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Sinha A, Mattson A, Njere I, Sinha CK. Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis. Ann R Coll Surg Engl 2024. [PMID: 38445605 DOI: 10.1308/rcsann.2023.0041] [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: 03/07/2024] Open
Abstract
INTRODUCTION Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). METHODS A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). RESULTS A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). CONCLUSIONS The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.
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Affiliation(s)
- A Sinha
- East and North Hertfordshire NHS Trust, UK
| | - A Mattson
- St George's University Hospitals NHS Foundation Trust, UK
| | - I Njere
- Royal Devon University Healthcare NHS Foundation Trust, UK
| | - C K Sinha
- St George's University Hospitals NHS Foundation Trust, UK
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Chauhan A, Parmar M, Rajesham JD, Shukla S, Sahoo KC, Chauhan S, Chitiboyina S, Sinha A, Srigana G, Gorla M, Pati S. Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India. BMC Public Health 2024; 24:453. [PMID: 38350875 PMCID: PMC10863254 DOI: 10.1186/s12889-024-17828-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Multimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes. METHODS We undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions). RESULTS More than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while 'DM + arthritis', 'depression + APD', 'depression + DM' were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients. CONCLUSIONS Our findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.
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Affiliation(s)
- A Chauhan
- Public Health Foundation of India, New Delhi, India
| | - M Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - J D Rajesham
- State Tuberculosis Cell, Hyderabad, Telangana, India
| | - S Shukla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - K C Sahoo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - S Chauhan
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - S Chitiboyina
- State TB Training and Demonstration Centre, Hyderabad, Telangana, India
| | - A Sinha
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - G Srigana
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - M Gorla
- World Health Organization, National Tuberculosis Elimination Programme - Technical Support Network, New Delhi, India
| | - Sanghamitra Pati
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
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Sinha A, Dutta U, Demir OM, De Silva K, Ellis H, Belford S, Ogden M, Li Kam Wa M, Morgan HP, Shah AM, Chiribiri A, Webb AJ, Marber M, Rahman H, Perera D. Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function. J Am Coll Cardiol 2024; 83:291-299. [PMID: 38199706 PMCID: PMC10790243 DOI: 10.1016/j.jacc.2023.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Exercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease. OBJECTIVES The aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA). METHODS Patients with ANOCA underwent invasive coronary physiological assessment using adenosine and acetylcholine. CMD was defined as impaired endothelium-independent and/or endothelium-dependent function. EST was performed using a standard Bruce treadmill protocol, with ischemia defined as the appearance of ≥0.1-mV ST-segment depression 80 ms from the J-point on electrocardiography. The study was powered to detect specificity of ≥91%. RESULTS A total of 102 patients were enrolled (65% women, mean age 60 ± 8 years). Thirty-two patients developed ischemia (ischemic group) during EST, whereas 70 patients did not (nonischemic group); both groups were phenotypically similar. Ischemia during EST was 100% specific for CMD. Acetylcholine flow reserve was the strongest predictor of ischemia during exercise. Using endothelium-independent and endothelium-dependent microvascular dysfunction as the reference standard, the false positive rate of EST dropped to 0%. CONCLUSIONS In patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom. https://twitter.com/AishSinha1
| | - Utkarsh Dutta
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Ozan M Demir
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Kalpa De Silva
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Howard Ellis
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Samuel Belford
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Mark Ogden
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Matthew Li Kam Wa
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Holly P Morgan
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Ajay M Shah
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Andrew J Webb
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Michael Marber
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Haseeb Rahman
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom.
| | - Divaka Perera
- British Heart Foundation Center of Excellence and National Institute for Health Research Biomedical Research Center at the School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom. https://twitter.com/divaka_perera
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Sinha A, Rahman H, Douiri A, Demir OM, De Silva K, Clapp B, Webb I, Gulati A, Pinho P, Dutta U, Ellis H, Shah AM, Chiribiri A, Marber M, Webb AJ, Perera D. ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trial. Circulation 2024; 149:36-47. [PMID: 37905403 PMCID: PMC10752262 DOI: 10.1161/circulationaha.123.066680] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Angina with nonobstructive coronary arteries is a common condition for which no effective treatment has been established. We hypothesized that the measurement of coronary flow reserve (CFR) allows identification of patients with angina with nonobstructive coronary arteries who would benefit from anti-ischemic therapy. METHODS Patients with angina with nonobstructive coronary arteries underwent blinded invasive CFR measurement and were randomly assigned to receive 4 weeks of amlodipine or ranolazine. After a 1-week washout, they crossed over to the other drug for 4 weeks; final assessment was after the cessation of study medication for another 4 weeks. The primary outcome was change in treadmill exercise time, and the secondary outcome was change in Seattle Angina Questionnaire summary score in response to anti-ischemic therapy. Analysis was on a per protocol basis according to the following classification: coronary microvascular disease (CMD group) if CFR<2.5 and reference group if CFR≥2.5. The study protocol was registered before the first patient was enrolled (International Standard Randomised Controlled Trial Number: ISRCTN94728379). RESULTS Eighty-seven patients (61±8 years of age; 62% women) underwent random assignment (57 CMD group and 30 reference group). Baseline exercise time and Seattle Angina Questionnaire summary scores were similar between groups. The CMD group had a greater increment (delta) in exercise time than the reference group in response to both amlodipine (difference in delta, 82 s [95% CI, 37-126 s]; P<0.001) and ranolazine (difference in delta, 68 s [95% CI, 21-115 s]; P=0.005). The CMD group reported a greater increment (delta) in Seattle Angina Questionnaire summary score than the reference group in response to ranolazine (difference in delta, 7 points [95% CI, 0-15]; P=0.048), but not to amlodipine (difference in delta, 2 points [95% CI, -5 to 8]; P=0.549). CONCLUSIONS Among phenotypically similar patients with angina with nonobstructive coronary arteries, only those with an impaired CFR derive benefit from anti-ischemic therapy. These findings support measurement of CFR to diagnose and guide management of this otherwise heterogeneous patient group.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Abdel Douiri
- Department of Medical Statistics, School of Life Course & Population Sciences (A.D.), King’s College London, UK
| | - Ozan M. Demir
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Kalpa De Silva
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Brian Clapp
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Ian Webb
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
- King’s College Hospital NHS Foundation Trust, London. UK (I.W., A.M.S.)
| | - Ankur Gulati
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Pedro Pinho
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Utkarsh Dutta
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Howard Ellis
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Ajay M. Shah
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- King’s College Hospital NHS Foundation Trust, London. UK (I.W., A.M.S.)
| | - Amedeo Chiribiri
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Michael Marber
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
| | - Andrew J. Webb
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences (A.S., H.R., O.M.D., U.D., H.E., A.M.S., A.C., M.M., A.J.W., D.P.), King’s College London, UK
- Guys’ and St. Thomas’ NHS Foundation Trust, London, UK (K.D.S., B.C., I.W., A.G., P.P., A.J.W., D.P.)
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Sinha A, Rahman H, Rajani R, Demir OM, Li KamWa M, Morgan H, Ezad SM, Ellis H, Hogan D, Gulati A, Shah AM, Chiribiri A, Webb AJ, Marber M, Perera D. Characterizing Mechanisms of Ischemia in Patients With Myocardial Bridges. Circ Cardiovasc Interv 2024; 17:e013657. [PMID: 37929596 PMCID: PMC10782941 DOI: 10.1161/circinterventions.123.013657] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Myocardial bridges (MBs) are prevalent and can be associated with acute and chronic ischemic syndromes. We sought to determine the substrates for ischemia in patients with angina with nonobstructive coronary arteries and a MB in the left anterior descending artery. METHODS Patients with angina with nonobstructive coronary arteries underwent the acquisition of intracoronary pressure and flow during rest, supine bicycle exercise, and adenosine infusion. Coronary wave intensity analysis was performed, with perfusion efficiency defined as accelerating wave energy/total wave energy (%). Epicardial endothelial dysfunction was defined as a reduction in epicardial vessel diameter ≥20% in response to intracoronary acetylcholine infusion. Patients with angina with nonobstructive coronary arteries and a MB were compared with 2 angina with nonobstructive coronary arteries groups with no MB: 1 with coronary microvascular disease (CMD: coronary flow reserve, <2.5) and 1 with normal coronary flow reserve (reference: coronary flow reserve, ≥2.5). RESULTS Ninety-two patients were enrolled in the study (30 MB, 33 CMD, and 29 reference). Fractional flow reserve in these 3 groups was 0.86±0.05, 0.92±0.04, and 0.94±0.05; coronary flow reserve was 2.5±0.5, 2.0±0.3, and 3.2±0.6. Perfusion efficiency increased numerically during exercise in the reference group (65±9%-69±13%; P=0.063) but decreased in the CMD (68±10%-50±10%; P<0.001) and MB (66±9%-55±9%; P<0.001) groups. The reduction in perfusion efficiency had distinct causes: in CMD, this was driven by microcirculation-derived energy in early diastole, whereas in MB, this was driven by diminished accelerating wave energy, due to the upstream bridge, in early systole. Epicardial endothelial dysfunction was more common in the MB group (54% versus 29% reference and 38% CMD). Overall, 93% of patients with a MB had an identifiable ischemic substrate. CONCLUSIONS MBs led to impaired coronary perfusion efficiency during exercise, which was due to diminished accelerating wave energy in early systole compared with the reference group. Additionally, there was a high prevalence of endothelial and microvascular dysfunction. These ischemic mechanisms may represent distinct treatment targets.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Ronak Rajani
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ozan M. Demir
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Matthew Li KamWa
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Holly Morgan
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Saad M. Ezad
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Howard Ellis
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Dexter Hogan
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ankur Gulati
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
| | - Ajay M. Shah
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Amedeo Chiribiri
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Andrew J. Webb
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Michael Marber
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
| | - Divaka Perera
- British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (A.S., H.R., O.M.D., M.L.K., H.M., S.M.E., H.E., A.M.S., A.C., A.J.W., M.M., D.P.)
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (R.R., D.H., A.G., D.P.)
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Sinha A, Rahman H, Perera D. Coronary microvascular dysfunction and heart failure with preserved ejection fraction: what are the mechanistic links? Curr Opin Cardiol 2023; 38:521-526. [PMID: 37668191 PMCID: PMC10552827 DOI: 10.1097/hco.0000000000001082] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure presentations and is associated with a dismal prognosis. HFpEF is an umbrella term that constitutes several distinct pathophysiological entities. Coronary microvascular dysfunction (CMD), defined as the inability of the coronary vasculature to augment blood flow adequately in the absence of epicardial coronary artery disease, is highly prevalent amongst the HFpEF population and likely represents one distinct HFpEF endotype, the CMD-HFpEF endotype. This review appraises recent studies that have demonstrated an association between CMD and HFpEF with an aim to understand the pathophysiological links between the two. This is of significant clinical relevance as better understanding of the pathophysiology underlying CMD-HFpEF may result in more targeted and efficacious therapeutic options in this patient cohort. RECENT FINDINGS There is a high prevalence of CMD, diagnosed invasively or noninvasively, in patients with HFpEF. Patients with HFpEF who have an impaired myocardial perfusion reserve (MPR) have a worse outcome than those with a normal MPR. Both MPR and coronary flow reserve (CFR) are associated with measures of left ventricular diastolic function and left ventricular filling pressures during exercise. Impaired lusitropy and subendocardial ischaemia link CMD and HFpEF mechanistically. SUMMARY CMD-HFpEF is a prevalent endotype of HFpEF and one that is associated with adverse cardiovascular prognosis. Whether CMD leads to HFpEF, through subendocardial ischaemia, or whether it is secondary to the impaired lusitropy that is characteristic of HFpEF is not known. Further mechanistic work is needed to answer this pertinent question.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research, Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Milinis K, Thiagarajan J, Leong S, De S, Sinha A, Sharma R, Sharma S. Review of management practices of sinogenic intracranial abscesses in children. J Laryngol Otol 2023; 137:1135-1140. [PMID: 36751894 DOI: 10.1017/s0022215123000166] [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: 02/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. METHOD This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months. RESULTS A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes. CONCLUSION Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.
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Affiliation(s)
- K Milinis
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - J Thiagarajan
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - S Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S De
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - A Sinha
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - R Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - S Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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8
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Rekart ML, Aung A, Cullip T, Mulanda W, Mun L, Pirmahmadzoda B, Kliescokova J, Achar J, Alvarez JL, Sitali N, Sinha A. Household drug-resistant TB contact tracing in Tajikistan. Int J Tuberc Lung Dis 2023; 27:748-753. [PMID: 37749832 PMCID: PMC10519379 DOI: 10.5588/ijtld.23.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND: Tajikistan has a high burden of rifampicin-resistant TB (RR-TB), with 2,700 new cases estimated for 2021 (28/100,000 population). TB is spread among household members through close interaction and children exposed through household contact progress to disease rapidly and frequently.METHODS: We retrospectively analysed programmatic data from household contact tracing in Dushanbe over 50 months. We calculated person-years of follow-up, contact tracing yield, number needed to screen (NNS) and number needed to test (NNT) to find one new case, and time to diagnosis.RESULTS: We screened 6,654 household contacts of 830 RR-TB index cases; 47 new RR-TB cases were detected, 43 in Year 1 and 4 in Years 2 or 3. Ten were aged <5 years; 46/47 had TB symptoms, 34/45 had chest radiographs consistent with TB, 11/35 were Xpert Ultra-positive, 29/32 were tuberculin skin test-positive and 28/47 had positive TB culture and phenotypic drug susceptibility results. The NNS to find one RR-TB case was 141.57 and the NNT was 34.49. The yields for different types of contacts were as follows: 0.7% for screened contacts, 2.9% for tested contacts, 17.0% for symptomatic contacts and 12.1% for symptomatic contacts aged below 5 years.CONCLUSION: RR-TB household contact tracing was feasible and productive in Tajikistan, a low middle-income country with an inefficient healthcare delivery system.
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Affiliation(s)
- M L Rekart
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - A Aung
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | | | - W Mulanda
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - L Mun
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | | | - J Kliescokova
- Médecins Sans Frontières (MSF), Dushanbe, Tajikistan
| | - J Achar
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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9
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Dahmer KJ, Palma-Cuero M, Ciuoderis K, Patiño C, Roitman S, Li Z, Sinha A, Hite JL, Bellido Cuellar O, Hernandez-Ortiz JP, Osorio JE, Christensen BM, Carlow CKS, Zamanian M. Molecular surveillance detects high prevalence of the neglected parasite Mansonella ozzardi in the Colombian Amazon. medRxiv 2023:2023.05.10.23289806. [PMID: 37215049 PMCID: PMC10197819 DOI: 10.1101/2023.05.10.23289806] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Mansonellosis is an undermapped insect-transmitted disease caused by filarial nematodes that are estimated to infect hundreds of millions of people globally. Despite their prevalence, there are many outstanding questions regarding the general biology and health impacts of the responsible parasites. Historical reports suggest that the Colombian Amazon is endemic for mansonellosis and may serve as an ideal location to pursue these questions in the backdrop of other endemic and emerging pathogens. We deployed molecular and classical diagnostic approaches to survey Mansonella prevalence among adults belonging to indigenous communities along the Amazon River and its tributaries near Leticia, Colombia. Deployment of a loop-mediated isothermal amplification (LAMP) assay on blood samples revealed an infection prevalence of ∼40% for Mansonella ozzardi . This assay identified significantly more infections than blood smear microscopy or LAMP assays performed using plasma, likely reflecting greater sensitivity and the ability to detect low microfilaremias or occult infections. Mansonella infection rates increased with age and were higher among males compared to females. Genomic analysis confirmed the presence of M. ozzardi that clusters closely with strains sequenced in neighboring countries. We successfully cryopreserved and revitalized M. ozzardi microfilariae, advancing the prospects of rearing infective larvae in controlled settings. These data suggest an underestimation of true mansonellosis prevalence, and we expect that these methods will help facilitate the study of mansonellosis in endemic and laboratory settings.
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Affiliation(s)
- KJ Dahmer
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
| | - M Palma-Cuero
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - K Ciuoderis
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - C Patiño
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - S Roitman
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - Z Li
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - A Sinha
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - JL Hite
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
| | | | - JP Hernandez-Ortiz
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
- Universidad Nacional de Colombia - UW-GHI One Health Colombia, Medellín, Colombia
| | - JE Osorio
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - BM Christensen
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
| | - CKS Carlow
- New England Biolabs, 240 County Road, Ipswich, MA USA
| | - M Zamanian
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
- University of Wisconsin Global Health Institute One Health Colombia, Madison, WI USA
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10
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Moe S, Rekart ML, Hernandez D, Sholpan A, Ismailov A, Oluya M, Bayniyazova A, Zinaida T, Nargiza P, Gomez-Restrepo C, Sitali N, Sinha A. Primary bedaquiline resistance in Karakalpakstan, Uzbekistan. Int J Tuberc Lung Dis 2023; 27:381-386. [PMID: 37143220 PMCID: PMC10171487 DOI: 10.5588/ijtld.22.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND: Bedaquiline (BDQ) is widely used in the treatment of rifampicin-resistant TB (RR-TB). However, resistance to BDQ is now emerging. There are no standardised regimens for BDQ-resistant TB. This study aims to share experience in managing primary BDQ-resistant TB.METHODS: We performed a retrospective study of patients treated for RR-TB in Karakalpakstan, Uzbekistan, from January 2017 to March 2022. We identified patients with resistance to BDQ with no history of BDQ exposure. We describe baseline characteristics, treatment and follow-up of these patients.RESULTS: Twelve of the 1,930 patients (0.6%) had baseline samples resistant to BDQ with no history of BDQ exposure, 75% (9/12) of whom had been previously treated for TB. Ten (83.3%) were resistant to fluoroquinolones; respectively 66% and 50% had culture conversion by Month 3 and Month 6. The interim treatment outcomes were as follows: unfavourable treatment outcomes (3/12, 25%), favourable outcomes (2/12, 17%); the remaining seven (58%) were continuing treatment.CONCLUSIONS: A large proportion of the cases had previously been treated for TB and had TB resistant to quinolone. Both patients who had not experienced culture conversion by Month 3 had an unfavourable treatment outcome. Therefore, we recommend monthly monitoring of culture status for patients on treatment regimens for BDQ resistance.
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Affiliation(s)
- S Moe
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - M L Rekart
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - D Hernandez
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Sholpan
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Ismailov
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - M Oluya
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - A Bayniyazova
- Medecins Sans Frontières, Karakalpakstan, Uzbekistan
| | - T Zinaida
- Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan
| | - P Nargiza
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
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11
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Dutta U, Sinha A, Demir OM, Ellis H, Rahman H, Perera D. Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries. J Am Heart Assoc 2022; 12:e027664. [PMID: 36565193 PMCID: PMC9973578 DOI: 10.1161/jaha.122.027664] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, adenosine-mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty-six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5±$$ \pm $$6.9 versus 20.2±$$ \pm $$6.9 cm/s; P=0.001 and 6.26±$$ \pm $$1.83 versus 5.36±$$ \pm $$1.83 mm Hg/cm/s; P=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%-0.50%] and 0.36 [95% CI, 0.23%-0.49%], respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.
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Affiliation(s)
- Utkarsh Dutta
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Aish Sinha
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Ozan M. Demir
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Howard Ellis
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Haseeb Rahman
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Divaka Perera
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
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12
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Perera D, Berry C, Hoole SP, Sinha A, Rahman H, Morris PD, Kharbanda RK, Petraco R, Channon K. Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation/National Institute for Health Research Partnership. Heart 2022; 109:88-95. [PMID: 35318254 PMCID: PMC9811089 DOI: 10.1136/heartjnl-2021-320718] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Nearly half of all patients with angina have non-obstructive coronary artery disease (ANOCA); this is an umbrella term comprising heterogeneous vascular disorders, each with disparate pathophysiology and prognosis. Approximately two-thirds of patients with ANOCA have coronary microvascular disease (CMD). CMD can be secondary to architectural changes within the microcirculation or secondary to vasomotor dysfunction. An inability of the coronary vasculature to augment blood flow in response to heightened myocardial demand is defined as an impaired coronary flow reserve (CFR), which can be measured non-invasively, using imaging, or invasively during cardiac catheterisation. Impaired CFR is associated with myocardial ischaemia and adverse cardiovascular outcomes.The CMD workstream is part of the cardiovascular partnership between the British Heart Foundation and The National Institute for Health Research in the UK and comprises specialist cardiac centres with expertise in coronary physiology assessment. This document outlines the two main modalities (thermodilution and Doppler techniques) for estimation of coronary flow, vasomotor testing using acetylcholine, and outlines a standard operating procedure that could be considered for adoption by national networks. Accurate and timely disease characterisation of patients with ANOCA will enable clinicians to tailor therapy according to their patients' coronary physiology. This has been shown to improve patients' quality of life and may lead to improved cardiovascular outcomes in the long term.
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Affiliation(s)
- Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Paul D Morris
- Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | | | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Keith Channon
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, 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S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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14
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Aziz W, Morgan H, Demir OM, Sinha A, Rua T, Rajani R, Chang AL, Woo E, Mak SM, Benedetti G, Villa A, Preston R, Navin R, O'Kane K, Hunter L, Ismail T, Carr-White G, Beckley-Hoelscher N, Peacock J, Marber M, Razavi R, Perera D. Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT). Heart 2022; 108:1972-1978. [PMID: 36288924 PMCID: PMC9726962 DOI: 10.1136/heartjnl-2022-320990] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/10/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. METHODS Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. RESULTS 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm-log-rank p=0.78). CONCLUSIONS CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. TRIAL REGISTRATION NUMBER NCT03583320.
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Affiliation(s)
- Waqar Aziz
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Holly Morgan
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Ozan M Demir
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Aish Sinha
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Tiago Rua
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ai-Lee Chang
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Eric Woo
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sze Mun Mak
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Adriana Villa
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Preston
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Roshan Navin
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Kevin O'Kane
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Laura Hunter
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Tevfik Ismail
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | | | - Janet Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Michael Marber
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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15
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Orlando M, Sinha A, Yao M, Shippey E, Kho R. Perioperative Venous Thromboembolism in Patients Undergoing Hysterectomy for Fibroids: A Nationwide Sample. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.020] [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: 11/26/2022]
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16
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Rahman H, Sinha A, Demir OM, Perera D. EDIT-CMD: Are We Comparing Apples With Oranges? JACC Cardiovasc Imaging 2022; 15:1674-1676. [PMID: 36075630 DOI: 10.1016/j.jcmg.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
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17
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Rekart ML, Morshed T, Mulanda WK, Klieascikova J, Sitali N, Rajabzoda A, Avzamova S, Pirmahmadzoda B, Aung A, Sayfulloev M, Sleit R, Sinha A. Family directly observed therapy for children with drug-resistant TB. Int J Tuberc Lung Dis 2022; 26:792-794. [PMID: 35898123 DOI: 10.5588/ijtld.22.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M L Rekart
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan, MSF, Uzbekistan
| | - T Morshed
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - W K Mulanda
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | | | - N Sitali
- MSF Holland, Amsterdam, The Netherlands
| | - A Rajabzoda
- National Tuberculosis Programme, Dushanbe, Tajikistan
| | - S Avzamova
- National Tuberculosis Programme, Dushanbe, Tajikistan
| | - B Pirmahmadzoda
- Dushanbe City Tuberculosis Programme, Dushanbe City, Tajikistan
| | - A Aung
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - M Sayfulloev
- Medecins Sans Frontieres (MSF), Dushanbe, Tajikistan
| | - R Sleit
- MSF Holland, Amsterdam, The Netherlands
| | - A Sinha
- Manson Unit, MSF, London, UK
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18
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Sinha A, Rahman H, Perera D. Vasospastic Angina: A Contemporary Review of its Pathophysiology, Diagnosis and Management. Heart Int 2022; 16:99-104. [PMID: 36741101 PMCID: PMC9872780 DOI: 10.17925/hi.2022.16.2.99] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 12/25/2022] Open
Abstract
Nearly 40% of patients presenting to the catheter laboratory with angina have non-obstructed coronary arteries (ANOCA), an umbrella term that encompasses distinct pathophysiological entities, such as coronary artery spasm. Coronary artery spasm leads to sudden reversible coronary flow attenuation, which clinically manifests as vasospastic angina (VSA). VSA is associated with poor quality of life and an increased risk of major adverse cardiac events. However, the pathophysiological mechanisms underlying this phenomenon are incompletely understood, which has resulted in limited therapeutic options for patients afflicted with this condition. The past decade has seen a surge in new research being conducted in the field of ANOCA and VSA. This review article provides a comprehensive summary of the underlying pathophysiological mechanisms of VSA and the current therapeutic options. We also appraise the current diagnostic approach in patients with suspected VSA.
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Affiliation(s)
- Aish Sinha
- The British Heart Foundation Centre of Excellence and the National Institute for Health and Care Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Haseeb Rahman
- The British Heart Foundation Centre of Excellence and the National Institute for Health and Care Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Divaka Perera
- The British Heart Foundation Centre of Excellence and the National Institute for Health and Care Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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19
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Couch LS, Sinha A, Navin R, Hunter L, Perera D, Marber MS, Kaier TE. Rapid risk stratification of acute coronary syndrome: adoption of an adapted European Society of Cardiology 0/1-hour troponin algorithm in a real-world setting. Eur Heart J Open 2022; 2:oeac048. [PMID: 36032815 PMCID: PMC9404254 DOI: 10.1093/ehjopen/oeac048] [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] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 05/26/2023]
Abstract
AIMS To evaluate the clinical feasibility of implementing the 2020 ESC 0/1 hr algorithm for rapid rule-out/rule-in of acute coronary syndrome (ACS). METHODS AND RESULTS Data were collected retrospectively from 5496 patients in 2020 and 7363 patients in 2021 who received cardiac troponin measurements through the ACS algorithm in acute care settings within a large tertiary cardiac centre in the United Kingdom. This period overlapped the introduction of the 2020 ESC 0/1 hr algorithm. After exclusion of haemolysis, 1905 patients underwent repeat troponin measurement within the study period in 2020 and 2658 in 2021. Median time to repeat was significantly reduced from 3 h 14 min for intermediate low risk patients (5-12 ng/L) in 2020 to 1 h 22 min in 2021, and from 3 h 30 min to 1 h 59 min in intermediate high-risk patients (12-51 ng/L). Less than 15% of patients requiring repeat testing had dynamic changes in troponin of sufficient magnitude to change their initial risk category. Of all patients, 58.1% of patients in 2020 were ultimately classified as 'low risk', 19.2% deemed 'ACS likely', and 22.7% as 'ACS possible', with similar distributions in 2021. CONCLUSION Whilst an efficient algorithm, our study demonstrates multi-faceted, practical limitations of achieving the 1 h target for the triage of patients with suspected ACS. Despite challenges predominantly of logistic nature, the algorithm enables rapid, streamlined, and efficient triage of large patient cohorts. Further work is required to streamline this process and achieve the targeted 1 h repeat in a resource-constrained healthcare environment, which would invariably require second blood draw before the result of first, as recommended by the ESC.
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Affiliation(s)
- Liam S Couch
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Aish Sinha
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Roshan Navin
- Acute Medicine Department, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
| | - Laura Hunter
- Emergency Department, St Thomas’ Hospital, Westminster Bridge Rd, London, UK
| | - Divaka Perera
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Michael S Marber
- King’s College London BHF Centre, The Rayne Institute, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Thomas E Kaier
- Corresponding author. Tel: +44 (0)20 7188 1048, Fax: +44 (0)20 7188 0970,
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al 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Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Nair P, Hasan T, Zaw KK, Allamuratova S, Ismailov A, Mendonca P, Bekbaev Z, Parpieva N, Singh J, Sitali N, Bermudez-Aza E, Sinha A. Acquired bedaquiline resistance in Karakalpakstan, Uzbekistan. Int J Tuberc Lung Dis 2022; 26:658-663. [PMID: 35768925 PMCID: PMC9272738 DOI: 10.5588/ijtld.21.0631] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The WHO recommends the use of bedaquiline (BDQ) in longer, as well as shorter, multidrug-resistant TB (MDR-TB) treatment regimens. However, resistance to this new drug is now emerging. We aimed to describe the characteristics of patients in Karakalpakstan, Uzbekistan, who were treated for MDR-TB and acquired BDQ resistance during treatment.METHODS: We performed a retrospective study of routinely collected data for patients treated for MDR-TB in Karakalpakstan between January 2015 and December 2020. We included patients on BDQ-containing regimens with baseline susceptibility to BDQ who developed BDQ resistance at any point after treatment initiation. Patients resistant to BDQ at baseline or with no confirmed susceptibility to BDQ at baseline were excluded.RESULTS: Of the 523 patients who received BDQ-containing regimens during the study period, BDQ resistance was detected in 31 patients (5.9%); 20 patients were excluded-16 with no prior confirmation of BDQ susceptibility and 4 who were resistant at baseline. Eleven patients with acquired BDQ resistance were identified. We discuss demographic variables, resistance profiles, treatment-related variables and risk factors for unfavourable outcomes for these patients.CONCLUSION: Our programmatic data demonstrated the acquisition of BDQ resistance during or subsequent to receiving a BDQ-containing regimen in a patient cohort from Uzbekistan. We highlight the need for individualised treatment regimens with optimised clinical and laboratory follow up to prevent resistance acquisition.
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Affiliation(s)
- P Nair
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - T Hasan
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - K K Zaw
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | | | - A Ismailov
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - P Mendonca
- Médecins Sans Frontières (MSF) Holland, Amsterdam
| | - Z Bekbaev
- Republican Center of Tuberculosis and Pulmonology, Nukus, Uzbekistan
| | - N Parpieva
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent, Uzbekistan
| | - J Singh
- Médecins Sans Frontières (MSF) Holland, Amsterdam
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Stubbs M, Hey J, Fung A, Maynard J, Parnell B, Sinha A. P.21 A multidisciplinary safety checklist to facilitate continuous fetal heart monitoring during labour epidural analgesia insertion. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103317] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Morgan H, Sinha A, Mcentegart M, Hardman SM, Perera D. Evaluation of the causes of sex disparity in heart failure trials. Heart 2022; 108:1547-1552. [PMID: 35361671 PMCID: PMC9484380 DOI: 10.1136/heartjnl-2021-320696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/08/2022] [Indexed: 12/31/2022]
Abstract
ObjectivesCardiovascular disease is one of the leading causes of mortality and morbidity in women. Despite this, even in contemporary research, female patients are poorly represented in trials. This study aimed to explore reasons behind the sex disparity in heart failure (HF) trials.MethodsHF trials published in seven high-impact clinical journals (impact factor >20), between 2000 and 2020, were identified. Trials with over 300 participants of both sexes were included. Large HF registries, as well as population statistics, were also identified using the same criteria.ResultsWe identified 146 HF trials, which included 248 620 patients in total. The median proportion of female patients was 25.8%, with the lowest proportions seen in trials enrolling patients with ischaemic cardiomyopathy (17.9%), severe systolic dysfunction (left ventricular ejection fraction (LVEF) <35%) (21.4%) and those involving an invasive procedure (21.1%). The highest proportion of women was seen in trials assessing HF with preserved LVEF (51.6%), as well as trials including older participants (40.5%). Significant differences were seen between prevalence of female trial participants and population prevalence in all LVEF categories (25.8% vs 49.0%, p<0.01).ConclusionsA significant sex disparity was identified in HF trials, most visible in trials assessing patients with severely reduced LVEF and ischaemic aetiology. This is likely due to a complex interplay between enrolment bias and biological variation. Furthermore, the degree of both these aspects may vary according to trial type. Going forward, we should encourage all HF trials to appraise their recruitment log and suggest reasons for any reported sex disparity.
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Affiliation(s)
- Holly Morgan
- Cardiovascular Division, King's College London, London, UK
| | - Aish Sinha
- Cardiovascular Division, King's College London, London, UK
| | | | - Suzanna Marie Hardman
- Clinical and Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK
| | - Divaka Perera
- Cardiovascular Division, King's College London, London, UK
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24
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Aharonian F, Ait Benkhali F, Angüner EO, Ashkar H, Backes M, Baghmanyan V, Barbosa Martins V, Batzofin R, Becherini Y, Berge D, Bernlöhr K, Bi B, Böttcher M, Boisson C, Bolmont J, de Bony de Lavergne M, Breuhaus M, Brose R, Brun F, Caroff S, Casanova S, Cerruti M, Chand T, Chen A, Cotter G, Damascene Mbarubucyeye J, Djannati-Ataï A, Dmytriiev A, Doroshenko V, Duffy C, Egberts K, Ernenwein JP, Fegan S, Feijen K, Fiasson A, Fichet de Clairfontaine G, Fontaine G, Füßling M, Funk S, Gabici S, Gallant YA, Ghafourizadeh S, Giavitto G, Giunti L, Glawion D, Glicenstein JF, Grondin MH, Hermann G, Hinton JA, Hörbe M, Hofmann W, Hoischen C, Holch TL, Holler M, Horns D, Huang Z, Jamrozy M, Jankowsky F, Jung-Richardt I, Kasai E, Katarzyński K, Katz U, Khangulyan D, Khélifi B, Klepser S, Kluźniak W, Komin N, Konno R, Kosack K, Kostunin D, Le Stum S, Lemière A, Lemoine-Goumard M, Lenain JP, Leuschner F, Lohse T, Luashvili A, Lypova I, Mackey J, Malyshev D, Malyshev D, Marandon V, Marchegiani P, Marcowith A, Martí-Devesa G, Marx R, Maurin G, Meyer M, Mitchell A, Moderski R, Mohrmann L, Montanari A, Moulin E, Muller J, Murach T, Nakashima K, de Naurois M, Nayerhoda A, Niemiec J, Priyana Noel A, O'Brien P, Ohm S, Olivera-Nieto L, de Ona Wilhelmi E, Ostrowski M, Panny S, Panter M, Parsons RD, Peron G, Pita S, Poireau V, Prokhorov DA, Prokoph H, Pühlhofer G, Punch M, Quirrenbach A, Reichherzer P, Reimer A, Reimer O, Renaud M, Reville B, Rieger F, Rowell G, Rudak B, Rueda Ricarte H, Ruiz-Velasco E, Sahakian V, Sailer S, Salzmann H, Sanchez DA, Santangelo A, Sasaki M, Schäfer J, Schüssler F, Schutte HM, Schwanke U, Senniappan M, Shapopi JNS, Simoni R, Sinha A, Sol H, Specovius A, Spencer S, Stawarz Ł, Steinmassl S, Steppa C, Takahashi T, Tanaka T, Taylor AM, Terrier R, Thorpe-Morgan C, Tsirou M, Tsuji N, Tuffs R, Uchiyama Y, Unbehaun T, van Eldik C, van Soelen B, Veh J, Venter C, Vink J, Wagner SJ, Werner F, White R, Wierzcholska A, Wong YW, Yusafzai A, Zacharias M, Zargaryan D, Zdziarski AA, Zech A, Zhu SJ, Zouari S, Żywucka N. Time-resolved hadronic particle acceleration in the recurrent nova RS Ophiuchi. Science 2022; 376:77-80. [PMID: 35271303 DOI: 10.1126/science.abn0567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Recurrent novae are repeating thermonuclear explosions in the outer layers of white dwarfs, due to the accretion of fresh material from a binary companion. The shock generated when ejected material slams into the companion star's wind can accelerate particles. We report very-high-energy (VHE, [Formula: see text]) gamma rays from the recurrent nova RS Ophiuchi, up to a month after its 2021 outburst, observed using the High Energy Stereoscopic System. The VHE emission has a similar temporal profile to lower-energy GeV emission, indicating a common origin, with a two-day delay in peak flux. These observations constrain models of time-dependent particle energization, favoring a hadronic emission scenario over the leptonic alternative. Shocks in dense winds provide favorable environments for efficient acceleration of cosmic-rays to very high energies.
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Affiliation(s)
- F Aharonian
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), 123 Hovsep Emin St Yerevan 0051, Armenia
| | - F Ait Benkhali
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - E O Angüner
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - H Ashkar
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - M Backes
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - V Baghmanyan
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - V Barbosa Martins
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - R Batzofin
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - Y Becherini
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - D Berge
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - B Bi
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - J Bolmont
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - M de Bony de Lavergne
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - M Breuhaus
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R Brose
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - F Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - S Caroff
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - S Casanova
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - M Cerruti
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - T Chand
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Chen
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - G Cotter
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | | | - A Djannati-Ataï
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Dmytriiev
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - V Doroshenko
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - C Duffy
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - J-P Ernenwein
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - S Fegan
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - K Feijen
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - A Fiasson
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - G Fichet de Clairfontaine
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - G Fontaine
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - M Füßling
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Funk
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - S Gabici
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Y A Gallant
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - S Ghafourizadeh
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - G Giavitto
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - L Giunti
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Glawion
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - J F Glicenstein
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M-H Grondin
- Université Bordeaux, CNRS, Laboratoire de Physique des Deux Infinis (LP2i), Bordeaux, Joint Research Unit (UMR 5797), F-33170 Gradignan, France
| | - G Hermann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - M Hörbe
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - C Hoischen
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - T L Holch
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - M Holler
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - D Horns
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - Zhiqiu Huang
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - I Jung-Richardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - E Kasai
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
| | - K Katarzyński
- Institute of Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Grudziadzka 5, 87-100 Torun, Poland
| | - U Katz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - D Khangulyan
- Department of Physics, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima-ku, Tokyo 171-8501, Japan
| | - B Khélifi
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - S Klepser
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - Nu Komin
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - R Konno
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Kosack
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Kostunin
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Le Stum
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - A Lemière
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - M Lemoine-Goumard
- Université Bordeaux, CNRS, Laboratoire de Physique des Deux Infinis (LP2i), Bordeaux, Joint Research Unit (UMR 5797), F-33170 Gradignan, France
| | - J-P Lenain
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), 4 Place Jussieu, F-75252 Paris, France
| | - F Leuschner
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - A Luashvili
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - I Lypova
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - J Mackey
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
| | - D Malyshev
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - D Malyshev
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - V Marandon
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - P Marchegiani
- School of Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2050 South Africa
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - G Martí-Devesa
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - R Marx
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - G Maurin
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - M Meyer
- Universität Hamburg, Institut für Experimentalphysik, Luruper Chaussee 149, D 22761 Hamburg, Germany
| | - A Mitchell
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - L Mohrmann
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Montanari
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - E Moulin
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Muller
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - T Murach
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - K Nakashima
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - M de Naurois
- Laboratoire Leprince-Ringuet, École Polytechnique, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - A Nayerhoda
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - J Niemiec
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - A Priyana Noel
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - P O'Brien
- Department of Physics and Astronomy, The University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - S Ohm
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - L Olivera-Nieto
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - E de Ona Wilhelmi
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - S Panny
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Panter
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R D Parsons
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - G Peron
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - S Pita
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - V Poireau
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - D A Prokhorov
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - H Prokoph
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Punch
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - P Reichherzer
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - B Reville
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - F Rieger
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - G Rowell
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - H Rueda Ricarte
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - E Ruiz-Velasco
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - V Sahakian
- Yerevan Physics Institute, 2 Alikhanian Brothers St., 375036 Yerevan, Armenia
| | - S Sailer
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - H Salzmann
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - D A Sanchez
- Université Savoie Mont Blanc, CNRS, Laboratoire d'Annecy de Physique des Particules - IN2P3, 74000 Annecy, France
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Sasaki
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - J Schäfer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - F Schüssler
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commisariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - H M Schutte
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstr. 15, D 12489 Berlin, Germany
| | - M Senniappan
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - J N S Shapopi
- University of Namibia, Department of Physics, Private Bag 13301, Windhoek 10005, Namibia
| | - R Simoni
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - A Sinha
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, CC 72, Place Eugène Bataillon, F-34095 Montpellier Cedex 5, France
| | - H Sol
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Specovius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - S Spencer
- University of Oxford, Department of Physics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - Ł Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, ul. Orla 171, 30-244 Kraków, Poland
| | - S Steinmassl
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - C Steppa
- Institut für Physik und Astronomie, Universität Potsdam, Karl-Liebknecht-Strasse 24/25, D 14476 Potsdam, Germany
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe (World Premier International Research Center Initiative (WPI)), The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba, 277-8583, Japan
| | - T Tanaka
- Department of Physics, Konan University, 8-9-1 Okamoto, Higashinada, Kobe, Hyogo 658-8501, Japan
| | - A M Taylor
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - R Terrier
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - C Thorpe-Morgan
- Institut für Astronomie und Astrophysik, Universität Tübingen, Sand 1, D 72076 Tübingen, Germany
| | - M Tsirou
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - N Tsuji
- Institute of Physical and Chemical Research (RIKEN), 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - R Tuffs
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - Y Uchiyama
- Department of Physics, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima-ku, Tokyo 171-8501, Japan
| | - T Unbehaun
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - C van Eldik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - B van Soelen
- Department of Physics, University of the Free State, PO Box 339, Bloemfontein 9300, South Africa
| | - J Veh
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - C Venter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - J Vink
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, Netherlands
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - F Werner
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - R White
- Max-Planck-Institut für Kernphysik, P.O. Box 103980, D 69029 Heidelberg, Germany
| | - A Wierzcholska
- Instytut Fizyki J[Formula: see text]drowej Polskiej Akademii Nauk (PAN), ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - Yu Wun Wong
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - A Yusafzai
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, Erwin-Rommel-Str. 1, D 91058 Erlangen, Germany
| | - M Zacharias
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - D Zargaryan
- Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2, Ireland
- High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), 123 Hovsep Emin St Yerevan 0051, Armenia
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, ul. Bartycka 18, 00-716 Warsaw, Poland
| | - A Zech
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - S J Zhu
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738, Germany
| | - S Zouari
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - N Żywucka
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
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Sinha A, McKenna M, Kollikonda S, Yao M, Mei L, Valentine L, Russo ML, Hornacek D, Kho R. The risk of venous thromboembolism in patients with and without leiomyomas undergoing hysterectomy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.113] [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]
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Upadhyaya Kafle S, Singh M, Kafle N, Sinha A, Guragain P, Rimal HS. Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences. Kathmandu Univ Med J (KUMJ) 2022; 20:97-101. [PMID: 36273300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
There isn't any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students' achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pretest and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science.
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Affiliation(s)
- S Upadhyaya Kafle
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - M Singh
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - N Kafle
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - A Sinha
- Department of Pathology, Birat Medical College Teaching Hospital, Morang, Nepal
| | - P Guragain
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | - H S Rimal
- Department of Pediatrics, Birat Medical College Teaching Hospital, Morang, Nepal
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Agrawal S, Chakraborty P, Sinha A, Maiti A, Chakraborty M. ADRENAL HISTOPLASMOSIS: AN EASTERN INDIAN PERSPECTIVE. Acta Endocrinol (Buchar) 2022; 18:106-114. [PMID: 35975261 PMCID: PMC9365407 DOI: 10.4183/aeb.2022.106] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT The clinical presentation of histoplasmosis is varied. Due to its propensity for adrenal involvement, histoplasmosis is an important differential diagnosis in any patient presenting with adrenal mass, bilateral in particular. OBJECTIVE Data on clinical presentation, pattern of adrenal involvement, radiological appearance and long-term follow-up of adrenal histoplasmosis are relatively sparse; hence we looked at it. DESIGN This record based single-centre retrospective study was conducted in one of the tertiary care hospitals, situated in eastern India catering the Gangetic delta. SUBJECTS AND METHODS Data on demographic characters, presenting manifestations, biochemical & hormonal parameters and radiological appearance of confirmed adrenal histoplasmosis cases (n=9), admitted between 2015-2019 have been retrieved. The treatment outcome and condition of patients after 1-4 years of follow-up has also been discussed. RESULTS Four out of the nine (44.4%) patients had predisposing immunocompromised conditions in the form of diabetes and/or chronic alcoholism while rest were immunocompetent. Seven out of nine patients (77.8 %) had signs and symptoms suggestive of adrenal insufficiency, while two (22.2%) presented with only pyrexia of unknown origin. All of them had bilateral adrenal mass, though the radiologically appearances were different. All patients received anti-fungal agents with/without hydrocortisone and/or fludrocortisone. One patient died (11.1%), while majority responded favourably to treatment. Adrenocortical function did not recover completely. CONCLUSIONS The possibility of adrenal histoplasmosis should always be considered in patients presenting with bilateral adrenal mass, irrespective of adrenal morphology. Treatment is effective, but many of them require supplemental hydrocortisone for quite a long period, if not lifelong. Mineralocorticoid deficiency, however, is not permanent.
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Affiliation(s)
- S.S. Agrawal
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - P.P. Chakraborty
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - A. Sinha
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - A. Maiti
- Endocrinology & Metabolism Medical College and Hospital Kolkata, West Bengal, India
| | - M. Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata,West Bengal, India
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Sinha A, Demir OM, Ellis H, Perera D. Dizziness in an avid cyclist: an unusual presentation of a common problem. Eur Heart J Case Rep 2021; 5:ytab459. [PMID: 34993402 PMCID: PMC8728714 DOI: 10.1093/ehjcr/ytab459] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
Background Presyncope and syncope are common presentations with a wide range of differential diagnoses; when it occurs primarily on exertion, a cardiovascular cause is more likely. Structural abnormalities and primary rhythm disturbances are the usual culprits in these patients. Case summary A 75-year-old gentleman presented with a history of progressive exertional presyncope. His investigations demonstrated normal cardiac structure, function, and rhythm. He underwent an exercise stress test, which demonstrated a significant reduction in peak blood pressure with equivocal electrocardiogram changes and absence of ischaemic symptoms. In view of his age and gender, a computerized tomography coronary angiogram (CTCA) was organized to exclude obstructive coronary artery disease (CAD). Intriguingly, the CTCA demonstrated a severe proximal left anterior descending (LAD) artery stenosis. This stenosis was confirmed to be functionally significant using invasive coronary physiology and was treated with percutaneous coronary intervention. At follow-up, there was no recurrence of exertional presyncope and the patient was continuing to return to his baseline function. Conclusion Presyncope and/or syncope as the sole manifestation of obstructive CAD, in the presence of normal ventricular function and valves, has rarely been reported. Myocardial ischaemia-mediated presyncope and/or syncope may be secondary to numerous mechanisms, which are described in this case report. Revascularization of the functionally significant proximal LAD stenosis resulted in cessation of exertional presyncope in our patient. The long-term outcome of revascularization in patients with presyncope and syncope needs to be further investigated.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London , Westminster Bridge Rd, London SE1 7EH, UK
| | - Ozan M Demir
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London , Westminster Bridge Rd, London SE1 7EH, UK
| | - Howard Ellis
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London , Westminster Bridge Rd, London SE1 7EH, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London , Westminster Bridge Rd, London SE1 7EH, UK
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Ali S, Khan SU, Gupta SK, Sinha A, Gupta MK, Abbasnia A, Mohammadi AA. Health risk assessment due to fluoride exposure from groundwater in rural areas of Agra, India: Monte Carlo simulation. Int J Environ Sci Technol 2021; 18:3665-3676. [DOI: 10.1007/s13762-020-03084-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/03/2020] [Accepted: 12/14/2020] [Indexed: 10/24/2023]
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Nathan A, Rashid A, Shukla S, Sinha A, Sivathasan S, Rassam J, Smart S, Patel K, Shah N, Lamb B. 198 Immediate Post-Operative PDE5i Therapy Improves Early Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1071] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function, continence, or safety outcomes.
Method
Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period.
Results
There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate (day 1-2), 7 and 14.8% of early (day 3-14) and 9.7 and 9.5% of late (day >14) therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication, or readmission outcomes.
Conclusions
Immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.
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Affiliation(s)
- A Nathan
- Addenbrooke's Hospital, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- University of Cambridge, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, Cambridge, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - S Sivathasan
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Rassam
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Smart
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Patel
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Shah
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - B Lamb
- Addenbrooke's Hospital, Cambridge, United Kingdom
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31
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Fricker M, Nathan A, Hanna N, Asif A, Patel S, Georgi M, Hang K, Sinha A, Mullins W, Shea J, Lamb B, Sridhar A, Kelly J, Collins J. 81 VIRTUAL: Virtual Interactive Surgical Skills Classroom – An Ongoing Randomized Controlled Trial. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.843] [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]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.
Results
Data collection will be completed in January 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusions
To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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Affiliation(s)
- M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - A Nathan
- University College London, London, United Kingdom
| | - N Hanna
- University of Cambridge, Cambridge, United Kingdom
| | - A Asif
- University of Leicester, Leicester, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - M Georgi
- University College London, London, United Kingdom
| | - K Hang
- University College London, London, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - W Mullins
- University of Cambridge, Cambridge, United Kingdom
| | - Jessie Shea
- University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - John Kelly
- University College London, London, United Kingdom
| | | |
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32
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Abstract
The etiopathogenesis of COVID-19 and its differential geographic spread suggest some populations are apparently 'less affected' through many host-related factors that involve angiotensin-converting enzyme 2 (ACE2) protein, which is also the entry receptor for SARS-CoV-2. The role of ACE2 has been well studied in COVID-19 but not in the context of malaria and COVID-19. We have previously suggested how malaria might intersect with COVID-19 through ACE2 mutation and here we evaluate the currently available data that could provide a link between the two diseases. Based on the existing global and Indian data on malaria, COVID-19 and the suggested ACE2 mutation, the association could not be examined robustly, neither accepting nor refuting the suggested hypothesis. We strongly recommend targeted evaluation of this hypothesis through carefully designed robust molecular epidemiological studies.
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Affiliation(s)
- A. De
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - M. Dash
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - A. Tiwari
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - A. Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India
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33
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Sinha A, Rahman H, Webb A, Shah AM, Perera D. Untangling the pathophysiologic link between coronary microvascular dysfunction and heart failure with preserved ejection fraction. Eur Heart J 2021; 42:4431-4441. [PMID: 34529791 PMCID: PMC8599060 DOI: 10.1093/eurheartj/ehab653] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023] Open
Abstract
Coronary microvascular disease (CMD), characterized by impaired coronary flow reserve (CFR), is a common finding in patients with stable angina. Impaired CFR, in the absence of obstructive coronary artery disease, is also present in up to 75% of patients with heart failure with preserved ejection fraction (HFpEF). Heart failure with preserved ejection fraction is a heterogeneous syndrome comprising distinct endotypes and it has been hypothesized that CMD lies at the centre of the pathogenesis of one such entity: the CMD–HFpEF endotype. This article provides a contemporary review of the pathophysiology underlying CMD, with a focus on the mechanistic link between CMD and HFpEF. We discuss the central role played by subendocardial ischaemia and impaired lusitropy in the development of CMD–HFpEF, as well as the clinical and research implications of the CMD–HFpEF mechanistic link. Future prospective follow-up studies detailing outcomes in patients with CMD and HFpEF are much needed to enhance our understanding of the pathological processes driving these conditions, which may lead to the development of physiology-stratified therapy to improve the quality of life and prognosis in these patients.
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Affiliation(s)
- Aish Sinha
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, St. Thomas' Hospital, Westminster bridge road, London SE1 7EH, UK
| | - Haseeb Rahman
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, St. Thomas' Hospital, Westminster bridge road, London SE1 7EH, UK
| | - Andrew Webb
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, St. Thomas' Hospital, Westminster bridge road, London SE1 7EH, UK
| | - Ajay M Shah
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, St. Thomas' Hospital, Westminster bridge road, London SE1 7EH, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, St. Thomas' Hospital, Westminster bridge road, London SE1 7EH, UK
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34
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Nathan A, Fricker M, Hanna N, Asif A, Patel S, Georgi M, Hang K, Sinha A, Mullins W, Shea J, Lamb B, Sridhar A, Kelly J, Collins J. O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol). Br J Surg 2021. [DOI: 10.1093/bjs/znab282.048] [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: 11/14/2022]
Abstract
Abstract
Introduction
High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.
Method
72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.
Result
Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.
Conclusion
This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.
Take-home Message
This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.
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Affiliation(s)
- A Nathan
- University College London, London, UK
| | | | - N Hanna
- University of Cambridge, Cambridge, UK
| | - A Asif
- University of Leicester, Leicester, UK
| | - S Patel
- University College London, London, UK
| | - M Georgi
- University College London, London, UK
| | - K Hang
- University College London, London, UK
| | - A Sinha
- University of Cambridge, Cambridge, UK
| | - W Mullins
- University of Cambridge, Cambridge, UK
| | - J Shea
- University of Cambridge, Cambridge, UK
| | - B Lamb
- Cambridge University Hospitals, Cambridge, UK
| | - A Sridhar
- University College London, London, UK
| | - J Kelly
- University College London, London, UK
| | - J Collins
- University College London, London, UK
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35
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Abdalla H, Aharonian F, Ait Benkhali F, Angüner EO, Arcaro C, Armand C, Armstrong T, Ashkar H, Backes M, Baghmanyan V, Barbosa Martins V, Barnacka A, Barnard M, Becherini Y, Berge D, Bernlöhr K, Bi B, Bissaldi E, Böttcher M, Boisson C, Bolmont J, de Bony de Lavergne M, Breuhaus M, Brun F, Brun P, Bryan M, Büchele M, Bulik T, Bylund T, Caroff S, Carosi A, Casanova S, Chand T, Chandra S, Chen A, Cotter G, Curyło M, Damascene Mbarubucyeye J, Davids ID, Davies J, Deil C, Devin J, Dirson L, Djannati-Ataï A, Dmytriiev A, Donath A, Doroshenko V, Dreyer L, Duffy C, Dyks J, Egberts K, Eichhorn F, Einecke S, Emery G, Ernenwein JP, Feijen K, Fegan S, Fiasson A, Fichet de Clairfontaine G, Fontaine G, Funk S, Füßling M, Gabici S, Gallant YA, Giavitto G, Giunti L, Glawion D, Glicenstein JF, Grondin MH, Hahn J, Haupt M, Hermann G, Hinton JA, Hofmann W, Hoischen C, Holch TL, Holler M, Hörbe M, Horns D, Huber D, Jamrozy M, Jankowsky D, Jankowsky F, Jardin-Blicq A, Joshi V, Jung-Richardt I, Kasai E, Kastendieck MA, Katarzyński K, Katz U, Khangulyan D, Khélifi B, Klepser S, Kluźniak W, Komin N, Konno R, Kosack K, Kostunin D, Kreter M, Lamanna G, Lemière A, Lemoine-Goumard M, Lenain JP, Leuschner F, Levy C, Lohse T, Lypova I, Mackey J, Majumdar J, Malyshev D, Malyshev D, Marandon V, Marchegiani P, Marcowith A, Mares A, Martí-Devesa G, Marx R, Maurin G, Meintjes PJ, Meyer M, Mitchell A, Moderski R, Mohrmann L, Montanari A, Moore C, Morris P, Moulin E, Muller J, Murach T, Nakashima K, Nayerhoda A, de Naurois M, Ndiyavala H, Niemiec J, Oakes L, O'Brien P, Odaka H, Ohm S, Olivera-Nieto L, de Ona Wilhelmi E, Ostrowski M, Panny S, Panter M, Parsons RD, Peron G, Peyaud B, Piel Q, Pita S, Poireau V, Priyana Noel A, Prokhorov DA, Prokoph H, Pühlhofer G, Punch M, Quirrenbach A, Raab S, Rauth R, Reichherzer P, Reimer A, Reimer O, Remy Q, Renaud M, Rieger F, Rinchiuso L, Romoli C, Rowell G, Rudak B, Ruiz-Velasco E, Sahakian V, Sailer S, Salzmann H, Sanchez DA, Santangelo A, Sasaki M, Scalici M, Schäfer J, Schüssler F, Schutte HM, Schwanke U, Seglar-Arroyo M, Senniappan M, Seyffert AS, Shafi N, Shapopi JNS, Shiningayamwe K, Simoni R, Sinha A, Sol H, Specovius A, Spencer S, Spir-Jacob M, Stawarz Ł, Sun L, Steenkamp R, Stegmann C, Steinmassl S, Steppa C, Takahashi T, Tam T, Tavernier T, Taylor AM, Terrier R, Thiersen JHE, Tiziani D, Tluczykont M, Tomankova L, Tsirou M, Tuffs R, Uchiyama Y, van der Walt DJ, van Eldik C, van Rensburg C, van Soelen B, Vasileiadis G, Veh J, Venter C, Vincent P, Vink J, Völk HJ, Wadiasingh Z, Wagner SJ, Watson J, Werner F, White R, Wierzcholska A, Wong YW, Yusafzai A, Zacharias M, Zanin R, Zargaryan D, Zdziarski AA, Zech A, Zhu SJ, Zorn J, Zouari S, Żywucka N, Evans P, Page K. Revealing x-ray and gamma ray temporal and spectral similarities in the GRB 190829A afterglow. Science 2021; 372:1081-1085. [PMID: 34083487 DOI: 10.1126/science.abe8560] [Citation(s) in RCA: 12] [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: 09/18/2020] [Accepted: 04/07/2021] [Indexed: 11/02/2022]
Abstract
Gamma-ray bursts (GRBs), which are bright flashes of gamma rays from extragalactic sources followed by fading afterglow emission, are associated with stellar core collapse events. We report the detection of very-high-energy (VHE) gamma rays from the afterglow of GRB 190829A, between 4 and 56 hours after the trigger, using the High Energy Stereoscopic System (H.E.S.S.). The low luminosity and redshift of GRB 190829A reduce both internal and external absorption, allowing determination of its intrinsic energy spectrum. Between energies of 0.18 and 3.3 tera-electron volts, this spectrum is described by a power law with photon index of 2.07 ± 0.09, similar to the x-ray spectrum. The x-ray and VHE gamma-ray light curves also show similar decay profiles. These similar characteristics in the x-ray and gamma-ray bands challenge GRB afterglow emission scenarios.
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Affiliation(s)
| | - H Abdalla
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - F Aharonian
- Dublin Institute for Advanced Studies, Dublin 2, Ireland. .,Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.,High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), Yerevan 0051, Armenia
| | - F Ait Benkhali
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - E O Angüner
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - C Arcaro
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Armand
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - T Armstrong
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - H Ashkar
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Backes
- University of Namibia, Department of Physics, Windhoek 10005, Namibia.,Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - V Baghmanyan
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | | | - A Barnacka
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - M Barnard
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - Y Becherini
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - D Berge
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - B Bi
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - E Bissaldi
- Dipartimento Interateneo di Fisica, Politecnico di Bari, 70125 Bari, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - J Bolmont
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - M de Bony de Lavergne
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - M Breuhaus
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - F Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - P Brun
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Bryan
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - M Büchele
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - T Bulik
- Astronomical Observatory, The University of Warsaw, 00-478 Warsaw, Poland
| | - T Bylund
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - S Caroff
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Carosi
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - S Casanova
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.,Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - T Chand
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - S Chandra
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Chen
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - G Cotter
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - M Curyło
- Astronomical Observatory, The University of Warsaw, 00-478 Warsaw, Poland
| | | | - I D Davids
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - J Davies
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - C Deil
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - J Devin
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - L Dirson
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - A Djannati-Ataï
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Dmytriiev
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Donath
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - V Doroshenko
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - L Dreyer
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Duffy
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - J Dyks
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - F Eichhorn
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - S Einecke
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - G Emery
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - J-P Ernenwein
- Aix Marseille Université, Centre national de la recherche scientifique (CNRS)/Institut National de Physique Nucléaire et Physique des Particules (IN2P3), Centre de Physique des Particules de Marseille (CPPM), Marseille, France
| | - K Feijen
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - S Fegan
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - A Fiasson
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - G Fichet de Clairfontaine
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - G Fontaine
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - S Funk
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Füßling
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - S Gabici
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Y A Gallant
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - G Giavitto
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - L Giunti
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France.,Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - D Glawion
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - J F Glicenstein
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M-H Grondin
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J Hahn
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - M Haupt
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - G Hermann
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - C Hoischen
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - T L Holch
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - M Holler
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Hörbe
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - D Horns
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - D Huber
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - D Jankowsky
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - A Jardin-Blicq
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - V Joshi
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - I Jung-Richardt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - E Kasai
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - M A Kastendieck
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - K Katarzyński
- Institute of Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, 87-100 Torun, Poland
| | - U Katz
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - D Khangulyan
- Department of Physics, Rikkyo University, Toshima-ku, Tokyo 171-8501, Japan.
| | - B Khélifi
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - S Klepser
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - Nu Komin
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - R Konno
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Kosack
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - D Kostunin
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - M Kreter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - G Lamanna
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Lemière
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - M Lemoine-Goumard
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - J-P Lenain
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - F Leuschner
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - C Levy
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - I Lypova
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - J Mackey
- Dublin Institute for Advanced Studies, Dublin 2, Ireland
| | - J Majumdar
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - D Malyshev
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - D Malyshev
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - V Marandon
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - P Marchegiani
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - A Mares
- Université Bordeaux, CNRS/IN2P3, Centre d'Études Nucléaires de Bordeaux Gradignan, 33175 Gradignan, France
| | - G Martí-Devesa
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - R Marx
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany.,Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - G Maurin
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - P J Meintjes
- Department of Physics, University of the Free State, Bloemfontein 9300, South Africa
| | - M Meyer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Mitchell
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - L Mohrmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Montanari
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - C Moore
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - P Morris
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - E Moulin
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Muller
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - T Murach
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - K Nakashima
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Nayerhoda
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - M de Naurois
- Laboratoire Leprince-Ringuet, CNRS, Institut Polytechnique de Paris, F-91128 Palaiseau, France
| | - H Ndiyavala
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - J Niemiec
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland
| | - L Oakes
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - P O'Brien
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - H Odaka
- Department of Physics, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - S Ohm
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - L Olivera-Nieto
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | | | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - S Panny
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - M Panter
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R D Parsons
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - G Peron
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - B Peyaud
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - Q Piel
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - S Pita
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - V Poireau
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Priyana Noel
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - D A Prokhorov
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - H Prokoph
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - M Punch
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden.,Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - S Raab
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - R Rauth
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - P Reichherzer
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, A-6020 Innsbruck, Austria
| | - Q Remy
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - F Rieger
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - L Rinchiuso
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - C Romoli
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.
| | - G Rowell
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - E Ruiz-Velasco
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany.
| | - V Sahakian
- Yerevan Physics Institute, 375036 Yerevan, Armenia
| | - S Sailer
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - H Salzmann
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - D A Sanchez
- Laboratoire d'Annecy de Physique des Particules (LAPP), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, 74000 Annecy, France
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - M Sasaki
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Scalici
- Institut für Astronomie und Astrophysik, Universität Tübingen, D 72076 Tübingen, Germany
| | - J Schäfer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - F Schüssler
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France.
| | - H M Schutte
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, D 12489 Berlin, Germany
| | - M Seglar-Arroyo
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - M Senniappan
- Department of Physics and Electrical Engineering, Linnaeus University, 351 95 Växjö, Sweden
| | - A S Seyffert
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - N Shafi
- School of Physics, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - J N S Shapopi
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - K Shiningayamwe
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - R Simoni
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - A Sinha
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - H Sol
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - A Specovius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - S Spencer
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - M Spir-Jacob
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - Ł Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, 30-244 Kraków, Poland
| | - L Sun
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - R Steenkamp
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - C Stegmann
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany.,Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany
| | - S Steinmassl
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - C Steppa
- Institut für Physik und Astronomie, Universität Potsdam, D 14476 Potsdam, Germany
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe (World Premier International Research Center Initiative (WPI)), The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Kashiwa, Chiba, 277-8583, Japan
| | - T Tam
- School of Physics and Astronomy, Sun Yat Sen University, Guangzhou 510275, People's Republic of China
| | - T Tavernier
- Institute for Research on the Fundamental Laws of the Universe (IRFU), Commissariat à l'énergie atomique (CEA), Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - A M Taylor
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany.
| | - R Terrier
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - J H E Thiersen
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - D Tiziani
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Tluczykont
- Universität Hamburg, Institut für Experimentalphysik, D 22761 Hamburg, Germany
| | - L Tomankova
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Tsirou
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R Tuffs
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - Y Uchiyama
- Department of Physics, Rikkyo University, Toshima-ku, Tokyo 171-8501, Japan
| | - D J van der Walt
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C van Eldik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - C van Rensburg
- University of Namibia, Department of Physics, Windhoek 10005, Namibia
| | - B van Soelen
- Department of Physics, University of the Free State, Bloemfontein 9300, South Africa
| | - G Vasileiadis
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, CNRS/IN2P3, F-34095 Montpellier Cedex 5, France
| | - J Veh
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - C Venter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - P Vincent
- Sorbonne Université, Université Paris Diderot, Sorbonne Paris Cité, CNRS/IN2P3, Laboratoire de Physique Nucléaire et de Hautes Energies (LPNHE), F-75252 Paris, France
| | - J Vink
- Gravitation and Astroparticle Physics at the University of Amsterdam (GRAPPA), Anton Pannekoek Institute for Astronomy, University of Amsterdam, 1098 XH Amsterdam, Netherlands
| | - H J Völk
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - Z Wadiasingh
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - J Watson
- University of Oxford, Department of Physics, Denys Wilkinson Building, Oxford OX1 3RH, UK
| | - F Werner
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - R White
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - A Wierzcholska
- Instytut Fizyki Jądrowej Polskiej Akademii Nauk (PAN), 31-342 Kraków, Poland.,Landessternwarte, Universität Heidelberg, Königstuhl, D 69117 Heidelberg, Germany
| | - Yu Wun Wong
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - A Yusafzai
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen Centre for Astroparticle Physics, D 91058 Erlangen, Germany
| | - M Zacharias
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa.,Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - R Zanin
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - D Zargaryan
- Dublin Institute for Advanced Studies, Dublin 2, Ireland.,High Energy Astrophysics Laboratory, Russian-Armenian University (RAU), Yerevan 0051, Armenia
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, 00-716 Warsaw, Poland
| | - A Zech
- Laboratoire Univers et Théories, Observatoire de Paris, Université PSL, CNRS, Université de Paris, 92190 Meudon, France
| | - S J Zhu
- Deutsches Elektronen-Synchrotron (DESY), D-15738 Zeuthen, Germany.
| | - J Zorn
- Max-Planck-Institut für Kernphysik, D 69029 Heidelberg, Germany
| | - S Zouari
- Université de Paris, CNRS, Astroparticule et Cosmologie, F-75013 Paris, France
| | - N Żywucka
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - P Evans
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
| | - K Page
- School of Physics and Astronomy, The University of Leicester, Leicester LE1 7RH, UK
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Zhou R, Prasad G, Robinson S, Shahane S, Sinha A. The significance of urgent ultrasound scan for shoulder dislocation in patients above the age of 40: A prospective British Elbow and Shoulder Society pathway implementation study. Shoulder Elbow 2021; 13:303-310. [PMID: 34659471 PMCID: PMC8512999 DOI: 10.1177/1758573220913285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The highlight of the British Elbow and Shoulder Society pathway for the management of traumatic anterior shoulder instability is early imaging in patients aged over 40 years to assess rotator cuff integrity and early repair, if indicated to optimise function. The senior author set up a protocol in our institute to streamline the diagnostic process for this cohort of patients. This was a retrospective analysis from a prospectively collected database to highlight the importance of early specialist imaging. METHODS Our protocol is to perform urgent ultrasound scans for all suitable patients above 40 years after first-time traumatic shoulder dislocation. Demographics, associated injuries, ultrasound scan results, operations and functional outcomes were collated. RESULTS One year following the introduction of our protocol, 40 patients with a mean age of 67 (range, 42-89; SD = 13.1) had ultrasound. The incidence of full-thickness rotator cuff tears was 57.5% (n = 23). Eleven patients with confirmed full-thickness rotator cuff tears underwent surgery. The mean age of surgical patients was significantly younger than the non-surgical group (p = 0.004). DISCUSSION The use of early diagnostic imaging demonstrated a high incidence of full-thickness rotator cuff tears in this cohort of patients. This allowed early surgical repair to optimise function.
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Affiliation(s)
- R Zhou
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - G Prasad
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Robinson
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - S Shahane
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
| | - A Sinha
- Division of Trauma and Orthopaedic Surgery, Chesterfield Royal Hospital, Chesterfield, UK
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Tripathi T, Singh AR, Kapoor R, Sinha A, Ghosh S, Kaur K, Pokhariya D, Maity S, Tapadar A, Chandra A. Dapsone-induced methaemoglobinaemia in leprosy: a close mimic of 'happy hypoxia' in the COVID-19 pandemic. J Eur Acad Dermatol Venereol 2021; 35:e568-e571. [PMID: 34037283 PMCID: PMC8242520 DOI: 10.1111/jdv.17394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Tripathi
- Department of Dermatology, Base Hospital Barrackpore, Kolkata, India
| | - A R Singh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - R Kapoor
- Departments of Medicine and Haematology, Command Hospital Eastern Command, Kolkata, India
| | - A Sinha
- Department of Dermatology, Military Hospital Kirkee, Pune, India
| | - S Ghosh
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - K Kaur
- Department of Pathology, Base Hospital Barrackpore, Kolkata, India
| | - D Pokhariya
- Department of Radiology, Base Hospital Barrackpore, Kolkata, India
| | - S Maity
- Department of Anaesthesiology and Critical Care, Base Hospital Barrackpore, Kolkata, India
| | - A Tapadar
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
| | - A Chandra
- Department of Medicine, Base Hospital Barrackpore, Kolkata, India
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38
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Nathan A, Shukla S, Sinha A, Sivathasan S, Rashid A, Rassam J, Smart S, Patel K, Shah N, Lamb B. 31 Immediate Post-Operative Phosphodiesterase-5 Inhibitors (PDE5i) Therapy Improves Early Erectile Function Outcomes After Robot Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.218] [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: 11/14/2022]
Abstract
Abstract
Introduction
To assess whether the timing of post-RARP PDE5i therapy affects early erectile function, continence, or safety outcomes.
Method
Data from 158 patients treated with PDE5is post-RARP was prospectively collected over two years from a single surgeon at one tertiary centre and retrospectively evaluated. Therapy was started: immediately (day 1-2) in 29%, early (day 3-14) in 37% and late (after day 14) post-op in 34%. EPIC-26 Erectile Function (EF) scores were collected pre-op and post-op after a median 43-day follow-up interval.
Results
Drop in EF scores and percentage return to baseline post unilateral nerve sparing (UNS) compared to bilateral nerve sparing (BNS) RARP was respectively 9 and 11.1% versus 3.5 and 42.9% of immediate therapy, 7 and 14.8% versus 5.5 and 35.5% of early and 9.7 and 9.5% versus 7.3 and 25% of late. Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early and 26% and 54% for late.
Conclusions
Immediate post RARP PDE5i therapy may protect EF and should be considered clinically, with more benefits for BNS than UNS patients. Immediate or early, rather than late, PDE5i therapy improved early continence in BNS patients.
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Affiliation(s)
- A Nathan
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - S Shukla
- University of Cambridge, Cambridge, United Kingdom
| | - A Sinha
- University of Cambridge, Cambridge, United Kingdom
| | - S Sivathasan
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - A Rashid
- University of Cambridge, Cambridge, United Kingdom
| | - J Rassam
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - S Smart
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - K Patel
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - N Shah
- Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - B Lamb
- Addenbrooke’s Hospital, Cambridge, United Kingdom
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Sinha A. A study of the intranuclear cascade evaporation model and its application in estimating helium and transmutation product cross-sections in spallation neutron sources / Untersuchung und Anwendung eines intranuklearen Verdampfungsmodells zur Abschätzung von Querschnitten für die Erzeugung von Helium und Transmutationsprodukten in Spallationsneutronenquellen. KERNTECHNIK 2021. [DOI: 10.1515/kern-1988-520116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mathew G, Sinha A, Grewal N, Ahmad A, Hari P, Bagga A. POS-457 EFFICACY AND SAFETY OF RITUXIMAB VERSUS TACROLIMUS IN FREQUENTLY RELAPSING NEPHROTIC SYNDROME: AN OPEN LABEL RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.483] [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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Sinha A, Ghanapriya K, Hari P, Bagga A. POS-462 EFFICACY AND SAFETY OF PREDNISOLONE ON ALTERNATE DAYS MADE DAILY WITH INFECTIONS VERSUS LEVAMISOLE IN FREQUENTLY RELAPSING NEPHROTIC SYNDROME: AN OPEN LABEL RANDOMIZED CONTROLLED TRIAL. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.488] [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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Sinha A, Rahman H, Perera D. Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management. Cardiovasc Endocrinol Metab 2021; 10:22-30. [PMID: 33634252 PMCID: PMC7901821 DOI: 10.1097/xce.0000000000000223] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
Coronary microvascular disease (CMD) is present in 30% of patients with angina and is associated with increased morbidity and mortality. We now have an improved understanding of the pathophysiology of CMD and the invasive and noninvasive tests that can be used to make the diagnosis. Recent studies have shown that management of CMD guided by physiological testing yields better results than empirical treatment. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined. This review article discusses recent advances in understanding the pathophysiology of CMD, the modalities that are available to diagnose it clinically, current management options and a look at what is in store for the future.
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Affiliation(s)
- Aish Sinha
- The BHF Centre of Excellence and the NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
| | - Haseeb Rahman
- The BHF Centre of Excellence and the NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
| | - Divaka Perera
- The BHF Centre of Excellence and the NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
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Patel A, Kong R, Sato T, Yoo S, Sinha A, Powell C, Zhu J, Watanabe H. FP12.11 Single-Cell RNA Sequencing Analyses Distinguishes Transcriptional Activity of c-Myc and L-Myc in Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.137] [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: 12/01/2022]
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Das PP, Mondal P, Anweshan, Sinha A, Biswas P, Sarkar S, Purkait MK. Treatment of steel plant generated biological oxidation treated (BOT) wastewater by hybrid process. Sep Purif Technol 2021. [DOI: 10.1016/j.seppur.2020.118013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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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Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, Cinalli G, Fountas K, Khan T, Signoretti S, Waran V, Adeleye AO, Amorim R, Bertuccio A, Cama A, Chesnut RM, De Bonis P, Estraneo A, Figaji A, Florian SI, Formisano R, Frassanito P, Gatos C, Germanò A, Giussani C, Hossain I, Kasprzak P, La Porta F, Lindner D, Maas AIR, Paiva W, Palma P, Park KB, Peretta P, Pompucci A, Posti J, Sengupta SK, Sinha A, Sinha V, Stefini R, Talamonti G, Tasiou A, Zona G, Zucchelli M, Hutchinson PJ, Servadei F. Consensus statement from the international consensus meeting on post-traumatic cranioplasty. Acta Neurochir (Wien) 2021; 163:423-440. [PMID: 33354733 PMCID: PMC7815592 DOI: 10.1007/s00701-020-04663-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022]
Abstract
Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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Das PP, Mondal P, Sinha A, Biswas P, Sarkar S, Purkait MK. Integrated ozonation assisted electrocoagulation process for the removal of cyanide from steel industry wastewater. Chemosphere 2021; 263:128370. [PMID: 33297281 DOI: 10.1016/j.chemosphere.2020.128370] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 05/22/2023]
Abstract
This work focuses on the removal of cyanide, chemical oxygen demand (COD), biological oxygen demand (BOD), and chloride from biological oxidation treated (BOT) effluent of the steel industry by integrated ozonation assisted electrocoagulation method. The removal efficiency of the pollutants was found to be inefficient when the electrocoagulation or ozonation process was performed separately. However, a combination of ozonation and electrocoagulation gives a highly satisfactory result. Such an integrated approach for the treatment of BOT effluent has not been previously investigated. The effects of operating variables viz. ozone generation rate, current density, and analysis time on pollutant removal were primarily analyzed for the hybrid process. The experimental operating condition was optimized and was seen that ozone generation rate of 1.33 mg s-1, ozonation time of 40 min, a current density of 100 A m-2, and electrolysis time of 30 min were sufficient for reducing the pollutant concentration below its permissible limits. The removal efficiencies of the combined process at optimum conditions were 99.8%, 94.7%, 95%, and 46.5% for cyanide, COD, BOD, and chloride ions, respectively. A kinetic study was performed for the degradation of the pollutants during ozonation. The pseudo-first-order kinetic model was found to be best suited for the analysis with the highest R2 value of 0.99 for cyanide, COD, BOD, and chloride, respectively. The mass transfer study conducted further showed that the volumetric mass transfer coefficient, Kla, was increased with that of the ozone generation rate. Cost estimation of the hybrid process was done and compared with that of the other reported integrated process.
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Affiliation(s)
- Pranjal P Das
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - Piyal Mondal
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - A Sinha
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - P Biswas
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - S Sarkar
- Environmental Research Group, Tata Steel Limited, Jamshedpur, 831007, India
| | - M K Purkait
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India.
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Nathan A, Shukla S, Sinha A, Sivathasan S, Rashid A, Rassam J, Smart S, Patel K, Shah N, Lamb B. Immediate post-operative PDE5i therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35855-9] [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] Open
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Abstract
PURPOSE OF REVIEW Nearly one-third of patients presenting with angina have unobstructed epicardial coronary arteries and evidence of coronary microvascular disease. Up until recently, the pathophysiology of coronary microvascular disease has been poorly understood, resulting in limited effective therapeutic options in these patients. As a result, patients with coronary microvascular disease continue to suffer from a poor quality of life and adverse cardiovascular outcomes. RECENT FINDINGS Recent mechanistic studies have improved our understanding of the pathophysiology underlying coronary microvascular dysfunction; these studies have implicated the nitric oxide and endothelin pathways as the main drivers. The aim of this article is to review our current understanding of the pathophysiology of ischaemia in patients with coronary microvascular disease. SUMMARY Patients with angina who have coronary microvascular disease, but no obstructive coronary artery disease, are unable to augment their coronary blood flow in response to physiological stress, thereby predisposing them to myocardial ischaemia as a result of supply:demand mismatch in the myocardium. In addition to abnormalities of vascular resistance, perturbations in cardiac-coronary coupling also contribute to ischaemia in these patients. Although impaired flow reserve is the diagnostic hallmark, mechanistic studies have demonstrated that the underlying pathophysiology is heterogeneous. At present, two main endotypes have been identified, which can be readily differentiated on the basis of minimal microvascular resistance. A better understanding of the pathophysiology and mechanisms driving ischaemia in coronary microvascular dysfunction may stimulate the development of individualised therapies that may lead to an improvement in patients' quality of life and prognosis.
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Affiliation(s)
- Aish Sinha
- The BHF Centre of Excellence and the NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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Rustagi N, Raghav P, Dutt N, Sinha A, Rodha MS. Assessing continuum of trauma care for road accident victim in Jodhpur, Rajasthan. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.555] [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: 11/12/2022] Open
Abstract
Abstract
Background
Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. The present study was designed to assess the existing process of pre-hospital trauma care administered to road accident victims in a fast urbanizing city of Jodhpur, Rajasthan
Methods
A cross-sectional study was designed from 1st November 2018 to 30th June 2019. All cases who were admitted to tertiary level trauma care facility in the study period were reviewed and were analyzed for type of injuries suffered, prehospital care services availed and the time duration that elapsed before patient arrived at tertiary health facility. Geographic information system was used to identify clustering of accident hot spots in the Jodhpur district.
Results
A total of 137 patients or their caregivers were interviewed during the study period. A large proportion of patients 57(41.6%) were unconscious in post-crash phase. Private taxis contributed to maximum patient transfer (75.9%) and only 12.4% were transported through ambulance. Almost three fourth (78.1%) of patients received some form of pre-hospital care within 30 minutes of accident. About one third patients (35.7%) reached the trauma facility directly after the accident while majority (64.9%) were referred from other health facilities
Conclusions
Pre-hospital trauma care for road traffic accident victims is available in golden hour for majority of victims in Jodhpur district. Victims from rural area and tourists form a sizeable proportion of accident victims brought to trauma care facility. The primary health care facilities play a pivotal role in managing victims as first point of care. Future research is thus warranted to explicitly examine the role of health professionals at primary health care facilities in administering pre-hospital trauma care.
Key messages
The primary health care facilities play a pivotal role in managing victims as first point of care. In areas with evolving trauma systems, pre-hospital trauma care strengthening requires capacity building of all level of health professionals.
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Affiliation(s)
- N Rustagi
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - P Raghav
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - N Dutt
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - A Sinha
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
| | - M S Rodha
- Community Medicine & Family Medicine, AIIMS Jodhpur, Jodhpur, India
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Kamal N, Tarafdar A, Sinha A, Kumar V. Effect of Glucose Cometabolism on Biodegradation of Gabapentin (an Anticonvulsant Drug) by Gram-Positive Bacteria Micrococcus luteus N.ISM.1. APPL BIOCHEM MICRO+ 2020. [DOI: 10.1134/s0003683820040067] [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: 11/23/2022]
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