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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.
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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
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Batra R, Kumar DA, Rao A, Kaloiya GS, Khan MA, Satapathy S, Chakrawarty A, Soni N, Kumar P, Chatterjee P. Clinical and neuropsychological characterization of SuperAgers residing in Delhi and National Capital Region of India-A cross-sectional study. Aging Med (Milton) 2024; 7:67-73. [PMID: 38571668 PMCID: PMC10985767 DOI: 10.1002/agm2.12285] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction SuperAgers (SA) are older adults who exhibit cognitive capacities comparable to individuals who are three or more decades younger than them. The current study aimed to identify the characteristics of Indian SA by categorizing 55 older adults into SA and Typical Older Adults (TOA) and comparing their performance with a group of 50 younger participants (YP) (aged 25-50). Methods A total of 105 participants were recruited after obtaining informed written consent. The cognitive abilities of the participants were assessed using Wechsler Adult Intelligence Scale (WAIS)-IVINDIA, Color Trails Test, Boston Naming Test (BNT), and Rey Auditory Verbal Learning Test. Results SA outperformed TOA in all cognitive assessments (P < 0.001) and surpassed YP in BNT and WAIS-IV. SA's delayed recall scores were notably higher (12.29 ± 1.51) than TOA (6.32 ± 1.44). Conclusion SA excelled in all cognitive domains demonstrating resilience to age-related cognitive decline. This study highlights Indian SuperAgers' exceptional cognitive prowess.
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Affiliation(s)
- Ritika Batra
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Deepa Anil Kumar
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Abhijith Rao
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | | | - Maroof Ahmad Khan
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Sujata Satapathy
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Avinash Chakrawarty
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Nidhi Soni
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Pramod Kumar
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Prasun Chatterjee
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
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Kumar S, Castelino R, Rao A, Gattani S, Kumar A, Pillai A, Sehgal A, Rane P, Ramaswamy A, Dhekale R, Krishnamurthy J, Banavali S, Badwe R, Prabhash K, Noronha V, Gota V. Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer. Cancer Med 2024; 13:e6797. [PMID: 38183404 PMCID: PMC10807583 DOI: 10.1002/cam4.6797] [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: 04/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. METHODS A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. RESULTS Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). CONCLUSIONS The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.
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Affiliation(s)
- Sharath Kumar
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Renita Castelino
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Abhijith Rao
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Shreya Gattani
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anita Kumar
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anupa Pillai
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Arshiya Sehgal
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Pallavi Rane
- Department of StatisticsAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Anant Ramaswamy
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Ratan Dhekale
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | | | - Shripad Banavali
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Rajendra Badwe
- Homi Bhabha National InstituteMumbaiIndia
- Department of Surgical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vanita Noronha
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vikram Gota
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
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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.
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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
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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).
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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
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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.
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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
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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.
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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
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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]
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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
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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
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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.
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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
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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
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Luo G, Chen L, Kostich WA, Hamman B, Allen J, Easton A, Bourin C, Gulianello M, Lippy J, Nara S, Pattipati SN, Dandapani K, Dokania M, Vattikundala P, Sharma V, Elavazhagan S, Verma MK, Lal Das M, Wagh S, Balakrishnan A, Johnson BM, Santone KS, Thalody G, Denton R, Saminathan H, Holenarsipur VK, Kumar A, Rao A, Putlur SP, Sarvasiddhi SK, Shankar G, Louis JV, Ramarao M, Conway CM, Li YW, Pieschl R, Tian Y, Hong Y, Bristow L, Albright CF, Bronson JJ, Macor JE, Dzierba CD. Discovery and Optimization of Biaryl Alkyl Ethers as a Novel Class of Highly Selective, CNS-Penetrable, and Orally Active Adaptor Protein-2-Associated Kinase 1 (AAK1) Inhibitors for the Potential Treatment of Neuropathic Pain. J Med Chem 2022; 65:4534-4564. [PMID: 35261239 DOI: 10.1021/acs.jmedchem.1c02132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent mouse knockout studies identified adapter protein-2-associated kinase 1 (AAK1) as a viable target for treating neuropathic pain. BMS-986176/LX-9211 (4), as a highly selective, CNS-penetrable, and potent AAK1 inhibitor, has advanced into phase II human trials. On exploring the structure-activity relationship (SAR) around this biaryl alkyl ether chemotype, several additional compounds were found to be highly selective and potent AAK1 inhibitors with good druglike properties. Among these, compounds 43 and 58 showed very good efficacy in two neuropathic pain rat models and had excellent CNS penetration and spinal cord target engagement. Both compounds also exhibited favorable physicochemical and oral pharmacokinetic (PK) properties. Compound 58, a central pyridine isomer of BMS-986176/LX-9211 (4), was 4-fold more potent than 4 in vitro and showed lower plasma exposure needed to achieve similar efficacy compared to 4 in the CCI rat model. However, both 43 and 58 showed an inferior preclinical toxicity profile compared to 4.
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Affiliation(s)
- Guanglin Luo
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Ling Chen
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Walter A Kostich
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Brian Hamman
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Jason Allen
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Amy Easton
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Clotilde Bourin
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Michael Gulianello
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Lippy
- Department of Lead Evaluation, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Susheel Nara
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sreenivasulu Naidu Pattipati
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kumaran Dandapani
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Dokania
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Pradeep Vattikundala
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vivek Sharma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Saravanan Elavazhagan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Kumar Verma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manish Lal Das
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Santosh Wagh
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anand Balakrishnan
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Benjamin M Johnson
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kenneth S Santone
- Department of Pharmaceutical Candidate Optimization, Bristol Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - George Thalody
- Discovery Toxicology, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Rex Denton
- Discovery Toxicology, Bristol Myers Squibb Company, Route 206 & Province Line Rd, Princeton, New Jersey 08543, United States
| | - Hariharan Saminathan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vinay K Holenarsipur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anoop Kumar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Abhijith Rao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Siva Prasad Putlur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sarat Kumar Sarvasiddhi
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Ganesh Shankar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Justin V Louis
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manjunath Ramarao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 & 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Charles M Conway
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yu-Wen Li
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Rick Pieschl
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yuan Tian
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yang Hong
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Linda Bristow
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Charles F Albright
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Joanne J Bronson
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - John E Macor
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Carolyn D Dzierba
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
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14
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Luo G, Chen L, Kostich WA, Hamman B, Allen J, Easton A, Bourin C, Gulianello M, Lippy J, Nara S, Maishal TK, Thiyagarajan K, Jalagam P, Pattipati SN, Dandapani K, Dokania M, Vattikundala P, Sharma V, Elavazhagan S, Verma MK, Das ML, Wagh S, Balakrishnan A, Johnson BM, Santone KS, Thalody G, Denton R, Saminathan H, Holenarsipur VK, Kumar A, Rao A, Putlur SP, Sarvasiddhi SK, Shankar G, Louis JV, Ramarao M, Conway CM, Li YW, Pieschl R, Tian Y, Hong Y, Ditta J, Mathur A, Li J, Smith D, Pawluczyk J, Sun D, Yip S, Wu DR, Vetrichelvan M, Gupta A, Wilson A, Gopinathan S, Wason S, Bristow L, Albright CF, Bronson JJ, Macor JE, Dzierba CD. Discovery of ( S)-1-((2',6-Bis(difluoromethyl)-[2,4'-bipyridin]-5-yl)oxy)-2,4-dimethylpentan-2-amine (BMS-986176/LX-9211): A Highly Selective, CNS Penetrable, and Orally Active Adaptor Protein-2 Associated Kinase 1 Inhibitor in Clinical Trials for the Treatment of Neuropathic Pain. J Med Chem 2022; 65:4457-4480. [PMID: 35257579 DOI: 10.1021/acs.jmedchem.1c02131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Recent mouse knockout studies identified adapter protein-2 associated kinase 1 (AAK1) as a viable target for treating neuropathic pain. Potent small-molecule inhibitors of AAK1 have been identified and show efficacy in various rodent pain models. (S)-1-((2',6-Bis(difluoromethyl)-[2,4'-bipyridin]-5-yl)oxy)-2,4-dimethylpentan-2-amine (BMS-986176/LX-9211) (34) was identified as a highly selective, CNS penetrant, potent AAK1 inhibitor from a novel class of bi(hetero)aryl ethers. BMS-986176/LX9211 (34) showed excellent efficacy in two rodent neuropathic pain models and excellent central nervous system (CNS) penetration and target engagement at the spinal cord with an average brain to plasma ratio of 20 in rat. The compound exhibited favorable physicochemical and pharmacokinetic properties, had an acceptable preclinical toxicity profile, and was chosen for clinical trials. BMS-986176/LX9211 (34) completed phase I trials with good human pharmacokinetics and minimum adverse events and is currently in phase II clinical trials for diabetic peripheral neuropathic pain (ClinicalTrials.gov identifier: NCT04455633) and postherpetic neuralgia (ClinicalTrials.gov identifier: NCT04662281).
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Affiliation(s)
- Guanglin Luo
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Ling Chen
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Walter A Kostich
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Brian Hamman
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Jason Allen
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Amy Easton
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Clotilde Bourin
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Michael Gulianello
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Lippy
- Department of Lead Evaluation, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Susheel Nara
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Tarun Kumar Maishal
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kamalraj Thiyagarajan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Prasadrao Jalagam
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sreenivasulu Naidu Pattipati
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Kumaran Dandapani
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Dokania
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Pradeep Vattikundala
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vivek Sharma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Saravanan Elavazhagan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manoj Kumar Verma
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manish Lal Das
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Santosh Wagh
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anand Balakrishnan
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Benjamin M Johnson
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kenneth S Santone
- Department of Pharmaceutical Candidate Optimization, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - George Thalody
- Discovery Toxicology, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Rex Denton
- Discovery Toxicology, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Hariharan Saminathan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Vinay K Holenarsipur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anoop Kumar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Abhijith Rao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Siva Prasad Putlur
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Sarat Kumar Sarvasiddhi
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Ganesh Shankar
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Justin V Louis
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Manjunath Ramarao
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Charles M Conway
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yu-Wen Li
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Rick Pieschl
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yuan Tian
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Yang Hong
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Jonathan Ditta
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Arvind Mathur
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Jianqing Li
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Daniel Smith
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Joseph Pawluczyk
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Dawn Sun
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Shiuhang Yip
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Dauh-Rurng Wu
- Department of Discovery Synthesis, Bristol-Myers Squibb Company, Route 206 and Province Line Rd, Princeton, New Jersey 08543, United States
| | - Muthalagu Vetrichelvan
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Anuradha Gupta
- Biocon-Bristol Myers Squibb Research and Development Centre, Biocon Park, Plot No. 2 and 3, Bommasandra Phase IV, Jigani Link Road, Bangalore 560099, India
| | - Alan Wilson
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Suma Gopinathan
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Suman Wason
- Lexicon Pharmaceuticals, 8800 Technology Forest Place, The Woodlands, Texas 77381, United States
| | - Linda Bristow
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Charles F Albright
- Department of Neuroscience Discovery Biology, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Joanne J Bronson
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - John E Macor
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Carolyn D Dzierba
- Department of Neuroscience Chemistry, Bristol-Myers Squibb Company, 5 Research Parkway, Wallingford, Connecticut 06492, United States
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15
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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]
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16
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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.
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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
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17
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Prabhash K, Noronha V, Rao A, Gattani S, Ramaswamy A, Kumar A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Pawar A, Mahajan S, Daptardar A, Sonsukare L, Deodhar J, Ansari N, Vagal M, Gota V, Banavali S, Badwe R. Impact of the geriatric assessment on cancer-directed systemic therapy in older Indian persons with cancer: An observational study. Cancer Res Stat Treat 2022. [DOI: 10.4103/crst.crst_298_22] [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: 02/17/2023] Open
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18
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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]
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19
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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]
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20
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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]
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21
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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]
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22
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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.
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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.)
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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]
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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.
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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
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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.
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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
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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]
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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.
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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
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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.
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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
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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.
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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
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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
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Sun LQ, Mull E, D'Andrea S, Zheng B, Hiebert S, Gillis E, Bowsher M, Kandhasamy S, Baratam VR, Puttaswamy S, Pulicharla N, Vishwakrishnan S, Reddy S, Trivedi R, Sinha S, Sivaprasad S, Rao A, Desai S, Ghosh K, Anumula R, Kumar A, Rajamani R, Wang YK, Fang H, Mathur A, Rampulla R, Zvyaga TA, Mosure K, Jenkins S, Falk P, Tagore DM, Chen C, Rendunchintala K, Loy J, Meanwell NA, McPhee F, Scola PM. Discovery of BMS-986144, a Third-Generation, Pan-Genotype NS3/4A Protease Inhibitor for the Treatment of Hepatitis C Virus Infection. J Med Chem 2020; 63:14740-14760. [PMID: 33226226 DOI: 10.1021/acs.jmedchem.0c01296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The discovery of a pan-genotypic hepatitis C virus (HCV) NS3/4A protease inhibitor based on a P1-P3 macrocyclic tripeptide motif is described. The all-carbon tether linking the P1-P3 subsites of 21 is functionalized with alkyl substituents, which are shown to effectively modulate both potency and absorption, distribution, metabolism, and excretion (ADME) properties. The CF3Boc-group that caps the P3 amino moiety was discovered to be an essential contributor to metabolic stability, while positioning a methyl group at the C1 position of the P1' cyclopropyl ring enhanced plasma trough values following oral administration to rats. The C7-fluoro, C6-CD3O substitution pattern of the P2* isoquinoline heterocycle of 21 was essential to securing the targeted potency, pharmacokinetic (PK), and toxicological profiles. The C6-CD3O redirected metabolism away from a problematic pathway, thereby circumventing the time-dependent cytochrome P (CYP) 450 inhibition observed with the C6-CH3O prototype.
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Affiliation(s)
- Li-Qiang Sun
- Bristol Myers Squibb Research and Early Development, Route 206 & Province Line Road, Princeton, New Jersey 08543, United States
| | - Eric Mull
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Stanley D'Andrea
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Barbara Zheng
- Bristol Myers Squibb Research and Early Development, Route 206 & Province Line Road, Princeton, New Jersey 08543, United States
| | - Sheldon Hiebert
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Eric Gillis
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Michael Bowsher
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Sarkunam Kandhasamy
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Venkata Rao Baratam
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Sunitha Puttaswamy
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Nagalakshmi Pulicharla
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Sureshbabu Vishwakrishnan
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Subba Reddy
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Ravi Trivedi
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Sarmistha Sinha
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Sankar Sivaprasad
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Abhijith Rao
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Salil Desai
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Kaushik Ghosh
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Rushith Anumula
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Amit Kumar
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Ramkumar Rajamani
- Bristol Myers Squibb Research and Early Development, 100 Binney Street, Cambridge, Massachusetts 02142, United States
| | - Ying-Kai Wang
- Bristol Myers Squibb Research and Early Development, Route 206 & Province Line Road, Princeton, New Jersey 08543, United States
| | - Hua Fang
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Arvind Mathur
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Richard Rampulla
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Tatyana A Zvyaga
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kathy Mosure
- Bristol Myers Squibb Research and Early Development, 100 Binney Street, Cambridge, Massachusetts 02142, United States
| | - Susan Jenkins
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Paul Falk
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Debarati M Tagore
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - Chaoqun Chen
- Bristol Myers Squibb Research and Development, 5 Research Parkway, Wallingford, Connecticut 06492, United States
| | - Kishore Rendunchintala
- Biocon-Bristol Myers Squibb Research and Development Center, Biocon Park, Bommasandra IV Phase, Jigani Link Road, Bangalore 560099, India
| | - James Loy
- Bristol Myers Squibb Research and Early Development, 100 Binney Street, Cambridge, Massachusetts 02142, United States
| | - Nicholas A Meanwell
- Bristol Myers Squibb Research and Early Development, Route 206 & Province Line Road, Princeton, New Jersey 08543, United States
| | - Fiona McPhee
- Bristol Myers Squibb Research and Early Development, 100 Binney Street, Cambridge, Massachusetts 02142, United States
| | - Paul M Scola
- Bristol Myers Squibb Research and Early Development, 100 Binney Street, Cambridge, Massachusetts 02142, United States
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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]
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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]
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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]
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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
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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
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37
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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
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38
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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.
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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.
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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
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40
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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]
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41
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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
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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.
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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
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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
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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
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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.
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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
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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
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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
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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
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49
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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]
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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]
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