1
|
Hegde D, Suprabha BS, Ginjupalli K, Suman E, Natarajan S, Shenoy R, Rao A. Addition of nisin to high-viscosity glass-ionomer cement: a comparative in vitro study on antibacterial and physical properties. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00910-w. [PMID: 38743212 DOI: 10.1007/s40368-024-00910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Nisin is a lantibiotic effective against Gram-positive microorganisms such as Streptococcus mutans. The study aimed to determine the effect of the addition of nisin to high-viscosity glass-ionomer cement (HVGIC) on its antibacterial activity, setting time, surface microhardness, and compressive strength. METHODS 1 and 3% w/w nisin were added to HVGIC before mixing. Unmodified HVGIC was the control. Agar disc diffusion, direct contact test, and scanning electron microscopy (SEM) analysis were used to evaluate antibacterial activity against S. mutans. Setting time, surface microhardness, and compressive strength were measured using Gilmore needle apparatus, digital microhardness tester, and universal testing machine, respectively. Statistical analysis included Student's t test, one-way ANOVA with Tamhane's post hoc test, and repeated-measures ANOVA. RESULTS As evidenced by the agar disc diffusion (p < 0.001), direct contact tests (p = 0.025), and SEM analysis of the S. mutans cell count and cell surface area (p = 0.049 and 0.003), 3% nisin had the strongest antibacterial activity. There was a dose-dependent increase in setting time (p = 0.005) and surface microhardness (p = 0.006), with no significant difference in compressive strength compared to control. CONCLUSION The addition of 3% nisin to HVGIC enhances the antibacterial action against S. mutans and surface microhardness without adversely affecting setting time and compressive strength.
Collapse
Affiliation(s)
- D Hegde
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - K Ginjupalli
- Department of Dental Materials, Manipal College of Dental Sciences Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - E Suman
- Department of Microbiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - S Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
2
|
Suprabha BS, Shenoy R, Mahabala KY, Nayak AP, Rao A, D'Souza V. Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions. JDR Clin Trans Res 2024:23800844231225193. [PMID: 38389414 DOI: 10.1177/23800844231225193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries. AIM To describe parental perceptions and challenges in dental care utilization for their children with ECC. DESIGN A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis. RESULTS Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits. CONCLUSION Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC. KNOWLEDGE TRANSFER STATEMENT The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.
Collapse
Affiliation(s)
- B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - V D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
3
|
Rao AR, Noronha V, Ramaswamy A, Kumar A, Pillai A, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nookala M, Chitre A, Kapoor A, Gota V, Banavali S, Badwe RA, Prabhash K. Correlation of the Geriatric Assessment with Overall Survival in Older Patients with Cancer. Clin Oncol (R Coll Radiol) 2024; 36:e61-e71. [PMID: 37953073 DOI: 10.1016/j.clon.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/09/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
AIMS Global guidelines recommend that all older patients with cancer receiving chemotherapy should undergo a geriatric assessment. However, utilisation of the geriatric assessment is often constrained by its time-intensive nature, which limits its adoption in settings with limited resources and high demand. There is a lack of evidence correlating the results of the geriatric assessment with survival from the Indian subcontinent. Therefore, the aims of the present study were to assess the impact of the geriatric assessment on survival in older Indian patients with cancer and to identify the factors associated with survival in these older patients. MATERIALS AND METHODS This was an observational study, conducted in the geriatric oncology clinic of the Tata Memorial Hospital (Mumbai, India). Patients aged 60 years and older with cancer who underwent a geriatric assessment were enrolled. We assessed the non-oncological geriatric domains of function and falls, nutrition, comorbidities, cognition, psychology, social support and medications. Patients exhibiting impairment in two or more domains were classified as frail. RESULTS Between June 2018 and January 2022, we enrolled 897 patients. The median age was 69 (interquartile range 65-73) years. The common malignancies were lung (40.5%), oesophagus (31.9%) and genitourinary (12.1%); 54.6% had metastatic disease. Based on the results of the geriatric assessment, 767 (85.4%) patients were frail. The estimated median overall survival in fit patients was 24.3 (95% confidence interval 18.2-not reached) months, compared with 11.2 (10.1-12.8) months in frail patients (hazard ratio 0.54; 95% confidence interval 0.41-0.72, P < 0.001). This difference in overall survival remained significant after adjusting for age, sex, primary tumour and metastatic status (hazard ratio 0.56; 95% confidence interval 0.41-0.74, P < 0.001). In the patients with a performance status of 0 or 1 (n = 454), 365 (80.4%) were frail; the median overall survival in the performance status 0-1 group was 33.0 months (95% confidence interval 24.31-not reached) in the fit group versus 14.4 months (95% confidence interval 12.25-18.73) in the frail patients (hazard ratio 0.50; 95% confidence interval 0.34-0.74, P = 0.001). In the multivariate analysis, the geriatric assessment domains that were predictive of survival were function (hazard ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.003), nutrition (hazard ratio 0.64; 95% confidence interval 0.48-0.85, P = 0.002) and cognition (hazard ratio 0.67; 95% confidence interval 0.49-0.91, P = 0.011). DISCUSSION The geriatric assessment is a powerful prognostic tool for survival among older Indian patients with cancer. The geriatric assessment is prognostic even in the cohort of patients thought to be the fittest, i.e. performance status 0 and 1. Our study re-emphasises the critical importance of the geriatric assessment in all older patients planned for cancer-directed therapy.
Collapse
Affiliation(s)
- A R Rao
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Kumar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Pillai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Gattani
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - A Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - R Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - J Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Nookala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - A Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - V Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India
| | - S Banavali
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
| |
Collapse
|
4
|
Gaikwad K, Ramakrishna G, Srivastava H, Saxena S, Kaila T, Tyagi A, Sharma P, Sharma S, Sharma R, Mahla HR, Kumar K, Sv AM, Solanke AU, Kalia P, Rao AR, Rai A, Sharma TR, Singh NK. The chromosome-scale genome assembly of cluster bean provides molecular insight into edible gum (galactomannan) biosynthesis family genes. Sci Rep 2023; 13:9941. [PMID: 37336893 DOI: 10.1038/s41598-023-33762-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 04/18/2023] [Indexed: 06/21/2023] Open
Abstract
Cluster bean (Cyamopsis tetragonoloba (L.) Taub 2n = 14, is commonly known as Guar. Apart from being a vegetable crop, it is an abundant source of a natural hetero-polysaccharide called guar gum or galactomannan. Here, we are reporting a chromosome-scale reference genome assembly of a popular cluster bean cultivar RGC-936, by combining sequencing data from Illumina, 10X Genomics, Oxford Nanopore technologies. An initial assembly of 1580 scaffolds with an N50 value of 7.12 Mb was generated and these scaffolds were anchored to a high density SNP linkage map. Finally, a genome assembly of 550.31 Mb (94% of the estimated genome size of ~ 580 Mb (through flow cytometry) with 58 scaffolds was obtained, including 7 super scaffolds with a very high N50 value of 78.27 Mb. Phylogenetic analysis using single copy orthologs among 12 angiosperms showed that cluster bean shared a common ancestor with other legumes 80.6 MYA. No evidence of recent whole genome duplication event in cluster bean was found in our analysis. Further comparative transcriptomics analyses revealed pod-specific up-regulation of genes encoding enzymes involved in galactomannan biosynthesis. The high-quality chromosome-scale cluster bean genome assembly will facilitate understanding of the molecular basis of galactomannan biosynthesis and aid in genomics-assisted improvement of cluster bean.
Collapse
Affiliation(s)
- Kishor Gaikwad
- ICAR-National Institute for Plant Biotechnology, New Delhi, India.
| | | | | | - Swati Saxena
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - Tanvi Kaila
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - Anshika Tyagi
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - Priya Sharma
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - Sandhya Sharma
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - R Sharma
- ICAR-Central Arid Zone Research Institute, Jodhpur, India
| | - H R Mahla
- ICAR-Central Arid Zone Research Institute, Jodhpur, India
| | - Kuldeep Kumar
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | - Amitha Mithra Sv
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| | | | - Pritam Kalia
- Division of Vegetable Sciences, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - A R Rao
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - Anil Rai
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - T R Sharma
- DDG (CS), Indian Council of Agricultural Research, New Delhi, India
| | - N K Singh
- ICAR-National Institute for Plant Biotechnology, New Delhi, India
| |
Collapse
|
5
|
Suprabha BS, Shenoy R, Mahabala KY, Nayak AP, Rao A, D'Souza V. Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration. JDR Clin Trans Res 2023; 8:131-138. [PMID: 35302409 DOI: 10.1177/23800844221083645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents. METHODS This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method. RESULTS Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices. CONCLUSION In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices. KNOWLEDGE TRANSFER STATEMENT The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.
Collapse
Affiliation(s)
- B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - V D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
6
|
Sharma H, Suprabha BS, Shenoy R, Rao A, Kotian H. Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00788-0. [PMID: 36947344 DOI: 10.1007/s40368-023-00788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up. METHODS In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test. RESULTS All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different. CONCLUSIONS The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children. CLINICAL TRIAL REGISTRATION The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).
Collapse
Affiliation(s)
- H Sharma
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India
| | - B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India.
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India
| | - H Kotian
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
7
|
Razzaq H, Rao A, Sathananthan S, Majeed A, Dworkin M. Screening tool to improve patient referral to acute surgical care from accident and emergency. Ann R Coll Surg Engl 2023; 105:14-19. [PMID: 35133208 PMCID: PMC9773239 DOI: 10.1308/rcsann.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days. METHODS The first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records. RESULTS In the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively; the overall accuracy was 88.4%. CONCLUSION A large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.
Collapse
Affiliation(s)
- H Razzaq
- Mid and South Essex NHS Foundation Trust, UK
| | - A Rao
- Mid and South Essex NHS Foundation Trust, UK
| | | | | | - M Dworkin
- Mid and South Essex NHS Foundation Trust, UK
| |
Collapse
|
8
|
Bishayi D, Srinivasan A, Mahabala KY, Natarajan S, Rao A, Nayak AP. A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration. Eur Arch Paediatr Dent 2022; 24:195-201. [PMID: 36575275 DOI: 10.1007/s40368-022-00773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant. METHODS This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test. RESULTS The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively). CONCLUSION Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.
Collapse
Affiliation(s)
- D Bishayi
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Srinivasan
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - S Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
9
|
Talish M, Fukushima L, Wang J, Lee C, Rao A. 228 Hold the mayo on the elexacaftor/tezacaftor/ivacaftor special! A single-center experience. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Haddad V, Hohos N, Stueve M, Timm A, Rao A, Slocum H, Lee J. 21P Analytical performance of FusionPlex Dx. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
11
|
Aggarwal R, Heller G, Hillman D, Xiao H, Picus J, Wang J, Taplin M, Dorff T, Appleman L, Weckstein D, Patnaik A, Bryce A, Shevrin D, Mohler J, Anderson D, Rao A, Tagawa S, Tan A, Eggener S, Morris M. LBA63 PRESTO: A phase III, open-label study of androgen annihilation in patients (pts) with high-risk biochemically relapsed prostate cancer (AFT-19). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
12
|
Llewellyn J, Garner D, Rao A. Complications in Device Therapy: Spectrum, Prevalence, and Management. Curr Heart Fail Rep 2022; 19:316-324. [PMID: 35932445 DOI: 10.1007/s11897-022-00563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Cardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications. RECENT FINDINGS Complications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that may offer alternative options to patients at high risk of/or already having encountered a complication. Adherence to guidelines, appropriate training, and selection of device, in addition to good surgical technique are key in reducing the burden of complications and improving acceptability of device therapy.
Collapse
Affiliation(s)
- J Llewellyn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
| | - D Garner
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Road, Upton, Wirral, CH49 5PE, UK
| | - A Rao
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
| |
Collapse
|
13
|
Munoz N, Pavuluri S, Dupuis C, Williams M, Dixon K, McWatters A, Zhang J, Rao A, Duda D, Kaseb A, Sheth R. Abstract No. 331 ▪ FEATURED ABSTRACT Immune modulation by molecularly targeted photothermal ablation in a mouse model of advanced hepatocellular carcinoma and cirrhosis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
14
|
Patel P, Nallandhighal S, Scoville D, Tran L, Cotta B, Udager A, Rao A, Palapattu G, Dadhania V, Pitchiaya S, Salami S. Spatial transcriptomic profiling of prostate cancer reveals zone specific androgen receptor signaling and immune infiltration. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Mohammed S, Ravikumar V, Warner E, Patel S, Bakas S, Rao A, Jain R. Quantifying T2-FLAIR Mismatch Using Geographically Weighted Regression and Predicting Molecular Status in Lower-Grade Gliomas. AJNR Am J Neuroradiol 2022; 43:33-39. [PMID: 34764084 PMCID: PMC8757555 DOI: 10.3174/ajnr.a7341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The T2-FLAIR mismatch sign is a validated imaging sign of isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas. It is identified by radiologists through visual inspection of preoperative MR imaging scans and has been shown to identify isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas with a high positive predictive value. We have developed an approach to quantify the T2-FLAIR mismatch signature and use it to predict the molecular status of lower-grade gliomas. MATERIALS AND METHODS We used multiparametric MR imaging scans and segmentation labels of 108 preoperative lower-grade glioma tumors from The Cancer Imaging Archive. Clinical information and T2-FLAIR mismatch sign labels were obtained from supplementary material of relevant publications. We adopted an objective analytic approach to estimate this sign through a geographically weighted regression and used the residuals for each case to construct a probability density function (serving as a residual signature). These functions were then analyzed using an appropriate statistical framework. RESULTS We observed statistically significant (P value = .05) differences between the averages of residual signatures for an isocitrate dehydrogenase-mutant 1p/19q noncodeleted class of tumors versus other categories. Our classifier predicts these cases with area under the curve of 0.98 and high specificity and sensitivity. It also predicts the T2-FLAIR mismatch sign within these cases with an under the curve of 0.93. CONCLUSIONS On the basis of this retrospective study, we show that geographically weighted regression-based residual signatures are highly informative of the T2-FLAIR mismatch sign and can identify isocitrate dehydrogenase-mutation and 1p/19q codeletion status with high predictive power. The utility of the proposed quantification of the T2-FLAIR mismatch sign can be potentially validated through a prospective multi-institutional study.
Collapse
Affiliation(s)
- S. Mohammed
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - V. Ravikumar
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - E. Warner
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - S.H. Patel
- Department of Radiology & Medical Imaging (S.H.P.), University of Virginia School of Medicine, Charlottesville, Virginia
| | - S. Bakas
- Departments of Radiology (S.B.),Pathology & Laboratory Medicine (S.B.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - A. Rao
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.),Radiation Oncology (A.R.),Michigan Institute for Data Sciences (A.R.),Department of Biomedical Engineering (A.R.), University of Michigan, Ann Arbor, Michigan
| | - R. Jain
- Departments of Radiology (R.J.),Neurosurgery (R.J.), New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
16
|
Rao A, Ng A, Sy R, Chia K, Hansen P, Chiha J, Kilian J, Kanagaratnam L. Interaction of Age, Sex, Body Mass Index and QRS Duration on Prevalence of Atrial Fibrillation in a Large Australian Cohort Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Gan G, Bhat A, Rao A, Gu K, Thangarajah M, Kean A, Michail D, Tanous D, Thomas L. Prevalence and Impact of Comorbid Atrial Fibrillation in Patients With Pulmonary Hypertension. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
18
|
Hong E, Rao A, Beringer P. 242: Evaluation of the drug-drug interaction potential of clofazimineivacaftor using a physiologically based pharmacokinetic simulation approach. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Mayo C, Mierzwa M, Medlin R, Casper K, Rao A, Worden F, Evans J. Anticipating Poor Outcomes: A Prognostic Machine Learning Model of Unplanned Visits to the Emergency Department for Patients Undergoing Treatment for Head and Neck Cancer Using Comprehensive Multi-Factor Electronic Health Records. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Malik P, Antonini L, Mannam P, Aboobacker FN, Merve A, Gilmour K, Rao K, Kumar S, Mani SE, Eleftheriou D, Rao A, Hemingway C, Sudhakar SV, Bartram J, Mankad K. MRI Patterns in Pediatric CNS Hemophagocytic Lymphohistiocytosis. AJNR Am J Neuroradiol 2021; 42:2077-2085. [PMID: 34620587 DOI: 10.3174/ajnr.a7292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Neuroimaging has an important role in detecting CNS involvement in children with systemic or CNS isolated hemophagocytic lymphohistiocytosis. We characterized a cohort of pediatric patients with CNS hemophagocytic lymphohistiocytosis focusing on neuroradiologic features and assessed whether distinct MR imaging patterns and genotype correlations can be recognized. MATERIALS AND METHODS We retrospectively enrolled consecutive pediatric patients diagnosed with hemophagocytic lymphohistiocytosis with CNS involvement treated at 2 pediatric neurology centers between 2010 and 2018. Clinical and MR imaging data were analyzed. RESULTS Fifty-seven children (40 primary, 70%) with a median age of 36 months (interquartile range, 5.5-80.8 months) were included. One hundred twenty-three MR imaging studies were assessed, and 2 broad imaging patterns were identified. Pattern 1 (significant parenchymal disease, 32/57, 56%) was seen in older children (P = .004) with worse clinical profiles. It had 3 onset subpatterns: multifocal white matter lesions (21/32, 66%), brainstem predominant disease (5, 15%), and cerebellitis (6, 19%). All patients with the brainstem pattern failed to meet the radiologic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. An attenuated imaging phenotype (pattern 2) was seen in 25 patients (44%, 30 studies) and was associated with younger age. CONCLUSIONS Distinct MR imaging patterns correlating with clinical phenotypes and possible genetic underpinnings were recognized in this cohort of pediatric CNS hemophagocytic lymphohistiocytosis. Disruptive mutations and missense mutations with absent protein expression correlate with a younger onset age. Children with brainstem and cerebellitis patterns and a negative etiologic work-up require directed assessment for CNS hemophagocytic lymphohistiocytosis.
Collapse
Affiliation(s)
- P Malik
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - L Antonini
- Department of Paediatric Hemato-Oncology (L.A.), G. Salesi Hospital, Ancona, Italy
| | - P Mannam
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | | | - A Merve
- Department of Histopathology (A.M.)
| | | | - K Rao
- Bone Marrow Transplant Unit (K.R.)
| | - S Kumar
- Child Heath (S.K.), Christian Medical College, Vellore, India
| | - S E Mani
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - D Eleftheriou
- Paediatric Rheumatology (D.E.), Great Ormond Street Hospital for Children and University College, London, UK
| | - A Rao
- Department of Pediatric Hematology (A.R., J.B.)
| | | | | | - J Bartram
- Department of Pediatric Hematology (A.R., J.B.)
| | - K Mankad
- Pediatric Neuroradiology Unit (S.V.S., K.M.)
| |
Collapse
|
21
|
Craver K, Beringer P, Lester M, Rao A. 182: Treatment of airway hyperreactivity in patients with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Ruge M, Gill A, Gomez JMD, Du Fay De Lavallaz J, Simmons JA, Williams KA, Volgman AS, Marinescu K, Rao A, Suboc T. In-hospital predictors of 60-day readmission in COVID-19 patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Preventing hospital readmissions can improve a patient's quality of life and decrease healthcare costs. While prior work has focused on pre-existing comorbidities to predict COVID-19 readmissions, the prognostic role of in-hospital data and complications has been less studied.
Methods
Data was collected on adult patients diagnosed with COVID-19 and admitted to a multicenter hospital system in Illinois between March and November 2020. Our cohort consisted of COVID-19 hospitalization survivors excluding those discharged to hospice care. Major adverse events (MAEs) were defined as venous thromboembolism (VTE), myocardial injury (troponin greater than upper limit of normal), stroke, new requirement for renal replacement therapy (RRT), life-threatening arrhythmia, or acute heart failure exacerbation. The primary outcome was readmission within 60 days of initial hospitalization.
Results
From the 1406 survivors of the index hospitalization, 223 (15.9%) patients were readmitted within 60 days. Those readmitted were older and more likely to have underlying comorbidities including atrial fibrillation, coronary artery disease, and hypertension (Table 1). Length of stay between the readmission and non-readmission groups was trending towards statistical significance (10.52 days vs 8.95 days, p=0.053).
Those with one or more MAE during their index hospitalization, when adjusted for age and body mass index, were at an increased risk of readmission (adjusted odds ratio [aOR] 1.90, p<0.01). Readmitted patients were more likely to have VTE during their index hospitalization than those not readmitted (7.2% vs 3.7%, p<0.05). The incidence of new RRT (4.9% vs 2.5%, p=0.083) and myocardial injury (3.6% vs 1.5%, p=0.067) between the groups was also trending towards statistical significance (Table 1). No statistical difference was present between the other individual MAEs; however, this is limited by small sample sizes of certain MAEs. Of the 322 patients with echocardiography during the index admission, 82 (25.5%) were readmitted. In this cohort, left ventricular ejection fraction (LVEF) that was reduced (LVEF <50%) or hyperdynamic (LVEF >65%) was not a statistically significant predictor of readmission (Figure 1).
Lastly, discharge disposition was predictive of readmission as those being sent to acute rehab (OR 2.04, p<0.01), long-term acute care (OR 2.58, p<0.01), or skilled nursing facility (OR 2.67, p<0.001) were at higher risk compared to those who were discharged to home (Figure 1).
Conclusion
In this cohort, the occurrence of any MAE during index COVID-19 hospitalization, particularly VTE, RRT, and myocardial injury, can be used to predict 60-day readmission. Furthermore, discharge disposition, but not LVEF, demonstrated prognostic value in our cohort. Identifying high risk patients prior to discharge helps health care providers focus resources on patients most likely to be readmitted.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Ruge
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - A Gill
- Rush University Medical Center, Chicago, United States of America
| | - J M D Gomez
- Rush University Medical Center, Chicago, United States of America
| | | | - J A Simmons
- Rush University Medical Center, Chicago, United States of America
| | - K A Williams
- Rush University Medical Center, Chicago, United States of America
| | - A S Volgman
- Rush University Medical Center, Chicago, United States of America
| | - K Marinescu
- Rush University Medical Center, Chicago, United States of America
| | - A Rao
- Rush University Medical Center, Chicago, United States of America
| | - T Suboc
- Rush University Medical Center, Chicago, United States of America
| |
Collapse
|
23
|
Essa H, Oguguo E, Douglas H, Foster A, Walker L, Hadcroft J, Bellieu J, Kahn M, Rao A, Cuthbertson D, Akpan A, Wong C, Sankaranarayanan R. One year outcomes of heart failure multispecialty multidisciplinary team virtual meetings. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Heart Failure is frequently associated with several comorbidities such as ischaemic heard disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and frailty. This level of complexity is best dealt with by a multispecialty multidisciplinary team (MDT) model.
This was a single centre observational study (January 2020-December 2020) that was undertaken in a British university hospital looking at effect of HF multispecialty virtual MDT meetings on HF outcomes. Patients acted as their own controls outcomes compared for equal period pre versus post MDT meeting. The multi-specialty meeting was conducted once monthly via video-conferencing. It consisted of heart failure cardiologists (from primary secondary and tertiary care), heart failure specialist nurses (hospital and community), nephrologist, endocrinologist, palliative care specialists, chest physician, pharmacist, pharmacologist and geriatrician. Recommendations were made as consensus from the multispecialty meeting. The main outcome measures were 1) number of hospitalisations and 2) outpatient clinic attendances 3) cost savings.
A total of 189 patients were discussed from January-December 2020. This was uninterrupted during the COVID-19 pandemic. The mean age was 70.3±18.1 years and median follow-up 6 months (range 1–13 months). The mean Charlson Co-morbidity score was 5.3±1.2 and Rockwood Frailty Score was 4.9±1. The mean number of outpatient clinic attendances avoided was 1.7±0.4. This reduced inconvenience to patients, saved patients money (transport and parking costs) and led to carbon footprint reduction. The MDT meeting total costs were £15,400 and the 31 clinic appointments they generated cost an estimated £3720. However, the MDT meetings prevented 277 clinic appointments (cost saving £33,352). Finally, the mean number of hospitalisations pre-MDT was 0.7 Vs 0.2 post MDT (p<0.01) with a saving of around 730 bed days (estimated cost-saving £260,000).
The HF multispecialty virtual MDT approach provides seamless integration of primary care community services with secondary and tertiary care. Consensus decision from MDT meetings provides holistic approach for HF patients with comorbidities and frailty, and reduces inconvenience to patients by preventing the need to attend multiple specialty clinics. This approach can also lead to significant cost-savings to the healthcare system.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- H Essa
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - E Oguguo
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - H Douglas
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Foster
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - L Walker
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Hadcroft
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Bellieu
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - D Cuthbertson
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Akpan
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - C Wong
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | | |
Collapse
|
24
|
Qin A, Lima F, Bell S, Kalemkerian G, Schneider B, Ramnath N, Lew M, Rao A, Frankel T. P57.03 Cellular Engagement and Interaction in the Tumor Microenvironment (TME) Predicts Response to ICI in Metastatic NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Gangwar NK, Pawaiya RVS, Gururaj K, Singh DD, Andani D, Kumar A, Sharma DK, Rao AR, Rai A. Chemotactic factor inducing Interleukin-8 (IL8) gene is transcriptionally elevated in experimental enterotoxaemia in goats caused by Clostridium perfringens type D. Heliyon 2021; 7:e07568. [PMID: 34345740 PMCID: PMC8319006 DOI: 10.1016/j.heliyon.2021.e07568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022] Open
Abstract
The current study was designed to analyse the effects of experimental induction of enterotoxaemia through intra-duodenal inoculation of C. perfringens type D culture isolated from spontaneous outbreaks in goats. Twenty goats (6–9 month age) were divided into four groups and C. perfringens type D culture was inoculated intra-duodenally as per following: Group-I (whole cultures-WC), group-II (culture supernatant-CS), group-III (washed cells-WS), and group-IV (uninfected control-C). The treated animals were sacrificed after 72 h post infection (hpi), and necropsy showed gross changes including haemorrhages and congestion in the ileal and colon mucosa, pulmonary congestion and edema in lung. Kidney, brain and spleen exhibited severe to moderate congestion. Microscopic changes like haemorrhages, degenerative and necrotic changes in the mucosal epithelium of intestine and haemorrhages in kidney parenchyma were observed in the H&E stained sections. Lung alveolar sacs were filled with proteinaceous fluid. Immunohistochemistry revealed positive immunolabelling for etx (epsilon toxin) in the mucosa of intestine in WC and CS group. Control animals did not exhibit any significant gross or microscopic changes. PCR amplification of DNA extracted from intestinal tissues of WC and CS groups showed positive for etx gene demonstrating the production of epsilon toxin. Transcriptional responses in experimental groups were assessed by quantitative reverse transcription real time PCR (qRT-PCR). Genes including IL-1β and IL2 showed up-regulation in all the experimental groups (WC, CS&WS). Specifically the toxin-based experimental groups (WC&CS) showed up-regulation of the gene responsible for chemotaxis viz. IL-8, while the washed cells group (WS) showed higher transcriptional response to Cathepsin-L (Cat-L) gene denoting the acute inflammatory response due to neutrophil elastase activity. These results take a cue on the evolving nature of the enterotoxaemia in goats due to various strains circulating in the field. The host response and its modulation due to the novel enterotoxaemia strains throws light on the current challenges in efficient control of the disease in goats.
Collapse
Affiliation(s)
- N K Gangwar
- Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, DUVASU, Mathura, UP, 281001, India
| | - R V S Pawaiya
- Division of Animal Health, ICAR-Central Institute for Research on Goat, Makhdoom, Farah, Mathura, UP, 281122, India
| | - K Gururaj
- Division of Animal Health, ICAR-Central Institute for Research on Goat, Makhdoom, Farah, Mathura, UP, 281122, India
| | - D D Singh
- Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, NDUAT, Kumarganj, Ayodhya, UP, 224229, India
| | - D Andani
- Division of Animal Health, ICAR-Central Institute for Research on Goat, Makhdoom, Farah, Mathura, UP, 281122, India
| | - A Kumar
- Division of Animal Health, ICAR-Central Institute for Research on Goat, Makhdoom, Farah, Mathura, UP, 281122, India
| | - D K Sharma
- Division of Animal Health, ICAR-Central Institute for Research on Goat, Makhdoom, Farah, Mathura, UP, 281122, India
| | - A R Rao
- Centre for Agricultural Bioinformatics, ICAR- Indian Agricultural Statistics Research Institute, Library Avenue, Pusa, New Delhi, 110012, India
| | - A Rai
- Centre for Agricultural Bioinformatics, ICAR- Indian Agricultural Statistics Research Institute, Library Avenue, Pusa, New Delhi, 110012, India
| |
Collapse
|
26
|
Llewellyn J, Meda G, Wright DJ, Rao A. Submuscular reburial as an alternative to lead extraction in high risk patients. Europace 2021. [DOI: 10.1093/europace/euab116.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The Heart Rhythm Society (HRS) and European Heart Rhythm Association (EHRA) consensus states complete extraction is recommended for all patients with definite cardiac implantable electronic device (CIED) infection. Although complete removal of hardware is the best way to manage infections, lead extraction is a complex procedure with significant risk. As age and complexity of patients increase so too does extraction risk. In very high risk cases conservative management is cited, though little is known on outcomes.
Purpose
We are a high volume tertiary centre which serves a population of 2 million. 2 experienced operators perform 65 extraction procedures per year for the past 10 years. We report our experience of device reburial as initial management of CIED pre-erosion and erosion in cases deemed too high risk for extraction.
Method
We retrospectively reviewed all reburial procedures undertaken over 9 years. Patient and lead factors influencing decisions were assessed. Information on number of leads, dwell time, prior procedure, infective status and comorbidity was collated. The outcomes included morbidity, defined by repeat procedure (revision and/or extraction) and mortality.
Results
86 patients underwent 96 procedures from March 2013 until August 2020. All patients undergoing device reburial were included. 55.8% of patients were male, mean age was 73. 21 patients died, 7 of these deaths occurred within 12 months of the index reburial procedure. The mean follow up period was 39 months (range 5–90). 65.1% of patients had a procedure (de novo implant, upgrade or replacement) within 12 months prior to revision.
We reviewed patients in 2 subgroups based on revision indication – erosion and pre-erosion. Erosion was defined as externalised lead/device. Pre-erosion was defined as superficial device with skin tethering but no exposure. The former is a definite indication for lead extraction, the latter a relative indication. All in the pre-erosion group were systemically well with no infection evident. One patient with erosion had a positive blood culture.
The mean age in the erosion group was 85 years with a Clinical Frailty Score (CFS) 4.98 and lead dwell time 17.87 years compared to age 68 years, CFS 3.98 and dwell time 8.14 years in the pre-erosion group. Patients in this cohort with an eroded device were deemed too high risk to undergo transvenous lead extraction.
A higher proportion of patients presenting with erosion died within 12 months of the index reburial procedure (16.67% vs 4.84%). 21% with an eroded device and 11% with a pre-eroding device undergoing reburial as first line management required future extraction.
Conclusion
Our 9 year data suggests less invasive intervention is a valid option in high risk groups such as older age, frailty, long lead dwell time, with an acceptable incidence of reintervention and/or extraction. This data can help guide informed consent in the future.
Collapse
Affiliation(s)
- J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - G Meda
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
27
|
Garner D, Leung WY, Llewellyn J, Goode R, Lunt L, Hughes S, Kahn M, Wright DJ, Rao A. CIED guided HF management : a prospective cohort study. Europace 2021. [DOI: 10.1093/europace/euab116.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group
Background
Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2)
Aim
To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams.
Methods
We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback.
Results
365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had >3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy.
Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive.
Conclusions
An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.
Collapse
Affiliation(s)
- D Garner
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - WY Leung
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Goode
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Lunt
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
28
|
Hansoti B, Hahn E, Rao A, Harris J, Jenson A, Markadakis N, Moonat S, Osula V, Pousson A. Calibrating a chief complaint list for low resource settings: a methodologic case study. Int J Emerg Med 2021; 14:32. [PMID: 34011284 PMCID: PMC8132346 DOI: 10.1186/s12245-021-00347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The chief or presenting complaint is the reason for seeking health care, often in the patient's own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs. METHODS This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list. RESULTS Overall, 3537 patients' chief complaints were reviewed, of which 640 were identified as 'potential mismatches.' When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. "Pain" was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list. CONCLUSIONS This study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.
Collapse
Affiliation(s)
- B Hansoti
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - E Hahn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Harris
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Jenson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N Markadakis
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S Moonat
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Osula
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Pousson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
29
|
Sheu T, Park S, Rao A, Gans D, King R, Whitehead T, Swischuk J. Abstract No. 577 Basket thrombectomy using distal protection wires for arterial thromboembolism: a case series. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
30
|
Elhalawani H, Volpe S, Cardenas C, Stieb S, Rock C, Lin T, Yang P, Wu H, Barua S, Zaveri J, Elgohari B, Abdallah L, Jethanandani A, Mohamed A, Court L, Gunn G, Rosenthal D, Frank S, Garden A, Rao A, Hutcheson K, Fuller C. Investigation of Longitudinal Dose-weighted FDG-Positron Emission Tomography Metabolic Imaging Biomarkers (PET MIBs) of Radiation-associated Dysphagia in OPC Cohort. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Mitra S, Jajodia A, Koyyala V, Mahawar V, Dewan A, Aggarwal S, Wahi IS, Barik S, Dobriyal K, Mukhee J, Khurana H, Tripathy R, Rao A, Chaturvedi A. PH-0718: Quantitative MRI in prognosticating clinical outcomes in carcinoma cervix treated with Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
Caissie A, Mierzwa M, Fuller C, Rajaraman M, Lin A, McDonald A, Popple R, Xiao Y, van Dijk L, Balter P, Fong H, Ping H, Kovoor M, Lee J, Rao A, Martel M, Thompson R, Merz B, Yao J, Mayo C. Radiotherapy (RT) Patterns Of Practice Variability Identified As A Challenge To Real-World Big Data: Recommendations From The Learning From Analysis Of Multicenter Big Data Aggregation (LAMBDA) Consortium. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
McSweeney SM, Christou EAA, Dand N, Boalch A, Holmes S, Harries M, Palamaras I, Cunningham F, Parkins G, Kaur M, Farrant P, McDonagh A, Messenger A, Jones J, Jolliffe V, Ali I, Ardern-Jones M, Mitchell C, Burrows N, Atkar R, Banfield C, Alexandroff A, Champagne C, Cooper HL, Patel GK, Macbeth A, Page M, Bryden A, Mowbray M, Wahie S, Armstrong K, Cooke N, Goodfield M, Man I, de Berker D, Dunnil G, Takwale A, Rao A, Siah TW, Sinclair R, Wade MS, Bhargava K, Fenton DA, McGrath JA, Tziotzios C. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK. Br J Dermatol 2020; 183:1136-1138. [PMID: 32652611 DOI: 10.1111/bjd.19399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S M McSweeney
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - E A A Christou
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - A Boalch
- Greenwich and Lewisham NHS Foundation Trust, London, SE13 6LH, UK
| | - S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | - F Cunningham
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | - G Parkins
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K Bhargava
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - D A Fenton
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - J A McGrath
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| |
Collapse
|
34
|
Lee CH, Shah A, Hsieh J, Rao A, Pinto A, Bilen M, Cohn A, Di Simone C, Shaffer D, Girones Sarrio R, Gunnestad Ribe S, Wu J, Schmidt E, Kubiak P, Okpara C, Smith A, Motzer R. 710P Phase II trial of lenvatinib (LEN) + pembrolizumab (PEMBRO) for progressive disease after PD-1/PD-L1 immune checkpoint inhibitor (ICI) in metastatic clear cell (mcc) renal cell carcinoma (RCC): Results by independent imaging review and subgroup analyses. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
35
|
Lam J, Bridgewater J, Alani M, Mullamitha S, Braun M, Kunene V, Baijal S, Holden C, Aboud K, Chopra N, Escola CL, Rao A, Samuel L, Denton A, Grumett S, Melcher L, Muthuramalingam S, Sankey P, Saunders M, Shiu KK. 502P Nivolumab, alone or with ipilimumab, for mismatch repair deficient metastatic colorectal cancer: A United Kingdom multicentre analysis of patient outcomes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
36
|
Affiliation(s)
- A R Rao
- Department of Urology, American Hospital Dubai, Oud Mehta, Dubai, United Arab Emirates.
| |
Collapse
|
37
|
Rao A, McBride EL, Zhang G, Xu H, Cai T, Notkins AL, Aronova MA, Leapman RD. Determination of secretory granule maturation times in pancreatic islet β-cells by serial block-face electron microscopy. J Struct Biol 2020; 212:107584. [PMID: 32736074 DOI: 10.1016/j.jsb.2020.107584] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023]
Abstract
It is shown how serial block-face electron microscopy (SBEM) of insulin-secreting β-cells in wild-type mouse pancreatic islets of Langerhans can be used to determine maturation times of secretory granules. Although SBEM captures the β-cell structure at a snapshot in time, the observed ultrastructure can be considered representative of a dynamic equilibrium state of the cells since the pancreatic islets are maintained in culture in approximate homeostasis. It was found that 7.2 ± 1.2% (±st. dev.) of the β-cell volume is composed of secretory granule dense-cores exhibiting angular shapes surrounded by wide (typically ≳100 nm) electron-lucent halos. These organelles are identified as mature granules that store insulin for regulated release through the plasma membrane, with a release time of 96 ± 12 h, as previously obtained from pulsed 35S-radiolabeling of cysteine and methionine. Analysis of β-cell 3D volumes reveals a subpopulation of secretory organelles without electron-lucent halos, identified as immature secretory granules. Another subpopulation of secretory granules is found with thin (typically ≲30 nm) electron-lucent halos, which are attributed to immature granules that are transforming from proinsulin to insulin by action of prohormone convertases. From the volume ratio of proinsulin in the immature granules to insulin in the mature granules, we estimate that the newly formed immature granules remain in morphologically-defined immature states for an average time of 135 ± 14 min, and the immature transforming granules for an average time of 130 ± 17 min.
Collapse
Affiliation(s)
- A Rao
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - E L McBride
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - G Zhang
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - H Xu
- Experimental Medicine Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - T Cai
- Experimental Medicine Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - A L Notkins
- Experimental Medicine Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - M A Aronova
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - R D Leapman
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA.
| |
Collapse
|
38
|
Koyyala V, Jajodia A, Gupta A, BP A, Chaturvedhi A, Rao A, Mehta A, Gupta N, Pasricha S, Joga S, Medisetty P, Mantia ML, Goyal S, Singh S. P-309 Correlation between baseline CEA levels and TNM stage at presentation in colorectal cancers in an Indian population. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
39
|
Gill J, Ramesh V, Leef S, Rao A, Mathews T, Zhao Z, Morrison S. 123 Identification of GAPDHS as a novel regulator of melanoma metastasis and metabolic plasticity. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
40
|
Koyyala V, Jajodia A, Gupta A, Chaturvedhi A, Rao A, Goyal S, Mehta A, Prosch H, Pasricha S, Choudhary A, La Mantia M, BP A, Gupta N, Singh S. P-189 Role of radiomics in clinical prognostication and prediction of survival among a cohort of metastatic intrahepatic cholangiocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
41
|
Wagner C, Amamcharla JK, Rao A, Metzger LE. Adapting blood glucose meter biosensors for the measurement of lactose in dairy ingredients. J Dairy Sci 2020; 103:7585-7597. [PMID: 32505394 DOI: 10.3168/jds.2019-17903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/28/2020] [Indexed: 11/19/2022]
Abstract
Commonly used lactose assays [enzymatic spectrophotometric absorbance (EZA) and HPLC] for dairy ingredients are relatively expensive and time consuming. A blood glucose meter (BGM)-based method has successfully been documented as a rapid lactose assay in milk. However, the BGM-based method has not been evaluated in dairy ingredients. The objective of this study was to evaluate the BGM-based lactose analysis method in whey-derived (WD) and skim milk-derived (SMD) ingredients. The study was carried out in 4 phases. In phase 1, the effect of pH and lactose concentrations on the BGM reading was investigated using a factorial design with 2 factors: pH (6.02-7.50) and lactose (0.2 or 0.4%). We found that BGM readings were significantly affected by lower pH values at both lactose levels. In phase 2, the effect of total solids and ingredient type was investigated using a factorial design with 2 factors: ingredient type (WD or SMD) and total solids (0-8%). It was observed that the BGM reading was significantly affected by ingredient type and total solids. Phase 3 involved developing a linear relationship between the BGM reading and the EZA reference method to ascertain the accuracy of the proposed BGM method. Different ingredient types (WD or SMD) and non-lactose solids (0.5-27%) model ingredient dilutions prepared over a range of lactose contents (0.08-0.62%) were measured using the BGM and EZA methods. The average absolute percentage bias difference between the BGM method and EZA reference method results for these model dilutions was found to be between 2.2 and 7.3%. In phase 4, 15 samples procured from commercial sources ranging from 0.01 to 81.9% lactose were evaluated using the BGM method and EZA reference method. The average absolute percentage bias difference for lactose results between the 2 methods ranged from 3.6 to 5.0% and 5.3 to 9.7% for well-performing and poorly performing meters, respectively. Overall, the BGM method is a promising tool for rapid and low-cost analysis of lactose in both high-lactose and low-lactose dairy ingredients.
Collapse
Affiliation(s)
- C Wagner
- Department of Animal Sciences and Industry/Food Science Institute, Kansas State University, Manhattan 66506; Agropur Ingredients, Appleton, WI 54915
| | - J K Amamcharla
- Department of Animal Sciences and Industry/Food Science Institute, Kansas State University, Manhattan 66506.
| | - A Rao
- Agropur Ingredients, Appleton, WI 54915
| | - L E Metzger
- Dairy Science Department, Midwest Dairy Foods Research Center, South Dakota State University, Brookings 57006
| |
Collapse
|
42
|
Chatterjee S, Bhattacharjee D, Misra S, Rao A, Chattopadhyay A, Ghosh A. AB0006 HYPOMETHYLATION OF THE PROMOTER REGION OF TLR4 GENE AT A SYSTEMIC LEVEL IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PERIODONTITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Periodontitis (PD) has long been linked with Rheumatoid arthritis (RA) [1]. Epigenetic modifications are being recently explored to explain such associations, DNA methylation being one such important mechanism.Objectives:To study the effect chronic generalized periodontitis on systemic methylation of TLR4 genes in comparison to only RA and RA with PD patients.Methods:Twenty-three RA patients, among which 11 patients had chronic generalized PD, 20 patients with only PD and 15 healthy individuals recruited. DNA was isolated from PBMCs of the participants blood, then were first bisulphite converted and then methylation specific PCR were performed using primers for methylated and um-methylated promoters of TLR4. The DNA amplifications were checked in horizontal gel electrophoresis. The methylation signatures were verified by DNA sequencing (Sanger) of the amplified products.Results:The anti-CCP, DAS-CRP and HAQ DI were higher in patients with both RA and PD (220±40, 5.7±0.2, 1.5±0.1 respectively, p<0.05). Control samples had shown amplification bands for methylated primers of TLR4 but not for un-methylated primers of TLR4. However, only RA, only PD and RA with PD samples, had shown amplification for un-methylated primers and not for methylated primers. These results together with DNA sequencing indicated that 4 CpG sites in the promoter ofTLR4 genes were hypo-methylated in the PBMCs of patients whereas those remain methylated in healthy individuals.Conclusion:The observations indicated that though PD is a localised disease of the gingiva there is a systemic involvement of TLR mediated pathways in them which is similar to those in RA. However, further validation in larger cohort and down-stream signalling molecules needs to be studied.References:[1]Ceccarelli F, Saccucci M, Di Carlo G, Lucchetti R, Pilloni A, Pranno N, Luzzi V, Valesini G, Polimeni A. Periodontitis and rheumatoid arthritis: the same inflammatory mediators?. Mediators of inflammation. 2019;2019.Disclosure of Interests:None declared
Collapse
|
43
|
Parashar A, Jajodia A, Chaturvedi A, Rao A, Mehta A, Doval D, Bp A, Medisetty P, Koyyala V, Pasricha S, la Mantia M, Chllamma M, Leithner D, Mayerhoefer M, Russo A, Prosch H. 72P Non-mass like enhancement patterns on MR mammography and their pathological correlation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
44
|
Kaur T, Dahiya S, Satija SH, Nawal SJ, Kshetrimayum N, Ningthoujam J, Chahal AK, Rao A. Foldscope as a primary diagnostic tool for oral and urinary tract infections and its effectiveness in oral health education. J Microsc 2020; 279:39-51. [PMID: 32286690 DOI: 10.1111/jmi.12896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
Due to its speed, accuracy and cost-effectiveness, microscopy has become an integral part of clinical examination for disease diagnosis. However, modern microscopes are very costly and require skilled personnel for their operation and maintenance, and specimen processing and analysis is labour-intensive. Further, lack of such expensive diagnostic tools in remote areas is a serious concern. Affordable point-of-care diagnostic tools are the most useful for timely disease diagnosis and management. The Foldscope is an affordable origami-based microscopy device composed of a series of paper clippings, which, upon assembly, can hold a specimen slide for observation, and this specimen can be viewed via a mobile phone camera attached to it. The present study evaluated the use of the Foldscope in the clinical diagnosis of oral and urinary tract infections and evaluated its efficacy as a motivational tool for improving oral health among school children in India. We qualitatively compared the Foldscope to a clinical microscope by examining five different types of clinical samples. Of the different types of clinical samples, the Foldscope was effective in detecting infection in dental plaque samples and urine samples. Thus, we further analysed 31 dental plaque samples of patients aged 3-13 years and 25 urine samples of patients aged 11-62 years. We also evaluated the use of the Foldscope as an educational tool for motivating oral hygiene among 80 school children aged 12 years and found that students in the Foldscope intervention group had better measures of oral hygiene than did students in the nonintervention group. In summary, our study indicated that the Foldscope is useful in detecting urinary tract infections and kidney stones in urine samples and is a useful motivational tool for oral health education among school-aged children. Furthermore, it may also be useful in oral health monitoring in resource poor settings. LAY DESCRIPTION: Poor and remote population often suffers due to lack of capacity to buy products or avail services which are expensive. In such a society people are not able to afford even the basic detection of diseases. Foldscope may come to rescue here! Foldscope is a paper-based, use-and-throw, affordable microscope. This study explores the use of Foldscope in clinics and diseases diagnosis using patient samples. Preliminary detection of disease associated symptoms in dental and urinary infections and digital record keeping via storage in mobile phone memory and hospital OPD records for monitoring patient's health are some of the advantages of Foldscope for clinical use in resource poor settings. It identifies that Foldscope not only can be used by students or teachers for educational purposes but it can also pave a path for promotion of dental hygiene among young children. The study also suggests that further improvement in design or resolution of Foldscope will broaden the scope of its application, in future.
Collapse
Affiliation(s)
- T Kaur
- CSIR-Institute of Microbial Technology, Chandigarh, India
| | - S Dahiya
- Civil Hospital, Panchkula, Haryana, India
| | - S H Satija
- Civil Hospital, Panchkula, Haryana, India
| | - S J Nawal
- Star Hospital, Bhiwadi, Rajasthan, India
| | - N Kshetrimayum
- Dental College Regional Institute of Medical Sciences, Imphal, India
| | - J Ningthoujam
- Dental College Regional Institute of Medical Sciences, Imphal, India
| | - A K Chahal
- CSIR-Institute of Microbial Technology, Chandigarh, India
| | - A Rao
- CSIR-Institute of Microbial Technology, Chandigarh, India.,Academy of Scientific and Innovation Research (AcSIR), Ghaziabad, India
| |
Collapse
|
45
|
Jajodia A, Gupta A, Mehta A, Chaturvedi A, Rao A, Gupta G, Doval D, Bp A, Medisetty P, Bommera S, Koyyala V, Pasricha S, Mayerhoefer M, Prosch H, Chllamma M, la Mantia M, Russo A. 71P Role of radiomics in predicting molecular phenotypes of female breast cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
46
|
Mishra DC, Sikka P, Yadav S, Bhati J, Paul SS, Jerome A, Singh I, Nath A, Budhlakoti N, Rao AR, Rai A, Chaturvedi KK. Identification and characterization of trait-specific SNPs using ddRAD sequencing in water buffalo. Genomics 2020; 112:3571-3578. [PMID: 32320820 DOI: 10.1016/j.ygeno.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/19/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
Single Nucleotide Polymorphism (SNP) is one of the important molecular markers widely used in animal breeding program for improvement of any desirable genetic traits. Considering this, the present study was carried out to identify, annotate and analyze the SNPs related to four important traits of buffalo viz. milk volume, age at first calving, post-partum cyclicity and feed conversion efficiency. We identified 246,495, 168,202, 74,136 and 194,747 genome-wide SNPs related to mentioned traits, respectively using ddRAD sequencing technique based on 85 samples of Murrah Buffaloes. Distribution of these SNPs were highest (61.69%) and lowest (1.78%) in intron and exon regions, respectively. Under coding regions, the SNPs for the four traits were further classified as synonymous (4697) and non-synonymous (3827). Moreover, Gene Ontology (GO) terms of identified genes assigned to various traits. These characterized SNPs will enhance the knowledge of cellular mechanism for enhancing productivity of water buffalo through molecular breeding.
Collapse
Affiliation(s)
- D C Mishra
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - Poonam Sikka
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
| | - Sunita Yadav
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - Jyotika Bhati
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - S S Paul
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
| | - A Jerome
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
| | - Inderjeet Singh
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
| | - Abhigyan Nath
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
| | - Neeraj Budhlakoti
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - A R Rao
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - Anil Rai
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - K K Chaturvedi
- ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India.
| |
Collapse
|
47
|
Oliveros E, Suboc T, Marinescu K, Rao A, Aggarwal N, Volgman-Santos A. National Inpatient Sample Database Reveals Pulmonary Artery Catheter Use Decreases Outcomes but Underused in Women. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
48
|
Stewart D, Rao A, Groninger H. Quality of Life Outcomes of Patients Receiving Palliative, Long-Term Continuous Intravenous Inotropic Support. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
49
|
Rao A, Zecchin R, Denniss A, Hickman L, DiGiacomo M, Phillips J, Newton P. 018 Do Social, Lifestyle and Cardiovascular Risk Factors Predict Dropout from Cardiac Rehabilitation Programs? A Longitudinal Cohort Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
50
|
Rao A, Hales S, Bhat A, Chen H, MacIntyre R, Tan T, Gan G. 470 COVID-19 Experience in New South Wales (NSW) - A Case Series. Heart Lung Circ 2020. [PMCID: PMC7648880 DOI: 10.1016/j.hlc.2020.09.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|