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Church PT, Cavanagh A, Lee SK, Shah V. Academic challenges for the preterm infant: Parent and educators' perspectives. Early Hum Dev 2019; 128:1-5. [PMID: 30326326 DOI: 10.1016/j.earlhumdev.2018.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known of educators' knowledge of the impact of preterm birth on academic achievement and nothing is known of parental perspective of this knowledge. AIMS To examine the knowledge of the impact of preterm birth on academic achievement amongst Canadian educators, characterize educators' attitudes towards these challenges, and examine parental perspectives of the educational system for their preterm child. STUDY DESIGN AND METHODS This was a mixed methods study involving kindergarten to Grade 3 educators and parents of preterm children aged 4-8 years. Focus groups were conducted with 35 educators and surveys were collected from 138 educators and 174 parents. Thematic analysis was employed for focus group data and findings from surveys were summarized using descriptive statistics. RESULTS Themes identified from focus groups included: educators' knowledge was experiential, limited information sharing by parents, and lack of resources. No consensus existed amongst educators on facilitators or barriers in the educational system to help children born preterm. On the parent survey, parental disclosure of medical history was more frequent with lower gestational age. Most parents (94.9%, 130/137) advocated for extended neonatal follow-up and only 59.9% (82/137) expressed confidence that the school was meeting their child's needs. The educator survey confirmed these themes, except educators advocated for disclosure of the child's medical history (91.7%, 100/109). Additional qualifications and experience enhanced educators' knowledge, being a parent of a child born preterm did not. CONCLUSION Educators are unprepared to address the academic challenges for the preterm child and training is needed. Parents and providers need to be prepared to advocate.
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Hungerford S, Bart N, Emmanuel S, Shah V, Hayward C, Muller D. Echocardiographic Outcomes of MitraClip™ Repair for Patients with Severe Mitral Regurgitation and Pre-Existing Left Ventricular Dysfunction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pandey S, Pandey SK, Shah V. Role of HAMP Genetic Variants on Pathophysiology of Iron Deficiency Anemia. Indian J Clin Biochem 2018; 33:479-482. [PMID: 30319197 DOI: 10.1007/s12291-017-0707-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022]
Abstract
Hepcidin is a 25-amino acid peptide hormone produced by hepatocytes and plays a key role in body iron metabolism. Hepcidin deficiency is the cause of iron overload in hereditary hemochromatosis, iron-loading anemia, and its excess is associated with anemia of inflammation, chronic disease and iron deficiency anemia (IDA). The aims of this study was to evaluate HAMP gene mutation, namely IVS2 + 1(-G) (c.148-150 + 1del) and Gly71 Asp (c.212G > A (rs104894696) association with iron status in IDA conditions. Our study participants were 500 IDA patients and 550 age and sex-matched healthy controls. Hepcidin, ferritin and CRP analysis was done by ELISA method while ESR analysis was done according to Wintrobe method. CBC analysis was done by auto-analyzer. Two mutations in the HAMP genes were analysed by PCR RFLP method. Among the IDA patients, 7 were heterozygous for Met50del IVS2 + 1(-G) mutation. Nine IDA patients were heterozygous for G71D G-A mutation and homozygous were not identified in both mutations.Controls were showing heterozygous frequency 1.8 and 2.1% of Met50del IVS2 + 1(-G) and G71D G-A mutations respectively. Mutation of HAMP (Met50del IVS2 + 1(-G) and G71D G-A) were clinically associated with IDA and act as modulator of disease.
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Shah PS, Dunn M, Aziz K, Shah V, Deshpandey A, Mukerji A, Ng E, Mohammad K, Ulrich C, Amaral N, Lemyre B, Synnes A, Piedboeuf B, Yee WH, Ye XY, Lee SK. Sustained quality improvement in outcomes of preterm neonates with a gestational age less than 29 weeks: results from the Evidence-based Practice for Improving Quality Phase 3 1. Can J Physiol Pharmacol 2018; 97:213-221. [PMID: 30273497 DOI: 10.1139/cjpp-2018-0439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quality improvement initiatives in neonatology have yielded positive results; however, few programs have demonstrated sustainability. We evaluated an ongoing, national quality improvement initiative (Evidence-based Practice for Improving Quality Phase 3 (EPIQ-3)) on outcomes of preterm neonates with a gestational age (GA) of 220-286 weeks (i.e., from 22 weeks and 0 days of gestation to 28 weeks and 6 days of gestation). Data from 7459 neonates admitted to 25 Canadian centers between 2013 and 2017 were studied. Trends in mortality and major morbidities were evaluated. The number of neonates with a GA of 220-236 weeks increased from 90 in 2013 to 139 in 2017 without a significant change in any other GA categories. In the entire cohort, the odds of composite outcome of mortality or any major morbidity (adjusted odds ratio (AOR) 0.72, 95% confidence interval (CI) 0.61-0.84) and of necrotizing enterocolitis (AOR 0.66, 95% CI 0.49-0.89) were lower in 2017 than in 2013. When calculated per year, the odds of composite outcome (AOR 0.93, 95% CI 0.89-0.97) and odds of necrotizing enterocolitis (AOR 0.89, 95% CI 0.82-0.96) decreased significantly. Among the subgroup of neonates with a GA of 260-286 weeks, the odds of composite outcome (AOR 0.63, 95% CI 0.51-0.79), necrotizing enterocolitis (AOR 0.44, 95% CI 0.26-0.73), and nosocomial infection (AOR 0.64, 95% CI 0.49-0.84) were reduced. The collaborative, multidisciplinary, nationwide EPIQ-3 program improved outcomes of preterm neonates, and the improvement was sustainable over 5 years.
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Leibel SL, Ye XY, Shah P, Shah V. Chronic lung disease in preterm infants receiving various modes of noninvasive ventilation at ≤30 weeks' postmenstrual age. J Matern Fetal Neonatal Med 2018; 33:1466-1472. [PMID: 30176762 DOI: 10.1080/14767058.2018.1519798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To determine the incidence of chronic lung disease (CLD) in mechanically ventilated infants who were born at <29 weeks' gestational age (GA), extubated to continuous positive airway pressure (CPAP) or nasal intermittent positive pressure ventilation (NIPPV), and treated with CPAP/NIPPV alone, changed to heated humidified high flow nasal cannula (HHHFNC), or exposed to a combination of CPAP/NIPPV and HHHFNC at ≤30 weeks' postmenstrual age (PMA).Study design: Retrospective cohort study of infants born at <29 weeks' GA admitted to tertiary Canadian neonatal intensive care units between 2011 and 2015. Infants were grouped according to the type of noninvasive ventilation they received at ≤30 weeks' PMA: CPAP/NIPPV alone, HHHFNC alone, or a combination of both.Results: Of the 2378 eligible infants, 1091 (46%) were on CPAP/NIPPV alone, 173 (7.3%) were on HHHFNC alone, and 1114 (47%) were on a combination of CPAP/NIPPV and HHHFNC at ≤30 weeks' PMA until weaned to room air or low flow nasal cannula. After adjustment for confounders, infants in both the CPAP/NIPPV (odds ratio [95% confidence interval]; 2.37 [1.18, 4.79]) and Combination (3.47 [2.06, 5.86]) groups had higher odds of developing CLD than infants in the HHHFNC group.Conclusions: Our results demonstrate that infants transitioned to HHHFNC ≤30 weeks' PMA after extubation to CPAP/NIPPV were associated with a lower odds of CLD than infants maintained on CPAP/NIPPV or a combination of CPAP/NIPPV and HHHFNC.
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Shah V, Hodgson K, Seshia M, Dunn M, Schmölzer GM. Golden hour management practices for infants <32 weeks gestational age in Canada. Paediatr Child Health 2018; 23:e70-e76. [PMID: 30038535 PMCID: PMC6007305 DOI: 10.1093/pch/pxx175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine 'Golden Hour' resuscitation and stabilization practices for infants <32 weeks gestational age in Canadian neonatal intensive care units (NICUs). METHODS A survey was distributed to investigators of the Evidence-based Practice for Improving Quality study within the Canadian Neonatal Network in June 2014. The questionnaire was designed to obtain information on antenatal counselling, resuscitation environment, resuscitation and management practices, including respiratory and nutritional practices in the first hour of life. Responses to these categories were stratified into gestational age groupings: 230/7-236/7, 240/7-256/7, 260/7-276/7 and 280/7-316/7 weeks. Findings were summarized using descriptive statistics. RESULTS Investigators from 14 of the 23 (61%) NICUs responded. Antenatal counselling was provided to >75% of expectant parents by Staff Neonatologists and Neonatal Fellows. Most NICUs (78%) provided resuscitation in a room adjacent to the high-risk delivery room or the NICU, while few (36%) resuscitated in the delivery room only. Twelve (86%) NICUs practiced delayed cord clamping while two practiced milking of the cord (14%) and 100% used thermal wrap for infants <28 weeks' gestation. All, with the exception of three NICUs used fraction of inspired oxygen ≤0.3 for initial resuscitation and 12/14 (86%) centres applied continuous positive airway pressure for spontaneously breathing infants <256/7 weeks' gestation. CONCLUSIONS Participating Canadian NICUs reported that they generally follow Neonatal Resuscitation Program recommendations for stabilization of preterm infants; however, considerable variation exists in the application of evidence-based interventions. Our findings can be used to inform quality improvement initiatives to improve clinical outcomes for this vulnerable population.
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Mukerji A, Shafey A, Jain A, Cohen E, Shah P, Shah V, Sander B. COST-EFFECTIVENESS OF PULSE OXIMETRY SCREENING FOR CRITICAL CONGENITAL HEART DEFECTS IN ONTARIO. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Critical congenital heart defects (CCHDs) are a leading cause of morbidity and mortality in newborns, and late diagnosis is associated with mortality and worse outcomes. Many jurisdictions in the USA and elsewhere have implemented routine pulse oximetry screening (POS) for CCHD, which the Canadian Paediatric Society has recently endorsed. Cost-effective analyses in USA and Europe support this approach, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges with regard to POS implementation.
OBJECTIVES
To estimate the cost-effectiveness of POS for CCHD in the context of its implementation in Ontario, Canada.
DESIGN/METHODS
A cost-effectiveness analysis using a Markov model was conducted inputting values derived from an extensive review of literature, and using relevant local databases. The base-case was a 24-hour clinically stable infant born in Ontario. The model employed the healthcare payer (ministry of health) perspective and a life-time horizon. A number of mutually exclusive health states were created, representative of the natural course of CCHDs. The strategies compared were routine pulse oximetry screening versus no screening. Outcome measures, all discounted 1.5%, were quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios. An a priori threshold of CAD$4,166.67 per QALM (equivalent to CAD$50,000 per quality adjusted life year) was used. Probabilistic sensitivity analysis was conducted using multiple simulations of the model within expected range of variables included in the model.
RESULTS
The incremental cost of performing POS was estimated to be $27.27 per individual, with a gain of 0.02455 QALMs (Table 1). This yielded an incremental cost-effectiveness ratio (ICER), [Δ Cost / Δ QALMs] of CAD$1,110.79, well below the pre-determined threshold for cost-effectiveness. A probabilistic sensitivity analysis estimated a 93% chance of routine implementation of POS of being cost-effective, with majority of simulated ICERs lying below the threshold of acceptability (Figure 1).
CONCLUSION
Routine implementation of POS for CCHD is expected to be cost-effective with a high degree of certainty. Further validation of this model may be conducted following implementation to confirm these findings based on local population data.
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Jegathesan T, Sgro M, Shah V, Campbell A, Campbell D. INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants.
OBJECTIVES
The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants.
DESIGN/METHODS
A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups.
RESULTS
A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age.
CONCLUSION
Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.
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Raghuram K, Dunn M, Jangaard K, Reilly M, Asztalos E, Kelly E, Vincer M, Shah V. Inhaled corticosteroids in ventilated preterm neonates: a non-randomized dose-ranging study. BMC Pediatr 2018; 18:153. [PMID: 29734948 PMCID: PMC5938808 DOI: 10.1186/s12887-018-1134-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Inhaled corticosteroids (ICS) offer targeted treatment for bronchopulmonary dysplasia (BPD) with minimal systemic effects compared to systemic steroids. However, dosing of ICS in the management of infants at high-risk of developing BPD is not well established. The objective of this study was to determine an effective dose of ICS for the treatment of ventilator-dependent infants to facilitate extubation or reduce fractional inspired oxygen concentration. Methods Forty-one infants born at < 32 weeks gestational age (GA) or < 1250 g who were ventilator-dependent at 10–28 days postnatal age were included. A non-randomized dose-ranging trial was performed using aerosolized inhaled beclomethasone with hydrofluoralkane propellant (HFA-BDP). Four dosing groups (200, 400, 600 and 800 μg twice daily for 1 week) with 11, 11, 10 and 9 infants in each group, respectively, were studied. The primary outcome was therapeutic efficacy (successful extubation or reduction in FiO2 of > 75% from baseline) in ≥60% of infants in the group. Oxygen requirements, complications and long-term neurodevelopmental outcomes were also assessed. Results The median age at enrollment was 22 (10–28) postnatal days. The primary outcome, therapeutic efficacy as defined above, was not achieved in any group. However, there was a significant reduction in post-treatment FiO2 at a dose of 800 μg bid. No obvious trends were seen in long-term neurodevelopmental outcomes. Conclusions Therapeutic efficacy was not achieved with all studied doses of ICS. A significant reduction in oxygen requirements was noted in ventilator-dependent preterm infants at 10–28 days of age when given 800 μg of HFA-BDP bid. Larger randomized trials of ICS are required to determine efficacy for the management of infants at high-risk for development of BPD. Trial registration This clinical trial was registered retrospectively on clinicaltrials.gov. The registration number is NCT03503994.
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Ivan CV, Mullineux JH, Verma R, Shah V, De A, Elabassy M, Rajesh A, Stephenson JA. Reply to Akingboye et al. Colorectal Dis 2018; 20:76-77. [PMID: 29027365 DOI: 10.1111/codi.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023]
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Ivan CV, Mullineux JH, Verma R, Shah V, De A, Elabassy M, Rajesh A, Stephenson JA. Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma. Colorectal Dis 2017; 19:1076-1080. [PMID: 28696522 DOI: 10.1111/codi.13811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023]
Abstract
AIM Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment. METHOD IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response. RESULTS IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively). CONCLUSION Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.
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Mukerji A, Shah V. Response to 'Non-invasive high frequency ventilation and the errors from the past: designing simple trials neglecting complex respiratory physiology'. J Perinatol 2017; 37:1067. [PMID: 28904404 DOI: 10.1038/jp.2017.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jenkins NW, Talbott JF, Shah V, Pandit P, Seo Y, Dillon WP, Majumdar S. [ 18F]-Sodium Fluoride PET MR-Based Localization and Quantification of Bone Turnover as a Biomarker for Facet Joint-Induced Disability. AJNR Am J Neuroradiol 2017; 38:2028-2031. [PMID: 28860213 DOI: 10.3174/ajnr.a5348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/06/2017] [Indexed: 11/07/2022]
Abstract
Our aim was to prospectively evaluate the relationship between low back pain-related disability and quantitative measures from [18F]-sodium fluoride ([18F]-NaF) MR imaging. Six patients with facetogenic low back pain underwent dynamic [18F]-NaF PET/MR imaging. PET metrics were correlated with clinical measures and MR imaging grading of lumbar facet arthropathy. A significant positive correlation was observed between maximum facet joint uptake rate and clinical disability (P < .05). These data suggest that dynamic [18F]-NaF PET may serve as a useful biomarker for facetogenic disability.
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Kadam PP, Gogtay NJ, Karande S, Shah V, Thatte UM. Evaluation of pharmacokinetics of single-dose chloroquine in malnourished children with malaria- a comparative study with normally nourished children. Indian J Pharmacol 2017; 48:498-502. [PMID: 27721533 PMCID: PMC5051241 DOI: 10.4103/0253-7613.190720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Studies on antimalarial kinetics in children or adults who are undernourished or malnourished are both limited and have yielded conflicting results. The present study was carried out with the objectives of evaluating the pharmacokinetics of single dose chloroquine and its metabolite desethylchloroquine in children who were undernourished and compare them with children who were normally nourished. METHODS Children of either gender between the ages of 5 and 12 years, smear positive for P. vivax malaria and classified either as well nourished or undernourished were included. Undernourishment was adjudged based on the Indian Academy of Pediatrics (IAP) classification of protein energy malnutrition [PEM] which in turn was based on Khadilkar's growth charts. All participants received 10 mg/kg on the first day followed by 10 mg/kg on Day 2 and 5 mg/kg on Day 3 along with supportive treatment. Blood samples for the levels of chloroquine [CQ] and desethylchloroquine [DECQ] were collected at 0, 0.5, 1, 2 4, 8, 12, 24, 48, 72 hours and 14 days after the first dose and levels assessed by High Performance Liquid Chromatography. RESULTS A total of 12 children who were normally nourished and 13 who were undernourished were studied. Wide inter-individual variability was seen in the levels of both drug and metabolite in both groups of patients. However, the differences in Cmax, AUC 0-inf, Clearance, half life and Vd between the two groups were not significantly different. DISCUSSION Our results indicate that dosage requirement is unlikely to be needed for chloroquine in undernourished children with uncomplicated P. vivax malaria.
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Shah V, Sherborne AL, Walker BA, Johnson DC, Boyle EM, Ellis S, Begum DB, Proszek PZ, Jones JR, Pawlyn C, Savola S, Jenner MW, Drayson MT, Owen RG, Houlston RS, Cairns DA, Gregory WM, Cook G, Davies FE, Jackson GH, Morgan GJ, Kaiser MF. Prediction of outcome in newly diagnosed myeloma: a meta-analysis of the molecular profiles of 1905 trial patients. Leukemia 2017; 32:102-110. [PMID: 28584253 PMCID: PMC5590713 DOI: 10.1038/leu.2017.179] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 05/25/2017] [Indexed: 12/11/2022]
Abstract
Robust establishment of survival in multiple myeloma (MM) and its relationship to recurrent genetic aberrations is required as outcomes are variable despite apparent similar staging. We assayed copy number alterations (CNA) and translocations in 1036 patients from the NCRI Myeloma XI trial and linked these to overall survival (OS) and progression-free survival. Through a meta-anlysis of these data with data from MRC Myeloma IX trial, totalling 1905 newly diagnosed MM patients (NDMM), we confirm the association of t(4;14), t(14;16), t(14;20), del(17p) and gain(1q21) with poor prognosis with hazard ratios (HRs) for OS of 1.60 (P=4.77 × 10-7), 1.74 (P=0.0005), 1.90 (P=0.0089), 2.10 (P=8.86 × 10-14) and 1.68 (P=2.18 × 10-14), respectively. Patients with 'double-hit' defined by co-occurrence of at least two adverse lesions have an especially poor prognosis with HRs for OS of 2.67 (P=8.13 × 10-27) for all patients and 3.19 (P=1.23 × 10-18) for intensively treated patients. Using comprehensive CNA and translocation profiling in Myeloma XI we also demonstrate a strong association between t(4;14) and BIRC2/BIRC3 deletion (P=8.7 × 10-15), including homozygous deletion. Finally, we define distinct sub-groups of hyperdiploid MM, with either gain(1q21) and CCND2 overexpression (P<0.0001) or gain(11q25) and CCND1 overexpression (P<0.0001). Profiling multiple genetic lesions can identify MM patients likely to relapse early allowing stratification of treatment.
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Jegathesan T, Campbell D, Debono M, Shah V, Twiss J, Sgro M. INVESTIGATING THE ACCURACY OF AN UPGRADED TRANSCUTANEOUS BILIRUBIN SCREENING TOOL BY SITE OF TESTING. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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DiLabio J, Zwicker J, Shah P, Shah V. MATERNAL AGE AND NEURODEVELOPMENTAL OUTCOMES OF PRETERM INFANTS <29 WEEKS GESTATIONAL AGE. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shah V, Barwad P, Vyas A, Dedhia A, Shah R, Bachani N, Lokhandwala Y. P1616Clinical profile and intermediate term outcome of 50 consecutive patient of ventricular tachycardia storm managed at a tertiary care center in india. Europace 2017. [DOI: 10.1093/ehjci/eux158.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Murphy K, Coo H, Warre R, Shah V, Dow K. Variations and similarities in clinical management of neonatal abstinence syndrome: Findings of a Canadian survey. Paediatr Child Health 2017; 22:148-152. [PMID: 29479202 DOI: 10.1093/pch/pxx054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background There are no evidence-based national guidelines for managing neonatal abstinence syndrome (NAS) and surveys from other countries have demonstrated considerable variations in practice. Objective To describe NAS management practices in Canada. Method The directors of all Level 2 and Level 3 neonatal intensive care units (NICUs) were contacted to request their participation in a structured telephone survey. Frequency distributions were generated and associations between practice variations and unit type (Level 2 or 3) and size were examined. Results Personnel at 65 of 103 sites (63.1%) participated. Most (92.3%) stated their hospital has a written NAS practice guideline. The majority (89.5%) use a version of Finnegan's scoring system to monitor signs. If pharmacological treatment is required, 89.2% admit infants to the NICU and 93.8% routinely use cardiorespiratory monitors when treatment is initiated. Morphine is the first-line medication at most sites (96.9%). There was greater variability in terms of other practices: 44.6% observe at-risk infants in the NICU, while 52.3% allow them to room-in with their mothers; 65.1% use adjunct medications; 36.9% and 38.9% will discharge infants on the first-line and adjunct medications respectively, and 53.8% reported that breastfeeding is always encouraged, while 44.6% discourage breastfeeding if the mother continues to use illicit drugs and 1.5% make recommendations on an individual basis. Few practice variations were associated with unit type or size. Conclusion While most NICUs surveyed have an NAS practice guideline, there are some notable differences in how NAS is managed. This underscores the need for research that can be translated into best practices.
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Siriwat R, wang L, Bena J, Shah V, Ibrahim S. 0868 THE ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA WITH INSULIN RESISTANCE IN OBESE CHILDREN. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thatrimontrichai A, Chanvitan P, Janjindamai W, Dissaneevate S, Jefferies A, Shah V. Brief communication (Original). Trends in neonatal sepsis in a neonatal intensive care unit in Thailand before and after construction of a new facility. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Neonatal sepsis is a cause of mortality and long-term morbidity worldwide.
Objectives: To describe longitudinal trends in the cumulative incidence of early- and late-onset sepsis (EOS and LOS), mortality, and causative organisms in a Thai Hospital before and after construction of a new neonatal intensive care unit (NICU).
Methods: Review of NICU admissions with blood cultures positive for bacteria or fungi for the periods 1995 to 2002 (preconstruction) and 2004 to 2010 (postconstruction). Sepsis was categorized into EOS (within first 3 days of life) and LOS (after first 3 days of life).
Results: Of 5,570 admissions, 241 (4.3%) neonates with 276 episodes of sepsis were identified. There was no difference in the rate of sepsis overall (P = 0.90), LOS (P = 0.30), or sepsis-related mortality (P = 0.61) over the two periods, but the rate of EOS increased significantly from 0.34% to 0.81% (P = 0.04). Rates of Klebsiella species and Escherichia coli sepsis increased from 13.6% to 25.6% (P = 0.01) and from 5.3% to 12.2% (P = 0.04), respectively, while rates of Staphylococcus aureus sepsis decreased from 12.9% to 4.3% (P < 0.007). Sepsisrelated mortality was 1.8%.
Conclusions: Although direct causality cannot be proven, the rate of EOS and the pattern of causative organisms changed following construction of the new NICU. Building a new unit does not necessarily result in a reduction in the rate of sepsis. This data may provide a baseline for implementing evidence-based infection control strategies to prevent/reduce sepsis and improve neonatal care.
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Mukerji A, Sarmiento K, Lee B, Hassall K, Shah V. Non-invasive high-frequency ventilation versus bi-phasic continuous positive airway pressure (BP-CPAP) following CPAP failure in infants <1250 g: a pilot randomized controlled trial. J Perinatol 2017; 37:49-53. [PMID: 27684415 DOI: 10.1038/jp.2016.172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Non-invasive high-frequency ventilation (NIHFV), a relatively new modality, is gaining popularity despite limited data. We sought to evaluate the effectiveness of NIHFV versus bi-phasic continuous positive airway pressure (BP-CPAP) in preterm infants failing CPAP. STUDY DESIGN Infants with BW<1250 g on CPAP were randomly assigned to NIHFV or BP-CPAP if they met pre-determined criteria for CPAP failure. Infants were eligible for randomization after 72 h age and until 2000 g. Guidelines for adjustment of settings and criteria for failure of assigned mode were implemented. The primary aim was to assess feasibility of a larger trial. In addition, failure of assigned non-invasive respiratory support (NRS) mode, invasive mechanical ventilation (MV) 72 h and 7 days post-randomization, and bronchopulmonary dysplasia (BPD) were assessed. RESULTS Thirty-nine infants were randomized to NIHFV (N=16) or BP-CPAP (N=23). There were no significant differences in mean (s.d.) postmenstrual age (28.6 (1.5) versus 29.0 (2.3) weeks, P=0.47), mean (s.d.) weight at randomization (965.0 (227.0) versus 958.1 (310.4) g, P=0.94) or other baseline demographics between the groups. Failure of assigned NRS mode was lower with NIHFV (37.5 versus 65.2%, P=0.09), although not statistically significant. There were no differences in rates of invasive MV 72 h and 7 days post-randomization or BPD. CONCLUSION NIHFV was not superior to BP-CPAP in this pilot study. Effectiveness of NIHFV needs to be proven in larger multi-center, appropriately powered trials before widespread implementation.
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Ehrhart MD, Shah V, Colip L, Sandy P, Ghahate D, Bobelu J, Faber T, Burge MR. Predictors of Physical Fitness among Southwestern Native American Adolescents at Risk for Diabetes. JOURNAL OF PEDIATRIC ENDOCRINOLOGY (JERSEY CITY, N.J.) 2017; 2:1013. [PMID: 29231926 PMCID: PMC5722221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The prevalence of obesity is increasing among children nationally. Native American children from Zuni Pueblo appear to be at increased risk for obesity, which also increases the risk for the metabolic syndrome, diabetes, and cardiovascular disease. While exercise and physical fitness can prevent or forestall these developments, predictors of physical fitness in this population are unknown. Forty-seven Native American adolescents completed four aspects of the Presidential Fitness Challenge (push-ups, sit-ups, step-ups, and timed walking) during screening for another study, and fitness was empirically summarized with a Presidential Fitness Index. Correlative analyses were subsequently performed to elucidate predictors of fitness. Age was the only independent predictor of the Presidential Fitness Index. Other variables that were not found to be independent predictors included BMI percentile, waist circumference, fat free mass, total body fat, and HDL cholesterol. Among adolescent Southwest Native Americans, older children performed better on the Presidential Fitness Challenge. Additionally, BMI was not found to be an independent predictor of fitness.
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Shah V, Wikramanayake T, DelCanto G, Granda A, Lens A, Jimenez J. 212 Scalp hypothermia as a preventive measure for chemotherapy-induced alopecia: A systematic review of the literature. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.231] [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]
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Michael A, Kadappu K, Shah V, Hewett N, Chow J, Rajaratnam R. Cardiac Outreach Program in Heart Failure-Impacts and Outcomes. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.238] [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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