diabetes mellitus (42.3%) were the most common comorbidities. Males had higher overall mortality compared to females (23 v 13.8%). Immunosuppression [odds ratio (OR) 3.6; (confidence interval (CI): 1.52-8.47, p=.003)], hypertension (OR 3.36; CI:1.3-8.6, p=.01), age ≥65 years (OR 3.1; CI:1.7-5.6, p<.001) and morbid obesity (OR 2.29; CI:1.11-4.69, p=.02), were independent predictors of in-hospital mortality. Female gender was an independent predictor of decreased in-hospital mortality. Mortality in intubated patients was 67%. Mortality was 8.9% in <50 years, compared to 20% in ≥50 years. CONCLUSIONS Immunosuppression, hypertension, age ≥ 65 years and morbid obesity were independent predictors of mortality, whereas female gender was protective for mortality in hospitalized Covid-19 patients in rural Southwest Georgia. KEY MESSAGES Patients hospitalized with Covid-19 in rural US have higher comorbidity burden. Immunosuppression, hypertension, age ≥ 65 years and morbid obesity are independent predictors of increased mortality. Female gender is an independent predictor of reduced mortality.
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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.
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