1
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Tham KW, Ahmed A, Boonyavarakul A, Garcia MM, Guajardo M, Hanipah ZN, Nam TQ, Nicodemus NA, Pathan F, Romano JGU, Soegonda S, Tolentino EL, Unnikrishnan AGAG, Oldfield BJ. ACTION APAC: Understanding perceptions, attitudes and behaviours in obesity and its management across south and Southeast Asia. Clin Obes 2024:e12644. [PMID: 38332544 DOI: 10.1111/cob.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024]
Abstract
To identify perceptions and attitudes among people with obesity (PwO) and healthcare professionals (HCPs) toward obesity and its management in nine Asia-Pacific (APAC) countries, a cross-sectional online survey was conducted among adult PwO with self-reported body mass index of ≥25 kg/m2 (≥27 kg/m2 , Singapore), and HCPs involved in direct patient care. In total, 10 429 PwO and 1901 HCPs completed the survey. Most PwO (68%) and HCPs (84%) agreed that obesity is a disease; however, a significant proportion of PwO (63%) and HCPs (41%) believed weight loss was the complete responsibility of PwO and only 43% of PwO discussed weight with an HCP in the prior 5 years. Most respondents acknowledged that weight loss would be extremely beneficial to PwO's overall health (PwO 76%, HCPs 85%), although nearly half (45%) of PwO misperceived themselves as overweight or of normal weight. Obesity was perceived by PwO (58%) and HCPs (53%) to negatively impact PwO forming romantic relationships. HCPs cited PwOs' lack of interest (41%) and poor motivation (37%) to lose weight as top reasons for not discussing weight. Most PwO (65%) preferred lifestyle changes over medications to lose weight. PwO and HCPs agreed that lack of exercise and unhealthy eating habits were the major barriers to weight loss. Our data highlights a discordance between the understanding of obesity as a disease and the actual behaviour and preferred approaches to manage it among PwO and HCPs. The study addresses a need to align these gaps to deliver optimal care for PwO.
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Affiliation(s)
- Kwang Wei Tham
- Endocrinology Services, Department of Medicine, Woodlands Health, National Healthcare Group, Singapore, Singapore
| | - Asma Ahmed
- The Aga Khan University Hospital, Karachi, Pakistan
| | - Apussanee Boonyavarakul
- Division of Endocrinology, Department of Internal Medicine, Phramongkutklao Hospital, Thailand
| | | | | | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | | | - Faruque Pathan
- Department of Endocrinology Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | | | - Sidartawan Soegonda
- Indonesia Diabetes Institute, Diabetes Connection & Care, Eka Hospitals, Jakarta, Indonesia
| | - Edgardo L Tolentino
- Ateneo School of Medicine and Public Health, Pasig, Metro Manila, Philippines
| | | | - Brian J Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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2
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Kalra S, Pathan F, Kshanti IAM, Bay NQ, Nagase T, Oliveria T, Bajpai S. Optimising Insulin Injection Techniques to Improve Diabetes Outcomes. Diabetes Ther 2023; 14:1785-1799. [PMID: 37715887 PMCID: PMC10570228 DOI: 10.1007/s13300-023-01460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/04/2023] [Indexed: 09/18/2023] Open
Abstract
The effectiveness of therapy in patients with diabetes depends on the correct use of the insulin injection technique. However, despite many established recommendations and evidence that an effective insulin injection technique is essential to improve glycaemic control and minimise the risk associated with diabetes, there is still a need to identify impediments to the insulin injection technique among patients and create awareness among patients and healthcare professionals about the importance of the optimisation of insulin injection techniques. This review focuses on the recent advancements in delivery devices, insulin injection technique teaching methods, monitoring, and complication management and highlights regional best practices and recommendations for optimising injection techniques to improve diabetes outcomes.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
- University Center for Research and Development, Chandigarh University, Mohali, India
| | - Faruque Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Ida Ayu Made Kshanti
- Division of Endocrinology, Metabolism, and Diabetes, Fatmawati National General Hospital, Jakarta, Indonesia
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3
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Desai A, Pathan F, Yadav R, Yogi D, Nanajkar MR. Phthalate induced hormetic effect reveals susceptibility of gill compared to muscle tissue after depuration in commercially important fish (Etroplus suratensis). Mar Pollut Bull 2023; 194:115238. [PMID: 37437518 DOI: 10.1016/j.marpolbul.2023.115238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
Effect of Bis-2ethylhexyl phthalate (DEHP) on commercially important tropical fish pearl spot has not been demonstrated at environmental concentrations along with depuration. The species is estuarine, juvenile and difficult to maintain but widely consumed and well distributed in tropical estuaries. Antioxidant activity of SOD, CAT and GPx was enhanced on all exposure days for gill and muscle suggesting high oxidative stress, except on day 5. Detoxifying enzyme-GST behaved differentially in gill and muscle tissue after depuration, depicting inhibited activity of GST in gill leading to lipid peroxidation. However, the muscle tissue was able to recover from stress after 7 days of depuration with the help of detoxifying enzymes. Overcompensation of antioxidant activity was observed over disruption of homeostasis defining hormesis effect. Integrated biomarker (IBR) index depicted high toxicity during entire exposure time, but after depuration, gill could not mediate LPO at lowest concentration (10 μg/l) while muscle tissue recovered, suggesting persistence of stress in gill.
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Affiliation(s)
- Aniket Desai
- CSIR-National Institute of Oceanography, Dona Paula, Goa 403004, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - F Pathan
- CSIR-National Institute of Oceanography, Dona Paula, Goa 403004, India
| | - R Yadav
- CSIR-National Institute of Oceanography, Dona Paula, Goa 403004, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - D Yogi
- CSIR-National Institute of Oceanography, Dona Paula, Goa 403004, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - M R Nanajkar
- CSIR-National Institute of Oceanography, Dona Paula, Goa 403004, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India.
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4
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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5
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Yu C, Pathan S, Jeyaprakash P, Pathan F, Kritharides L, Negishi K. Cardiac magnetic resonance relaxometry compared to left ventricular ejection fraction in the identification of anthracycline related cardiac changes: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2567] [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
Anthracyclines are associated with cancer therapeutics related cardiac dysfunction (CTRCD). The identification of CTRCD currently uses a change in left ventricular ejection fraction (LVEF). Myocardial damage associated with anthracyclines include myocardial inflammation and oedema. This can be assessed using cardiac magnetic resonance (CMR) relaxometry techniques; T1 and T2 mapping and extracellular volume (ECV) fraction.
Purpose
In this meta-analysis, we compared the magnitude of the changes in LVEF and CMR relaxometry techniques wihtin a month of anthracycline therapy completion.
Methods
We performed a structured literature review as per the PRISMA guidelines across three databases (EMBASE, MEDLINE, and SCOPUS) for studies evaluating CMR relaxometry parameter at baseline and soon after completion of anthracycline therapy (3–5 months post baseline). CMR parameters pre and post anthracycline-based chemotherapy were abstracted. A random effects model was used to pool mean difference (MD) in LVEF and ECV given standardisation in imaging acquisition techniques. A random effects model was used to pool standardized mean difference (SMD) in LVEF, T1, T2 and ECV after anthracycline to adjust for variations in imaging techniques and comparison between techniques.
Results
A total of 174 patients were included from seven studies. 91% were female with a mean age of 55.6 years. The pooled MD in LVEF and ECV was −3.15% [95% CI −4.99, −1.31] and 1.61% [0.90, 2.32], respectively. The pooled SMD in LVEF, T1, T2 and ECV was −0.61 [−0.96, −0.25] 0.34 [0.04, 0.63], 0.67 [0.12,1.21], 0.6 [0.31, 0.89], respectively (Table 1).
Conclusions
T2 mapping, ECV and LVEF can identify early myocardial changes better than T1 mapping. These changes suggest there is marked oedema in the myocardial injury from anthracycline therapy. Whilst these findings support the role of CMR relaxometry in identifying CTRCD, further studies are required.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Yu
- University of Sydney , Sydney , Australia
| | - S Pathan
- Concord General Repatriation Hospital , Sydney , Australia
| | | | - F Pathan
- University of Sydney , Sydney , Australia
| | | | - K Negishi
- University of Sydney , Sydney , Australia
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6
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Jeyaprakash P, Sangha S, Low G, Yu C, Pathan F, Negishi K. Cardioprotection against cardiac dysfunction from breast cancer chemotherapy: a bayesian and frequentist network meta-analysis of randomised controlled trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2579] [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: 11/14/2022] Open
Abstract
Abstract
Background
Anthracyclines (ANT) are the cornerstone of multiple chemotherapy regimens but at the risk of potential cardiotoxicity. Previous RCTs have tested the prophylactic effects of multiple cardioprotective agents to prevent ANT-related cardiotoxicity. Unfortunately, attempts to combine RCT findings in previous meta-analyses have been heterogeneous, creating further uncertainty. There remains an unmet need to determine the role of cardio-protective agents in breast cancer.
Purpose
To assess the comparative efficacy of cardioprotective drugs in patients with breast cancer using both Bayesian and frequentist analyses of randomised controlled trials
Methods
We performed a systematic review using four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTs evaluating cardio protective drugs in breast cancer patients without prior ANT exposure. The population included was anthracycline naïve, and trials were excluded if cardio-protective agents were commenced post anthracycline treatment. The primary outcome was a mean change in LVEF pre and post ANT dosing. Results were pooled with both Bayesian and frequentist approaches using random effects models in R statistical software.
Results
We identified 12 RCTs from 2807 search results (n=1126, Age 51 years, ANT dose 412m/m2, baseline LVEF 62.6%) with comparisons including beta-blockers (BB) (n=9), Angiotensin Converting Enzyme inhibitors (ACEi)/Angiotensin Receptor Blockers (ARB) (n=3), combination BB + AA (n=2), spironolactone (n=1) and statins (n=1). All included trials had either intermediate or high risk of bias, with marked heterogeneity in ANT dosing and LVEF monitoring. Overall, our Bayesian network meta-analysis showed no statistically significant difference in mean LVEF preservation between AA (1.3%, 95% credible interval [−0.20, 2.9]), BB (0.77, [−0.21, 1.8]), AABB (0.84 [−1.1, 2.8]), SPR (0.72, [−2.3, 3.7]) or statin (0.60, [−2.4, 3.6]) when compared against placebo. After ranking for efficacy, ACEi/ARBs achieved the most protection against LVEF decline of 1.3% [95% CI: −0.2, 2.9] although still not significant. Conversely, frequentist analysis showed benefit in using AA (Standardised Mean Difference (SMD) 1.32% [0.32, 2.33]) and BB (SMD 0.76% [0.12, 1.4]).
Conclusion
Bayesian analysis demonstrated no difference in LVEF with cardio-protective agents. In contrast, frequentist analysis showed that AA and BB may provide significant cardio-protection. The quality of RCT data to date is limited by a high risk of bias and significant heterogeneity between RCA reporting. Larger trials with clear population definition are required to determine whether any drug class provides benefit in this setting.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Sangha
- Nepean Hospital , Sydney , Australia
| | - G Low
- Nepean Hospital , Sydney , Australia
| | - C Yu
- University of Sydney , Sydney , Australia
| | - F Pathan
- University of Sydney , Sydney , Australia
| | - K Negishi
- University of Sydney , Sydney , Australia
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7
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Yu C, Pathan S, Jeyaprakash P, Pathan F, Kritharides L, Negishi K. Cardiac Magnetic Resonance Relaxometry Compared to Left Ventricular Ejection Fraction in the Identification of Anthracycline Related Cardiac Changes: A Systematic Review and Meta-analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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8
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Yu C, Negishi T, Thavendiranathan P, Pathan F, Penicka M, Côté M, Massey R, Miyazaki S, Shirazi M, Santoro C, Cho G, Popescu B, Vinereanu D, Kosmala W, Thomas L, Marwick T, Negishi K. Baseline Left Atrial Strain is Predictive of Chemotherapy Induced Cardiotoxicity in High-Risk Cancer Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Yu C, Pathan F, Chow V, Brieger D, Kritharides L, Ng A, Negishi K. Five-Year Cancer Incidence and Mortality Rates Involving 94,567 Patients Hospitalised With Heart Failure. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.089] [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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10
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Deshmukh T, Hume R, Pathan F, Chong J. Platelet Derived Growth Factor-AB Accelerates Scar Maturity in a Porcine Model of Ischaemia/Reperfusion. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Selvakumar D, Clayton Z, Prowse A, Dingwall S, George J, Shah H, Paterson H, Jeyaprakesh P, Wu Z, Campbell T, Kotake Y, Turnbull S, Nguyen Q, Grieve S, Palpant N, Pathan F, Kizana E, Kumar S, Gray P, Chong J. Cellular Heterogeneity of Pluripotent Stem Cell Derived Cardiomyocyte Grafts is Mechanistically Linked to Treatable Arrhythmias. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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12
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Selvakumar D, Deshmukh T, Foster S, Sinaei N, Min A, Grieve S, Pathan F, Chong J. Comparative Assessment of Motion Averaged Free-Breathing or Breath-Held Cardiac Magnetic Resonance Imaging Protocols in a Porcine Myocardial Infarction Model. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Ranasinghe M, Nolan M, Pathan F, Eskandari M, Black A, Marwick T. Comparison of Multi-Planar Acquisition Scan and Echocardiography Strategies for Detecting Cancer-Treatment-Related Cardiac Dysfunction in a Prospective Cohort. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Kalra S, Shaikh S, Priya G, Baruah MP, Verma A, Das AK, Shah M, Das S, Khandelwal D, Sanyal D, Ghosh S, Saboo B, Bantwal G, Ayyagari U, Gardner D, Jimeno C, Elbarbary N, Hafidh KA, Bhattarai J, Minulj TT, Zufry H, Bulugahapitiya U, Murad M, Tan A, Shahjada S, Bello MB, Katulanda P, Podgorski G, AbuHelaiqa WI, Tan R, Latheef A, Govender S, Assaad-Khalil SH, Kootin-Sanwu C, Joshi A, Pathan F, Nkansah DA. Correction to: Individualizing Time-in-Range Goals in Management of Diabetes Mellitus and Role of Insulin: Clinical Insights From a Multinational Panel. Diabetes Ther 2021; 12:2627-2629. [PMID: 34363138 PMCID: PMC8385018 DOI: 10.1007/s13300-021-01120-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - Shehla Shaikh
- Department of Endocrinology, KGN Institute of Diabetes and Endocrinology, Mumbai, Maharashtra, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Manas P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - Abhyudaya Verma
- Endocrine Division, Index Medical College, Indore, Madhya Pradesh, India
| | - Ashok K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mona Shah
- HARMONY Endocrine Diabetes and Metabolic Clinic, Vadodara, Gujarat, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Usha Ayyagari
- Department of Endocrinology, Apollo Sugar Clinics, Chennai, Tamil Nadu, India
| | - Daphne Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Cecilia Jimeno
- Department of Endocrinology, Philippine Society of Endocrinology, Diabetes and Metabolism, Manila, Philippines
| | - Nancy Elbarbary
- Department of Endocrinology, Ain Shams University, Cairo, Egypt
| | - Khadijah A Hafidh
- Department of Endocrinology, Rashid Hospital-Dubai Health Authority, Dubai, UAE
| | - Jyoti Bhattarai
- Department of Endocrinology, Metro Kathmandu Hospital, Kathmandu, Nepal
| | - Tania T Minulj
- Department of Endocrinology, General Hospital Karyadi, Semarang, Indonesia
| | - Hendra Zufry
- Department of Endocrinology, General Hospital Zainoel Abidin, Aceh, Indonesia
| | | | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Alexander Tan
- Department of Endocrinology, Sunway Medical Centre, Kuala Lumpur, Malaysia
| | - Selim Shahjada
- Department of Endocrinology, BSMMU (Bangabandhu Sheikh Mujib Medical University Hospital), Dhaka, Bangladesh
| | - Mijinyawa B Bello
- Department of Endocrinology, Gwarinpa District Hospital, Abuja, Nigeria
| | - Prasad Katulanda
- Department of Endocrinology, University of Colombo, Colombo, Sri Lanka
| | - Gracjan Podgorski
- Department of Endocrinology, Greenacres Hospital, Port Elizabeth, South Africa
| | | | - Rima Tan
- Department of Endocrinology, FEU-NRMF Medical Center, Quezon City, Philippines
| | - Ali Latheef
- Department of Endocrinology, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | | | | | - Ansumali Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Center, Kathmandu, Nepal
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Diana A Nkansah
- Department of Endocrinology, 37 Military Hospital Accra, Accra, Ghana
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Pathan F, Selim S, Fariduddin M, Rahman MH, Ashrafuzzaman SM, Afsana F, Qureshi NK, Hossain T, Saifuddin M, Kamrul-Hasan AB, Mir AS. Bangladesh Endocrine Society (BES) Position Statement for Management of Diabetes and Other Endocrine Diseases in Patients with COVID-19. Diabetes Metab Syndr Obes 2021; 14:2217-2228. [PMID: 34040407 PMCID: PMC8140905 DOI: 10.2147/dmso.s293688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The year 2020 witnessed a largely unprecedented pandemic of coronavirus disease (COVID-19), caused by SARS COV-2. Many people with COVID-19 have comorbidities, including diabetes, hypertension and cardiovascular diseases, which are significantly associated with worse outcomes. Moreover, COVID-19 itself is allied with deteriorating hyperglycemia. Therefore, Bangladesh Endocrine Society has formulated some practical recommendations for management of diabetes and other endocrine diseases in patients with COVID-19 for use in both primary and specialist care settings. OBJECTIVE The objective of the article is to develop a guideline to protect the vulnerable group with utmost preference - the elderly and those with comorbid conditions. Therefore, to ensure the adequate protective measures and timely treatment for COVID-19 patients with diabetes, other endocrine diseases or any other comorbidities. CONSIDERING AND MONITORING ISSUES The risk of a fatal outcome from COVID-19 may be up to 50% higher in patients with diabetes than in non-diabetics.Patients with diabetes and COVID had CFR 7.3-9.2%, compared with 0.9-1.4% in patients without comorbidities.Diabetic ketoacidosis may be one of the causes of mortality in COVID-19.There is wide fluctuation of blood glucose in these patients, probably due to irregular diet, reduced exercise, increased glucocorticoids secretion, and use of glucocorticoids. HbA1c should be <7.0% for the majority of the patients, this target may be relaxed in appropriate clinical settings.More emphasis should be given on day-to-day blood glucose levels. Hypoglycemia (<3.9 mmol/l) must be avoided.Frequent monitoring of blood glucose is needed in critically ill patients. CONCLUSION The fight against COVID-19 has been proven to be a challenging one. Therefore, all healthcare personnel should make the best use of updated knowledge and skills to ensure adequate protective measures and timely treatment for COVID-19 patients with diabetes, other endocrine diseases or any other comorbidities.
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Affiliation(s)
- Faruque Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Fariduddin
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - S M Ashrafuzzaman
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | | | - Tanjina Hossain
- Department of Endocrinology, Green Life Medical College Hospital, Dhaka, Bangladesh
| | - M Saifuddin
- Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | | | - Ahmed Salam Mir
- Department of Endocrinology, BIHS General Hospital, Dhaka, Bangladesh
| | - On behalf of the BES Diabetes and COVID Task Force
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Bangladesh Endocrine Society, Dhaka, Bangladesh
- National Healthcare Network (NHN) Uttara EC, Dhaka, Bangladesh
- Department of Endocrinology, Green Life Medical College Hospital, Dhaka, Bangladesh
- Department of Endocrinology, Dhaka Medical College Hospital, Dhaka, Bangladesh
- Mymensingh Medical College Hospital, Dhaka, Bangladesh
- Department of Endocrinology, BIHS General Hospital, Dhaka, Bangladesh
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16
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Kalra S, Shaikh S, Priya G, Baruah MP, Verma A, Das AK, Shah M, Das S, Khandelwal D, Sanyal D, Ghosh S, Saboo B, Bantwal G, Ayyagari U, Gardner D, Jimeno C, Barbary NE, Hafidh KA, Bhattarai J, Minulj TT, Zufry H, Bulugahapitiya U, Murad M, Tan A, Shahjada S, Bello MB, Katulanda P, Podgorski G, AbuHelaiqa WI, Tan R, Latheef A, Govender S, Assaad-Khalil SH, Kootin-Sanwu C, Joshi A, Pathan F, Nkansah DA. Individualizing Time-in-Range Goals in Management of Diabetes Mellitus and Role of Insulin: Clinical Insights From a Multinational Panel. Diabetes Ther 2021; 12:465-485. [PMID: 33367983 PMCID: PMC7846622 DOI: 10.1007/s13300-020-00973-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetes mellitus is a global health concern associated with significant morbidity and mortality. Inadequate control of diabetes leads to chronic complications and higher mortality rates, which emphasizes the importance of achieving glycemic targets. Although glycated hemoglobin (HbA1c) is the gold standard for measuring glycemic control, it has several limitations. Therefore, in recent years, along with the emergence of continuous glucose monitoring (CGM) technology, glycemic control modalities have moved beyond HbA1c. They encompass modern glucometrics, such as glycemic variability (GV) and time-in-range (TIR). The key advantage of these newer metrics over HbA1c is that they allow personalized diabetes management with person-centric glycemic control. Basal insulin analogues, especially second-generation basal insulins with properties such as longer duration of action and low risk of hypoglycemia, have demonstrated clinical benefits by reducing GV and improving TIR. Therefore, for more effective and accurate diabetes management, the development of an integrated approach with second-generation basal insulin and glucometrics involving GV and TIR is the need of the hour. With this objective, a multinational group of endocrinologists and diabetologists reviewed the existing recommendations on TIR, provided their clinical insights into the individualization of TIR targets, and elucidated on the role of the second-generation basal insulin analogues in addressing TIR.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - Shehla Shaikh
- Department of Endocrinology, KGN Institute of Diabetes and Endocrinology, Mumbai, Maharashtra, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Manas P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - Abhyudaya Verma
- Endocrine Division, Index Medical College, Indore, Madhya Pradesh, India
| | - Ashok K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mona Shah
- HARMONY Endocrine Diabetes and Metabolic Clinic, Vadodara, Gujarat, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - Banshi Saboo
- Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Usha Ayyagari
- Department of Endocrinology, Apollo Sugar Clinics, Chennai, Tamil Nadu, India
| | - Daphne Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Cecilia Jimeno
- Department of Endocrinology, Philippine Society of Endocrinology, Diabetes and Metabolism, Manila, Philippines
| | - Nancy E Barbary
- Department of Endocrinology, Ain Shams University, Cairo, Egypt
| | - Khadijah A Hafidh
- Department of Endocrinology, Rashid Hospital-Dubai Health Authority, Dubai, UAE
| | - Jyoti Bhattarai
- Department of Endocrinology, Metro Kathmandu Hospital, Kathmandu, Nepal
| | - Tania T Minulj
- Department of Endocrinology, General Hospital Karyadi, Semarang, Indonesia
| | - Hendra Zufry
- Department of Endocrinology, General Hospital Zainoel Abidin, Aceh, Indonesia
| | | | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Alexander Tan
- Department of Endocrinology, Sunway Medical Centre, Kuala Lumpur, Malaysia
| | - Selim Shahjada
- Department of Endocrinology, BSMMU (Bangabandhu Sheikh Mujib Medical University Hospital), Dhaka, Bangladesh
| | - Mijinyawa B Bello
- Department of Endocrinology, Gwarinpa District Hospital, Abuja, Nigeria
| | - Prasad Katulanda
- Department of Endocrinology, University of Colombo, Colombo, Sri Lanka
| | - Gracjan Podgorski
- Department of Endocrinology, Greenacres Hospital, Port Elizabeth, South Africa
| | | | - Rima Tan
- Department of Endocrinology, FEU-NRMF Medical Center, Quezon City, Philippines
| | - Ali Latheef
- Department of Endocrinology, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | | | | | - Ansumali Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Center, Kathmandu, Nepal
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Diana A Nkansah
- Department of Endocrinology, 37 Military Hospital Accra, Accra, Ghana
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17
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Pathan F, Lam P, Sivapathan S, Orde S, Nanan R, Negishi K. The impact of maternal diabetes on fetal left atrial size and function. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0125] [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
Introduction
The developmental impact of maternal diabetes on the fetal left atrium (LA) is unclear.
Purpose
To determine if maternal diabetes mellitus (DM) impacts fetal LA size and function (fetal LA strain (LAS)).
Methods
We evaluated LA area (LAA) and LAS on fetuses of diabetic and control mothers who attended a mandated 24 week fetal morphology scan. Participants were excluded from the study if: there was a history of pre-eclampsia or if the fetus did not have adequate images for LAS analysis
We used fetal cardiac 4-chamber view for analysis. A region of interest was drawn along the LA endocardial border for tracking and was used for assessment of maximum LAA.
Baseline variables were compared using Student t test or Mann-Whitney U test and are presented as Mean ± Standard Deviation or Median (Interquartile range (IQR)). Body mass index (BMI), maternal age, gestational age, fetal heart rate (FHR), smoking status, estimated fetal weight (EFW) and Maternal DM were analysed in univariate and multivariate models with respect to LAA and LAS.
Results
160 pregnant women (50 controls, 110 diabetics) were scanned. 9 were excluded due to poor image quality, resulting in 104 mothers with diabetes (T1DM 9, T2DM 8, and gestational DM 87) and 47 controls without diabetes.
The mothers were well matched for age, blood pressure, smoking prevalence and gestational age. The diabetic mothers had a significantly higher BMI: Median (IQR) ((30.4 kg/m2 (25.1–34.8) vs 20.8 kg/m2 (21.4–27.4), p<0.001) and had higher weight (77 kg (65–93) vs 64 kg (62–68), p<0.001).
FHR was higher in fetuses of diabetic mothers (147±10 vs 144±8, p 0.04). Maternal DM resulted in larger LAA 1.68 cm2±0.39 cm2 vs 1.56 cm2±0.36 cm2; p=0. 08, however the result was not significant. The LAS was significantly lower in fetuses with maternal DM compared to fetuses of controls: 28.8% ± 8.8% vs 32.3% ± 9.2%; p 0.033.
On multivariate analysis (Table 1), the predictors of LAS were Maternal DM and FHR and predictors of LAA were EFW and Maternal DM.
Conclusions
Maternal diabetes modulates both LA size and LA function. The association between LA function and FHR may provide an explanation for fetal tachycardia in Maternal DM.
Fetal left atrial strain
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Pathan
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - P Lam
- University of Sydney, Charles Perkins Centre, Sydney, Australia
| | - S Sivapathan
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - S Orde
- Nepean Hospital, Department of Intensive Care, Sydney, Australia
| | - R Nanan
- University of Sydney, Charles Perkins Centre, Sydney, Australia
| | - K Negishi
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
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18
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Sangha S, Gupta A, Negishi K, Pathan F. The reporting of reproducibility of cardiac imaging biomarkers. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3549] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
There is inconsistency in the reporting of reproducibility of imaging biomarkers in published literature.
Purpose
To assess the reporting of reproducibility of imaging biomarkers described in original articles across the top 3 multi-modality cardiovascular imaging journals.
Methods
We reviewed all published articles in 2018 in the 3 leading cardiovascular imaging journals: JACC cardiovascular Imaging (A), Circulation. Cardiovascular Imaging (B), and EHJ Cardiovascular Imaging (C). Articles were excluded if they were not original research or reproducibility reporting was not required: case reports, editorials, research supports, meta- analysis, reviews, miscellaneous.
The remaining articles were assessed for the following reproducibility reporting parameters:
1) Discuss reproducibility; 2) Assess reproducibility in current study; 3) Reproducibility tools used: Intra-class correlation coefficient (ICC), coefficient of variance (COV), Bland Altman analysis (BA), etc and 5) Proportion of total population used in reproducibility analysis
Results
Among 951 articles published (Journal A/B/C 521/ 171/ 259), 692 were excluded due to above reasons. 259 articles were assessed for reproducibility data (Figure 1a). 122 of the 259 (47%) articles discussed reproducibility, including 26/122 (21%) referring to previous reproducibility data. Remaining 96/122 (79%) articles demonstrated reproducibility in the current manuscript- there was no difference in the frequency of articles discussing reproducibility across three journals (A 35/85 (41%); B 25/52 (48%); C 62/122 (51%), p=0.39).
Modality differences between reporting of reproducibility were as follows: (Echo 66/122 (54%); CT 14/38 (37%); CMR 27/55 (49%); Nuclear 9/26 (35%) and others 6/18 (33%), p=0.04)
Measures used to demonstrate reproducibility were as follows: (1.) ICC 64/96 (67%); 2.) BA 28/96 (29%); 3.) COV 16/96 (17%); 4.) Agreement 18/96 (19%); 5.) Correlation (Pearson's r) 3/96 (3%) p<0.001) (Figure 1b).
The proportion of the total population used for reproducibility analysis ranged from 0.8% to 100%, median 18.6% IQR (7.8%- 56.3%). Regression revealed proportion of total population used, was inversely related to population size (r=−0.32, p 0.002). Modality differences were as follows: (Echo 12.0% (5.7%- 36.1%); CT 17.1% (7.8%- 100%); CMR 25.0% (16.1%- 97.1%); Nuclear 68.9% (29.6% - 100%) and others 56.1% (32.6%- 62.3%), p=0.03).
Conclusions
Approximately half original research manuscripts published across 3 major multi-modality imaging journals discussed or demonstrated reproducibility. No differences across journals were identified. There are differences between modalities with respect to reporting reproducibility. The most common tool used to report reproducibility was ICC. There is marked heterogeneity in the proportion of the total population used to demonstrate reproducibility, this is partly determined by the size of population being examined.
Figure 1. A Snapshot of reproducibility reporting
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Sangha
- Liverpool Hospital, Sydney, Australia
| | - A Gupta
- Nepean Hospital, Sydney, Australia
| | - K Negishi
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - F Pathan
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
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Nayyar D, Nguyen T, Pathan F, Vo T, Richards D, Thomas L, Dimitri H, Otton J. Cardiac magnetic resonance derived left atrial function after ST-elevation myocardial infarction: an important prognostic indicator. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0235] [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: 11/12/2022] Open
Abstract
Abstract
Background
The prognostic value of cardiac magnetic resonance (CMR) derived left atrial (LA) strain, ejection fraction (LAEF) and volumes (LAVImax and LAVImin) after STEMI is controversial.
Aim
To assess the relationship between LA function and major adverse cardiovascular events (MACE) within 2 years after STEMI.
Methods
We prospectively recruited 213 consecutive STEMI patients who underwent CMR at median day 4. 202 patients had complete CMR data for feature tracking assessment. LA reservoir and booster strain were quantified by one blinded observer based on the average of three independently repeated measurements from two- and four-chamber views. MACE was a composite of all-cause mortality, reinfarction, new or worsening heart failure, stroke and sustained ventricular arrhythmias.
Results
The cohort included 174 (86.1%) males, median age 56 years (IQR 50–65 years). MACE occurred in 35 (17.3%) patients. Patients with MACE had lower median reservoir strain (18.9 vs 29.4%, p<0.001), booster strain (9.4 vs 13.0%, p=0.002) and LAEF (41.5 vs 49.2%, p<0.001), and higher LAVImax (43.5 vs 38.6ml/m2, p=0.019) and LAVImin (23.7 vs 19.3ml/m2, p<0.001) than patients without MACE. Patients with reduced left ventricular ejection fraction (LVEF≤40%) had lower median reservoir strain (22.5 vs 30.1%, p<0.001), booster strain (11.3 vs 12.9%, p=0.021) and LAEF (43.3 vs 50.3%, p<0.001) than patients with LVEF>40%. AUC analyses showed reservoir strain (AUC 0.769; 95% CI 0.676–0.861, p<0.001), booster strain (AUC 0.684; 95% CI 0.558–0.810, p=0.002) and LAEF (AUC 0.698; 95% CI 0.596–0.800, p<0.001) predicted MACE. Kaplan Meier analyses showed a difference in MACE between high- and low-risk groups for reservoir strain (cutoff 21%, p<0.001), booster strain (cutoff 9.6%, p<0.001) and LAEF (cutoff 41%, p<0.001). Univariate Cox regression analyses showed all LA parameters had a significant effect on MACE, while multivariate analyses found additional prognostic utility using reservoir strain.
Conclusion
LA reservoir strain provided incremental prognostic value beyond established clinical and CMR parameters for predicting MACE after STEMI.
Kaplan Meier analyses
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Nayyar
- Liverpool Hospital, Sydney, Australia
| | - T Nguyen
- Liverpool Hospital, Sydney, Australia
| | - F Pathan
- Nepean Hospital, Sydney, Australia
| | - T Vo
- Liverpool Hospital, Sydney, Australia
| | | | - L Thomas
- Westmead Hospital, Sydney, Australia
| | - H Dimitri
- Liverpool Hospital, Sydney, Australia
| | - J Otton
- Liverpool Hospital, Sydney, Australia
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20
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Jeyaprakash P, Sangha S, Robeldo K, Ellenberger K, Sivapathan S, Pathan F, Negishi K. The role of cardio-protective agents in breast cancer patients to prevent anthracycline induced cardiotoxicity: a systematic review and network meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anthracycline (ANT)-based chemotherapy for breast malignancies have significantly improved cancer outcomes. However, the cardiotoxicity induced by ANTs in the breast cancer population has increased major adverse cardiac events. While randomised controlled trials (RCTs) have explored different primary preventative agents to confer cardio-protection pre chemotherapy, comparisons between agents has been limited. It is unclear which drug is the most efficacious in preserving Left Ventricular Ejection Fraction (LVEF) amongst this population.
Purpose
To perform a network meta-analysis of RCTs comparing the impact on LVEF of various prophylactic cardio-protective agents, when prescribed to breast cancer patients prior to ANT-based chemotherapy.
Methods
Two independent authors performed a literature search as per the PRISMA guidelines using four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTS evaluating cardio protective agents. The trial population was limited to patients with breast cancer without prior ANT exposure. Trials were only included if the cardio-protective agents were commenced prior to ANT dosing. The assessed outcome was a mean change in LVEF pre and post ANT dosing, compared to placebo prevention. Extracted data included age, ANT dose, and LVEF pre and post chemotherapy. The Cochrane Risk of Bias tool was used to appraise included RCTs.
Results
From 2807 search results, we identified twelve RCTs which evaluated 1126 patients. Seven studies assessed beta-blockers alone and two assessed combination ACE inhibitors and beta blockers. Individual studies assessing ACE inhibitors, spironolactone or rosuvastatin alone were also included. All patients were female with an average age of 50.5 and average ANT dose of 412 mg/m2. Our network meta-analysis showed beta-blockers showed significant protection with higher LVEF than placebo by 2.38% [0.52, 4.25]. ACE inhibitors showed a similar magnitude of LVEF preservation 2.59% [−0.20, 5.38] but not statistically significant due to wider CI because of lower sample size (n=250). Spironolactone showed a statistically significant preservation in LVEF by 12.80% [3.44, 22.16], however this was based on a single study (n=83), with marked measurement bias and deviations from intended intervention. All included trials had an intermediate or high risk of bias, with marked heterogeneity in ANT dosing and LVEF monitoring.
Conclusion
Beta-blockers minimise LVEF decline when administered prior to anthracycline chemotherapy, compared against alternate agents. Data may be underpowered to demonstrate the benefit of ACE inhibitor and combination beta blocker/ACE inhibitor prescription. The quality of RCT data to date is limited by a high risk of bias and significant heterogeneity between RCA reporting. This analysis is likely to inform clinical practice, and allow clinicians to prescribe primary cardio-protection in patients at high risk of cardiotoxicity.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - S Sangha
- Nepean Hospital, Sydney, Australia
| | - K Robeldo
- University of Sydney, Sydney, Australia
| | | | | | - F Pathan
- Nepean Hospital, Sydney, Australia
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Kalra S, Bajaj S, Sharma SK, Priya G, Baruah MP, Sanyal D, Das S, Chaudhury T, Gangopadhyay KK, Das AK, Sethi B, Ayyar V, Shaikh S, Shah P, Jindal S, Deshmukh V, Dave J, Amod A, Joshi A, Pokharel S, Pathan F, Afsana F, Prasad I, Murad M, Soelistijo SA, Purwoto J, Hussein Z, Horn LC, Sahay R, Somasundaram N, Antonypillai C, Sumanathilaka M, Bulugahapitiya U. A Practitioner's Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel. Diabetes Ther 2020; 11:585-606. [PMID: 31981212 PMCID: PMC7048897 DOI: 10.1007/s13300-020-00764-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
AIM To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM). BACKGROUND Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. REVIEW RESULTS After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. CONCLUSIONS In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - Sarita Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Surendra Kumar Sharma
- Diabetes, Thyroid and Endocrine Centre, Galaxy Specialty Centre, Jaipur, Rajasthan, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Manash P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Tirthankar Chaudhury
- Department of Diabetes and Endocrinology, Apollo Gleneagles Hospital, Kolkata, India
| | - Kalyan Kumar Gangopadhyay
- Department of Diabetology and Endocrinology, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India
| | - Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Bipin Sethi
- Department of Endocrinology, CARE Hospitals, Hyderabad, Telangana, India
| | - Vageesh Ayyar
- Department of Endocrinology, St John Hospital, Bangalore, Karnataka, India
| | - Shehla Shaikh
- Department of Endocrinology, KGN Institute of Diabetes and Endocrinology, Mumbai, Maharashtra, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Sushil Jindal
- Department of Endocrinology, Peoples Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - Joel Dave
- Department of Endocrinology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Aslam Amod
- Department of Endocrinology, Life Chatsmed Garden Hospital, Durban, South Africa
| | - Ansumali Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Kathmandu, Nepal
| | - Sunil Pokharel
- Department of Endocrinology, Alka Hospital, Kathmandu, Nepal
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Johanes Purwoto
- Department of Endocrinology, MRCCC Siloam Hospitals, Jakarta, Indonesia
| | - Zanariah Hussein
- Department of Endocrinology, Putrajaya Hospital, Putrajaya, Malaysia
| | - Lee Chung Horn
- Department of Diabetes and Endocrinology, Gleneagles Medical Centre, Singapore, Singapore
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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22
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Ghoreyshi-Hefzabad S, Vo Q, Gupta A, Pathan F, Negishi K. 410 Subclinical Alteration of Left Ventricular Mechanics Detected by 2D Speckle Tracking Echocardiography in Diabetes Mellitus: A Systematic Review and Meta-analysis of Three Global Strains. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.417] [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: 11/24/2022]
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23
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Pathan F, Lam P, Sivapathan S, Orde S, Negishi K, Nanan R. P1378 Impact of maternal diabetes on fetal left atrial function. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.812] [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/Introduction: Diabetes impacts 12- 14% of pregnancies. Evaluating the impact of maternal diabetes on the fetal heart is challenging due to variable image quality and limited time for structural changes to manifest. Left atrial reservoir strain (ER) is a sensitive marker of early left atrial dysfunction which may elucidate fetal atrial dysfunction resulting from maternal diabetes.
Purpose
We sought to evaluate if fetal ER can detect impairment of left atrial function in the fetal heart as a result of maternal diabetes.
Methods
We performed a prospective observational study evaluating patients who were referred to the high risk pregnancy service as a result of maternal diabetes (pre-existing or gestational) and healthy controls.
Patients were excluded if adequate imaging of the fetal myocardium was not possible. Baseline characteristics of the mother and cardio-metabolic risk factors were recorded.
The fetal echocardiogram focused on the 4 chamber view. We used the 4 chamber view with closure of the mitral valve as the zero reference point (R-R) gating. The strain curves from 6 atrial segments were averaged.
Normality of the data was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was used to compare ER between fetuses, whose mothers had diabetes versus those fetuses whose mothers were healthy controls.
Results
A total of 120 fetal scans were performed. 5 were excluded due to poor image quality, which prevented strain analysis. 115 fetal scans were analysed (87 with maternal diabetes and 27 healthy controls). The diabetic subjects and controls did not defer significantly in age Mean ± SD (31± 5 vs 30± 5, p= 0.81). The mothers with diabetes had a higher body mass index than controls (Median [IQR]) (30.5 kg/m2 [25.1, 35.3] vs 24.6 kg/m2 [22.1, 28.6] p < 0.001).
The presence of maternal diabetes resulted in lower fetal ER (28.5% [22.1, 36.2] vs 33.4% [26.6, 41.6] P = 0.01).
Figure 1 illustrates the Box-Whisker plot comparing Fetal ER between fetuses exposed to maternal diabetes and fetuses where mothers were healthy controls.
Conclusion
The presence of maternal diabetes results in impaired fetal left atrial function as measured by fetal left atrial strain (ER).
Abstract P1378 Figure 1
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Affiliation(s)
- F Pathan
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - P Lam
- Nepean Hospital, Sydney, Australia
| | | | - S Orde
- Nepean Hospital, Sydney, Australia
| | - K Negishi
- University of Sydney, Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - R Nanan
- University of Sydney, Charles Perkins Centre, Sydney, Australia
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Paul V, Joseph A, Sivapathan S, Madronio C, Pathan F. 644 The Impact of a Nurse Led Heart Failure Optimization Clinic. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.651] [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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25
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Ellenberger K, Neigishi K, Thai W, Jeyaprakash P, Sivapathan S, Pathan F. 278 A Real World Comparison of Body Surface Area Formulae. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.285] [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: 11/15/2022]
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26
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Ghoreyshi Hefzabad S, Vo Q, Gupta A, Pathan F, Negishi K. 389 Pooled Summary of Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Diabetes Mellitus Using 2D and 3D Speckle Tracking: A Systematic Review and Meta-analysis of 7256 Diabetics. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.396] [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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27
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Ferkh A, Stefani L, Trivedi S, Brown P, Pathan F, Thomas L. P1504 Inter-vendor comparison of left atrial 2-dimensional strain using multilayer analysis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.928] [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
Left atrial strain (LAS) is increasingly being accepted as a marker of left atrial function. Different vendors utilise different techniques of measuring LAS in echocardiography.
AIMS
To determine the difference between multilayer endocardial and mid-myocardial measurements of LA strain on General Electric (GE) Echopac compared to the TOMTEC system which tracks endocardial strain.
METHODS
Peak reservoir left atrial strain (LAS) was measured on 50 healthy controls using the two different echocardiographic software packages. GE Echopac (v201) 2D-speckle tracking echocardiography technique (LV package) was used to measuremid-myocardial (GE-mid) and endocardial (GE-endo) LAS. This was compared to LAS measurement using TOMTEC (v4.6) which uses an endocardial tracking technique. LAS was measured in 4ch and 2ch views and average biplane strain measurement was obtained.
RESULTS
The mean of GE-mid LAS was 36.3 ± 6.3%, GE-endo LAS was higher with a mean of 44.1 ± 8.0%, while TOMTEC LAS was 42.1 ± 6.3 %. GE-mid and GE-endo LAS correlated well with TOMTEC LAS (r = 0.9, p < 0.001 for both). On Bland-Altman Analysis, GE-mid LAS measurements were systematically lower than TOMTEC LAS (mean difference -5.77), whereas GE-endo LAS had no systematic bias (mean difference 1.99).
CONCLUSIONS
Mid-myocardial peak reservoir left atrial strain, which is routinely measured using GE Echopac software, systematically underestimates LAS as compared to TOMTEC LAS or GE endocardial LAS. This suggests that serial follow up of LAS measurements for patients should be performed on the same software.
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Affiliation(s)
- A Ferkh
- University of Sydney, Sydney, Australia
| | - L Stefani
- University of Sydney, Sydney, Australia
| | - S Trivedi
- University of Sydney, Sydney, Australia
| | - P Brown
- Westmead Hospital, Sydney, Australia
| | - F Pathan
- University of Sydney, Sydney, Australia
| | - L Thomas
- University of Sydney, Sydney, Australia
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28
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Chen H, Stephens M, Fernandez F, Bhat A, Gan G, Pathan F, Tan T. 371 Left Ventricular Geometry Impacts on Left Ventricular Function and Myocardial Energetics. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Nayyar D, Nguyen T, Pathan F, Vo T, Richards D, Thomas L, Dimitri H, Otton J. 011 Cardiac Magnetic Resonance Derived Left Atrial Strain Predicts Major Adverse Cardiovascular Events After ST-Elevation Myocardial Infarction. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.018] [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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30
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Bhowmik B, Ahmed T, Afsana F, Qureshi N, Siddiquee T, Pathan F, Amin F, Vale Moreira ND, Samad MA, Ashrafuzzaman SM, Ahmed T, Latif Z, Bhuiyan A, Alim A, Munir S, Karmokar R, Choudhury K, Zabeen B, Islam K, Rahman M, Rahman M, Milon S, Ozaki R, Alam MA, Huda T, Rahman MH, Hossain AHME, Mahtab H, Hussain A, Khan AKA. Guide on diabetes and COVID-19 for healthcare professionals in Bangladesh. J Diabetol 2020. [DOI: 10.4103/jod.jod_51_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Vilcek J, Moussad A, Sivapathan S, Jeyaprakash P, Negishi K, Pathan F. 333 Echocardiography Reporting in Ischaemic Heart Disease and Compliance With European Association Cardiovascular Imaging (EACVI) Recommendations. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick TH. 3224Incremental benefit of left ventricular global longitudinal strain over clinical and left atrial parameters for predicting new-onset atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0043] [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: 11/14/2022] Open
Abstract
Abstract
Background
Although LV hypertrophy and dysfunction are associated with atrial fibrillation (AF), AF often occurs in the absence of LV hypertrophy or reduced ejection fraction. The effect of subclinical LV dysfunction on AF has not been fully studied.
Purpose
We sought the association between subclinical LV dysfunction (measured with global longitudinal strain, GLS) and new-onset AF.
Methods
This observational study evaluated 531 consecutive patients (median age, 67 years [interquartile range, 56 to 78]; 56% male), without a history of AF who underwent strain echocardiography after cryptogenic stroke. The CHARGE-AF score was used to calculate the 5-year risk of developing AF. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir strain, pump strain, and conduit strain) and LV strain (GLS). A strain analysis was conducted using a dedicated software package, using R-R gating. The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared.
Results
Over 2.5 years of follow-up, 61 patients (11%) had new-onset AF. Patients who developed AF were older, had a higher CHARGE-AF score, larger LA volume, worse LA strain, and worse GLS than those who did not. Areas under the receiver-operating curve for GLS (0.84) was comparable to CHARGE-AF (0.79), LA pump strain (0.83), and LA reservoir strain (0.85). In the nested Cox models, GLS demonstrated an independent and incremental predictive value over the clinical and LA parameters (Figure). Moreover, adding GLS to the combined clinical and LA parameters model resulted in a significantly improved reclassification (net reclassification improvement, 0.32; p=0.016). Importantly, the predictive value of GLS was confirmed in patients with abnormal LA volumes (LA volume index≥34ml/m2) but not in patients with normal LA volumes.
Figure 1
Conclusion
GLS is associated with new-onset AF, especially in patients with abnormal LA volumes. This effect is independent of and incremental to the clinical and LA parameters.
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Affiliation(s)
- H Kawakami
- Baker Heart and Diabetes Institute, Cardiac Imaging, Melbourne, Australia
| | - S Ramkumar
- Baker Heart and Diabetes Institute, Cardiac Imaging, Melbourne, Australia
| | - F Pathan
- Menzies Research Institute, Hobart, Australia
| | - L Wright
- Baker Heart and Diabetes Institute, Cardiac Imaging, Melbourne, Australia
| | - T H Marwick
- Baker Heart and Diabetes Institute, Cardiac Imaging, Melbourne, Australia
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33
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Ramkumar S, Pathan F, Kawakami H, Ochi A, Yang H, Potter E, Marwick TH. P5979Impact of disease stage on performance of strain markers for prediction of atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0700] [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
Efforts to predict incident atrial fibrillation (AF) may be associated with complications, and there is interest in AF prediction in primary prevention (PP; pts with risk factors) and secondary prevention (SP; pts with possible AF complications). These pts have different risk levels, we sought whether that influenced the predictive value of LV dysfunction (measured as global longitudinal strain, GLS) or LA dysfunction (LA reservoir strain).
Methods
The PP cohort comprised 351 community-based pts ≥65 years with ≥1 risk factor for AF (age 70±4y,43% male, median follow-up 22 months) and the SP cohort comprised 532 pts after transient ischaemic attack or stroke (age 68±12y, 51% male, median follow-up 36 months). GLS and LA strain were measured offline (Image Arena-Tomtec, Germany). AF was diagnosed by 12 lead ECG, Holter or by single lead monitor. The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models were used to assess for independent and incremental predictive value of LA strain/GLS in both cohorts.
Results
Compared to SP, PP had higher clinical AF risk (CHARGE-AF 5.6±5.5% vs 4.7±12.1%, p=0.02) but a lower thromboembolic risk (CHA2DS2-VASC 3±2 vs. 4±2, p<0.001). AF developed in 42 PP pts (12%) and 61 SP (12%). AF patients were older, with higher CHARGE-AF score, LA volume and LV mass. Pts developing AF had reduced GLS (17±4% vs. 20±3%, p<0.001), reservoir (28±11% vs. 35±8%, p<0.001) and pump strain (13±7% vs. 17±5%, p<0.001). GLS and LA strain had greater AUC in SP (0.84 vs 0.58 for GLS and 0.85 vs 0.57 for reservoir strain, both p<0.001). Nested cox-regression models showed that LA reservoir strain was independently associated with AF in both cohorts (p<0.05). GLS was only independently associated with incident AF in SP (Figure).
Conclusion
LA reservoir strain is independently associated with AF in different risk cohorts and its effect is incremental to clinical parameters and LA volume. GLS may be more useful in AF risk assessment in those in SP.
Acknowledgement/Funding
This study was partially supported by the Tasmanian Community Fund and Siemens Healthcare Australia.
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Affiliation(s)
- S Ramkumar
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - F Pathan
- Menzies Research Institute, Hobart, Australia
| | - H Kawakami
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Ochi
- Menzies Research Institute, Hobart, Australia
| | - H Yang
- Menzies Research Institute, Hobart, Australia
| | - E Potter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - T H Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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34
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Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, Sahay R, Shukla R, Das S, Tiwaskar M, Vijayakumar G, Chawla M, Eliana F, Suastika K, Orabi A, Rahim AAA, Uloko A, Bahendeka S, Abdela AA, Mohammed F, Pathan F, Rahman MH, Afsana F, Selim S, Moosa M, Murad M, Shreshtha PK, Shreshtha D, Giri M, Hussain W, Al-Ani A, Ramaiya K, Singh S, Raza SA, Aye TT, Garusinghe C, Muthukuda D, Weerakkody M, Kahandawa S, Bavuma C, Ruder S, Vanny K, Khanolkar M, Czupryniak L. Glucocrinology of Modern Sulfonylureas: Clinical Evidence and Practice-Based Opinion from an International Expert Group. Diabetes Ther 2019; 10:1577-1593. [PMID: 31267358 PMCID: PMC6778594 DOI: 10.1007/s13300-019-0651-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 12/16/2022] Open
Abstract
AIM The primary objective of this document is to develop practice-based expert group opinion on certain important but less discussed endocrine and metabolic effects of modern sulfonylureas (SUs) and their usage in the management of diabetes mellitus (DM). BACKGROUND Modern SUs may be considered a panacea in DM care with their beneficial extra-pancreatic, pleiotropic, and cardiovascular effects. Safe glycemic control with SUs could be achieved with appropriate patient selection, drug and dosage selection, and patient empowerment. Additionally, sulfonylureas also exhibit certain endocrine and metabolic effects, which could be considered beneficial in the management of DM. In this regard, a group of international clinical experts discussed the less known beneficial aspects of SUs and safe and smart prescription of modern SUs in DM care. RESULTS The concept of glucocrinology or the relationship of glycemia with the endocrine system was emphasized during the meetings. Clinical experts arrived at a consensus for the usage of modern SUs in the presence of other endocrine dysfunction and the impact of these drugs on endocrine health. The beneficial pleiotropic and cardiovascular effects of modern SUs were also discussed. The key discussion points were considered to develop clinical expert opinions for the use of modern SUs in persons with DM. Clinical expert opinions were developed for indications, pleiotropic benefits, cardiovascular outcomes, adherence, and safe use of modern SUs. CONCLUSIONS Appropriate clinical judgement coupled with a patient-centered approach is crucial to achieve the best outcome in persons with DM. Owing to their safety, efficacy, extra-pancreatic benefits including effects on endocrine and metabolic aspects, and low cost of therapy, modern SUs could be considered as drugs/agents of choice for the treatment of diabetes. FUNDING Sanofi India.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - M P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspecialty Care, Siliguri, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital Ltd., Kanpur, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, India
| | - G Vijayakumar
- Department of Diabetology, Apollo Hospitals, Chennai, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Ketut Suastika
- Indonesian Association of Endocrinology, Jakarta, Indonesia
| | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Andrew Uloko
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Silver Bahendeka
- Department of Internal Medicine, Diabetes and Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Fariduddin Mohammed
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Shajada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muaz Moosa
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Dina Shreshtha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - Mimi Giri
- Department of Endocrinology, Nepal Mediciti Hospital, Kathmandu, Nepal
| | - Wiam Hussain
- Department of Endocrinology and Diabetes, Dr Wiam Clinic, Royal Hospital, Awali Hospital, Awali, Bahrain
| | - Ahmed Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - Kaushik Ramaiya
- Department of Diabetology, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Surender Singh
- Department of Internal Medicine, Aster Al Raffah Hospital, Muscat, Oman
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Hospital and Research Center, Lahore, Pakistan
| | - Than Than Aye
- Myanmar Society of Endocrinology and Metabolism, Yangon, Myanmar
| | - Chaminda Garusinghe
- Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Dimuthu Muthukuda
- Department of Endocrinology, Sri Jayawardenepura General Hospital, Sri Jayawardenepura Kotte, Sri Lanka
| | - Muditha Weerakkody
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | | | - Charlotte Bavuma
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Rwanda
| | - Sundeep Ruder
- Department of Endocrinology and Metabolism, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Koy Vanny
- Department of Diabetes and Endocrinology, Dr Koy Vanny Diabetes and Endocrine Clinic, Phnom Penh, Cambodia
| | - Manish Khanolkar
- Department of Endocrinology and Diabetes, Waikato Hospital, Hamilton, New Zealand
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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35
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Kalra S, Kishor K, Sawhney J, Kumar K, Raza SA, Shrestha D, Aye TT, Chaudhary S, Shaikh K, Somasundaram N, Pathan F, Sahay R, Priya G. The Lipo- Phenotypic Screening Tool for Familial Hypercholesterolaemia. J PAK MED ASSOC 2019; 69:1052-1054. [PMID: 31983747] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Familial hypercholesterolaemia (FH) is a common disorder of lipid metabolism. However, it is rarely diagnosed in time, leading to a high burden of preventable cardiovascular (CV) morbidity. The authors describe a lipophenotypic screening tool, which can be used by clinicians to screen for FH. This simple construct is based on history, physical examination, lipid profile and non-invasive cardioimaging. Structured as a bidirectional three column rubric, this tool should be able to improve clinical skills and teaching related to FH.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - Jps Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital New Delhi
| | - Krishna Kumar
- Department of Cardiology, Government Medical College, Trivandum, India
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Than Than Aye
- President, Myanmar Society of Endocrinology & Metabolism, Yangon, Myanmar
| | - Sandeep Chaudhary
- Department of Endocrinology, NMC Speciality Hospital, Al Nahada, Dubai, UAE
| | - Khalid Shaikh
- Department of Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Hospital, Hyderabad, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
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Barua M, Pathan F, Nabi MU, Kabir M. Assessment of clinical and biochemical profile of prediabetic subject in Bangladesh, attending in BIRDEM and results of intervention by lifestyle modification, metformin, and DPP4 inhibitor. Diabetes Metab Syndr 2019; 13:1603-1608. [PMID: 31336528 DOI: 10.1016/j.dsx.2019.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
Prediabetes increases an individual's risk for progress to diabetes. The aim of the study is to assess prediabetic profile before and after life style modification only, lifestyle with metformin and lifestyle with DPP-4 inhibitor. This study was carried out at BIRDEM. The subjects were IGT, IFG or combined. In Group A 50 subjects were advised with lifestyle, 42 were follow up with the results showed that highly significant change in BMI, Fasting & 2 h plasma glucose, serum triglyceride, and reduced HbA1c level, reduction rate of DM is 43%. In Group B 50 subjects were advised with lifestyle plus metformin, 44 were follow up with the results showed that significant change in BMI, Fasting, 2 h plasma glucose, triglyceride, and reduced HbA1c, reduction rate of DM is 58%. In Group C 50 subjects were advised with lifestyle plus DPP4i, 37 were follow up with the results showed that significantly change in BMI, Fasting, 2 h plasma glucose, triglyceride and reduced HbA1c level, reduction rate of DM is 43%. There is significant outcome difference in BMI in between A vs. B and A vs. C group. More mean changed in 2hrs after blood glucose level in group A vs. group B and B vs. C group. There is significant outcome difference in TG level in A vs. B, B vs. C group but no difference in A vs. C group.
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Affiliation(s)
- Milton Barua
- Endocrinology and Metabolism, BIRDEM, Dhaka, Bangladesh.
| | | | - Masud Un Nabi
- Endocrinology and Metabolism, BIRDEM, Dhaka, Bangladesh
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37
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Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick T. Incremental Benefit of Left Ventricular Global Longitudinal Strain over Clinical and Left Atrial Parameters for Predicting New-Onset Atrial Fibrillation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Autore C, Pathan F, Kozor R. A Systematic Review on the Cost-Effectiveness of Cardiovascular Magnetic Resonance. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.238] [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: 10/26/2022]
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39
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Chokshi N, Karmakar B, Pathan F. A Systematic Review of Frailty Scores Used in Heart Failure Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.058] [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: 10/26/2022]
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40
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Ferkh A, Trivedi S, Stefani L, Brown P, Pathan F, Thomas L. Multivendor Analysis of Left Atrial Strain using Multilayer Analysis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Haji K, Pathan F, Wong C, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. P5633Handheld ultrasound: a way to reduce requests for inappropriate echocardiograms. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Haji
- Western Hospital, Cardiology, Melbourne, Australia
| | - F Pathan
- Menzies Research Institute, Hobart, Australia
| | - C Wong
- Western Hospital, Cardiology, Melbourne, Australia
| | - C Neil
- Western Hospital, Cardiology, Melbourne, Australia
| | - N Cox
- Western Hospital, Cardiology, Melbourne, Australia
| | - A Mulligan
- Western Hospital, Cardiology, Melbourne, Australia
| | - M Oreto
- Western Hospital, Cardiology, Melbourne, Australia
| | - L Wright
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - T Marwick
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Pathan F, Zainal Abidin HA, Zhou H, Dangelo T, Elen E, Arendt C, Puntmann V, Nagel E. P5643Vector aligned flow imaging to evaluate diastolic function on cardiac magnetic resonance. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Pathan
- Menzies Research Institute, Hobart, Australia
| | - H A Zainal Abidin
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - H Zhou
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - T Dangelo
- G. Martino University Hospital Messina, Department of Biomedical Sciences and Morphological and Functional Imaging, Messina, Italy
| | - E Elen
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - C Arendt
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - V Puntmann
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - E Nagel
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
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Winau L, Pathan F, Heinke R, Haslbauer J, Puntmann V, Nagel E. P5640Global longitudinal and circumferential strain in combination with ejection fraction: an approach to measure cardiac function in ischaemic, dilative and inflammatory disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Winau
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
| | - F Pathan
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
| | - R Heinke
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
| | - J Haslbauer
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
| | - V Puntmann
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
| | - E Nagel
- JW Goethe University, kardiovaskuläre Bildgebung, Frankfurt am Main, Germany
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Pathan F, Zhou H, Zainal Abidin HA, Dangelo T, Elen E, Arendt C, Puntmann V, Nagel E. P3694Rapid two breath hold real time cardiovascular magnetic resonance for assessment of biventricular function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Pathan
- Menzies Research Institute, Hobart, Australia
| | - H Zhou
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - H A Zainal Abidin
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - T Dangelo
- G. Martino University Hospital Messina, Department of Biomedical Sciences and Morphological and Functional Imaging, Messina, Italy
| | - E Elen
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - C Arendt
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - V Puntmann
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
| | - E Nagel
- Goethe Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt, Germany
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Zhou H, Zainal HA, Arendt C, Pathan F, Wichmann J, Angelo T, Vogl T, Zeiher A, Nagel E, Puntmann V. P3700Comparison of different cardiac magnetic resonance imaging sequences of T1 mapping. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Zhou
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - H A Zainal
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - C Arendt
- JW Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - F Pathan
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - J Wichmann
- JW Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - T Angelo
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - T Vogl
- JW Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main, Germany
| | - A Zeiher
- JW Goethe University, Cardiology, Frankfurt am Main, Germany
| | - E Nagel
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - V Puntmann
- JW Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
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Ahammed A, Pathan F, Afsana F, Ahammed I, Mir AS, Yusuf A. The Burden of Severe Hypoglycemia on Quality of Life among Diabetes Mellitus Patients in a Tertiary Level Hospital of Bangladesh. Indian J Endocrinol Metab 2018; 22:499-504. [PMID: 30148097 PMCID: PMC6085957 DOI: 10.4103/ijem.ijem_338_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to determine the impact of hypoglycemia on health-related quality of life from a patient perspective. MATERIALS AND METHODS A cross-sectional study was conducted in 164 type 2 diabetes patients admitted due to severe hypoglycemia from August 2015 to October 2016 at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, in Dhaka. Impact of severe hypoglycemia on health-related quality of life in diabetic patients was evaluated using the disease-specific questionnaire audit of diabetes-dependent quality of life-19 (ADDQOL-19). RESULTS The median ADDQOL score was calculated at -3.31. Totally, 88 (53.7%) patients reported an ADDQOL score of - 3.31 or more, and 76 (46.3%) patients had an ADDQOL score of less than -3.31 (lower quality of life [QoL]). After considering weighting, "Freedom to eat" (mean Weighted Impact Score-6.32 ± 1.94) was the most and "Holidays" (mean Weighted Impact Score-0.96 ± 0.19) was the least affected QoL domains, respectively. In multivariate logistic regression analysis, severe hypoglycemia impact on ADDQOL was related with age (odds ratio [OR] 0.932, 95% confidence intervals [CIs] 0.897-0.969, P < 0.001), sex (OR 0.088, 95% CIs 0.023-0.338, P < 0.001), glycated hemoglobin (%) (OR 0.613, 95% CIs 0.422-0.890, P = 0.010), and marital status (OR 9.264, 95% CIs 2.467-34.790, P = 0.001). CONCLUSIONS The results of this analysis suggest hypoglycemia impacts heavily on the well-being and quality of life of people with diabetes, and every effort should be made to minimize hypoglycemia while aiming for good glycemic control.
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Affiliation(s)
- Afsar Ahammed
- Department of Physiotherapy, National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Imran Ahammed
- Officer on Special Duty, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ahmed Salam Mir
- Department of Endocrinology, Dhaka Central International Medical College and Hospital, Dhaka, Bangladesh
| | - Abdullah Yusuf
- Department of Microbiology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
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Bhowmik B, Afsana F, Ahmed T, Siddiquee T, Ahmed T, Pathan F, Mahtab H, Khan AKA. Evaluation of knowledge regarding gestational diabetes mellitus: a Bangladeshi study. Public Health 2018; 161:67-74. [PMID: 29913317 DOI: 10.1016/j.puhe.2018.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the level of knowledge about gestational diabetes mellitus (GDM) in Bangladeshi people. STUDY DESIGN Cross-sectional study. METHODS This study involving 1374 participants was conducted in 15 outpatient clinics of Diabetic Association of Bangladesh and its affiliated associations, Bangabandhu Sheikh Mujib Medical University and four medical college hospitals in Bangladesh from August 2015 to December 2015. A pretested interviewer-administered questionnaire was used to obtain information related to sociodemographic status, level of education, types of profession, and medical history. The questionnaire included eight questions on GDM. Level of knowledge (mean ± 1 standard deviation [SD]) was categorized as poor, average, and good. Descriptive, Chi-squared, and regression analysis were performed to express the results. RESULTS Of total knowledge score of 8, participants' mean knowledge score (±SD) was 2.7 ± 1.5. The levels of good, average, and poor knowledge were 26.3%, 63.1%, and 10.6%, respectively. In multivariate analysis, participants aged below 30 years (P < 0.001), male gender (P < 0.001), high-income group (P < 0.001), having university education (P < 0.001), health professionals (P < 0.001), capital Dhaka city residents (P < 0.001), those with family history of diabetes (P = 0.007), and participants with diabetes (P = 0.007) were found to be significantly associated with the good knowledge score. CONCLUSIONS Participants in this study had average knowledge about GDM. New innovative strategies should be developed to improve the knowledge of GDM among health professionals and general population.
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Affiliation(s)
- B Bhowmik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo 0318, Norway; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh.
| | - F Afsana
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka 1000, Bangladesh
| | - T Ahmed
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka 1000, Bangladesh
| | - T Siddiquee
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh
| | - T Ahmed
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka 1000, Bangladesh
| | - F Pathan
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka 1000, Bangladesh
| | - H Mahtab
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka 1000, Bangladesh
| | - A K A Khan
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh
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Pathan F, Puntmann V, Zhou H, Zainal Abidin H, D’Angelo T, Arendt C, Elen E, Winau L, Marwick T, Nagel E. Real-Time Rapid Two-Breath-Hold Cardiovascular Magnetic Resonance to Image Entire Left and Right Ventricle. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.503] [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: 10/28/2022]
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49
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Pathan F, Puntmann V, Zainal Abidin H, Zhou H, Elen E, D’Angelo T, Arendt C, Winau L, Marwick T, Nagel E. Echo Plane Flow Imaging to Evaluate Diastolic Function on Cardiac Magnetic Resonance. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.435] [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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50
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Haji K, Wong C, Pathan F, Neil C, Cox N, Mulligan A, Oreto M, Wright L, Marwick T. Using Handheld Ultrasound to Reduce Rarely Appropriate Echocardiograms. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.539] [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: 10/28/2022]
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