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Gupta N, Gupta D, Vaska KG, Prinja S. Cost-Effectiveness Analysis of Systemic Therapy for Intensification of Treatment in Metastatic Hormone-Sensitive Prostate Cancer in India. Appl Health Econ Health Policy 2024; 22:415-426. [PMID: 38198103 DOI: 10.1007/s40258-023-00866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Androgen-deprivation therapy is the mainstay of treatment for patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). However, the intensification of treatment with either docetaxel or novel anti-androgens (abiraterone-acetate plus prednisone [AAP], enzalutamide, and apalutamide) is being recommended based on the improved clinical outcomes and quality of life among patients. This study aimed to determine the most cost-effective drug for treatment intensification for patients with mHSPC in India. METHODS A Markov model was developed with four health states: progression-free survival, progressive disease, best supportive care, and death. Lifetime costs and consequences were estimated for four treatment sequences: AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost effectiveness using a willingness to pay threshold of 1 × per capita gross domestic product in India. RESULTS We estimated that the total lifetime cost per patient was ₹1,367,454 (US$17,487), ₹2,168,885 (US$27,735), ₹7,678,501 (US$98,190), and ₹1,358,746 (US$17,375) in the AAP-first, enzalutamide-first, apalutamide-first, and docetaxel-first treatment sequence, respectively. The mean quality-adjusted life-years lived per patient were 4.78, 5.03, 3.22, and 2.61, respectively. The AAP-first sequence incurs an incremental cost of ₹4014 (US$51) per quality-adjusted life-year gained as compared with the docetaxel-first sequence, with a 87% probability of being cost effective at the willingness-to-pay threshold of 1 × per-capita gross domestic product of India. The use of AAP-first also incurs an incremental net monetary benefit of ₹396,491 (US$5070) as compared with the docetaxel-first treatment sequence. Nearly a 48% reduction in the price of enzalutamide is required to make it a cost-effective treatment sequence as compared with AAP-first in India. CONCLUSIONS We concur with the inclusion of standard-dose AAP in India's publicly financed health insurance scheme for the intensification of treatment in mHSPC as it is the only cost-effective sequence among the various novel anti-androgens when compared with the docetaxel-first treatment sequence. Furthermore, a systematic reduction in the price of enzalutamide would further help to improve clinical outcomes among patients with mHSPC.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Madhya Marg, Near Gol Market, Sector 14, Chandigarh, 160014, India
| | - Kiran Gopal Vaska
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Madhya Marg, Near Gol Market, Sector 14, Chandigarh, 160014, India.
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Sharma A, Prinja S, Thakur R, Gupta D, Kaur R, Sharma S, Munjal S, Panda N. Healthcare Cost of Cochlear Implantation in India. Indian J Otolaryngol Head Neck Surg 2024; 76:1716-1723. [PMID: 38566707 PMCID: PMC10982277 DOI: 10.1007/s12070-023-04389-7] [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: 10/23/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
Making evidence-based policy decisions is challenging when there is a lack of information, especially when deciding provider payment rates for publicly funded health insurance plans. Therefore, the goal of this study was to estimate the cost of a cochlear implant operation in a tertiary care setting in India. We also looked at the patients' out-of-pocket (OOP) expenses for the cochlear implant surgery. From the perspectives of the patients and the healthcare systems, we assessed the financial costs of the cochlear implantation procedure. A bottom-up pricing model was used to assess the cost that the healthcare system would bear for a cochlear implant procedure. Information on all the resources (both capital and ongoing) required to offer cochlear implantation services for hearing loss was gathered over the course of a year. 120 individuals with hearing loss who had cochlear implantation surgery disclosed their out-of-pocket (OOP) costs, which included both direct medical and non-medical expenses. All costs for the budgetary year 2018-2019 were anticipated. The unit health system spent ₹ 151($2), ₹ 578($7.34) and ₹ 37,449($478) on ear exams, audiological evaluations, and cochlear implant surgeries, respectively. Per bed-day in the otolaryngology ward, hospitalization cost ₹ 202($2.6), or ₹ 1211($15.5). The estimated average out-of-pocket cost for a cochlear implant operation was ₹ 682,230($8710). Our research can be used to establish package rates for publicly funded insurance plans in India, plan the growth of public sector hearing care services, and do cost-effectiveness assessments on various hearing care models. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04389-7.
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Affiliation(s)
- Anuradha Sharma
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Shankar Prinja
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravinder Thakur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dharna Gupta
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajwinder Kaur
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sameer Sharma
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Munjal
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh Panda
- Department of Otolaryngology, Speech and Hearing Unit, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Dixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, Singh A, Malhotra P, Gupta D, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S, Prinja S. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes 2024; 22:26. [PMID: 38481231 PMCID: PMC10938809 DOI: 10.1186/s12955-024-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. METHODS Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. RESULTS Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45-60 years and females (49.3-58.3%). Most patients were found to be in stage III (40-40.6%) or stage IV (29.4-37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). CONCLUSION Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Amal Kataki
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Partha Roy
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Gupta D, Gupta N, Singh N, Prinja S. Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase- and ROS1 Fusion-Positive Non-Small Cell Lung Cancer in India. JCO Glob Oncol 2024; 10:e2300260. [PMID: 38359374 PMCID: PMC10881089 DOI: 10.1200/go.23.00260] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Targeted therapies, such as crizotinib and ceritinib, have shown promising results in treating non-small cell lung cancer (NSCLC) with specific oncogenic drivers like anaplastic lymphoma kinase (ALK), c-ros (ROS1) oncogene, etc. This study aims to assess the cost-effectiveness of these therapies for patients with NSCLC in India. METHODS The Markov model consisted of three health states: progression-free survival, progressive disease, and death. Lifetime costs and consequences were estimated for three treatment arms: crizotinib, ceritinib, and chemotherapy for patients with ALK- and ROS1-positive NSCLC. Incremental cost per quality-adjusted life-year (QALY) gained with crizotinib and ceritinib was compared to chemotherapy and assessed using a willingness-to-pay threshold of one-time per capita gross domestic product in India. RESULTS The total lifetime cost per patient for ALK-positive NSCLC was ₹332,456 ($4,054 US dollars [USD]), ₹1,284,100 ($15,659 USD), and ₹2,337,779 ($28,509 USD) in the chemotherapy, crizotinib, and ceritinib arms, respectively. The mean QALYs lived per patient were 1.20, 2.21, and 3.34, respectively. For patients with ROS1-positive NSCLC, the total cost was ₹323,011 ($3,939 USD) and ₹1,763,541 ($21,507 USD) for chemotherapy and crizotinib, with mean QALYs lived per patient of 1.16 and 2.73, respectively. Nearly 92% and 81% reduction in the price of ceritinib and crizotinib is required to make it a cost-effective treatment option for ALK- and ROS1-positive NSCLC, respectively. CONCLUSION Our study findings suggest that the prices of ceritinib and crizotinib need to be reduced significantly to justify their value for inclusion in India's publicly financed health insurance scheme for treatment of patients with locally advanced/metastatic ALK- and ROS1-positive NSCLC, respectively.
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Affiliation(s)
- Dharna Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Alvarez A, Killian M, Pietra B, Ahmed M, Peek G, Jacobs J, Bleiweis M, Fricker F, Gupta D. Impact of Donor Hypernatremia on Outcomes after Heart Transplantation in Adult and Pediatric Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1629] [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: 04/05/2023] Open
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Magua W, Okoh A, Pranav P, Wang J, Karadkhele G, Cole R, Daneshmand M, Gupta D, Larsen C, Morris A. Belatacept-Based Immunosuppression in Heart Transplant Recipients: National Trends with Outcomes from a Single Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.564] [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: 04/05/2023] Open
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Eichenberger E, Satola S, Gupta D, Pouch S. Bloodstream Infection in Pre-Heart Transplant Patients on Temporary Mechanical Circulatory Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1567] [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: 04/05/2023] Open
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8
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Patel K, Yadalam A, DeStefano R, Almuwaqqat Z, Desai S, Alkhoder A, Ejaz K, Alvi Z, Book W, Gupta D, Quyyumi A. Lipoprotein(a) Levels Predict Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.060] [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: 04/05/2023] Open
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9
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Killian M, Schelbe L, Lustria M, Gupta D. In-App Messaging by Adolescent Heart Transplant Patients During Mobile App-Based Video Directly Observed Therapy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1312] [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: 04/05/2023] Open
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10
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McLendon L, Kaufmann E, Killian M, Beckwith S, Coppola J, Martin E, Rackley J, Coleman L, Blanchette H, Shih R, Pietra B, Fricker F, Gupta D. Pediatric Psychosocial Assessment Tool: An Initial Risk Assessment Tool for Pediatric Heart Transplant Candidates. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.176] [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: 04/05/2023] Open
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11
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Killian M, Tian S, Xing A, Gupta D, He Z. Predicting Health Outcomes Using Machine Learning in Pediatric Heart Transplantation Using UNOS Data. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.042] [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: 04/05/2023] Open
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12
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Gupta D, Singh A, Gupta N, Mehra N, Bahuguna P, Aggarwal V, Krishnamurthy MN, Roy PS, Malhotra P, Gupta S, Kumar L, Kataki A, Prinja S. Cost-Effectiveness of the First Line Treatment Options For Metastatic Renal Cell Carcinoma in India. JCO Glob Oncol 2023; 9:e2200246. [PMID: 36795991 PMCID: PMC10166401 DOI: 10.1200/go.22.00246] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Tyrosine kinase inhibitors such as sunitinib and pazopanib are the mainstay of treatment of metastatic renal cell carcinoma (mRCC) in India. However, pembrolizumab and nivolumab have shown significant improvement in the median progression-free survival and overall survival among patients with mRCC. In this study, we aimed to determine the cost-effectiveness of the first-line treatment options for the patients with mRCC in India. METHODS A Markov state-transition model was used to measure the lifetime costs and health outcomes associated with sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab among patients with first-line mRCC. Incremental cost per quality-adjusted life-year (QALY) gained with a given treatment option was compared against the next best alternative and assessed for cost-effectiveness using a willingness to pay threshold of one-time per capita gross-domestic product of India. The parameter uncertainty was analyzed using the probabilistic sensitivity analysis. RESULTS We estimated the total lifetime cost per patient of ₹ 0.27 million ($3,706 US dollars [USD]), ₹ 0.35 million ($4,716 USD), ₹ 9.7 million ($131,858 USD), and ₹ 6.7 million ($90,481 USD) for the sunitinib, pazopanib, pembrolizumab/lenvatinib, and nivolumab/ipilimumab arms, respectively. Similarly, the mean QALYs lived per patient were 1.91, 1.86, 2.75, and 1.97, respectively. Sunitinib incurs an average cost of ₹ 143,269 ($1,939 USD) per QALY lived. Therefore, sunitinib at current reimbursement rates (₹ 10,000 per cycle) has a 94.6% probability of being cost-effective at a willingness to pay threshold of 1-time per capita gross-domestic product (₹ 168,300) in the Indian context. CONCLUSION Our findings support the current inclusion of sunitinib under India's publicly financed health insurance scheme.
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Affiliation(s)
- Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Vipul Aggarwal
- National Health Authority, Ayushman Bharat PM-JAY, Government of India, New Delhi, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amal Kataki
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Granstedt EM, Osin D, Gupta D, Kinley J, Knapp K, Muñoz-Burgos JM. Helium line ratio imaging in the C-2W divertor. Rev Sci Instrum 2022; 93:113533. [PMID: 36461464 DOI: 10.1063/5.0101822] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
A 2D imaging instrument has been designed and deployed on C-2W ("Norman") [H. Gota et al., Nucl. Fusion 61, 106039 (2021)] to study the plasma in the expander divertor by simultaneously measuring three neutral helium spectral lines. Ratios of these images, in conjunction with a collisional-radiative model, yield 2D maps of electron temperature and density. Almost the entire radial plasma cross-section (∼60 cm) can be mapped with a spatial resolution ≲1 cm. These data can, in principle, be acquired at 3 kHz. The neutral helium target is provided by a custom-built supersonic gas injector located inside the divertor vessel, which injects helium toward the magnetic axis and perpendicular to the camera sight-cone. Images of helium emission and reconstructed electron density and temperature profiles of the plasma produced from an end gun are presented. Voltages applied to concentric annular electrodes located in the divertors are used to stabilize beam-driven field reversed configuration plasmas. Magnetic field expansion is also employed to thermally isolate electrons from the end electrodes. Measurements of electron temperature and density in the divertor are important in order to study the effects of both the electrostatic biasing and the divertor magnetic field on electron confinement, neutral gas transport, and the overall machine performance.
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Affiliation(s)
- E M Granstedt
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - D Osin
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - D Gupta
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - J Kinley
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - K Knapp
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
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Charan K, Sharma N, Baksi A, Banerjee N, Rodha M, Gupta D. OC-003 PORT POSITIONS IN TEP FOR SHORT PATIENTS: OUR EXPERIENCE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Totally extraperitoneal repair (TEP) is a popular technique for repair of inguinal hernia. One common technique of TEP involves placement of one 10 mm port 1–2 cm below the umbilicus just off the midline, one 5 mm port 2–3 cm above the pubic symphysis, and a third 5 mm port between these 2 ports in the midline (Figure 1a). In case the distance from the superior border of the symphysis pubis to the inferior edge of the umbilicus is less than 15 cm, this leads to crowding of instruments and results in ergonomic problems during the operation. Daes has popularized eTEP for this indication. The aim is to shift the first 10 mm port to a position 5 cm superior and 4 cm lateral to the umbilicus (Figure 1b). eTEP has also found application in the repair of ventral hernias. However, for most inguinal hernias, we feel that eTEP is an overkill.
Methods
We place the first 10 mm port at the level of the superior border of the umbilicus and just lateral to it (Figure 1c). The two 5 mm ports are placed in the midline. Initial dissection is performed telescopically.
Results
This technique provides 2–3 cm of extra working space, which improves ergonomics while operating on patients with a short pubo-umbilical distance. Other parameters like operating time, postoperative pain and other complications remain the same.
Conclusion
We recommend placement of the 10 mm port at the superior border of the umbilicus, particularly in short patients.
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Affiliation(s)
- K Charan
- General Surgery , AIIMS Jodhpur, Jodhpur , India
| | - N Sharma
- General Surgery , AIIMS Jodhpur, Jodhpur , India
| | - A Baksi
- General Surgery , AIIMS Jodhpur, Jodhpur , India
| | - N Banerjee
- General Surgery , AIIMS Jodhpur, Jodhpur , India
| | - M Rodha
- General Surgery , AIIMS Jodhpur, Jodhpur , India
| | - D Gupta
- General Surgery , AIIMS Jodhpur, Jodhpur , India
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Rodha MS, Gupta D. P-011 FEASIBILITY OF VENTRAL-TAPP FOR VENTRAL HERNIA REPAIR IN A LOW INCOME COUNTRY LIKE INDIA. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Minimal invasive repair is now the established procedure for ventral hernia. Surgeons are now validating newer techniques each year to deal with the ventral hernia. It becomes difficult to choose, best fit technique from this large armamentarium. For a low income country like India, ventral- trans abdominal preperitoneal (TAPP) technique is cost effective and uses simple polyester or polypropylene mesh.
Methods
For this article we used our experience with ventral-TAPP performed from July 1, 2021 to May 31, 2022. Patients were followed up for 6 months.
Results
In the above time period, we had performed 10 ventral-TAPP. Out of these, 3 had completed the follow up. Median age was 45.0 years, BMI was 26.56 kg/m2. One patient was male (33.33%). All patients were presented to surgery due to bulge or pain in the anterior abdominal wall.
The median hernia defect measured 80 mm, median mesh diameter was 15 cm and median operative time was 125 min. No intraoperative complications occurred.
Postoperatively, none of the patients developed complications. Length of hospital stay was 3.0 days. Six months after surgery, neither recurrence nor chronic pain were recorded.
Conclusion
We have concluded that mesh used in repair with ventral-TAPP costs one fourth to one-fifth to that of composite mesh used in intraperitoneal onlay mesh (IPOM) repair with the comparable results. So in a low income country like India, ventral TAPP should be a preferred approach.
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Affiliation(s)
- M S Rodha
- Of General Surgery, All India Institute Of Medical Sciences , Jodhpur , India
| | - D Gupta
- Of General Surgery, All India Institute Of Medical Sciences , Jodhpur , India
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Spevack E, Gupta D, Moran A, Watkins K, Seeley N. The impact of an integrative medicine program on ERAS-compliant pancreaticoduodenectomies. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.059] [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: 10/14/2022]
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17
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Yap T, Konstantinopoulos P, Grisham R, Gupta D, Wilkinson G, Cao A, Jeffers M, Sharma N. 494TiP Phase Ib study of elimusertib (ATRi; BAY 1895344) in combination with niraparib (PARPi) in patients with advanced solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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18
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Gupta N, Gupta D, Dixit J, Mehra N, Singh A, Krishnamurthy MN, Jyani G, Rajsekhar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Malhotra P, Gupta S, Kumar L, Kataki A, Prinja S. Cost Effectiveness of Ribociclib and Palbociclib in the Second-Line Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer in Post-Menopausal Indian Women. Appl Health Econ Health Policy 2022; 20:609-621. [PMID: 35534752 DOI: 10.1007/s40258-022-00731-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In this study, we evaluate the cost and outcomes of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) plus fulvestrant, fulvestrant alone, and conventional chemotherapy as the second-line therapy for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in India. METHODS Using a Markov model, the clinical effectiveness of managing HR+, HER2- MBC in postmenopausal women with either a CDK4/6i (either ribociclib or palbociclib) and fulvestrant, fulvestrant alone, and chemotherapy (single-agent paclitaxel or capecitabine) was measured in terms of quality-adjusted life-years (QALYs). The costs were estimated from two different points of view: scenario I, as per the prevailing market prices of the drugs; and scenario II, as per the reimbursement rates set up by the publicly financed national health insurance scheme. Incremental cost per QALY gained with a given treatment option was compared against the next best alternative and was assessed for cost effectiveness using a threshold of 1-time the per capita gross domestic product (GDP) in India from a societal perspective. RESULTS In scenario I, an MBC patient was found to incur a lifetime cost of Indian Rupees (₹) 2.54 million ($34,644), ₹2.53 million ($34,496), ₹512,598 ($6,984), ₹326,026 ($4,442) and ₹237,115 ($3,230) for the ribociclib and palbociclib combination arms, fulvestrant monotherapy, single-agent paclitaxel and the single-agent capecitabine treatment arms, respectively. The lifetime cost for CDK4/6i (ribociclib and palbociclib) combination therapy, fulvestrant monotherapy, paclitaxel, and capecitabine arms was estimated to be ₹1.94 million ($26,459), ₹1.92 million ($26,220), ₹315,387 ($4,296), ₹187,392 ($2,553) and ₹153,263 ($2,088), respectively, in scenario II. The mean QALYs lived per MBC patient with CDK4/6i (either ribociclib or palbociclib) combination therapy, fulvestrant, paclitaxel and capecitabine were estimated to be 1.4, 1.0, 0.9 and 0.7, respectively. None of the treatment arms are cost effective at current prices and reimbursement rates at a threshold of 1-time the per capita GDP of India. However, a 78% reduction in the current market price or a 72% reduction in the reimbursement rate of fulvestrant in the government-funded insurance program will make it a cost-effective treatment option for HR+, HER2- MBC patients in India. CONCLUSION CDK4/6i (ribociclib and palbociclib) therapy is not a cost-effective treatment option for MBC patients. A 72% reduction in the reimbursement rate for fulvestrant monotherapy will make it a cost-effective treatment option in the Indian context.
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Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manjunath Nookala Krishnamurthy
- Department of Clinical Pharmacology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekhar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amal Kataki
- Department of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Ali SM, Gupta D, Kundalia K, Saha SK, Tengblad O, Ovejas JD, Perea A, Martel I, Cederkall J, Park J, Szwec S. Resonance Excitations in ^{7}Be(d,p)^{8}Be^{*} to Address the Cosmological Lithium Problem. Phys Rev Lett 2022; 128:252701. [PMID: 35802450 DOI: 10.1103/physrevlett.128.252701] [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] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
The anomaly in lithium abundance is a well-known unresolved problem in nuclear astrophysics. A recent revisit to the problem tried the avenue of resonance enhancement to account for the primordial ^{7}Li abundance in standard big-bang nucleosynthesis. Prior measurements of the ^{7}Be(d,p)^{8}Be^{*} reaction could not account for the individual contributions of the different excited states involved, particularly at higher energies close to the Q value of the reaction. We carried out an experiment at HIE-ISOLDE, CERN to study this reaction at E_{c.m.}=7.8 MeV, populating excitations up to 22 MeV in ^{8}Be for the first time. The angular distributions of the several excited states have been measured and the contributions of the higher excited states in the total cross section at the relevant big-bang energies were obtained by extrapolation to the Gamow window using the talys code. The results show that by including the contribution of the 16.63 MeV state, the maximum value of the total S factor inside the Gamow window comes out to be 167 MeV b as compared to earlier estimate of 100 MeV b. However, this still does not account for the lithium discrepancy.
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Affiliation(s)
- Sk M Ali
- Department of Physics, Bose Institute, 93/1 APC Road, Kolkata 700009, India
| | - D Gupta
- Department of Physics, Bose Institute, 93/1 APC Road, Kolkata 700009, India
| | - K Kundalia
- Department of Physics, Bose Institute, 93/1 APC Road, Kolkata 700009, India
| | - Swapan K Saha
- Department of Physics, Bose Institute, 93/1 APC Road, Kolkata 700009, India
| | - O Tengblad
- Instituto de Estructura de la Materia-CSIC, Serrano 113 bis, ES-28006 Madrid, Spain
| | - J D Ovejas
- Instituto de Estructura de la Materia-CSIC, Serrano 113 bis, ES-28006 Madrid, Spain
| | - A Perea
- Instituto de Estructura de la Materia-CSIC, Serrano 113 bis, ES-28006 Madrid, Spain
| | - I Martel
- University of Huelva, Avenida Fuerzas Armadas sin numero Campus "El Carmen", 21007 Huelva, Spain
| | - J Cederkall
- Department of Physics, Lund University, Box 118, SE-221 00 Lund, Sweden
| | - J Park
- Department of Physics, Lund University, Box 118, SE-221 00 Lund, Sweden
| | - S Szwec
- Accelerator Laboratory, Department of Physics, University of Jyväskylä, FI-40014 Jyväskylä, Finland
- Helsinki Institute of Physics, University of Helsinki, FIN-00014 Helsinki, Finland
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20
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Khanra D, Calvert P, Wright P, Hughes S, Mahida S, Hall M, Todd D, Gupta D, Luther V. Differentiating border-zone tissue from post-infarct scar using ripple mapping during VT ablation. Europace 2022. [DOI: 10.1093/europace/euac053.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Areas of post-infarct ventricular scar and border-zone slow conduction are often highlighted on a bipolar voltage map with generalized values 0.5mV–1.5mV. The true voltage that differentiates regions of conducting from non-conducting tissue is unknown. Ripple Mapping (RM)displays allows conducting tissue to be seen as areas supporting Ripple activation, and non-conducting tissue as areas devoid of Ripple activation.
Purpose
We describe application of Ripple Maps to differentiate areas of scar from conducting tissue during ischemic VT ablation.
Methods
Dense bipolar voltage maps were created (Pentaray catheter, pacing 80-100bpm) and presented as a single value (e.g. 0.5mV-0.5mV) to binarize the color display (red and purple). RMs were superimposed on the voltage map and played above a pre-set noise threshold (>0.05mV). The voltage map mV limit was sequentially reduced ("border-zone threshold") until only those areas devoid of Ripple bars appeared red. The surrounding border-zone supporting ripple activation thus appeared purple. We performed off-line analysis of border-zone voltage thresholds from a series of RM guided VT ablations.
Results
10 consecutive patients (LVEF 32.3±7.5%) with remote myocardial infarction underwent VT ablation (median 19days (IQR 8-33) since last VT). Bipolar voltage mapping (5873±2841 points, median shell area 224cm2), revealed voltages<0.5mV covered a median 11% (IQR 7-17%) of the shell. The border-zone voltage threshold was median 0.2mV (range 0.12mV - 0.3mV). Non-conducting tissue below this value covered only median 5% (IQR 3-7%) of the entire shell. VT was mappable in 4 patients, and the isthmus was bordered by tissue below the same border-zone threshold as found in normal rhythm. The border-zone was homogenized with ablation(40-50W, median 29 mins (IQR 22-33), and clinical VT was non-inducible in all, and 9 pts (91%) remain sustained VT-free at median 90-day follow-up (IQR 23-139), 2-weeks blanking period).
Picture 1 presents an infero-lateral LV infarct collected in an RV paced rhythm (7340points) and displayed at conventional bipolar voltage settings 0.5-1.5mV. Tissue with voltages<0.5mV appear red and cover 30% of the total area. In this case, this border-zone voltage threshold was defined as 0.25mV. Non-conducting tissue, seen as areas devoid of ripple bars below this value, now appeared as red, and covered only 11% of the total area. Picture 2 demonstrates the morphologies of 4 poorly tolerated induced VTs during this case. Each had near perfect pacemaps to the exit sites of border-zone tissue defined using this approach, and were targets for ablation resulting in complete non-inducibility and no VT recurrence in early follow-up.
Conclusion
The bipolar voltage that differentiates putative scar from bordering conducting tissue is unique to each patient, and far lower than 0.5mV-1.5mV. RM presents a practical approach to visualize the border-zone activation to guide ablation.
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Affiliation(s)
- D Khanra
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Calvert
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Mahida
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Todd
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - V Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Bost J, Gupta D, El Andaloussi S, Saher O. Exosomes/EVs: GROWTH MEDIA CONDITIONS INFLUENCE THE SECRETION ROUTE AND RELEASE LEVELS OF ENGINEERED EXTRACELLULAR VESICLES. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00276-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Patel P, Bhatia-Patel S, Sykalo C, Thigpen C, Adams A, Egolum U, Howard B, Gupta D. Warfarin Discontinuation in Patients with HeartMate3 Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Gupta D, Clifford S, Skivington G, Kimbro A, Rackley J, Martin E, Pietra B, Fricker F, Killian M. Acceptability of Mobile Directly Observed Therapy for Immunosuppression Medication Adherence in Adolescent Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1631] [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] Open
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24
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Yadalam A, Yoo B, Bhatia-Patel S, Patel P, Laskar S, Bhatt K, Gupta D. Successful Pregnancy with HeartMate 3 (Abbott) Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Gupta D, Cantor R, Zhao H, Clifford S, Bansal N, Hope K, Albers E, Prada-Ruiz A, Reinhardt Z, Sorabella R, Kirklin J, Ramakrishnan K. Use of Donor Hearts with Low Ejection Fraction in Pediatric Heart Transplantation: A PHTS Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.156] [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] Open
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26
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BhatiaPatel S, Raj L, Yoo B, Patel P, Nicholson W, Daneshmand M, Abdou M, Gupta D. Cardiogenic Shock Following Successful CTO Revascularization. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Tadros H, Saidi A, Black E, Cattier C, Rackley J, Kimbro A, Clifford S, Martin E, Pietra B, Fricker F, Gupta D. End-of-life Decision Making In Pediatric Heart Transplant Families: A Study Analyzing The Parental Perspective. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Coppola J, Gupta D, Lopez-Colon D, DeGroff C, Vyas H. Elevated Aortic Stiffness After Pediatric Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Krishnamurti L, Gupta D. Hematopoietic stem cell transplantation for hemoglobinopathies: Progress and prospects. Indian J Med Paediatr Oncol 2022. [DOI: 10.4103/0971-5851.51444] [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: 11/04/2022] Open
Abstract
AbstractAllogeneic bone marrow transplantation from an HLA-identical donor is currently the only means of curing thalassemia . Transplant outcome depends upon the presence of risk factors (hepatomegaly, portal fibrosis and poor quality of chelation). patients are defined to have class I - if no risk factor, class II with one or two and class III - if all three risk factors are present. For patients under 16 years of age, for class I, class II and III the probabilities of survival are approximately 95%, >80% and 60-70%, respectively. The risk of transplant related morbidity& mortality is low when transplant is done at an early age. Currently, busulfan, cyclophospahmide and antithymocyte globulin based combination is used for conditioning. More than 200 patients with sickle cell disease (SCD) have undergone allogeneic SCT with long term survival in >80% of patients. Results are better if donor is an HLA-identical sibling and if transplant is done early in the course of disease. Presently, experience with reduced intensity SCT and matched unrelated donor transplant is limited to recommend their routine use.
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Affiliation(s)
- Lakshmanan Krishnamurti
- Department of Comprehensive Hemoglobinopathies Program Division of Hematology/Oncology/BMT Children′s Hospital of Pittsburgh 3705 Fifth Avenue, Pittsburgh, PA 15213, India
| | - D Gupta
- Department of Comprehensive Hemoglobinopathies Program Division of Hematology/Oncology/BMT Children′s Hospital of Pittsburgh 3705 Fifth Avenue, Pittsburgh, PA 15213, India
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Gupta D, Jyani G, Ramachandran R, Bahuguna P, Ameel M, Dahiya BB, Kohli HS, Prinja S, Jha V. Peritoneal dialysis–first initiative in India: a cost-effectiveness analysis. Clin Kidney J 2022; 15:128-135. [PMID: 35035943 PMCID: PMC8757426 DOI: 10.1093/ckj/sfab126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background The increasing burden of kidney failure (KF) in India necessitates provision of cost-effective kidney replacement therapy (KRT). We assessed the comparative cost-effectiveness of initiating KRT with peritoneal dialysis (PD) or haemodialysis (HD) in the Indian context. Methods The cost and clinical effectiveness of starting KRT with either PD or HD were measured in terms of life years (LYs) and quality-adjusted life years (QALYs) using a mathematical Markov model. Complications such as peritonitis, vascular access–related complications and blood-borne infections were considered. Health system costs, out-of-pocket expenditures borne by patients and indirect costs were included. Two scenarios were considered: Scenario 1 (real-world scenario)—as per the current cost and utilization patterns; Scenario 2 (public programme scenario)—use in the public sector as per Pradhan Mantri National Dialysis Programme (PMNDP) guidelines. The lifetime costs and health outcomes among KF patients were assessed. Results The mean QALYs lived per KF person with PD and HD were estimated to be 3.3 and 1.6, respectively. From a societal perspective, a PD-first policy is cost-saving as compared with an HD-first policy in both Scenarios 1 and 2. If only the costs directly attributable to patient care (direct costs) are considered, the PD-first treatment policy is estimated to be cost-effective only if the price of PD consumables can be brought down to INR70/U. Conclusions PD as initial treatment is a cost-saving option for management of KF in India as compared with HD first. The government should negotiate the price of PD consumables under the PMNDP.
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Affiliation(s)
- Dharna Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohammed Ameel
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Bharat Bhushan Dahiya
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Harbir Singh Kohli
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- The George Institute of Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Koyyala V, Chandra S, Goel V, Pasricha S, Gupta M, Muppalla B, Vanapala K, Gupta S, Gupta D, Sen S, Srinivasulu V, Medisetty P, Patnaik R. 76P Need for awareness about immune-related adverse events (iRAEs) among community physicians in India. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pandey R, Batra R, Dhaigude P, Gupta D. Primitive neuroectodermal tumor of the kidney: a rare case. Afr J Urol 2021. [DOI: 10.1186/s12301-021-00138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primitive neuroectodermal tumor commonly occurs in bones and is equivalent to Ewing’s sarcoma. Very few cases have been reported in the literature and they had a very different presentation and very aggressive behavior.
Case presentation
We present a case of a young 23-year-old male who presented with complaints of pain in left lumbar region of abdomen since 8 months and hematuria off and on. CT scan of the abdomen was done which revealed a large heterogeneously enhancing mass lesion in the left lumbar region arising from the superior and mid-pole of left kidney showing multiple non-enhancing necrotic areas. A diagnosis of left renal cell carcinoma was kept. Through the transperitoneal approach, the left kidney was approached and a left radical nephrectomy was done. The histopathology report revealed the tumor cells to be positive for CD99 and focally positive for Vimentin and negative for cytokeratin thereby making a diagnosis of primary neuroectodermal tumor (PNET).
Conclusions
Renal PNET is a rare renal malignancy that should be kept in the differential diagnosis of a renal SOL especially when it is a presenting feature in adolescent and young adult. It has a very aggressive course and multimodal therapy has to be considered in its treatment
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Ramaswami A, Sahu AK, Kumar A, Suresh S, Nair A, Gupta D, Chouhan R, Bhat R, Mathew R, Majeed JA, Aggarwal P, Nayer J, Ekka M, Thakar A, Singh G, Xess I, Wig N. COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients. QJM 2021; 114:464-470. [PMID: 34254132 PMCID: PMC8420631 DOI: 10.1093/qjmed/hcab190] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India. AIM Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED). DESIGN This was a retrospective, single-centre, observational study. METHODS We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected. RESULTS Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned. CONCLUSION COVID-19 infection along with its medical management have increased patient susceptibility to MM.
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Affiliation(s)
- A Ramaswami
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A K Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - S Suresh
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Nair
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - D Gupta
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Chouhan
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Bhat
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - J A Majeed
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - P Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - J Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - M Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - A Thakar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - G Singh
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - I Xess
- Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - N Wig
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Hermans ANL, Gawalko M, Van Der Velden RMJ, Verhaert DVM, Betz K, Hemels MEW, Steven D, Duncker D, Gupta D, Manninger M, Lodzinski P, Crijns HJGM, Pluymaekers NAHA, Hendriks JM, Linz D. Evaluation of the feasibility and accuracy of remote mobile app-based self-reported atrial fibrillation risk factor assessment in patients with atrial fibrillation: TeleCheck-AF results. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previously, we introduced the TeleCheck-AF approach, which is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring as well as mobile app-based self-reported atrial fibrillation (AF) risk factor assessment to allow comprehensive remote AF management through teleconsultation. Herein, we evaluated the feasibility and accuracy of remote mobile app-based self-reported AF risk factor assessment in AF patients.
Methods
In our University Medical Center, 545 patients were managed within the TeleCheck-AF project by an on-demand heart rate and rhythm mHealth infrastructure through teleconsultation. Patients were asked to fill in a short mobile app-based 10-item questionnaire related to AF risk factors. A reminder to complete the questionnaire automatically popped-up after the following four heart rate and rhythm recordings. Furthermore, patient's medical history was retrieved from the electronic health records (EHRs).
Results
Out of 545 patients, 542 (99.4%) patients (217 female, age 67 (59–72) years) completed the mobile app-based 10-item questionnaire and were included in this analysis. The number of patients with diabetes mellitus was similar in the EHRs and mobile app-based questionnaire (both 11.3%, p=1.000). There was no significant difference in the number of patients who had a medical history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) and artery disease (coronary artery disease and peripheral artery disease) in the EHRs and mobile app-based questionnaire (11.4% vs 12.2%, p=0.608 and 14.8% vs 13.3%, p=0.366, respectively). Heart failure was more frequently reported in the mobile app-based questionnaire compared to the EHRs (33.4% vs 14.0%, p<0.001). A total of 260 (48.0%) patients had a diagnosis of hypertension verified in EHRs and only 239 (44.1%) patients reported hypertension in the mobile app-based questionnaire (p=0.044). There was no significant difference in number of patients with CHA2DS2-VASc-score ≥2 between the EHRs and mobile app-based questionnaire (64.2% vs 66.1%, p=0.275). The accuracy of mobile app-based assessment of diabetes mellitus was 85.4%, of TIA/CVA 78.9%, of artery disease 60.9%, of heart failure 78.8%, and of hypertension 89.3%.
Conclusion
Patient self-reported AF risk factors by a remote mobile app-based assessment is feasible and may be useful for future digital trials and comprehensive remote AF management through teleconsultation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A N L Hermans
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | - D V M Verhaert
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | - D Steven
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - D Duncker
- Hannover Heart Center, Hannover, Germany
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - P Lodzinski
- Medical University of Warsaw, Warsaw, Poland
| | - H J G M Crijns
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | | | - D Linz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
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Chase D, Perhanidis J, Gupta D, Kalilani L, Lechpammer S, Woodward T, González-Martín A. 742P Survival in patients (pts) with advanced ovarian cancer (AOC) changes with cumulative number of risk factors (RFs): A US real-world (RW) analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1184] [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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Prinja S, Dixit J, Gupta N, Mehra N, Singh A, Krishnamurthy MN, Gupta D, Rajsekar K, Kalaiyarasi JP, Roy PS, Malik PS, Mathew A, Pandey A, Malhotra P, Gupta S, Kumar L, Kataki A, Singh G. Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol. BMJ Open 2021; 11:e048513. [PMID: 34326050 PMCID: PMC8323373 DOI: 10.1136/bmjopen-2020-048513] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer. METHODS AND ANALYSIS The present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care. ETHICS AND DISSEMINATION Approval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute-WIA, Chennai, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, India Ministry of Health and Family Welfare, New Delhi, Delhi, India
| | | | - Partha Sarathi Roy
- Department of Medical Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | | | - Anisha Mathew
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Awadhesh Pandey
- Radiotherapy and Oncology, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Sudeep Gupta
- Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, Delhi, India
| | - Amal Kataki
- Department of Gynaecologic Oncology, Dr B Borooah Cancer Society Trust, Guwahati, Assam, India
| | - Gurpreet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Nations M, Gupta D, Sweeney J, Frausto L, Tobin M. Publisher's Note: "Measurements of impurity ion temperature and velocity distributions via active charge-exchange recombination spectroscopy in C-2W" [Rev. Sci. Instrum. 92, 053512 (2021)]. Rev Sci Instrum 2021; 92:069901. [PMID: 34243518 DOI: 10.1063/5.0056405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M Nations
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - D Gupta
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - J Sweeney
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - L Frausto
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - M Tobin
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
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Karim N, Kozhuharov N, Jarman J, Furniss S, Veasey R, Ullah W, Vouliotis AI, Martin C, Kalla M, Osmanagic A, Ginks M, Pope M, Christian Sitcherling C, Gupta D, Wong T. Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort. Europace 2021. [DOI: 10.1093/europace/euab116.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Sven Knecht and the International Octogenarian AF ablation group
Background
Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group.
Purpose
Investigation of complications & outcomes in octogenarians undergoing CA for AF.
Methods
Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged <80 years. The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure.
Results
216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged <80 years (62.4 ± 9.5 years, 34.7% females), p <0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively. 17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively.
Conclusion
In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged < 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) < 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) < 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 < 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073
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Affiliation(s)
- N Karim
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Kozhuharov
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Jarman
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Furniss
- Eastbourne District General Hospital, Eastbourne, United Kingdom of Great Britain & Northern Ireland
| | - R Veasey
- Eastbourne District General Hospital, Eastbourne, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - A-I Vouliotis
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - C Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Osmanagic
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Ginks
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Pope
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - T Wong
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Linz D, Pluymaekers N, Duncker D, Manninger M, Van Der Velden R, Hermans A, Verhaert D, Hemels M, Sultan A, Gupta D, Heidbuchel H, Sohaib A, Svennberg E, Crijns H, Hendriks J. The TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Patient experiences. Europace 2021. [PMCID: PMC8194565 DOI: 10.1093/europace/euab116.521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/12/2022] Open
Abstract
Funding Acknowledgements OnBehalf Aims Methods Results Conclusions
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Affiliation(s)
- D Linz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - N Pluymaekers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Duncker
- Hannover Medical School, Cardiology, Hannover, Germany
| | - M Manninger
- Medical University of Graz, Cardiology, Graz, Austria
| | - R Van Der Velden
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - A Hermans
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Verhaert
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - M Hemels
- Rijnstate Hospital, Arnhem, Netherlands (The)
| | - A Sultan
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | | | - A Sohaib
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Svennberg
- Karolinska University Hospital, Stockholm, Sweden
| | - H Crijns
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - J Hendriks
- Flinders Medical Centre and Flinders University, Adelaide, Australia
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Tovmassian L, Bierme C, Kozhuharov N, Ding WY, Obeidat M, Chu G, O"brien J, Snowdon RL, Gupta D. Ablation Index-guided 50W ablation for left atrial posterior wall isolation compared with lower powers: feasibility and lesion level analysis. Europace 2021. [DOI: 10.1093/europace/euab116.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Groupe de Rythmologie de la Société Française de Rythmologie
Background
Posterior Wall Isolation (PWI) is increasingly performed for Atrial Fibrillation (AF). The use of Ablation Index (AI)-guided 50W ablation for PWI has not been described, nor the interplay between ablation parameters at this power when compared to lower powers.
Methods
40 consecutive AF patients (26 males, 65.5 ± 10.0 years. 95% non-paroxysmal AF) underwent PWI following pulmonary vein isolation. A roof line and floor line were created with point-by-point ablation, targeting a contact force (CF) of 10-30g, AI 550-600 on the roof and 400-450 on the floor, and inter-tag distance of <6mm. 35-40W powers were used for the first 20 patients, and 50W used for the next 20. Generator impedance was monitored in real time for each lesion. Ablation inside the box was delivered in case of failure of first pass isolation (FPI). All VisiTags (n = 959) were analyzed retrospectively.
Results
PWI was successful in 19(95%) of the 35-40W group and in all 20 patients in the 50W group, with FPI seen in 8(40%) and 10(50%) respectively, p = 0.53. The mean CF and number of RF applications on the roof. floor and inside the box were similar between the two groups. Ablation time per lesion (10.4 [8.8-12.5]sec) and total ablation time per patient (3.84[3.34-4.66] min) were shorter in the 50W group as compared to 35-40W (13.0 [11.6-16.2] sec and 5.86 [4.23-7.73] min respectively), p < 0.005. The mean AI and Impedance Drop were larger in the 50W group (Table). There was no steam pop observed in any of the 959 radiofrequency applications.
Conclusion
Ablation Index guided 50W ablation has a very high success rate for posterior wall isolation with shorter ablation times and higher impedance drop compared to conventional powers. Steam pops may be avoidable by targeting CF < 30g, and by monitoring impedance in real-time. 50W Group(N = 458) 35-40W Group(N = 501) p-value Number of lesions (s, IQR)Roof lineFloor lineAdditional ablation inside box 21.5 [19.5-26.3]7.0 [5.8-9.0]13.0 [10.8-14.3]6.0 [6.0-6.8] 24.0 [20.8-29.5]8.0 [6.0-10.0]12.5 [10.8-14.0]5.5 [2.8-9.0] 0.330.180.850.59 Ablation Time per lesion (s, IQR)Roof lineFloor lineAdditional ablation inside box 10.4 [8.8-12.5]13.0 [10.9-16.0]9.9 [8.7-11.4]8.1 [6.9-9.0] 13.0 [11.6-16.2]14.5 [12.4-19.0]12.7 [11.4-15.9]11.8 [10.6-14.0] <0.005<0.005<0.005<0.005 Total RF Time (min, IQR)Roof lineFloor lineAdditional ablation inside box 3.84 [3.34-4.66]1.54 [1.15-1.90]2.06 [1.68-2.54]0.79 [0.65-1.07] 5.86 [4.23-7.73]1.98 [1.62-2.59]2.78 [2.28-3.25]1.07 [0.59-1.42] < 0.0050.0190.0090.50 Impedance Drop (ohms, IQR)Roof lineFloor lineAdditional ablation inside box 7.4 [5.2-10.3]8.7 [6.1-11.3]6.9 [5.0-10.1]7.1 [5.4-9.8] 6.9 [4.8-9.7]7.5 [5.1-10.0]6.0 [4.2-8.3]8.3 [5.8-10.9] 0.0070.04< 0.0050.17 Contact Force (g, IQR)Roof lineFloor lineAdditional ablation inside box 21.1 [14.5-30.3]23.9 [17.8-32.7]19.2 [13.2-25.3]25.5 [18.5-36.9] 21.2 [14.9-28.1]24.3 [17.2-30.3]19.0 [14.1-25.0]23.1 [16.9-31.7] 0.560.450.870.21 Ablation Index (IQR)Roof lineFloor lineAdditional ablation inside box 471 [441-519]560 [509-571]453 [436-475]461 [430-488] 461 [434-493]502 [466-541]446 [426-464]455 [434-478] < 0.005< 0.005< 0.0050.59 Lesion level analysis for Posterior Wall Isolation
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Affiliation(s)
- L Tovmassian
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - C Bierme
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - N Kozhuharov
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - WY Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Obeidat
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - G Chu
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J O"brien
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - RL Snowdon
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Linz D, Pluymaekers N, Hermans A, Van Der Velden R, Verhaert D, Gupta D, Steven D, Duncker D, Manninger M, Svennberg E, Heidbuchel H, Crijns H, Sahaib A, Tomlinson D, Hendriks J. Remote app-based management of atrial fibrillation during the COVID-19: The centre characteristics and experiences of the European TeleCheck-AF project. Europace 2021. [PMCID: PMC8194584 DOI: 10.1093/europace/euab116.522] [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: 11/12/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. OnBehalf TeleCheck-AF Investigators Aims Herein we describe the characteristics, inclusion rates and experiences from participating centres in the European TeleCheck-AF project. TeleCheck-AF is a multicentre international project initiated to maintain care delivery for patients with atrial fibrillation (AF) during COVID-19 through teleconsultations supported by an on-demand photoplethysmography-based heart rate and rhythm monitoring app (FibriCheck®). Methods Two surveys exploring centre characteristics (n = 25) and centre experiences (n = 23) were completed. Results Most centres were academic (64%) and specialized public cardiology/district hospitals (36%). Majority of centres had AF outpatient clinics (64%) and only 36% had AF ablation clinics. The time required to start patient inclusion and total number of included patients in the project was comparable for centres experienced (56%) or inexperienced in mHealth use. Within 28 weeks, 1930 AF patients were recruited, mainly for remote AF control (31% of patients) and AF ablation follow-up (42%). Average inclusion rate was highest during the lockdown restrictions and reached a steady state at a lower level after easing the restrictions (188 vs 52 weekly recruited patients). Majority (>80%) of the centres reported no problems during the implementation of the TeleCheck-AF approach. Centres agreed that the on-boarding process of their center in the TeleCheck-AF project was simple and access to the patients measurements via stand-alone cloud infrastructure was trouble-free and possible from the first day on. They also agreed that remote heart rate and rhythm assessment by the FibriCheck® app around teleconsulatation supported their medical decision making; that their patients responded positively to use FibriCheck® for seven days; and that they felt comfortable to interpret PPG recordings. Conclusions Despite different health care settings and mHealth experiences, the TeleCheck-AF approach could be set up within an extremely short time and easily used in different European centres during COVID-19.
Abstract Figure. ![]()
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Affiliation(s)
- D Linz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - N Pluymaekers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - A Hermans
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - R Van Der Velden
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Verhaert
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Steven
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - D Duncker
- Hannover Medical School, Hannover, Germany
| | | | - E Svennberg
- Karolinska University Hospital, Stockholm, Sweden
| | | | - H Crijns
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - A Sahaib
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Tomlinson
- Plymouth Hospitals NHS Trust, Plymouth, United Kingdom of Great Britain & Northern Ireland
| | - J Hendriks
- Flinders Medical Centre and Flinders University, Adelaide, Australia
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Pius C, Ahmad H, Snowdon R, Ashrafi R, Waktare J, Borbas Z, Luther V, Mahida S, Modi S, Hall M, Gupta D, Todd D. Assessing atrial fibrillation ablation priority during COVID-19 -does use of patient questionnaires help in stratification above physician assessment? Europace 2021. [PMCID: PMC8194591 DOI: 10.1093/europace/euab116.292] [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: 11/17/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation for atrial fibrillation (AF) is largely offered for symptomatic relief. The ORBIT registry has shown that patients with a higher EHRA class and lower quality of life (QoL) scores (AFEQT score <65.7) are more likely to suffer emergency hospital admissions. To help prevent unplanned AF admissions and to best utilise the reduced capacity for elective work during the COVID-19 pandemic, it has become even more important to prioritise the most symptomatic AF patients for ablation. Purpose: To evaluate the accuracy of a subjective symptom-based clinician prioritisation schema compared to objective patient-completed quality of life (QoL) scores. Methods: In July 2020, all elective cases awaiting AF ablation at our institution were categorised by their cardiologist as either category 1 (C1-urgent), category 2 (C2–priority, procedure to be done during the ongoing COVID-19 pandemic) or category 3 (C3–routine, procedure may be delayed until post pandemic). This categorisation was based on review of clinic letters where EHRA AF symptom class or PROMS are not routinely recorded. All patients in C2 and C3 were then posted an AF specific (AFEQT) and a generic (EQ5D) QoL questionnaire to complete. Physicians were blinded to patient responses on the QoL questionnaires. Results: Details of physician prioritisation and completed questionnaires were available for 85 patients (62 ± 10 years, PAF in 61%, males 66%). The 18 patients that had been categorised in C2 (priority) group were found to have a significantly lower AFEQT score (30.4, IQR 17.2-51.9) compared to the 67 patients classed in C3 (routine) group (56.5, IQR 32.1-74.1; p < 0.01)(Figure 1a). EQ5D scores also tended to be lower in the C2 patients (0.7, IQR 0.4-0.8) compared to C3 (0.8, IQR 0.6-0.9; p = 0.056) (Figure 1c). 16 (89%) patients in C2 had significant AF-related impact on QoL (as defined as AFEQT score <65.7) compared to 42 (63%) of patients in C3. However, there was significant overlap between groups (Figure 1b). 4 patients in C3 had unplanned AF related hospital admissions while awaiting ablation, as compared to none in C2. The median AFEQT score of these 4 patients was 23.3, indicating that they were highly symptomatic despite being classified in C3 by their cardiologist. Conclusion : Physician assessments are moderately accurate in prioritising patients awaiting AF ablation. The addition of formal patient-completed QoL assessment such as with AFEQT, helps to identify the most symptomatic patients at risk of emergency hospital admission, and physicians should consider using these as part of routine assessment, especially during the COVID pandemic.
Abstract Figure 1 ![]()
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Affiliation(s)
- C Pius
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - H Ahmad
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Snowdon
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Ashrafi
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Waktare
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - Z Borbas
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - V Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Mahida
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Modi
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Todd
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Kumar N, Gupta M, Gupta D, Tiwari S. Novel deep transfer learning model for COVID-19 patient detection using X-ray chest images. J Ambient Intell Humaniz Comput 2021; 14:469-478. [PMID: 34025813 PMCID: PMC8123104 DOI: 10.1007/s12652-021-03306-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
Around the world, more than 250 countries are affected by the COVID-19 pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This outbreak can be controlled only by the diagnosis of the COVID-19 infection in early stages. It is found that the radiographic images are ideal for the fastest diagnosis of COVID-19 infection. This paper proposes an ensemble model which detects the COVID-19 infection in the early stage with the use of chest X-ray images. The transfer learning enables to reuse the pretrained models. The ensemble learning integrates various transfer learning models, i.e., EfficientNet, GoogLeNet, and XceptionNet, to design the proposed model. These models can categorize patients as COVID-19 (+), pneumonia (+), tuberculosis (+), or healthy. The proposed model enhances the classifier's generalization ability for both binary and multiclass COVID-19 datasets. Two popular datasets are used to evaluate the performance of the proposed ensemble model. The comparative analysis validates that the proposed model outperforms the state-of-art models in terms of various performance metrics.
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Affiliation(s)
- N. Kumar
- Department of Computer Science & Engineering, Maharaja Surajmal Institute of Technology, C-4, Janakpuri, New Delhi, India
| | - M. Gupta
- Department of Computer Science & Engineering, Moradabad Institute of Technology, Moradabad, India
| | - D. Gupta
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab India
| | - S. Tiwari
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala, India
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Nations M, Gupta D, Sweeney J, Frausto L, Tobin M. Measurements of impurity ion temperature and velocity distributions via active charge-exchange recombination spectroscopy in C-2W. Rev Sci Instrum 2021; 92:053512. [PMID: 34243240 DOI: 10.1063/5.0043838] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/07/2021] [Indexed: 06/13/2023]
Abstract
In TAE Technologies' C-2W experiment, electrode biasing is utilized for boundary control of a field-reversed configuration (FRC) plasma embedded in a magnetic mirror. Understanding the underlying physics associated with FRC rotation, stabilization, and heating is crucial for improving machine performance. Impurity ion rotation and temperature are sensitive to biasing effects, and measurements of these quantities can provide insight into important plasma dynamics and overall effectiveness of the biasing system. To this end, a charge-exchange recombination spectroscopy (ChERS) diagnostic was developed and deployed to measure local impurity ion temperature and velocity in the confinement vessel of C-2W. The system utilizes a new diagnostic neutral beam (40 keV, 8.5 A) and a fiber-coupled spectrometer with an image-intensified high-speed camera to measure beam-induced spectral line emission at multiple lines-of-sight. Design details and the first experimental results obtained with this new diagnostic are presented and discussed.
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Affiliation(s)
- M Nations
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - D Gupta
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - J Sweeney
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - L Frausto
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
| | - M Tobin
- TAE Technologies, Rancho Santa Margarita, California 92688, USA
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Schwartz A, Hu Y, Nayak A, Tannu M, Laskar S, Gupta D, Vega J, Morris A. The Stanford Integrated Psychosocial Assessment for Transplantation Score Predicts Frequency of Hospital Readmissions in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sheftman D, Signorelli M, Gupta D. Measurement of E × B drift of impurities in the C-2W inner divertor using spatial heterodyne spectroscopy. Rev Sci Instrum 2021; 92:043541. [PMID: 34243420 DOI: 10.1063/5.0043832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
Edge control in the C-2W field-reversed configuration experiment is crucial for the stability and energy confinement of the core plasma. Such edge control is achieved by electrical biasing on the end-on electrode plates. The radial electric field generated by the electrode biasing can be measured by E × B induced drift of impurity ions. Spatial heterodyne spectroscopy (SHS) is a promising method of high light throughput spectroscopy. Doppler shifted spectra of O4+ ion emission lines have been measured using a novel, in-house built SHS system. The electric field in the jet plasma inside the inner divertor of C-2W was estimated using the temporal profile of the rotational velocity of the oxygen ions. SHS system details, obtained measurements, and the methods of improving the system performance will be discussed.
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Affiliation(s)
- D Sheftman
- TAE Technologies, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688-7010, USA
| | - M Signorelli
- TAE Technologies, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688-7010, USA
| | - D Gupta
- TAE Technologies, Inc., P.O. Box 7010, Rancho Santa Margarita, California 92688-7010, USA
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Granstedt EM, Gupta D, Sweeney J, Tobin M, Dikovsky M. Comprehensive imaging of C-2W plasmas: Instruments and applications. Rev Sci Instrum 2021; 92:043515. [PMID: 34243377 DOI: 10.1063/5.0043778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 06/13/2023]
Abstract
The C-2W device ("Norman") [Gota et al., Nucl. Fusion 59, 112009 (2019)] has produced and sustained beam-driven field-reversed configuration (FRC) plasmas embedded in a magnetic mirror geometry using neutral beams and end-bias electrodes located in expander divertors. Several discrete vessels comprise this device, and many imaging instruments are required in order to view the plasma throughout. To meet this need, a suite of spatially and radiometrically calibrated, high-speed camera systems have been deployed. Besides global visualization of the plasma evolution and macro-stability, this imaging suite has been used in a variety of applications. One example application is a tomographic reconstruction of passive impurity emission. Calculation of the magnetic field in the equilibrium vessel is complicated by eddy currents in conducting structures and internal currents in the high-β FRC plasma. In addition, thus far non-perturbative measurements of internal field have not been available. The tomographic reconstruction of O4+ impurity emission enables an independent visualization of the plasma geometry, serving as a check on magnetic modeling and indirect evidence for field reversal within the FRC. A second application uses the cameras to view the Balmer-α emission throughout the plasma in order to estimate the ionization rate in each region. These rates can then be incorporated into particle balance calculations and a circuit model for currents from the end-bias electrodes. Finally, arcing on the electrode surfaces is identified through automated image processing of carefully selected spectral line emission.
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Affiliation(s)
- E M Granstedt
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - D Gupta
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - J Sweeney
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - M Tobin
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - M Dikovsky
- Google, Inc., 1600 Amphitheatre Parkway, Mountain View, California 94043, USA
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Bajpai J, Majumdar A, Satwik R, Rohatgi N, Jain V, Gupta D, Agarwal R, Mittal S, Verma SK, Parikh PM, Aggarwal S. Practical consensus recommendations on fertility preservation in patients with breast cancer. South Asian J Cancer 2020; 7:110-114. [PMID: 29721475 PMCID: PMC5909286 DOI: 10.4103/sajc.sajc_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 01/17/2023] Open
Abstract
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Majumdar
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - R Satwik
- Center of IVF and Human Reproduction, Sir Gangaram Hospital, New Delhi, India
| | - N Rohatgi
- Department of Medical Oncology, Max Saket Hospital, New Delhi, India
| | - V Jain
- Department of Gynaecology and Obstretics, Ludhiana Medicity Hospital, Ludhiana, Punjab, India
| | - D Gupta
- Department of Medical Oncology, Dharamshila Cancer Hospital, New Delhi, India
| | - R Agarwal
- Department of Surgical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | - S Mittal
- Department of Medical Oncology, Action Balajee Cancer Center, New Delhi, India
| | - S K Verma
- Department of Medical Oncology, Jolly Grant Himalayan Institute, Dehradoon, Uttarakhand, India
| | - P M Parikh
- Department of Oncology, Shalby Cancer and Research Institutes, Mumbai, Maharashtra, India
| | - S Aggarwal
- Department of Medical Oncology, Sir Gangaram Hospital, New Delhi, India
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Banerjee S, Kaliyaperumal V, Kamraj D, Gupta D, Bisht S, Narang K, Singh G, Kataria T. Experience With Indigenously Designed Novel Cylindrical Intravaginal Template For Volumetric Brachytherapy Of Advanced Cervical Cancers By Intracavitary + Interstitial (IC+IS) Technique. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1551] [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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Iff J, Tuttle E, Gerrits C, Gupta D, Zhong Y. DMD – THERAPY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.288] [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: 10/23/2022]
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