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Tandon A, Hoang-Vu Eozenou P, Neelsen S. Compulsion and redistribution remain key tenets for financing universal health coverage. Soc Sci Med 2024; 345:115744. [PMID: 36725438 DOI: 10.1016/j.socscimed.2023.115744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Ajay Tandon
- World Bank, 1818, H Street, NW, Washington, DC, 20433, United States.
| | | | - Sven Neelsen
- World Bank, 1818, H Street, NW, Washington, DC, 20433, United States.
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Tandon A, Roder-DeWan S, Chopra M, Chhabra S, Croke K, Cros M, Hasan R, Jammy GR, Manchanda N, Nagaraj A, Pandey R, Pradhan E, Rajkumar AS, Peters MA, Kruk ME. Adverse birth outcomes among women with 'low-risk' pregnancies in India: findings from the Fifth National Family Health Survey, 2019-21. Lancet Reg Health Southeast Asia 2023; 15:100253. [PMID: 37521318 PMCID: PMC10382663 DOI: 10.1016/j.lansea.2023.100253] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
Background Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services-such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide 'high-risk' women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as 'low risk' in India. Methods We used the 2019-21 Fifth National Family Health Survey (NFHS-5)-India's Demographic and Health Survey-which includes modules administered to women aged 15-49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as 'high risk' versus 'low risk' and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent's last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states. Findings Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India's newborn deaths and 56.3% of stillbirths were among women who were 'low risk' according to national guidelines. Women classified as 'low risk' had a Caesarean section rate of 8.4% (95% CI 8.1-8.7%), marginally lower than the national average of 10.0% (95% CI 9.8-10.3%). In India as a whole, 32.0% (95% CI 31.5-32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates. Interpretation Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of 'low risk' should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care. Funding Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.
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Affiliation(s)
- Ajay Tandon
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Sanam Roder-DeWan
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Mickey Chopra
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Sheena Chhabra
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Kevin Croke
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Marion Cros
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Rifat Hasan
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Guru Rajesh Jammy
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Navneet Manchanda
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Amith Nagaraj
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Rahul Pandey
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Elina Pradhan
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Andrew Sunil Rajkumar
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Michael A. Peters
- Global Program for Health, Nutrition and Population, World Bank, Washington, DC 20433, USA
| | - Margaret E. Kruk
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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Mallary C, Berg CJ, Buck JR, Tandon A. Listening for rain: Principal component analysis and linear discriminant analysis for broadband acoustic rainfall detection. J Acoust Soc Am 2023; 154:556-570. [PMID: 37504376 DOI: 10.1121/10.0020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
Rain falling on the ocean creates acoustic signals. Ma and Nystuen [(2005). J. Atmos. Oceanic Technol. 22, 1225-1248] described an algorithm that compares three narrowband "discriminant" frequencies to detect rain. In 2022, Trucco, Bozzano, Fava, Pensieri, Verri, and Barla [(2022). IEEE J. Oceanic Eng. 47(1), 213-225] investigated rain detection algorithms that use broadband spectral data averaged over 1 h. This paper implements a rainfall detector that uses broadband acoustic data at 3-min time resolution. Principal Component Analysis (PCA) reduces the dimensionality of the broadband data. Rainfall is then detected via a Linear Discriminant Analysis (LDA) on the data's principal component projections. This PCA/LDA algorithm was trained and tested on 5 months of data recorded by hydrophones in a shallow noisy cove, where it was not feasible to average spectral data over 1 h. The PCA/LDA algorithm successfully detected 78 ± 5% of all rain events over 1 mm/h, and 73 ± 5% of all rain events over 0.1 mm/h, for a false alarm rate of ≈ 1% in both cases. By contrast, the Ma and Nystuen algorithm detected 32 ± 5% of the rain events over 1.0 mm/h when run on the same data, for a comparable false alarm rate.
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Affiliation(s)
- C Mallary
- School of Marine Science and Technology, University of Massachusetts Dartmouth, New Bedford, Massachusetts 02744, USA
| | - C J Berg
- ECE Department, University of Massachusetts Dartmouth, New Bedford, Massachusetts 02747, USA
| | - J R Buck
- ECE Department, University of Massachusetts Dartmouth, New Bedford, Massachusetts 02747, USA
| | - A Tandon
- School of Marine Science and Technology, University of Massachusetts Dartmouth, New Bedford, Massachusetts 02744, USA
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Soucat A, Tandon A, Gonzales Pier E. From Universal Health Coverage services packages to budget appropriation: the long journey to implementation. BMJ Glob Health 2023; 8:bmjgh-2022-010755. [PMID: 37188361 DOI: 10.1136/bmjgh-2022-010755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Abstract
Essential packages of health services (EPHS) potentially contribute to universal health coverage (UHC) financing through several pathways. Generally, expectations on what an EPHS can achieve for health financing are high, yet stakeholders rarely spell out mechanisms to reach desired outcomes. This paper analyses how EPHS relate to the three health financing functions (revenue raising, risk pooling and purchasing) and to public financial management (PFM). Our review of country experiences found that using EPHS to directly leverage funds for health has rarely been effective. Indirectly, EPHS can translate into increased revenue through fiscal measures, including health taxes. Through improved dialogue with public finance authorities, health policy-makers can use EPHS or health benefit packages to communicate the value of additional public spending connected with UHC indicators. Overall, however, empirical evidence on EPHS contribution to resource mobilisation is still pending. EPHS development exercises have been more successful in advancing resource pooling across different schemes: EPHS can help comparing performance of coverage schemes, occasionally leading to harmonisation of UHC interventions and identifying gaps between health financing and service delivery. EPHS development and iterative revisions play an essential role in core strategic purchasing activities as countries develop their health technology assessment capacity. Ultimately, packages need to translate into adequate public financing appropriations through country health programme design, ensuring funding flows directly address obstacles to increased coverage.
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Affiliation(s)
- Agnès Soucat
- Health & Social Protection, Agence Francaise de Developpement, Paris, France
| | - Ajay Tandon
- World Bank Group, Washington, District of Columbia, USA
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Yazbeck AS, Soucat AL, Tandon A, Cashin C, Kutzin J, Watson J, Thomson S, Nguyen SN, Evetovits T. Addiction to a bad idea, especially in low- and middle-income countries: Contributory health insurance. Soc Sci Med 2023; 320:115168. [PMID: 36822716 DOI: 10.1016/j.socscimed.2022.115168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/10/2022] [Accepted: 06/21/2022] [Indexed: 02/23/2023]
Abstract
Despite limited evidence of successful development and implementation of contributory health insurance and low and middle income countries, many countries are in the process implementing such schemes. This commentary summarizes all available evidence on the limitations of contributory health insurance including the lack of good theoretical underpinning and the considerable evidence of inequity and fragmentation created by such schemes. Moreover, the initiation of a contributory health insurance scheme has not been found to increase revenues to the health sector or help health countries achieve universal health coverage. Low and middle income countries can improve equity and efficiency of the health sector by replacing out-of-pocket spending with pre-paid pooling mechanisms, but that is best done through budget transfers and not by contributory insurance that links payment to sub-population entitlements.
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Affiliation(s)
- Abdo S Yazbeck
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | | | | | | | - Joseph Kutzin
- Health Financing Policy at the World Health Organization, Geneva, Switzerland
| | | | - Sarah Thomson
- WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain
| | | | - Tamas Evetovits
- WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain
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Andersen CT, Cain JS, Chaudhery DN, Ghimire M, Higashi H, Tandon A. Assessing public financing for nutrition in Bhutan, Nepal and Sri Lanka. Matern Child Nutr 2022; 18:e13320. [PMID: 35307937 DOI: 10.1111/mcn.13320] [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] [Received: 06/26/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess public financing for nutrition in Bhutan, Nepal and Sri Lanka to identify limitations of available data and to discuss policy implications. A variant of the Scaling Up Nutrition Movement methodology was used. Budget allocations and expenditures for relevant government ministries during 2012-2018 were identified. Nutrition-related line items were tagged using definitions of nutrition-specific and nutrition-sensitive interventions. Data were aggregated by year and calculated in constant United States dollars (USD). Expenditures by year were presented as a proportion of gross domestic product and general government expenditures. The percent utilization of budget allocations and proportion of funding from central government sources were determined. Per capita expenditures on nutrition-specific interventions varied from USD 1.08-8.76 and for nutrition-sensitive interventions varied from USD 20.22-51.20. Nutrition-specific expenditures as a percent of gross domestic product ranged from 0.08% in Sri Lanka in 2017% to 0.34% in Nepal in 2016. The median utilization rate was 64% for nutrition-specific and 84% for nutrition-sensitive interventions. Nutrition-specific funding financed by the central government was 90.7% in Bhutan and 99.4% in Sri Lanka. This study revealed the need to prioritize and invest in evidence-based interventions, including balancing investments in nutrition-specific versus -sensitive interventions. Challenges in estimation of nutrition expenditures and cross-country comparison were also observed, highlighting the need for appropriate nutrition line item tagging and standardized systems for data collection.
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Affiliation(s)
- Christopher T Andersen
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Jewelwayne S Cain
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
| | - Deepika N Chaudhery
- The World Bank, Health, Nutrition, and Population Global Practice, New Delhi, India
| | - Mamata Ghimire
- The World Bank, Health, Nutrition, and Population Global Practice, Kathmandu, Nepal
| | - Hideki Higashi
- The World Bank, Health, Nutrition, and Population Global Practice, Colombo, Sri Lanka
| | - Ajay Tandon
- The World Bank, Health, Nutrition, and Population Global Practice, Washington, District of Columbia, USA
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Tandon A, Reddy KS. Redistribution and the health financing transition. J Glob Health 2021; 11:16002. [PMID: 34912554 PMCID: PMC8645237 DOI: 10.7189/jogh.11.16001] [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] [Indexed: 11/16/2022] Open
Abstract
Public financing is necessary for realizing universal health coverage (UHC), a policy commitment that emphasizes that everyone should have access to health services they need, of sufficient quality to be effective, and that the use of these services does not expose individuals to financial hardship. As countries undergo their health financing transitions, moving away from external and out-of-pocket (OOP) financing toward domestically-sourced public financing, finding ways to increase public financing in an efficient, equitable, and sustainable manner is front and center in the policy dialogue around UHC. This paper focuses on one aspect of the health financing transition that has generally received less attention: that UHC is also intrinsically about a policy direction that emphasizes at its core redistribution of resources from the well-off to the poor. Differences in the level and organization of public financing for health for a given level of national income also reflect differences in social and political preferences for redistribution and equity across countries. Hence, navigation of a country’s health financing transition in ways that accelerates progress towards UHC also implies that public resources are targeted and expended in ways to improve effective service coverage and reduce OOP spending specifically for the poor. To leverage a country’s health financing transition for UHC, mechanisms should be introduced for: (i) ensuring that benefit entitlements are explicit and intertemporally commensurate with levels of public financing; (ii) fragmentation in pooling mechanisms is reduced to facilitate cross-subsidization without jeopardizing equity; (iii) levels of OOP and complementary sources of financing are nudged towards the well-off until core levels of public financing are adequate to provide similar levels of coverage for all; and (v) that purchasing of services is done in ways that helps reduce geographic- and income-related inequities in access and supply of quality health services. This implies careful policy choices need to be made, ones that require looking beyond the simplistic dichotomy between OOP and public sources of financing for UHC at the aggregate level to more nuanced and disaggregated assessments of the organization, use, and net fiscal incidence of financing and expenditures.
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Affiliation(s)
- Ajay Tandon
- World Bank Group, Washington, District of Columbia, USA
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Santoro G, Sheriff N, Noronha J, Nunes QM, Tandon A. Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis. Ann R Coll Surg Engl 2021; 104:158-164. [PMID: 34730401 DOI: 10.1308/rcsann.2020.7123] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Heller myotomy (HM) remains the gold standard procedure for achalasia. The addition of different types of fundoplication to HM has been debated in several studies. Given the contradictory reports, this meta-analysis was undertaken to compare different outcomes after HM and HM with fundoplication (HMF). METHODS An electronic search was performed among five major databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) from inception to October 2019, identifying all randomised and non-randomised studies comparing HM with HMF. Two authors searched electronic databases using the keywords 'achalasia' AND 'dysphagia' AND 'gastroesophageal reflux' and all data were pooled for random-effects meta-analysis. The primary and secondary outcomes were gastroesophageal reflux and dysphagia, respectively. RESULTS A total of six studies were included and involved 576 patients comparing HM and HMF. There was no statistically significant difference between gastroesophageal reflux in the HM vs HMF group (21.3% vs 22.9%, RR 1.32, 95% CI 0.60-2.88, p = 0.49). There was a slightly higher incidence of dysphagia observed in HM vs HMF (14.8% vs 10.8%, RR 1.54, 95% CI 0.98-2.41, p = 0.06). CONCLUSIONS There was no statistically significant difference in long-term outcomes between a group of patients undergoing HM and a group who underwent HM with fundoplication.
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Affiliation(s)
- G Santoro
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - N Sheriff
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | | | | | - A Tandon
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
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Abstract
COVID-19 has shocked all countries' economic and health systems. The combined direct health impact and the current macro-fiscal picture present real and present risks to health financing that facilitate progress toward universal health coverage (UHC). This paper lays out the health financing mechanisms through which the UHC objectives of service coverage and financial protection may be impacted. Macroeconomic, fiscal capacity, and poverty indicators and trends are analyzed in conjunction with health financing indicators to present spending scenarios. The analysis shows that falling or reduced economic growth, combined with rising poverty, is likely to lead to a fall in service use and coverage, while any observed reductions in out-of-pocket spending have to be analyzed carefully to make sure they reflect improved financial protection and not just decreased utilization of services. Potential decreases in out-of-pocket spending will likely be drive by households' financial constraints that lead to less service use. In this way, it is critical to measure and monitor both the service coverage and financial protection indicators of UHC to have a complete picture of downstream effects. The analysis of historical data, including available evidence since the start of the COVID-19 pandemic, lay the foundation for health financing-related policy options that can effectively safeguard UHC progress particularly for the poor and most vulnerable. These targeted policy options are based on documented evidence of effective country responses to previous crises as well as the overall evidence base around health financing for UHC.
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Affiliation(s)
- Susan P Sparkes
- Health Financing, World Health Organization, Geneva, Switzerland
| | | | - David Evans
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
| | | | - Joseph Kutzin
- Health Financing, World Health Organization, Geneva, Switzerland
| | - Ajay Tandon
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
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Tandon A, Ivatts S, Cowley P, Roubal T, Dodd R, Pepperall J, Mikkelsen-Lopez I, Irava WJ, Palu T. Economic Contraction from COVID-19 in the Pacific: Implications for Health Financing. Health Syst Reform 2020; 6:e1847991. [PMID: 33337274 DOI: 10.1080/23288604.2020.1847991] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Pacific Island countries (PIC) have emerged as among the most at-risk globally from the collateral economic damage resulting from the COVID-19 pandemic, despite being largely spared its direct health effects so far. Current projections indicate that all PIC will experience an economic contraction in 2020, ranging from -1.0% in Tuvalu to -21.7% in Fiji, worse than most countries globally on average. Given that more than 80% of financing for health in the Pacific comes from domestic and external public sources, the net impact of the economic contraction on resources for health will depend on whether overall public spending can offset the decline in economic activity and how health will be prioritized in government budgets relative to other sectors. Without active reprioritization, most countries could see a slowdown or even decline in per capita levels of public spending for health in the region, risking gains made in advancing universal health coverage in recent years. If health ministries do not act quickly and in consort with other ministries (particularly ministries of finance), including by taking active steps to improve the efficient use of existing resources and other measures to mitigate the economic effects of the crisis on resources for health, it is likely that current economic circumstances will result in unplanned changes. These changes may not deliver the health outcomes that the health ministries would select themselves and may result in a reversal of hard-fought health gains.
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Affiliation(s)
- Ajay Tandon
- Global Program for Health, Nutrition, and Population, World Bank , Washington, DC, USA
| | - Susan Ivatts
- Global Program for Health, Nutrition, and Population, World Bank , Sydney, Australia
| | - Peter Cowley
- Regional Office for the Western Pacific, World Health Organization , Manila, Philippines
| | - Tomas Roubal
- Regional Office for the Western Pacific, World Health Organization , Manila, Philippines
| | - Rebecca Dodd
- Department of Foreign Affairs and Trade, Global Health Policy Branch , Canberra, Australia
| | - Jane Pepperall
- Department of Foreign Affairs and Trade, Global Health Policy Branch , Canberra, Australia
| | | | - Wayne Jeremy Irava
- Global Program for Health, Nutrition, and Population, World Bank , Honiara, Solomon Islands
| | - Toomas Palu
- Global Program for Health, Nutrition, and Population, World Bank , Geneva, Switzerland
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Tandon A, Cain J, Kurowski C, Dozol A, Postolovska I. From slippery slopes to steep hills: Contrasting landscapes of economic growth and public spending for health. Soc Sci Med 2020; 259:113171. [PMID: 32674847 PMCID: PMC7335632 DOI: 10.1016/j.socscimed.2020.113171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
Identifying ways to increase public spending on health is critical for the achievement of universal health coverage. While policymakers and donors often look at available options for increasing public spending for health in the medium-term, examining trends and drivers of past growth can help countries elucidate important lessons and to anticipate changes in the future. This note analyzes trends in inflation-adjusted per capita public spending for health vis-à-vis economic growth within and across a sample of 150 countries over the 2000-2017 period. Since 2000, per capita public spending for health across low- and middle-income countries has more than doubled. Less than one-fifth of this increase, however, resulted from a higher priority for health in government budgets. The remainder was largely due to conducive macroeconomic conditions such as economic growth and increases in total public spending. Furthermore, across most countries, a single time trend does not adequately capture the evolution either of economic growth or of per capita public spending on health. Instability in growth rates is large for both indicators, revealing distinct episodic patterns.
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Yazbeck AS, Savedoff WD, Hsiao WC, Kutzin J, Soucat A, Tandon A, Wagstaff A, Chi-Man Yip W. The Case Against Labor-Tax-Financed Social Health Insurance For Low- And Low-Middle-Income Countries. Health Aff (Millwood) 2020; 39:892-897. [DOI: 10.1377/hlthaff.2019.00874] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Abdo S. Yazbeck
- Abdo S. Yazbeck is a lecturer in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - William D. Savedoff
- William D. Savedoff is a principal health specialist at the Inter-American Development Bank, in Washington, D.C
| | - William C. Hsiao
- William C. Hsiao is the K. T. Li Professor of Economics in the Harvard T. H. Chan School of Public Health, in Cambridge, Massachusetts
| | - Joe Kutzin
- Joe Kutzin is a coordinator of health financing in the Department of Health Systems, Financing, and Governance, World Health Organization, in Geneva, Switzerland
| | - Agnès Soucat
- Agnès Soucat is director of the Department of Health Systems, Financing, and Governance, World Health Organization
| | - Ajay Tandon
- Ajay Tandon is lead economist with the Global Practice for Health, Nutrition, and Population at the World Bank in Washington, DC
| | - Adam Wagstaff
- Adam Wagstaff is a research manager in the Development Research Group at the World Bank in Washington, D.C
| | - Winnie Chi-Man Yip
- Winnie Chi-Man Yip is a professor of the practice of international health policy and economics in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health
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Atlani M, Tandon A. SAT-380 OUTCOME OF CRANIOCAUDALLY (CCD) PERFORMED KIDNEY BIOPSIES BY NEPHROLOGIST- A SINGLE CENTER EXPERIENCE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Tagraxofusp is a toxin-cytokine fusion protein consisting of engineered diphtheria toxin (DT) and interleukin-3 (IL-3). The IL-3 domain binds to the cluster of differentiation 123 (CD123) and translocates DT into the cytosol, which leads to cell death. Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with a strong expression of CD123. Historical data show that the prognosis of BPDCN is poor, with a median overall survival of 9 to 13 months. On December 21, 2018, the United States Food and Drug Administration (FDA) approved tagraxofusp for the treatment of adults and children with newly diagnosed or relapsed/refractory BPDCN, becoming the first FDA-approved drug for this disease. In this review, we examine the preclinical studies and phase I/II clinical studies that led to FDA approval of tagraxofusp, focusing on its molecular pharmacology, pharmacokinetics, efficacy and safety profile. We also discuss future directions regarding BPDCN management.
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Affiliation(s)
- A Tandon
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Y Zhang
- Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - L Sokol
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA.
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Dieleman JL, Cowling K, Agyepong IA, Alkenbrack S, Bollyky TJ, Bump JB, Chen CS, Grépin KA, Haakenstad A, Harle AC, Kates J, Lavado RF, Micah AE, Ottersen T, Tandon A, Tsakalos G, Wu J, Zhao Y, Zlavog BS, Murray CJL. The G20 and development assistance for health: historical trends and crucial questions to inform a new era. Lancet 2019; 394:173-183. [PMID: 31257126 DOI: 10.1016/s0140-6736(19)31333-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/25/2019] [Accepted: 05/31/2019] [Indexed: 11/29/2022]
Abstract
One of the most important gatherings of the world's economic leaders, the G20 Summit and ministerial meetings, takes place in June, 2019. The Summit presents a valuable opportunity to reflect on the provision and receipt of development assistance for health (DAH) and the role the G20 can have in shaping the future of health financing. The participants at the G20 Summit (ie, the world's largest providers of DAH, emerging donors, and DAH recipients) and this Summit's particular focus on global health and the Sustainable Development Goals offers a unique forum to consider the changing DAH context and its pressing questions. In this Health Policy perspective, we examined trends in DAH and its evolution over time, with a particular focus on G20 countries; pointed to persistent and emerging challenges for discussion at the G20 Summit; and highlighted key questions for G20 leaders to address to put the future of DAH on course to meet the expansive Sustainable Development Goals. Key questions include how to best focus DAH for equitable health gains, how to deliver DAH to strengthen health systems, and how to support domestic resource mobilisation and transformative partnerships for sustainable impact. These issues are discussed in the context of the growing effects of climate change, demographic and epidemiological transitions, and a global political shift towards increasing prioritisation of national interests. Although not all these questions are new, novel approaches to allocating DAH that prioritise equity, efficiency, and sustainability, particularly through domestic resource use and mobilisation are needed. Wrestling with difficult questions in a changing landscape is essential to develop a DAH financing system capable of supporting and sustaining crucial global health goals.
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Affiliation(s)
- Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Krycia Cowling
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Irene A Agyepong
- Ghana Health Service, Dodowa Health Research Center, Dodowa, Ghana; Ghana College of Physicians and Surgeons, Public Health Department, Accra, Ghana
| | - Sarah Alkenbrack
- Health Nutrition and Population Global Practice, World Bank Group, Washington DC, USA
| | - Thomas J Bollyky
- Council on Foreign Relations Global Health Program, Washington DC, USA; Georgetown University Georgetown Law, Washington DC, USA
| | - Jesse B Bump
- Harvard T H Chan School of Public Health Global Health and Population, Boston, MA, USA
| | - Catherine S Chen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Karen A Grépin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Annie Haakenstad
- Harvard T H Chan School of Public Health Global Health and Population, Boston, MA, USA
| | - Anton C Harle
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Rouselle F Lavado
- Central and West Asia Department, Asian Development Bank, Metro Manila, Philippines
| | - Angela E Micah
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Trygve Ottersen
- Norwegian Institute of Public Health, Division for Health Services, Oslo, Norway; Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway; Centre for Global Health, University of Oslo, Oslo, Norway
| | - Ajay Tandon
- Health Nutrition and Population Global Practice, World Bank Group, Washington DC, USA
| | - Golsum Tsakalos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Junjie Wu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Yingxi Zhao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Bianca S Zlavog
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Bajaj V, Anshuman R, Verma N, Singh MP, Tandon A. Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method. Malays Orthop J 2018; 12:14-18. [PMID: 30555641 PMCID: PMC6287136 DOI: 10.5704/moj.1811.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.
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Affiliation(s)
- V Bajaj
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
| | - R Anshuman
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
| | - N Verma
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
| | - MP Singh
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
| | - A Tandon
- Department of Orthopaedics, University College of Medical Sciences, Delhi, India
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Barroy H, Kutzin J, Tandon A, Kurowski C, Lie G, Borowitz M, Sparkes S, Dale E. Assessing Fiscal Space for Health in the SDG Era: A Different Story. Health Syst Reform 2017. [DOI: 10.1080/23288604.2017.1395503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hélène Barroy
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Joseph Kutzin
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Ajay Tandon
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA
| | - Christoph Kurowski
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA
| | - Geir Lie
- Strategy, Investment and Impact Division, The Global Fund, Vernier, Switzerland
| | - Michael Borowitz
- Strategy, Investment and Impact Division, The Global Fund, Vernier, Switzerland
| | - Susan Sparkes
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Elina Dale
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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Tandon A, Rao R, Hotouras A, Nunes QM, Hartley M, Gunasekera R, Howes N. Safety and effectiveness of antireflux surgery in obese patients. Ann R Coll Surg Engl 2017; 99:515-523. [PMID: 28853597 PMCID: PMC5697051 DOI: 10.1308/rcsann.2017.0144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction The incidence of gastro-oesophageal reflux disease and obesity has increased significantly in recent years. The number of antireflux procedures being carried out on people with a higher body mass index (BMI) has been rising. Evidence is conflicting for outcomes of antireflux surgery in obese patients in terms of its safety and efficacy. Given the contradictory reports, this meta-analysis was undertaken to establish the outcomes of antireflux surgery (ARS) in obese patients and its associated safety. Methods A systematic electronic search was conducted using the PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ databases to identify studies that analysed the effect of BMI on the outcomes of ARS. A meta-analysis was performed using the random effects model. The intraoperative and postoperative outcomes that were examined included operative time, conversion to an open procedure, mean length of hospital stay, recurrence of acid reflux requiring reoperation and wrap migration. Results A total of 3,772 patients were included in 13 studies. There was no significant difference in procedure conversion rate, recurrence of reflux requiring reoperation or wrap migration between obese and non-obese patients. However, both the mean operative time and mean length of stay were longer for obese patients. Conclusions ARS in obese patients with gastro-oesophageal reflux disease is safe and outcomes are comparable with those in patients with a BMI in the normal range. A high BMI should therefore not be a deterrent to considering ARS for appropriate patients.
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Affiliation(s)
- A Tandon
- Aintree University Hospital NHS Foundation Trust , UK
| | - R Rao
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK
| | | | - Q M Nunes
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK
| | - M Hartley
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK
| | - R Gunasekera
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK
| | - N Howes
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , UK
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Ahuja M, Sharma R, Tandon A, Pandit S. Comparative study of implantation rate in cleavage embryo transfer vs blastocyst transfer among couples undergoing in vitro fertilization for treatment of infertility. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.08.103] [Citation(s) in RCA: 2] [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: 11/29/2022]
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Dieleman J, Campbell M, Chapin A, Eldrenkamp E, Fan VY, Haakenstad A, Kates J, Liu Y, Matyasz T, Micah A, Reynolds A, Sadat N, Schneider MT, Sorensen R, Evans T, Evans D, Kurowski C, Tandon A, Abbas KM, Abera SF, Kiadaliri AA, Ahmed KY, Ahmed MB, Alam K, Alizadeh-Navaei R, Alkerwi A, Amini E, Ammar W, Amrock SM, Antonio CAT, Atey TM, Avila-Burgos L, Awasthi A, Barac A, Bernal OA, Beyene AS, Beyene TJ, Birungi C, Bizuayehu HM, Breitborde NJK, Cahuana-Hurtado L, Castro RE, Catalia-Lopez F, Dalal K, Dandona L, Dandona R, de Jager P, Dharmaratne SD, Dubey M, Farinha CSES, Faro A, Feigl AB, Fischer F, Fitchett JRA, Foigt N, Giref AZ, Gupta R, Hamidi S, Harb HL, Hay SI, Hendrie D, Horino M, Jürisson M, Jakovljevic MB, Javanbakht M, John D, Jonas JB, Karimi SM, Khang YH, Khubchandani J, Kim YJ, Kinge JM, Krohn KJ, Kumar GA, El Razek HMA, El Razek MMA, Majeed A, Malekzadeh R, Masiye F, Meier T, Meretoja A, Miller TR, Mirrakhimov EM, Mohammed S, Nangia V, Olgiati S, Osman AS, Owolabi MO, Patel T, Caicedo AJP, Pereira DM, Perelman J, Polinder S, Rafay A, Rahimi-Movaghar V, Rai RK, Ram U, Ranabhat CL, Roba HS, Salama J, Savic M, Sepanlou SG, Shrime MG, Talongwa RT, Ao BJT, Tediosi F, Tesema AG, Thomson AJ, Tobe-Gai R, Topor-Madry R, Undurraga EA, Vasankari T, Violante FS, Werdecker A, Wijeratne T, Xu G, Yonemoto N, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Murray CJL. Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet 2017; 389:1981-2004. [PMID: 28433256 PMCID: PMC5440770 DOI: 10.1016/s0140-6736(17)30874-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. METHODS We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. FINDINGS Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. INTERPRETATION Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. FUNDING The Bill & Melinda Gates Foundation.
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Tandon A, Rajendran I, Aziz M, Kolamunnage-Dona R, Nunes QM, Shrotri M. Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre. Ann R Coll Surg Engl 2017; 99:325-331. [PMID: 27869493 PMCID: PMC5449677 DOI: 10.1308/rcsann.2016.0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.
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Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - I Rajendran
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - M Aziz
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - R Kolamunnage-Dona
- MRC North West Hub for Trials Methodology Research , Liverpool , UK
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University, Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , UK
| | - M Shrotri
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
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Tandon A, Rajendran I, Aziz M, Nunes Q, Shrotri M. Laparoscopic assisted gastrectomy in elderly versus non-elderly patients with gastric cancer: A UK center experience. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.429] [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: 10/20/2022]
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Tandon A, Shahzad K, Pathak S, Oommen CM, Nunes QM, Smart N. Parietex™ Composite mesh versus DynaMesh ®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study. Ann R Coll Surg Engl 2016; 98:568-573. [PMID: 27659375 DOI: 10.1308/rcsann.2016.0292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 12/21/2022] Open
Abstract
INTRODUCTION Laparoscopic incisional and ventral hernia repair (LIVHR) is widely accepted and safe but the type of mesh used is still debated. We retrospectively compared postoperative outcomes with two different meshes commonly used in LIVHR. METHODS This is a retrospective study of patients who underwent incisional hernia repair between January 2008 and December 2010. Two meshes were used: Parietex™ Composite (Covidien, New Haven, CT, USA) and the DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Germany). The two groups were compared with respect to recurrence rates, incidence of seroma and intestinal obstruction. RESULTS Among the 88 patients who underwent LIVHR, 75 patients (85.2%) presented with primary incisional hernia, 10 (11.4%) presented with a first recurrence and 3 (3.4%) presented with a second recurrence. Median follow-up was 53.6 months (range 40-61 months). 12.9% of patients had recurrence in the Parietex™ Composite mesh group (n=62) in comparison to 3.8% in the DynaMesh®-IPOM mesh group (n=26; P=0.20). DynaMesh®-IPOM was associated with a significantly higher incidence of intestinal obstruction secondary to adhesions (11.5% vs. 0%, P=0.006) and lower incidence of seroma and haematoma formation compared to Parietex™ composite mesh group (0% vs. 6.4% of patients; P=0.185). CONCLUSIONS LIVHR is a safe and feasible technique. Dynamesh®-IPOM is associated with a significantly higher incidence of adhesion related bowel obstruction, albeit with a lower incidence of recurrence, seroma and haematoma formation compared with Parietex™ Composite mesh. However, there is a need for further well-designed, multicentre randomised controlled studies to investigate the use of these meshes.
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Affiliation(s)
- A Tandon
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - K Shahzad
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
| | - C M Oommen
- Rotherham General Hospital , Rotherham , UK
| | - Q M Nunes
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - N Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
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Tandon A, Sunderland G, Nunes QM, Misra N, Shrotri M. Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre. Ann R Coll Surg Engl 2016; 98:329-33. [PMID: 27087326 DOI: 10.1308/rcsann.2016.0125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Symptomatic gall stones may require laparoscopic cholecystectomy (LC), which is one of the most commonly performed general surgical operations in the western world. Patients with a high body mass index (BMI) are at increased risk of having gall stones, and are often considered at high risk of surgical complications due to their increased BMI. We believe that day case surgery could nevertheless have significant benefits in terms of potential cost savings and patient satisfaction in this population. We therefore compared the outcomes of day case patients undergoing LC stratified by BMI, with a specific focus on the safety and success of the procedure in obese and morbidly obese groups. METHODS We reviewed a database of day case procedures performed between January 2004 and December 2012, including all patients with symptomatic gall stone disease who underwent LC. The patients were divided in four BMI groups: less than 25 kg/m(2), 25-29 kg/m(2), 30-39 kg/m(2) and 40 kg/m(2) or above. RESULTS The overall success rate for day case surgery was 78%. There were no significant differences in rates of intra-abdominal collection or readmission with increasing BMI. However, increasing BMI was associated with a significant increase in the rate of wound infection. CONCLUSIONS LC in patients with a high BMI is safe and can be performed effectively as a day case procedure.
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Affiliation(s)
- A Tandon
- Aintree University Hospital , Liverpool , UK
| | | | - Q M Nunes
- Aintree University Hospital , Liverpool , UK.,Royal Liverpool & Broadgreen University Hospitals NHS Trust , UK
| | - N Misra
- Aintree University Hospital , Liverpool , UK
| | - M Shrotri
- Aintree University Hospital , Liverpool , UK
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Banerjee A, Srivastava B T, Kumar S, Tandon A, Pandit S. Agenesis of dorsal wall of sacrum: A case report. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 2016; 103:1598-1607. [DOI: 10.1002/bjs.10268] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 06/10/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation.
Methods
A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.
Results
A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.
Conclusion
CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
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Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J R Lyons
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
- National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Byrne N, Velasco Forte M, Tandon A, Valverde I, Hussain T. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis 2016; 5:2048004016645467. [PMID: 27170842 PMCID: PMC4853939 DOI: 10.1177/2048004016645467] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/29/2016] [Indexed: 12/01/2022] Open
Abstract
Background Shortcomings in existing methods of image segmentation preclude the widespread adoption of patient-specific 3D printing as a routine decision-making tool in the care of those with congenital heart disease. We sought to determine the range of cardiovascular segmentation methods and how long each of these methods takes. Methods A systematic review of literature was undertaken. Medical imaging modality, segmentation methods, segmentation time, segmentation descriptive quality (SDQ) and segmentation software were recorded. Results Totally 136 studies met the inclusion criteria (1 clinical trial; 80 journal articles; 55 conference, technical and case reports). The most frequently used image segmentation methods were brightness thresholding, region growing and manual editing, as supported by the most popular piece of proprietary software: Mimics (Materialise NV, Leuven, Belgium, 1992–2015). The use of bespoke software developed by individual authors was not uncommon. SDQ indicated that reporting of image segmentation methods was generally poor with only one in three accounts providing sufficient detail for their procedure to be reproduced. Conclusions and implication of key findings Predominantly anecdotal and case reporting precluded rigorous assessment of risk of bias and strength of evidence. This review finds a reliance on manual and semi-automated segmentation methods which demand a high level of expertise and a significant time commitment on the part of the operator. In light of the findings, we have made recommendations regarding reporting of 3D printing studies. We anticipate that these findings will encourage the development of advanced image segmentation methods.
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Affiliation(s)
- N Byrne
- Department of Medical Physics, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Paediatric Cardiology, Evelina London Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - M Velasco Forte
- Paediatric Cardiology, Evelina London Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - A Tandon
- Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - I Valverde
- Paediatric Cardiology, Evelina London Children's Hospital at Guy's and St. Thomas' NHS Foundation Trust, London, UK; Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Paediatric Cardiology, Hospital Virgen del Rocio, Seville, Spain; Institute of Biomedicine of Seville, Seville, Spain
| | - T Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Departments of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
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Paul T, Uppin S, Uppin M, Tandon A, Jacob R, Raghunadharao D. 291 MEGALOBLASTOID ERYTHROPOIESIS IN IMATINIB TREATED CHRONIC MYELOID LEUKEMIA (CML) PATIENTS - DOES IT HAVE ANY SIGNIFICANCE? COULD IT BE A POSSIBLE FORERUNNER TO MYELODYSPLASIA? Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kanemoto S, Griffin J, Markham-Coultes K, Aubert I, Tandon A, George-Hyslop PS, Fraser PE. Proliferation, differentiation and amyloid-β production in neural progenitor cells isolated from TgCRND8 mice. Neuroscience 2014; 261:52-9. [PMID: 24361736 PMCID: PMC4116598 DOI: 10.1016/j.neuroscience.2013.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 11/05/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022]
Abstract
The amyloid precursor protein (APP) and amyloid-β (Aβ) peptide play central roles in the pathology and etiology of Alzheimer's disease. Amyloid-induced impairments in neurogenesis have been investigated in several transgenic mouse models but the mechanism of action remains to be conclusively demonstrated. The changes in neurogenesis during this transition of increasing Aβ levels and plaque formation were investigated in the present study. We found that the proliferation of newborn cell in the dentate gyrus was enhanced prior to elevations in soluble Aβ production as well as amyloid deposition in 5-week-old TgCRND8 mice, which are well-established Alzheimer's disease models, compared to non-transgenic (Non-Tg) mice. The number of BrdU-positive cells remained higher in TgCRND8 vs Non-Tg mice for a period of 8weeks. The numbers of BrdU/NeuN-positive cells were not significantly different in TgCRND8 compared to Non-Tg mice. A significant decrease in BrdU/GFAP but not in BrdU/S100β was found in Tg vs Non-Tg at 6-weeks of age. In addition, a unique observation was made using isolated neuroprogenitor cells from TgCRND8 mice which were found to be less viable in culture and produced substantial amounts of secreted Aβ peptides. This suggests that the proliferation of neural progenitors in vivo may be modulated by high levels of APP expression and the resulting Aβ generated directly by the progenitor cells. These findings indicate that cell proliferation is increased prior to Aβ deposition and that cell viability is decreased in TgCRND8 mice over time.
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Affiliation(s)
- S Kanemoto
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 2S8, Canada.
| | - J Griffin
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 2S8, Canada
| | - K Markham-Coultes
- Sunnybrook Research Institute and Department of Laboratory Medicine and Pathobiology, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - I Aubert
- Sunnybrook Research Institute and Department of Laboratory Medicine and Pathobiology, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - A Tandon
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 2S8, Canada; Department of Medicine (Neurology), University of Toronto, Canada
| | - P S George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 2S8, Canada; Department of Medicine (Neurology), University of Toronto, Canada; Cambridge Institute for Medical Research, Cambridge National Institute of Health Research, Biomedical Research Unit in Dementia, University of Cambridge, Cambridge CB2 0XY, UK
| | - P E Fraser
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON M5T 2S8, Canada; Department of Medical Biophysics, University of Toronto, Canada
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Tandon A, Fleisher L, Li R, Yap WA. Reprioritizing government spending on health: pushing an elephant up the stairs? WHO South East Asia J Public Health 2014; 3:206-212. [PMID: 28612804 DOI: 10.4103/2224-3151.206742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure averaged 12% in the 170 countries for which data were available. However, country differences were striking: ranging from a low of 1% in Myanmar to a high of 28% in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes some of the key theoretical and empirical perspectives on allocation of public resources to health vis-à-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. The paper argues that theory and cross-country empirical analyses do not provide clear-cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defence, education and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggest that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts - in particular efforts to explicitly expand the breadth and depth of health coverage as opposed to efforts focused only on government budgetary benchmarking targets - are more likely to result in sustained and politically feasible prioritization of health from a fiscal space perspective.
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Affiliation(s)
- Ajay Tandon
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Lisa Fleisher
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Rong Li
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Wei Aun Yap
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
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Anwar M, Lupo J, Molinaro A, Clarke J, Butowski N, Prados M, Chang S, HaasKogan D, Nelson S, Ashman J, Drazkowski J, Zimmerman R, Lidner T, Giannini C, Porter A, Patel N, Atean I, Shin N, Toltz A, Laude C, Freeman C, Seuntjens J, Roberge D, Back M, Kastelan M, Guo L, Wheeler H, Beauchesne P, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Bowers J, Bennion N, Lomas H, Spencer K, Richardson M, McAllister W, Sheehan J, Schlesinger D, Kersh R, Brower J, Gans S, Hartsell W, Goldman S, Chang JHC, Mohammed N, Siddiqui M, Gondi V, Christensen E, Klawikowski S, Garg A, McAleer M, Rhines L, Yang J, Brown P, Chang E, Settle S, Ghia A, Edson M, Fuller GN, Allen P, Li J, Garsa A, Badiyan S, Simpson J, Dowling J, Rich K, Chicoine M, Leuthardt E, Kim A, Robinson C, Gill B, Peskorski D, Lalonde R, Huq MS, Flickinger J, Graff A, Clerkin P, Smith H, Isaak R, Dinh J, Grosshans D, Allen P, de Groot J, McGovern S, McAleer M, Gilbert M, Brown P, Mahajan A, Gupta T, Mohanty S, Kannan S, Jalali R, Hardie J, Laack N, Kizilbash S, Buckner J, Giannini C, Uhm J, Parney I, Jenkins R, Decker P, Voss J, Hiramatsu R, Kawabata S, Furuse M, Niyatake SI, Kuroiwa T, Suzuki M, Ono K, Hobbs C, Vallow L, Peterson J, Jaeckle K, Heckman M, Bhupendra R, Horowitz D, Wuu CS, Feng W, Drassinower D, Lasala A, Lassman A, Wang T, Indelicato D, Rotondo R, Bradley J, Sandler E, Aldana P, Mendenhall N, Marcus R, Kabarriti R, Mourad WF, Mejia DM, Glanzman J, Patel S, Young R, Bernstein M, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Khatua S, Hou P, Wolff J, Hamilton J, Zaky W, Mahajan A, Ketonen L, Kim SH, Lee SR, Ji, Oh Y, Krishna U, Shah N, Pathak R, Gupta T, Lila A, Menon P, Goel A, Jalali R, Lall R, Lall R, Smith T, Schumacher A, McCaslin A, Kalapurakal J, Chandler J, Magnuson W, Robins HI, Mohindra P, Howard S, Mahajan A, Manfredi D, Rogers CL, Palmer M, Hillebrandt E, Bilton S, Robinson G, Velasco K, Mehta M, McGregor J, Grecula J, Ammirati M, Pelloski C, Lu L, Gupta N, Bell S, Moller S, Law I, Rosenschold PMA, Costa J, Poulsen HS, Engelholm SA, Morrison A, Cuglievan B, Khatib Z, Mourad WF, Kabarriti R, Young R, Santiago T, Blakaj DM, Welch M, Graber J, Patel S, Hong LX, Patel A, Tandon A, Bernstein MB, Shourbaji RA, Glanzman J, Kinon MD, Fox JL, Lasala P, Kalnicki S, Garg MK, Nicholas S, Salvatori R, Lim M, Redmond K, Quinones A, Gallia G, Rigamonti D, Kleinberg L, Patel S, Mourad W, Young R, Kabarriti R, Santiago T, Glanzman J, Bernstein M, Patel A, Yaparpalvi R, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Redmond K, Mian O, Degaonkar M, Sair H, Terezakis S, Kleinberg L, McNutt T, Wharam M, Mahone M, Horska A, Rezvi U, Melian E, Surucu M, Mescioglu I, Prabhu V, Clark J, Anderson D, Robbins J, Yechieli R, Ryu S, Ruge MI, Suchorska B, Hamisch C, Mahnkopf K, Lehrke R, Treuer H, Sturm V, Voges J, Sahgal A, Al-Omair A, Masucci L, Masson-Cote L, Atenafu E, Letourneau D, Yu E, Rampersaud R, Lewis S, Yee A, Thibault I, Fehlings M, Shi W, Palmer J, Li J, Kenyon L, Glass J, Kim L, Werner-wasik M, Andrews D, Susheela S, Revannasiddaiah S, Muzumder S, Mallarajapatna G, Basavalingaiah A, Gupta M, Kallur K, Hassan M, Bilimagga R, Tamura K, Aoyagi M, Ando N, Ogishima T, Yamamoto M, Ohno K, Maehara T, Xu Z, Vance ML, Schlesinger D, Sheehan J, Young R, Blakaj D, Kinon MD, Mourad W, LaSala PA, Hong L, Kalnicki S, Garg M, Young R, Mourad W, Patel S, Fox J, LaSala PA, Hong L, Graber JJ, Santiago T, Kalnicki S, Garg M, Zimmerman AL, Vogelbaum MA, Barnett GH, Murphy ES, Suh JH, Angelov L, Reddy CA, Chao ST. RADIATION THERAPY. Neuro Oncol 2013; 15:iii178-iii188. [PMCID: PMC3823902 DOI: 10.1093/neuonc/not187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
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Yang C, Tandon A. A Pictorial Review of Diabetic foot Manifestations. Med J Malaysia 2013; 68:279-289. [PMID: 23749027] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The diabetic foot with its many associated complications and presentations can provide a challenge in diagnosis and subsequent treatment. MRI, being increasingly available commonly, is now the main investigative modality. In particular, it is helpful in differentiating between neuroarthropathy and osteomyelitis and in cases where the latter is superimposed on the former. By being well versed in the interpretation of the images, the radiologist can make crucial contribution to the care and management of these patients.
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Affiliation(s)
- C Yang
- National University Hospital, Radiology, 25 Aida street, Singapore, Singapore 459950, Singapore.
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Abstract
Neonatal systemic hypertension is an underappreciated etiology of cardiac failure. We present a series of three neonates who presented in cardiogenic shock secondary to severe hypertension, recognized after initial resuscitation efforts. Although the underlying etiology of the hypertension varied, all three patients had improved hemodynamics after their blood pressure was controlled. These cases suggest that neonates presenting in cardiogenic shock with hypertension, and without structural heart disease, may benefit from a thorough renal evaluation and institution of anti-hypertensive therapy.
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Affiliation(s)
- N Xiao
- Division of Pediatric Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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35
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Singh I, Mehrotra G, Jaura M, Tandon A, Agarwal V, Joshi M. UP-01.035 Virtual Cystoscopy (Pneumo-Cystoscopy): Its Utility in the Prospective Evaluation of Bladder Tumor. Urology 2011. [DOI: 10.1016/j.urology.2011.07.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tandon R, Tandon A, Abrari A, Chandrashekhar M, Das P, Bansal B. Juvenile psammomatoid ossifying fibroma: a rare cause of unilateral proptosis. Case Reports 2011; 2011:bcr.05.2011.4195. [DOI: 10.1136/bcr.05.2011.4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mohan RR, Tovey JCK, Gupta R, Sharma A, Tandon A. Decorin biology, expression, function and therapy in the cornea. Curr Mol Med 2011; 11:110-28. [PMID: 21342131 DOI: 10.2174/156652411794859241] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 12/24/2010] [Indexed: 11/22/2022]
Abstract
Decorin is a small leucine-rich proteoglycan (SLRP) that plays a vital role in many important cellular processes in several tissues including the cornea. A normal constituent of the corneal stroma, decorin is also found in the majority of connective tissues and is related structurally to other small proteoglycans. It interacts with various growth factors such as epidermal growth factor (EGF) and transforming growth factor beta (TGFβ) to regulate processes like collagen fibrillogenesis, extracellular matrix (ECM) compilation, and cell-cycle progression. Studies have linked decorin dysregulation to delayed tissue healing in patients with various diseases including cancer. In the cornea, decorin is involved in the regulation of transparency, a key function for normal vision. It has been reported that mutations in the decorin gene are associated with congenital stromal dystrophy, a disease that leads to corneal opacity and visual abnormalities. Decorin also antagonizes TGFβ in the cornea, a central regulatory cytokine in corneal wound healing. Following corneal injury, increased TGFβ levels induce keratocyte transdifferentiation to myofibroblasts and, subsequently, fibrosis (scarring) in the cornea. We recently reported that decorin overexpression in corneal fibroblasts blocks TGFβ-driven myofibroblast transformation and fibrosis development in the cornea in vitro suggesting that decorin gene therapy can be used for the treatment of corneal scarring in vivo.
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Affiliation(s)
- R R Mohan
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201, USA.
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Tandon A, Karim MA, Muddaiah A, Baranyovits P. A case report of chronic frontal bone osteitis presenting with recurrent unilateral lid swelling. J Surg Case Rep 2010; 2010:1. [PMID: 24945838 PMCID: PMC3649182 DOI: 10.1093/jscr/2010.10.1] [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] [Indexed: 11/13/2022] Open
Abstract
Despite the advances in modern antimicrobial treatment, paranasal sinus disease remains relatively common. A case of chronic inflammatory frontal sinus disease presented with unilateral recurrent eyelid swelling. Clinical features and management in conjunction with ENT are discussed. An extensive literature search has shown only one other similar case reported in Russian language whose management details however are not available.
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Affiliation(s)
- A Tandon
- Kettering General Hospital, Kettering, UK
| | | | - A Muddaiah
- Kettering General Hospital, Kettering, UK
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Barker CA, Chang M, Lassman AB, Beal K, Chan TA, Hunter K, Grisdale K, Ritterhouse M, Moustakas A, Iwamoto FM, Kreisl TN, Sul J, Kim L, Butman J, Albert P, Fine HA, Chamberlain MC, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Takahashi K, Ikeda N, Kajimoto Y, Miyatake S, Kuroiwa T, Iwamoto F, Lamborn K, Kuhn J, Wen P, Yung WKA, Gilbert M, Chang S, Lieberman F, Prados M, Fine H, Lu-Emerson C, Norden AD, Drappatz J, Quant EC, Ciampa AS, Doherty LM, LaFrankie DC, Wen PY, Sherman JH, Moldovan K, Yeoh HK, Starke BM, Pouratian N, Shaffrey ME, Schiff D, O'Connor PC, Kroon HA, Recht L, Montano N, Cenci T, Martini M, D'Alessandris QG, Banna GL, Maira G, De Maria R, Larocca LM, Pallini R, Kim CH, Yang MS, Cheong JH, Kim JM, Shonka N, Gilbert M, Alfred Yung WK, Piao Y, Liu J, Bekele N, Wen P, Chen A, Heymach J, de Groot J, Gilbert MR, Wang M, Aldape K, Sorensen AG, Mikkelsen T, Bokstein F, Woo SY, Chmura SJ, Choucair AK, Mehta M, Perez Segura P, Gil M, Balana C, Chacon I, Munoz J, Martin M, Flowers A, Salner A, Gaziel TB, Soerensen M, Hasselbalch B, Poulsen HS, Lassen U, Peyre M, Cartalat-Carel S, Meyronet D, Sunyach MP, Jouanneau E, Guyotat J, Jouvet A, Frappaz D, Honnorat J, Ducray F, Wagle N, Nghiemphu PL, Lai A, Cloughesy TF, Kairouz VF, Elias EF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Parchman AJ, Nock CJ, Bartolomeo J, Norden AD, Drappatz J, Ciampa AS, Doherty LM, LaFrankie DC, Ruland S, Quant EC, Beroukhim R, Wen PY, Graber JJ, Lassman AB, Kaley T, Johnson DR, Kimmel DW, Burch PA, Cascino TL, Giannini C, Wu W, Buckner JC, Dirier A, Abacioglu U, Okkan S, Pak Y, Guney YY, Aksu G, Soyuer S, Oksuzoglu B, Meydan D, Zincircioglu B, Yumuk PF, Alco G, Keven E, Ucer AR, Tsung AJ, Prabhu SS, Shonka NA, Alistar AT, van den Bent M, Taal W, Sleijfer S, van Heuvel I, Smitt PAS, Bromberg JE, Vernhout I, Porter AB, Dueck AC, Karlin NJ, Hiramatsu R, Kawabata S, Miyatake SI, Kuroiwa T, Easson MW, Vicente MGH, Sahebjam S, Garoufalis E, Guiot MC, Muanza T, Del Maestro R, Kavan P, Smolin AV, Konev A, Nikolaeva S, Shamanskaya Y, Malysheva A, Strelnikov V, Vranic A, Prestor B, Pizem J, Popovic M, Khatua S, Finlay J, Nelson M, Gonzalez I, Bruggers C, Dhall G, Fu BD, Linskey M, Bota D, Walbert T, Puduvalli V, Ozawa T, Brennan CW, Wang L, Squatrito M, Sasayama T, Nakada M, Huse JT, Pedraza A, Utsuki S, Tandon A, Fomchenko EI, Oka H, Levine RL, Fujii K, Ladanyi M, Holland EC, Raizer J, Avram MJ, Kaklamani V, Cianfrocca M, Gradishar W, Helenowski I, McCarthy K, Mulcahy M, Rademaker A, Grimm S, Landolfi JC, Chen S, Peeraully T, Anthony P, Linendoll NM, Zhu JJ, Yao K, Mignano J, Pfannl R, Pan E, Vera-Bolanos E, Armstrong TS, Bekele BN, Gilbert MR, Alexandru D, Glantz MJ, Kim L, Chamberlain MC, Bota DA, Albrecht V, Juerchott K, Selbig J, Tonn JC, Schichor C, Sawale KB, Wolff J, Vats T, Ketonen L, Khasraw M, Kaley T, Panageas K, Reiner A, Goldlust S, Tabar V, Green RM, Woyshner EA, Cloughesy TF, Abe T, Morishige M, Shiqi K, Momii Y, Sugita K, Fukuyoshi Y, Kamida T, Fujiki M, Kobayashi H, Lavon I, Refael M, Zrihan D, Siegal T, Elias EF, Kairouz VF, Chahine GY, Comair YG, Dimassi H, Kamar FG, Tham CK, See SJ, Toh CK, Kang SH, Park KJ, Kim CY, Yu MO, Park CK, Park SH, Chung YG, Park KJ, Yu MO, Kang SH, Cho TH, Chung YG, Sasaki H, Sano K, Nariai T, Uchino Y, Kitamura Y, Ohira T, Yoshida K, Kirson ED, Wasserman Y, Izhaki A, Mordechovich D, Gurvich Z, Dbaly V, Vymazal J, Tovarys F, Salzberg M, Rochlitz C, Goldsher D, Palti Y, Ram Z, Gutin PH, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Torcuator RG, Ibaoc K, Rafael A, Mariano M, Reardon DA, Peters K, Desjardins A, Sampson J, Vredenburgh JJ, Gururangan S, Friedman HS, Le Rhun E, Kotecki N, Zairi F, Baranzelli MC, Faivre-Pierret M, Dubois F, Bonneterre J, Arenson EB, Arenson JD, Arenson PK, Pierick M, Jensen W, Smith DB, Wong ET, Gautam S, Malchow C, Lun M, Pan E, Brem S, Raizer J, Grimm S, Chandler J, Muro K, Rice L, McCarthy K, Mrugala M, Johnston SK, Chamberlain M, Marosi C, Handisurya A, Kautzky-Willer A, Preusser M, Elandt K, Widhalm G, Dieckmann K, Torcuator RG, Opinaldo P, Chua E, Barredo C, Cuanang J, Grimm S, Phuphanich S, Recht LD, Rosenfeld SS, Chamberlain MC, Zhu JJ, Fadul CE, Swabb EA, Pope C, Beelen AP, Raizer JJ, Kim IH, Park CK, Han JH, Lee SH, Kim CY, Kim TM, Kim DW, Kim JE, Paek SH, Kim IA, Kim YJ, Kim JH, Nam DH, Rhee CH, Lee SH, Park BJ, Kim DG, Heo DS, Jung HW, Desjardins A, Peters KB, Vredenburgh JJ, Friedman HS, Reardon DA, Becker K, Baehring J, Hammond SN, Norden AD, Fisher DC, Wong ET, Cote GM, Ciampa AS, Doherty LM, Ruland SF, LaFrankie DC, Wen PY, Drappatz J, Brandes AA, Franceschi E, Tosoni A, Poggi R, Agati R, Bartolini S, Spagnolli F, Pozzati E, Marucci G, Ermani M, Taillibert S, Guillevin R, Dehais C, Bellanger A, Delattre JY, Omuro A, Taillibert S, Hoang-Xuan K, Barrie M, Guiu S, Chauffert B, Cartalat-Carel S, Taillandier L, Fabbro M, Laigre M, Guillamo JS, Geffrelot J, Rouge TDLM, Bonnetain F, Chinot O, Gil MJ, de las Penas R, Reynes G, Balana C, Perez-Segura P, Garcia-Velasco A, Gallego O, Herrero A, de Lucas CFC, Benavides M, Perez-Martin X, Mesia C, Martinez-Garcia M, Muggeri AD, Cervio A, Rojas M, Arakaki N, Sevlever GE, Diez BD, Muggeri AD, Cerrato S, Martinetto H, Diez BD, Peereboom DM, Brewer CJ, Suh JH, Chao ST, Parsons MW, Elson PJ, Vogelbaum MA, Sade B, Barnett GH, Shonka NA, Yung WKA, Bekele N, Gilbert MR, Kobyakov G, Absalyamova O, Amanov R, Rauschkolb PK, Drappatz J, Batchelor TT, Meyer LP, Fadul CE, Lallana EC, Nghiemphu PL, Kohanteb P, Lai A, Green RM, Cloughesy TF, Mrugala MM, Lee LK, Graham CA, Fink JR, Spence AM, Portnow J, Badie B, Liu X, Frankel P, Chen M, Synold TW, Al Jishi AA, Golan J, Polley MYC, Lamborn KR, Chang SM, Butowski N, Clarke JL, Prados M, Grommes C, Oxnard GR, Kris MG, Miller VA, Pao W, Lassman AB, Renfrow J, DeTroye A, Chan M, Tatter S, Ellis T, McMullen K, Johnson A, Mott R, Lesser GJ, Cavaliere R, Abrey LE, Mason WP, Lassman AB, Perentesis J, Ivy P, Villalona M, Nayak L, Fleisher M, Gonzalez-Espinoza R, Reiner A, Panageas K, Lin O, Liu CM, Deangelis LM, Omuro A, Taylor LP, Ammirati M, Lamki T, Zarzour H, Grecula J, Dudley RW, Kavan P, Garoufalis E, Guiot MC, Del Maestro RF, Maurice C, Belanger K, Moumdjian R, Dufresne S, Fortin C, Fortin MA, Berthelet F, Renoult E, Belair M, Rouleau D, Gallego O, Benavides M, Segura PP, Balana C, Gil MJG, Berrocal A, Reynes G, Garcia JL, Mazarico J, Bague S. Medical and Neuro-Oncology. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s6] [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: 11/13/2022] Open
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Tandon A, Gupta A, Yateesh S, Dua A, Kumar S. Necrotising fasciitis of the cervicofacial region: a bizarre presentation. J Wound Care 2010; 19:454-6. [PMID: 20948494 DOI: 10.12968/jowc.2010.19.10.79093] [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: 11/11/2022]
Abstract
The following paper presents the case of a middle-aged woman, who presented with a necrotising soft tissue infection of the cervicofacial region with maggots in situ. She was managed with aggressive surgical debridement, but eventually succumbed to the disease because of erosion of the great vessels of the neck by the maggots. The purpose of this case report is to emphasise the severity of this disease and also to present an unusual case, which had a fatal outcome.
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Affiliation(s)
- A Tandon
- Department of General Surgery, University College of Medical Sciences and Associated, Guru Teg Bahdur Hospital, New Delhi, India
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Mulvihill AO, Jones P, Tandon A, Fleck BW, Minns RA. An inter-observer and intra-observer study of a classification of RetCam images of retinal haemorrhages in children. Br J Ophthalmol 2010; 95:99-104. [DOI: 10.1136/bjo.2009.168153] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tandon A, Gulleria K, Gupta S, Goel S, Bhargava SK, Vaid NB. Mature ovarian dermoid cyst invading the urinary bladder. Ultrasound Obstet Gynecol 2010; 35:751-753. [PMID: 20069670 DOI: 10.1002/uog.7524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Mature ovarian dermoid cysts are common lesions, accounting for up to 10-25% of all ovarian neoplasms. Uncomplicated dermoid cysts are often asymptomatic and are relatively easy to diagnose on imaging and to treat. Symptoms develop once complications set in and these may cause diagnostic dilemmas. Torsion (16%) is the most common complication, while rupture, suppuration and malignant transformation are relatively uncommon. Of all these complications, spontaneous rupture into the urinary bladder is least common. The diagnosis of this condition has been through the use of cystoscopy or laparotomy in all cases reported so far. We report a case of a 30-year-old patient with pyuria and dysuria, where ultrasound examination clearly demonstrated an ovarian dermoid cyst invading the urinary bladder. A clear-cut imaging diagnosis helped to allow planning of surgery in advance and a mucosa-sparing partial bladder resection could be performed.
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Affiliation(s)
- A Tandon
- Department of Radiology & Imaging, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi, India
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Mahadevan A, Tandon A, Ferrari R. Rapid changes in mixed layer stratification driven by submesoscale instabilities and winds. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2008jc005203] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fleck BW, Tandon A, Jones PA, Mulvihill AO, Minns RA. An interrater reliability study of a new 'zonal' classification for reporting the location of retinal haemorrhages in childhood for clinical, legal and research purposes. Br J Ophthalmol 2009; 94:886-90. [DOI: 10.1136/bjo.2009.162271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Umesh S, Tandon A, Santosh V, Anandh B, Sampath S, Chandramouli BA, Sastry Kolluri VR. Clinical and immunohistochemical prognostic factors in adult glioblastoma patients. Clin Neuropathol 2009; 28:362-372. [PMID: 19788052] [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: 05/28/2023] Open
Abstract
OBJECTIVE Glioblastomas are the commonest and the most malignant of all adult brain tumors, characterized by genetic instability, intratumoral histopathological variability, and unpredictable clinical behavior. The utility of tumor markers that reflect their underlying biology is becoming increasingly important with respect to patient prognostication and their potential role as molecular targets of therapy is being recognized. In this study, we aimed to identify the clinical factors and some immunohistochemical markers that could have an effect on patient survival in supratentorial glioblastomas. MATERIALS AND METHODS We evaluated 54 cases of adult supratentorial glioblastomas operated over a span of 1 year, with respect to clinical features such as age, Karnofsky performance score (KPS), extent of resection, adjuvant therapy, and immunohistochemical expression of p53, EGFR (Epidermal Growth Factor Receptor) and PTEN (Phosphatase and Tensin homolog). RESULTS Radiotherapy and KPS at presentation were significant predictors of outcome in both univariate and multivariate analyses. Among immunohistochemical variables; loss of PTEN expression in association with over-expression of EGFR showed a trend towards poorer survival, in univariate analysis. Over-expression of EGFR and/or p53 emerged as significant predictors of poor outcome on multivariate analysis, despite failing to prognosticate on univariate analysis. CONCLUSIONS Our study shows that EGFR and p53 overexpression along with loss of PTEN expression are important adjuncts to clinical variables in prognosticating glioblastoma patients.
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Affiliation(s)
- S Umesh
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Scherer ML, Nalls MA, Pawlikowska L, Ziv E, Mitchell G, Huntsman S, Hu D, Sutton-Tyrrell K, Lakatta EG, Hsueh WC, Newman AB, Tandon A, Kim L, Kwok PY, Sung A, Li R, Psaty B, Reiner AP, Harris T. Admixture mapping of ankle-arm index: identification of a candidate locus associated with peripheral arterial disease. J Med Genet 2009; 47:1-7. [PMID: 19586928 DOI: 10.1136/jmg.2008.064808] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is associated with significant morbidity and mortality, and has a higher prevalence in African Americans than Caucasians. Ankle-arm index (AAI) is the ratio of systolic blood pressure in the leg to that in the arm, and, when low, is a marker of PAD. METHODS The authors used an admixture mapping approach to search for genetic loci associated with low AAI. Using data from 1040 African American participants in the observational, population based Health, Aging, and Body Composition Study who were genotyped at 1322 single nucleotide polymorphisms (SNPs) that are informative for African versus European ancestry and span the entire genome, we estimated genetic ancestry in each chromosomal region and then tested the association between AAI and genetic ancestry at each locus. RESULTS The authors found a region of chromosome 11 that reaches its peak between 80 and 82 Mb associated with low AAI (p<0.001 for rs12289502 and rs9665943, both within this region). 753 African American participants in the observational, population based Cardiovascular Health Study were genotyped at rs9665943 to test the reproducibility of this association, and this association was also statistically significant (odds ratio (OR) for homozygous African genotype 1.59, 95% confidence interval (CI) 1.12 to 2.27). Another candidate SNP (rs1042602) in the same genomic region was tested in both populations, and was also found to be significantly associated with low AAI in both populations (OR for homozygous African genotype 1.89, 95% CI 1.29 to 2.76). CONCLUSION This study identifies a novel region of chromosome 11 representing an area with a potential candidate gene associated with PAD in African Americans.
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Affiliation(s)
- M L Scherer
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD 20892-9205, USA
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Tandon A, Bhargava SK, Gupta A, Bhatt S. Spontaneous transmural migration of retained surgical textile into both small and large bowel: a rare cause of intestinal obstruction. Br J Radiol 2009; 82:e72-5. [PMID: 19325042 DOI: 10.1259/bjr/32683906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Retained surgical textile is an infrequent but serious complication of abdominal surgery. Diagnosis is often delayed owing to non-specific clinical symptoms and inconclusive imaging features. Medicolegal implications further complicate the issue. We report a case of a 30-year-old woman who had previously undergone caesarean section and who presented with pain and features of intestinal obstruction. Contrast-enhanced CT revealed a heterogeneous ill-defined mass with mottled air densities lying within both the large and the small bowel. Barium study beautifully demonstrated the intraluminal mass in the transverse colon extending into the jejunum, with a fistulous communication between the two loops. To the best of our knowledge, this is the first reported case in which the gauze migrated simultaneously into the large and small bowel, and where the exact site of migration was clearly mapped out on pre-operative imaging studies.
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Affiliation(s)
- A Tandon
- University College of Medical Sciences & Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi 110095, India
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