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Wei N, Lamba A, Franciosi S, Law I, Ochoa L, Johnsrude C, Kwok S, Tan T, Dhillon S, Fournier A, Seslar S, Stephenson E, Blaufox A, Cabrera Ortega M, Escudero C, Sanatani S. SUPRAVENTRICULAR TACHYCARDIA IN INFANTS: DOES MEDICATION CHOICE MATTER? Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.068] [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] Open
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Lamba A, Parekh P, Dvorak CT, Karlitz JJ. Pedigree analysis supports a correlation between an AXIN2 variant and polyposis/colorectal cancer. World J Med Genet 2018; 8:1-4. [DOI: 10.5496/wjmg.v8.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/18/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
We present a patient with a history of colonic polyposis and family history significant for colon polyps and colorectal cancer (CRC). The patient and the family also had a history of bone loss of the jaw and early tooth loss, consistent with oligodontia. Genetic testing revealed the patient to have a previously unpublished variant of unknown significance (VUS) in the AXIN2 gene. These clinical findings have been demonstrated previously in only two other families, both of which exhibited oligodontia, colorectal neoplasia (polyps and cancer) and a heterozygous mutation in AXIN2. The AXIN2 protein is component of the Wnt pathway, which is known to be vital for organism development and cellular homeostasis. Alterations of the Wnt pathway lead to cell proliferation and neoplasm, in addition to agenesis of physical structures (such as teeth). The analysis of our pedigree further supports an association between colonic neoplasm (polyposis and CRC), the AXIN2 gene in general, and this particular VUS. It also highlights the importance of analyzing and disseminating information on pedigrees with less commonly encountered genomic abnormalities so that genotypic-phenotypic correlations can be solidified.
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Affiliation(s)
- Amrit Lamba
- Department of Internal Medicine, Tulane University, New Orleans, LA 70112, United States
| | - Parth Parekh
- Department of Gastroenterology, Carillion Clinic, Roanoke, VA 24016, United States
| | - Chris T Dvorak
- Department of Genetics, Tulane University, New Orleans, LA 70112, United States
| | - Jordan J Karlitz
- Department of Gastroenterology, Tulane University, New Orleans, LA 70112, United States
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Seidu S, Than T, Kar D, Lamba A, Brown P, Zafar A, Hussain R, Amjad A, Capehorn M, Martin E, Fernando K, McMoran J, Millar-Jones D, Kahn S, Campbell N, Brice R, Mohan R, Mistry M, Kanumilli N, St John J, Quigley R, Kenny C, Khunti K. Therapeutic inertia amongst general practitioners with interest in diabetes. Prim Care Diabetes 2018; 12:87-91. [PMID: 28993141 DOI: 10.1016/j.pcd.2017.09.001] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists. METHODS In this retrospective audit, we assessed the prevalence of the phenomenon of therapeutic inertia amongst primary care physicians with an interest in diabetes in UK. We also assessed the predictive abilities of various patient level characteristics on therapeutic inertia amongst this group of clinicians. RESULTS Out of the 240 patients reported on, therapeutic inertia was judged to have occurred in 53 (22.1%) of patients. The full model containing all the selected variables was not statistically significant, p=0.59. So the model was not able to distinguish between situations in which therapeutic inertia occurred and when it did not occur. None of the patient level characteristics on its own was predictive of therapeutic inertia. CONCLUSION Therapeutic inertia was present only in about a fifth of patient patients with diabetes being managed by primary care physicians with an interest in diabetes.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, Gwendolen Road, Leicester General Hospital, Leicester LE5 4WP, United Kingdom.
| | - Tun Than
- Diabetes Research Centre, Gwendolen Road, Leicester General Hospital, Leicester LE5 4WP, United Kingdom
| | - Deb Kar
- Diabetes Research Centre, Gwendolen Road, Leicester General Hospital, Leicester LE5 4WP, United Kingdom
| | - Amrit Lamba
- Colindale Medical Centre, 61 Colindeep Lane, Colindale, London, NW9 6DJ, United Kingdom
| | - Pam Brown
- Kings Road Surgery, Mumbles, Swansea, United Kingdom
| | - Azhar Zafar
- Diabetes Research Centre, Gwendolen Road, Leicester General Hospital, Leicester LE5 4WP, United Kingdom
| | | | - Ahmed Amjad
- Cheetham Hill Primary Care Centre, 244 Cheetham Hill Road, Manchester, Greater Manchester, M8 8UP, United Kingdom
| | | | - Elizabeth Martin
- Diabetes Department, St. James Teaching Hospital, United Kingdom
| | - Kevin Fernando
- North Berwick Health Centre, North Berwick Group Practice, 54 St. Baldred's Road, North Berwick, EH39 4PU, United Kingdom
| | - Jim McMoran
- The Community Diabetes and Cardiovascular Risk Clinic service is based on the first floor Spires Suite of City of Coventry Health Centre, 2 Stoney Stanton Road, Coventry CV1 4FS, United Kingdom
| | | | - Shahzada Kahn
- Vicarage Lane Health Centre, 10 Vicarage Lane, Stratford, London, Greater London, E15 4ES, United Kingdom
| | - Nigel Campbell
- Lisburn Health Centre, Linenhall Street, Lisburn, BT28 1LU, United Kingdom
| | - Richard Brice
- Estuary View Medical Centre, Boorman Way, Whitstable, CT5 3SE, United Kingdom
| | - Rahul Mohan
- Church House Surgery, Shaw Street, NG11 6HF Ruddington, United Kingdom
| | - Mukesh Mistry
- The Community Diabetes and Cardiovascular Risk Clinic service is based on the first floor Spires Suite of City of Coventry Health Centre, 2 Stoney Stanton Road, Coventry CV1 4FS, United Kingdom
| | | | - Joan St John
- Law Medical Group Practice, Wembley and Willesden, United Kingdom
| | - Richard Quigley
- Thornliebank Health Centre, 20 Kennishead Road, Glasgow, G46 8NY, United Kingdom
| | | | - Kamlesh Khunti
- Diabetes Research Centre, Gwendolen Road, Leicester General Hospital, Leicester LE5 4WP, United Kingdom
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Abstract
This case of infective endocarditis masquerading as mixed cryoglobulinemia in a man with a history of intravenous drug use (IVDU) and hepatitis C virus (HCV) highlights the importance of maintaining a broad differential and continually re-evaluating the working diagnosis as new information presents itself. The patient presented to an outside hospital and was treated for presumptive mixed cryoglobulinemia with corticosteroid therapy. When the patient did not improve, he was transferred to a tertiary care center for possible Rituximab and/or plasmapheresis. Further investigation revealed Enterococcus bacteremia with subsequent workup consistent with infective endocarditis (IE). This case highlights a diagnostic dilemma and demonstrates the importance of a thorough evaluation as it pertains to overlapping features of IE and mixed cryoglobulinemia.
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Affiliation(s)
- Amrit Lamba
- Tulane University, Department of Internal Medicine, United States
| | - Meghan Kapp
- Vanderbilt University, Department of Pathology, United States
| | | | - Parth J. Parekh
- Tulane University, Department of Internal Medicine, Division of Gastroenterology and Hepatology, United States
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Lamba A. AND YOU THOUGHT HORMONES WERE THE PROBLEM IN PREGNANCY. J La State Med Soc 2015; 167:151. [PMID: 27159472] [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] [Indexed: 06/05/2023]
Abstract
A 20-year-old woman, G2P1, presented to the labor and delivery triage with right flank pain and emesis of sudden onset without any precipitating factors. The patient denied history of trauma, anticoagulant therapy, or hypertension. At the time of admission, the patient was in severe pain, was afebrile, had a blood pressure of 139/79, and heart rate of 96. Abdominal exam revealed no tenderness to palpation without guarding or rebound. Musculoskeletal tenderness was elicited from infra-scapular region to the sacroiliac joint on the right side. Mild right costovertebral tenderness was noted. Her cervix was dilated 3cm, effaced 50 percent, with fetal station at -3, unchanged from previous visit. Fetal monitor tracing was reassuring and obstetric ultrasonogram at 22 weeks showed normal fetal anatomy. Magnetic resonance imaging (MRI) revealed T2 hyperintense signal involving and surrounding the right adrenal gland suggesting infarct.
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Affiliation(s)
- A Lamba
- Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
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Lentz TJ, Dotson GS, Williams PR, Maier A, Gadagbui B, Pandalai SP, Lamba A, Hearl F, Mumtaz M. Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors. J Occup Environ Hyg 2015; 12 Suppl 1:S112-26. [PMID: 26583907 PMCID: PMC4654690 DOI: 10.1080/15459624.2015.1060326] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 02/20/2015] [Accepted: 03/02/2015] [Indexed: 05/20/2023]
Abstract
Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.
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Affiliation(s)
- T. J. Lentz
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
- Address correspondence to Thomas J. Lentz, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Education and Information Division, 1090 Tusculum Avenue, MS C-32, Cincinnati45226, OH. E-mail:
| | - G. S. Dotson
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | | | - A. Maier
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - B. Gadagbui
- Toxicology Excellence for Risk Assessment, Cincinnati, Ohio
| | - S. P. Pandalai
- Education and Information Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - A. Lamba
- Office of Pollution Prevention and Toxics, Environmental Protection Agency, Washington, DC
| | - F. Hearl
- Office of the Director, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC
| | - M. Mumtaz
- Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kakkar N, Vasishta RK, Lamba A, Narang A, Banerjee AK. Pathology teach and tell: perinatal recessive polycystic kidney disease with congenital hepatic fibrosis. Pediatr Pathol Mol Med 2001; 20:227-34. [PMID: 11486353] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- N Kakkar
- Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India
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Kakkar N, Vasishta RK, Lamba A, Trehan A, Marwaha RK. Special feature: pathological case of the month. Denouement and discussion: congenital adrenocortical carcinoma. Arch Pediatr Adolesc Med 2000; 154:1267-8. [PMID: 11115315 DOI: 10.1001/archpedi.154.12.1267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- S Kiran
- Department of Anesthesiology & Critical Care, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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