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Paul P, Shah M, Sridivya Chowdary V, Anusha Raaj A, Paul G. Suture-fixation of a levonorgestrel-releasing intrauterine device under hysteroscopic guidance. Facts Views Vis Obgyn 2023; 15:355-358. [PMID: 38128094 PMCID: PMC10832649 DOI: 10.52054/fvvo.15.4.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a common gynaecological condition. The levonorgestrel-releasing Intrauterine device (LNG-IUD) is an effective medical treatment. option which carries a small risk of device expulsion. For those who experience expulsion, some may benefit from a more robust surgical approach. Objectives To demonstrate the technique for suture fixation of an LNG-IUD under hysteroscopic guidance. Materials and methods: Stepwise video demonstration of the technique using a 5mm hysteroscope and a 3mm laparoscopic needle holder. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video described a modified surgical technique. Informed consent was obtained from the patient. Main outcome measures A 35yr old parous woman with a nine-month history of AUB and severe dysmenorrhoea had an LNG-IUD sited with effective symptom relief. Unfortunately, the device was expelled six months after insertion, and she responded poorly to other medical treatments. Transvaginal ultrasonography (TVUS) suggested posterior wall adenomyosis. Considering her relief of symptoms with the LNG-IUD and history of expulsion, the patient was counselled regarding suture-fixation of the LNG-IUD. Results She was followed-up at 6 months post insertion. The LNG-IUD was noted in the uterine cavity without displacement or expulsion. Conclusion Hysteroscopy-guided suture fixation of an LNG-IUD is a minimally invasive, effective option for patients with a history of expulsion of an IUD. However, further studies are required to establish the safety and efficacy of this approach. Learning Objective To demonstrate LNG -IUD suture fixation technique using hysteroscopy for patients diagnosed with AUB and a history of device expulsion.
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Affiliation(s)
- P.G. Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - M Shah
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - V Sridivya Chowdary
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - A Anusha Raaj
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - G Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
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Zampoli M, Morrow BM, Paul G. Real-world disparities and ethical considerations with access to CFTR modulator drugs: Mind the gap! Front Pharmacol 2023; 14:1163391. [PMID: 37050905 PMCID: PMC10083423 DOI: 10.3389/fphar.2023.1163391] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
The third Sustainable Development Goal (SDG), to ensure healthy lives and promote well-being for all at all ages, has particular relevance and implementation challenges amongst people living with rare diseases such as cystic fibrosis (CF). Although the treatment and projected outcome of CF has significantly improved with the advent of CF transmembrane conductance regulator protein modulator (CFTRm) therapy, there remains significant global inequality with regards to access to these life-saving and life-altering drugs. Elexacaftor, tezacaftor, and ivacaftor (ETI) triple combination therapy, first licensed in the United States in 2019, has rapidly become the standard of care for children aged 6 years and older in most high-income countries for individuals with CFTR variants responsive to ETI. Negotiated agreements for access to ETI are currently in place in North America,Europe, Israel ,Australia and New Zealand. However, less priority has been given to negotiate agreements for access to CFTRm in low-middle income countries(LMIC) with significant CF populations such as Central and South America, India, the Middle East, and Southern Africa. These countries and individuals living with CF are therefore effectively being left behind, in direct conflict with the stated principle of the 2030 SDGs. In this review, we highlight the current global inequity in access to CFTRm drugs and its impact on widening disparities between high-income countries and LMIC in CF outcomes and survival. We further discuss the reasons for this inequity and explore the ethical- and human rights-based principles and dilemmas that clinicians, families, governments, and healthcare funders must consider when prioritizing fair and affordable access to expensive CFTRm drugs. Lastly, we propose possible solutions to overcoming the barriers to accessing affordable CFTRm drugs in LMIC and illustrate with examples how access to drug therapies for other conditions have been successfully negotiated in LMIC through innovative partnerships between governments and pharmaceutical industries.
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Affiliation(s)
- M. Zampoli
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- *Correspondence: M. Zampoli,
| | - B. M Morrow
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - G Paul
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
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Kumar M, Danda S, Reddy H, S J, Paul G, Varkki S. 158: Late diagnosis of cystic fibrosis after first decade of life: Clinical observations of a milder phenotype in India. J Cyst Fibros 2021. [PMCID: PMC8518449 DOI: 10.1016/s1569-1993(21)01583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Huang Y, Lee J, Yarlagadda S, McCoy K, Paul G, Naren A. 575: Improved clinical outcome in an N1303K-CFTR patient treated with elexacaftor/tezacaftor/ivacaftor based on in vitro experimental evidence. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aaron R, Chapla A, Kumar M, Paul G, Danda S, Varkki S. 657: Importance of screening for splice site and deep intronic variants—Insights from cystic fibrosis genetic testing on patients from the Indian subcontinent. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paul G, Meißner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, Scheyerer MJ, Malin JJ, Suárez I, Lehmann C, Exner M, Wiesmüller GA, Higgins PG, Seifert H, Fätkenheuer G, Zweigner J, Jung N. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect 2021; 116:1-9. [PMID: 34298033 DOI: 10.1016/j.jhin.2021.07.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
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Affiliation(s)
- G Paul
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - A Meißner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Neuneier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuschmelting
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Grau
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A Yagdiran
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - M Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - G A Wiesmüller
- Abteilung Infektions- and Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - J Zweigner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Bhogal P, Paul G, Collins G, Jaffer O. Letter in response to: circulating von Willebrand factor and high molecular weight multimers as markers of endothelial injury predict COVID-19 in-hospital mortality. Angiogenesis 2021; 24:413-415. [PMID: 34101095 PMCID: PMC8186348 DOI: 10.1007/s10456-021-09790-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022]
Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, London, E1 1BB, UK.
| | - G Paul
- Department, of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Krigesbergstraße 60, 70174, Stuttgart, Germany
| | - G Collins
- Department of Cardiology, St. Bartholomew's Hospital, Barts NHS Trust, London, UK
| | - O Jaffer
- Department of Interventional Radiology, The Royal London Hospital, Barts NHS Trust, London, UK
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Gao L, Miletto I, Ivaldi C, Paul G, Marchese L, Coluccia S, Jiang F, Gianotti E, Pera-Titus M. Rational design of bifunctional hierarchical Pd/SAPO-5 for the synthesis of tetrahydrofuran derivatives from furfural. J Catal 2021. [DOI: 10.1016/j.jcat.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Benjamin J, Roy K, Paul G, Kumar S, Charles E, Miller E, Narsi-Prasla H, Mahan JD, Thammasitboon S. Improving Resident Self-Efficacy in Tracheostomy Management Using a Novel Curriculum. MedEdPORTAL 2020; 16:11010. [PMID: 33204834 PMCID: PMC7666842 DOI: 10.15766/mep_2374-8265.11010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patients receiving pediatric tracheostomy have significant risk for mortality due to compromised airway. Timely management of airway emergencies in children with tracheostomies is an important clinical skill for pediatricians. We developed this curriculum to improve residents' self-efficacy with tracheostomy management. METHODS We collected baseline data on 67 residents from two hospitals while creating a blended curriculum with video-based instruction on routine tracheostomy change and team management of tracheostomy emergency. Forty residents enrolled in the curriculum. During an ICU rotation, they received face-to-face instruction on routine tracheostomy change in small groups, followed by assessment of managing a tracheostomy emergency during a simulation. A video completed prior to the simulation took 9 minutes, the routine tracheostomy change didactic session took 15 minutes, and the simulation instruction was completed in 10-15 minutes. We collected feedback on the effectiveness of the curriculum from the participants. RESULTS All 107 residents from the baseline and intervention groups completed the self-efficacy survey. The intervention group had significantly higher changes in scores across all self-efficacy domains than the baseline group. On the curriculum feedback survey, residents rated the curriculum very highly, between 4.4 and 4.8 on a 5-point Likert scale. DISCUSSION Our blended curriculum increased learners' self-efficacy and promoted learner competence in tracheostomy management. Residents scored more than 80% across all aspects of simulation assessment and reported higher self-efficacy scores following our curricular intervention.
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Affiliation(s)
- J. Benjamin
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - K. Roy
- Medical Director-TICU, Baylor College of Medicine and Texas Children's Hospital; Assistant Professor of Pediatrics, Department of Pediatric ICU, Texas Children's Hospital and Baylor College of Medicine
| | - G. Paul
- Assistant Professor, Department of Pulmonology, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Kumar
- Instructor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Charles
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Miller
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - H. Narsi-Prasla
- Nurse Practitioner, Department of Otolaryngology, Baylor College of Medicine and Texas Children's Hospital
| | - J. D. Mahan
- Associate Director, Center for Faculty Advancement, Mentoring and Engagement (FAME), the Ohio State University College of Medicine; Professor, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University College of Medicine; Program Director, Pediatric Nephrology Fellowship Programs, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Thammasitboon
- Associate Professor and Director, Center for Research, Innovation and Scholarship (CRIS) in Medical Education, Baylor College of Medicine and Texas Children's Hospital
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Paul G, Wesselmann J, Adzic D, Malin JJ, Suarez I, Priesner V, Kümmerle T, Wyen C, Jung N, van Bremen K, Schlabe S, Wasmuth JC, Boesecke C, Fätkenheuer G, Rockstroh J, Schwarze-Zander C, Lehmann C. Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med 2020; 22:165-171. [PMID: 33128333 DOI: 10.1111/hiv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/25/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. METHODS From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. RESULTS In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. CONCLUSION Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
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Affiliation(s)
- G Paul
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - J Wesselmann
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - D Adzic
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - I Suarez
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - T Kümmerle
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K van Bremen
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J-C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - G Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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Frazer K, Paul G, Kroll T. Learning from Nightingale’s engagement with complex systems: 21st-century public health issues of homelessness and achieving Sustainable Development Goals. Perspect Public Health 2020; 140:139-140. [DOI: 10.1177/1757913920914653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- K Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - G Paul
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - T Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Affiliation(s)
- E. Suhir
- Portland State University, Portland, OR, USA
- Vienna Institute of Technology, Vienna, Austria
- James Cook University, Mackay, QLD, Australia
- ERS Co, Los Altos, CA, USA
| | - G. Paul
- James Cook University, Mackay, QLD, Australia
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Waldrop M, Lowes L, Toops J, Alfano L, Miller N, Iammarino M, Kotha K, Paul G, Moore-Clingenpeel M, Tsao C, Noritz G, Shell R, Flanigan K. P.365Clinical outcomes in patients with spinal muscular atrophy type 1, 2 or 3 after 1 year of nusinersen therapy. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.527] [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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Lee JD, Eftekari H, Paul G, Zhupaj A, Panikker S, Dhanjal T, Yusuf S, Hayat S, Osman F. P6561Diagnostic yield of implantable loop recorders: a comparison of arrhythmia nurse specialists versus clinicians. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1151] [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
Implantable loop recorders (ILR) are recommended in guidelines to determine symptom-rhythm correlation. Arrhythmia Nurse Specialists (ANS) play a critical role in the assessment of such patients. Their effectiveness at risk stratification for ILR implantation is unknown. The ESC 2018 Syncope guidelines recommend more research in this field.
Aim
To evaluate the diagnostic yield of consecutive ILR implants at a tertiary centre over a 2year period and compare ANS versus Clinicians.
Methods
A retrospective study of all patients undergoing ILR implant between April 2016 and April 2018. Data collected included baseline patient demographics, referral source and management changes made by ILR findings.
Results
305 patients had an ILR; median age was 71yrs (interquartile range 52–81), 55% male. Median follow-up time was 15months. Referrals were from general cardiology (GC) = 98 (32%), electrophysiology (EP) = 105 (34%), and ANS-led syncope clinic = 102 (34%). Indications for ILR implant were syncope = 203 (65.9%), palpitation = 21 (6.9%), pre-syncope = 16 (5.2%), cryptogenic stroke = 35 (11.5%) and others 7 (8.9%) (falls, channelopathies). Of the entire cohort, 102 (34.0%) experienced arrhythmias recorded on the ILR that resulted in a change of management. This included: pacemaker implant = 49 (16.1%), complex-device implant = 7 (2.3%), AF=28 (9.2%), SVT=14 (4.6%), VT=1 (0.3%). Of those with a syncope indication (n=203), findings on ILR altered management in 73patients (36.0%) over a median follow-up of 18months; a pacing indication in this syncope group was present in 44 (21.9%) patients (median time to diagnosis: 2.7 months) with 24 receiving a pacemaker indication within 3 months of ILR insertion. ANS had a higher pacemaker implant rate. Overall, an ILR resulted in a diagnostic yield of 34.1% (n=104). Specialist nurse referral resulted in an overall greater trend towards change of management in 38.2% of patients compared with GC (32.7%) and EP (31.0%) (p=0.593 nurse vs. consultant).
Conclusion
The overall diagnostic yield of ILR insertion was 34% in our study. ANS had a trend towards a greater diagnostic yield compared with clinicians, and significantly more pacemaker indications. Our data suggests that ANS patient selection for ILR insertion are at least comparable to clinicians.
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Affiliation(s)
- J D Lee
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - H Eftekari
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - G Paul
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - A Zhupaj
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Panikker
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - T Dhanjal
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Yusuf
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - S Hayat
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - F Osman
- University Hospital Coventry and Warwickshire NHS Trust, and Warwick Medical School, Coventry, United Kingdom
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Paul B, Paul G, Singh G. Gender association of impulse control disorders (ICD-RBS) in patients with Parkinson's disease and its impact on quality of life. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.1442] [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: 10/25/2022]
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16
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Battegazzore D, Lavaselli M, Cheng B, Li D, Yang R, Frache A, Paul G, Marchese L. Reactive extrusion of sol-gel silica as fire retardant synergistic additive in ethylene-vinyl acetate copolymer (EVA) composites. Polym Degrad Stab 2019. [DOI: 10.1016/j.polymdegradstab.2019.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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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Abstract
Chorea is a rare manifestation of poisoning. We report an index case of a young woman who developed generalized chorea following propiconazole toxin ingestion. As large series on neurological complications of toxic compounds are difficult to be compiled, it is of interest to report our experience. This report adds one more compound to the increasing list of toxic chorea.
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Affiliation(s)
- B S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - G Paul
- Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J Kaur
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - G Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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18
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Shell R, Al-Zaidy S, Arnold W, Rodino-Klapac L, Prior T, Kotha K, Paul G, Lowes L, Alfano L, Berry K, Church K, Kissel J, Nagendran S, Ogrinc F, Sproule D, Wells C, Meyer K, Likhite S, Kaspar B, Mendell J. SMA THERAPIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.206] [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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Gatti G, Costenaro D, Vittoni C, Paul G, Crocellà V, Mangano E, Brandani S, Bordiga S, Cossi M, Marchese L, Bisio C. CO 2 adsorption on different organo-modified SBA-15 silicas: a multidisciplinary study on the effects of basic surface groups. Phys Chem Chem Phys 2018; 19:14114-14128. [PMID: 28524206 DOI: 10.1039/c6cp08048k] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hybrid organic-inorganic SBA-15 silicas functionalized with increasing amounts of amino groups were studied in this work aiming to evaluate the effects of their physico-chemical properties on CO2 capture ability. Three different amino-silane species were used: 3-aminopropyltriethoxysilane (APTS), 3-(2-aminoethyl)aminopropyltrimethoxysilane (EAPTS) and 3-[2-(2-aminoethyl)aminoethyl] aminopropyltrimethoxysilane (PAPTS). More specifically, samples were prepared by using two methods, following a post-synthesis grafting procedure and a one-pot preparation method. Experimental and computational techniques were used to study the structural and textural properties of the obtained samples and their surface species in relation to the adopted preparation method. For the most reactive samples, additional hints on the interactions of organosilane species with the silica surface were obtained by a combination of IR and SS-NMR spectroscopy, with particular emphasis on the effects of the silane chain length on the mobility of the organic species. Advanced complementary solid-state NMR techniques provided deeper information on the interactions of organosilane species with the silica surface. Finally, the amount of CO2 adsorbed was estimated by comparing the classical microcalorimetric analysis method with a new type of screening test, the Zero Length Column analysis, which is able to evaluate small amounts of samples in a very short time and the adsorption properties of the adsorbents. The reactivity of the amino-modified silica samples is deeply influenced by both the preparation route and by the type of organosilane used for the functionalization of the materials. In particular, samples prepared by the post-synthesis grafting procedure and containing higher amount of amino groups in the chain are more reactive, following the order PAPTS > EAPTS > APTS.
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Affiliation(s)
- G Gatti
- Dipartimento di Scienze e Innovazione Tecnologica and "Centro interdisciplinare Nano-SiSTeMI", Università del Piemonte Orientale, via T. Michel 11, 15121 Alessandria, Italy.
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Padwick A, Osman F, Paul G, Jones G, Hayat S, Eftekhari H. 9Implementation of opportunistic screening at Pre-Assessment Clinics for upgrade/downgrade of cardiac devices. Europace 2017. [DOI: 10.1093/europace/eux283.018] [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: 11/13/2022] Open
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21
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Eftekhari HR, Osman F, Paul G, Padwick A, Hayat S. 103How is our local AF management? The management of atrial fibrillation (af) in coventry and rugby clinical commissioning group (ccg), england compared to national data and nice (national institute for clinical excellence) 2014. Europace 2017. [DOI: 10.1093/europace/eux283.097] [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: 11/14/2022] Open
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22
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Draeger D, Zahn T, Berenberg-Goßler P, Paul G, Neuwirth J, Kuhlmey A. GENDER-SPECIFIC PREVALENCE OF COMORBIDITIES AND USE OF HEALTH CARE SERVICES IN GERMAN CENTENARIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D. Draeger
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
| | - T. Zahn
- GeWINO Institut der AOK Nordost, Berlin, Germany
| | | | - G. Paul
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
| | - J. Neuwirth
- GeWINO Institut der AOK Nordost, Berlin, Germany
| | - A. Kuhlmey
- Charite - Universitätsmedizin Berlin, Berlin, Germany,
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Gatti G, Vittoni C, Costenaro D, Paul G, Mangano E, Brandani S, Marchese L, Bisio C. The influence of particle size of amino-functionalized MCM-41 silicas on CO2 adsorption. Phys Chem Chem Phys 2017; 19:29449-29460. [DOI: 10.1039/c7cp05177h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effect of the particle size of hybrid organic–inorganic MCM-41 silicas on the CO2 adsorption properties has been investigated.
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Affiliation(s)
- G. Gatti
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - C. Vittoni
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - D. Costenaro
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - G. Paul
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - E. Mangano
- Scottish Carbon Capture and Storage, School of Engineering, University of Edinburgh
- Edinburgh
- UK
| | - S. Brandani
- Scottish Carbon Capture and Storage, School of Engineering, University of Edinburgh
- Edinburgh
- UK
| | - L. Marchese
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
| | - C. Bisio
- Dipartimento di Scienze e Innovazione Tecnologica and “Centro interdisciplinare Nano-SiSTeMI”, Università del Piemonte Orientale
- Alessandria
- Italy
- ISTM-CRN Istituto di Scienze e Tecnologie Molecolari
- Milano
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Rezaienia MA, Paul G, Avital EJ, Mozafari S, Rothman M, Korakianitis T. In-vitro investigation of the hemodynamic responses of the cerebral, coronary and renal circulations with a rotary blood pump installed in the descending aorta. Med Eng Phys 2016; 40:2-10. [PMID: 28040435 DOI: 10.1016/j.medengphy.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/02/2016] [Accepted: 11/13/2016] [Indexed: 02/08/2023]
Abstract
This study investigates the hemodynamic responses of the cardiovascular system when a rotary blood pump is operating in the descending aorta, with a focus on the cerebral, coronary and renal autoregulation, using our in-house cardiovascular emulator. Several improvements have been made from our previous studies. A novel coronary system was developed to replicate the native coronary perfusion. Three pinch valves actuated by stepper motors were used to simulate the regional autoregulation systems of the native cerebral, coronary and renal circulations. A rotary pump was installed in the descending aorta, in series with the heart, and the hemodynamic responses of the cardiovascular system were investigated with a focus on cerebral, coronary and renal circulation over a wide range of pump rotor speeds. Experiments were performed twice, once with the autoregulation systems active and once with the autoregulation systems inactive, to reflect that there will be some impairment of autoregulatory systems in a patient with heart failure. It was shown that by increasing the rotor speed to 3000 rpm, the cardiac output was improved from 2.9 to 4.1 L/min as a result of an afterload reduction induced by the pressure drop upstream of the pump. The magnitudes of changes in perfusion in the cerebral, coronary and renal circulations were recorded with regional autoregulation systems active and inactive.
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Affiliation(s)
- M A Rezaienia
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - G Paul
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - E J Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - S Mozafari
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - M Rothman
- Department of Cardiology, London Chest Hospital, Barts and the London NHS Trust, London E2 9JX, UK
| | - T Korakianitis
- Parks College of Engineering, Aviation and Technology, Saint Louis University, St. Louis, Missouri 63103, USA.
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25
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Miller CG, Bogado CC, Nino AJ, Northcutt AR, Yu HJ, Lewiecki EM, Paul G, Cobitz AR, Wooddell MJ, Bilezikian JP, Fitzpatrick LA. Evaluation of Quantitative Computed Tomography Cortical Hip Quadrant in a Clinical Trial With Rosiglitazone: A Potential New Study Endpoint. J Clin Densitom 2016; 19:485-491. [PMID: 27052635 DOI: 10.1016/j.jocd.2016.02.003] [Citation(s) in RCA: 5] [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: 06/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) measurements have been used extensively to ascertain information about bone quality and density due to the 3-dimensional information provided and the ability to segment out trabecular and cortical bones. QCT imaging helps to improve our understanding of the role that each bone compartment plays in the pathogenesis and prognosis of fracture. This study was conducted to explore longitudinal changes in femoral neck (FN) cortical bone structure using both volumetric bone mineral density (vBMD) and cortical shell thickness assessments via QCT in a double-blind, randomized, multicenter clinical trial in postmenopausal women with type 2 diabetes mellitus. This study also examined whether treatment-associated changes in the cortical bone vBMD and thickness in femoral neck quadrants could be evaluated. Subjects were randomized to rosiglitazone (RSG) or metformin (MET) for 52 wk followed by 24 wk of open-label MET. A subset of 87 subjects underwent QCT scans of the hip at baseline, after 52 wk of double-blind treatment, and after 24 wk of treatment with MET using standard full-body computed tomography scanners. All scans were evaluated and analyzed centrally. Cortical vBMD at the FN was precisely segmented from trabecular bone and used to assess a possible therapeutic effect on this bone compartment. QCT analysis showed reductions in adjusted mean percentage change in vBMD and in absolute cortical thickness occurred with RSG treatment from baseline to week 52, whereas changes with MET were generally minimal. The reductions observed during RSG treatment for 1 yr appeared to partially reverse during the open-label MET phase from weeks 52 to 76. The femoral neck quadrant may provide utility as a potential endpoint in clinical trials for the understanding of the therapeutic effect of new entities on cortical bone vs trabecular bone; however, further clinical validation is needed. TRIAL REGISTRATION The protocol (GSK study number AVD111179) was registered on ClinicalTrials.gov as NCT00679939.
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Affiliation(s)
| | - Cesar C Bogado
- Instituto Investigaciones Metabolicas, Buenos Aires, Argentina
| | - Antonio J Nino
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA.
| | | | - Hui Jing Yu
- Medical Affairs, BioClinica Inc., Princeton, NJ, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - G Paul
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
| | | | | | - John P Bilezikian
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Martins Estevão B, Cucinotta F, Hioka N, Cossi M, Argeri M, Paul G, Marchese L, Gianotti E. Rose Bengal incorporated in mesostructured silica nanoparticles: structural characterization, theoretical modeling and singlet oxygen delivery. Phys Chem Chem Phys 2016; 17:26804-12. [PMID: 26396040 DOI: 10.1039/c5cp03564c] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rose Bengal (RB), a xanthene dye, incorporated into mesostructured silica nanoparticles (MSNs) exhibits efficient singlet oxygen ((1)O2) generation when illuminated with 540 nm green light which is particularly promising for PDT applications. Several systems with different RB loadings were synthesized and fully characterized by means of spectroscopic techniques in combination with a computational study, to optimize the amount of RB in order to avoid the formation of aggregates that is detrimental for a high (1)O2 delivery.
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Affiliation(s)
- B Martins Estevão
- Department of Science and Technological Innovation and Nano-SiSTeMI Centre, Università del Piemonte Orientale, Viale T. Michel 11, 15121 Alessandria, Italy.
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Paul G, Kempa A, Bosse A, Zoller W. Pulmonale Filariose als seltene Ursache einer chronischen Pneumonie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572227] [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: 10/22/2022]
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28
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Kovalenko S, Paul G, Matyash N, Kozyakov A. P107. EJC Suppl 2015. [DOI: 10.1016/j.ejcsup.2015.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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29
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Loete T, Paul G, Ismail E. A preliminary investigation of the dynamic viscoelastic relaxation of bovine cortical bone. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/20159403004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Choudhuri NC, Paul G, Kundu A, Kundu MS, De AK, Ram N. Evaluation of egg quality traits of endangered Nicobari fowl and its crosses under intensive and backyard system of Andaman and Nicobar Islands, India. Vet World 2014. [DOI: 10.14202/vetworld.2014.693-697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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De Vleeschauwer AR, Lefebvre DJ, Willems T, Paul G, Billiet A, Murao LE, Neyts J, Goris N, De Clercq K. A Refined Guinea Pig Model of Foot-and-Mouth Disease Virus Infection for Assessing the Efficacy of Antiviral Compounds. Transbound Emerg Dis 2014; 63:e205-12. [DOI: 10.1111/tbed.12255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. R. De Vleeschauwer
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - D. J. Lefebvre
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - T. Willems
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
| | - G. Paul
- MSD Animal Health; Intervet International GmbH; Köln Germany
| | | | | | - J. Neyts
- Aratana Therapeutics NV; Leuven Belgium
- Department of Microbiology and Immunology; Rega Institute for Medical Research; Katholieke Universiteit Leuven; Leuven Belgium
| | - N. Goris
- Aratana Therapeutics NV; Leuven Belgium
| | - K. De Clercq
- Unit of Vesicular and Exotic Diseases; OD Viral Diseases; CODA-CERVA; Veterinary and Agrochemical Research Centre; Brussel Belgium
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Cloete TJ, Paul G, Ismail EB. Hopkinson bar techniques for the intermediate strain rate testing of bovine cortical bone. Philos Trans A Math Phys Eng Sci 2014; 372:20130210. [PMID: 24711493 PMCID: PMC3982653 DOI: 10.1098/rsta.2013.0210] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Detailed knowledge of the dynamic viscoelastic properties of bone is required to understand the mechanisms of macroscopic bone fracture in humans, and other terrestrial mammals, during impact loading events (e.g. falls, vehicle accidents, etc.). While the dynamic response of bone has been studied for several decades, high-quality data remain limited, and it is only within the last decade that techniques for conducting dynamic compression tests on bone at near-constant strain rates have been developed. Furthermore, there appears to be a lack of published bone data in the intermediate strain rate (ISR) range (i.e. 1-100 s(-1)), which represents a regime in which many dynamic bone fractures occur. In this paper, preliminary results for the dynamic compression of bovine cortical bone in the ISR regime are presented. The results are obtained using two Hopkinson-bar-related techniques, namely the conventional split Hopkinson bar arrangement incorporating a novel cone-in-tube striker design, and the recently developed wedge bar apparatus. The experimental results show a rapid transition in the strain rate sensitive behaviour of bovine cortical bone in the ISR range. Finally, a new viscoelastic model is proposed that captures the observed transition behaviour.
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Affiliation(s)
- T. J. Cloete
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
| | - G. Paul
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
| | - E. B. Ismail
- Blast Impact and Survivability Research Unit (BISRU), University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
- Department of Mechanical Engineering, University of Cape Town, Private bag X3, Rondebosch 7701, South Africa
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Paul G, Kempa A, Zoller W. Seltener Fall einer Larynxtuberkulose, mit kompletter Destruktion der Epiglottis. Pneumologie 2014. [DOI: 10.1055/s-0034-1367897] [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: 10/25/2022]
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Paul G, Zachrisson O, Varrone A, Almqvist P, Jerling M, Lindh G, Rehncrona S, Linderoth B, Bjartmarz H, Svensson M, Mercer KJ, Forsberg A, Shafer L, Lang AJ, Halldin C, Svenningsson P, Widner H, Frisen J, Pålhagen S, Haegerstrand A. Safety and efficacy of recombinant human platelet derived growth factor (Rhpdgf) in Parkinson's disease. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.457] [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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Paul BS, Singh G, Bansal RK, Paul G. Author reply: To PMID 23793316. J Postgrad Med 2013; 59:248-249. [PMID: 24156125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Sacchetto V, Gatti G, Paul G, Braschi I, Berlier G, Cossi M, Marchese L, Bagatin R, Bisio C. The interactions of methyl tert-butyl ether on high silica zeolites: a combined experimental and computational study. Phys Chem Chem Phys 2013; 15:13275-87. [DOI: 10.1039/c3cp51684a] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Paul BS, Bansal R, Singh G, Paul G. Diffusion weighted MR imaging of 5-fluorouracil and oxaliplatin-induced leukoencephalopathy. J Postgrad Med 2013; 59:135-7. [DOI: 10.4103/0022-3859.113845] [Citation(s) in RCA: 9] [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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Sirker A, Paul G, Dworakowski R, Melikian N, Byrne J. 020 Comparison of fractional flow reserve measurements obtained using central vs distal peripheral intravenous adenosine infusion to induce hyperaemia. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Al-Dirini RMA, Thewlis D, Paul G. A comprehensive literature review of the pelvis and the lower extremity FE human models under quasi-static conditions. Work 2012; 41 Suppl 1:4218-29. [PMID: 22317369 DOI: 10.3233/wor-2012-1039-4218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Finite Element Modeling (FEM) has become a vital tool in the automotive design and development processes. FEM of the human body is a technique capable of estimating parameters that are difficult to measure in experimental studies with the human body segments being modeled as complex and dynamic entities. Several studies have been dedicated to attain close-to-real FEMs of the human body (Pankoke and Siefert 2007; Amann, Huschenbeth et al. 2009; ESI 2010). The aim of this paper is to identify and appraise the state-of-the art models of the human body which incorporate detailed pelvis and/or lower extremity models. Six databases and search engines were used to obtain literature, and the search was limited to studies published in English since 2000. The initial search results identified 636 pelvis-related papers, 834 buttocks-related papers, 505 thigh-related papers, 927 femur-related papers, 2039 knee-related papers, 655 shank-related papers, 292 tibia-related papers, 110 fibula-related papers, 644 ankle-related papers, and 5660 foot-related papers. A refined search returned 100 pelvis-related papers, 45 buttocks-related papers, 65 thigh-related papers, 162 femur-related papers, 195 knee-related papers, 37 shank-related papers, 80 tibia-related papers, 30 fibula-related papers and 102 ankle-related papers and 246 foot-related papers. The refined literature list was further restricted by appraisal against a modified LOW appraisal criteria. Studies with unclear methodologies, with a focus on populations with pathology or with sport related dynamic motion modeling were excluded. The final literature list included fifteen models and each was assessed against the percentile the model represents, the gender the model was based on, the human body segment/segments included in the model, the sample size used to develop the model, the source of geometric/anthropometric values used to develop the model, the posture the model represents and the finite element solver used for the model. The results of this literature review provide indication of bias in the available models towards 50th percentile male modeling with a notable concentration on the pelvis, femur and buttocks segments.
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Crystal E, Shwiri TZ, Yang Y, Lashevsky I, Lau C, Paul G, Dick A, Kiss A, Singh S, Wright G. 686 Cardiac MRI predicts inducible ventricular tachycardia and appropriate defibrillator therapies in ischemic cardiomyopathy. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
OBJECTIVE To test the effectiveness of peer support for patients with type 2 diabetes. DESIGN Cluster randomised controlled. SETTING 20 general practices in the east of the Republic of Ireland. PARTICIPANTS 395 patients (192 in intervention group, 203 in control group) and 29 peer supporters with type 2 diabetes. INTERVENTION All practices introduced a standardised diabetes care system. The peer support intervention ran over a two year period and contained four elements: the recruitment and training of peer supporters, nine group meetings led by peer supporters in participant's own general practice, and a retention plan for the peer supporters. MAIN OUTCOME MEASURES HbA(1c); cholesterol concentration; systolic blood pressure; and wellbeing score. RESULTS There was no difference between intervention and control patients at baseline. All practices and 85% (337) of patients were followed up. At two year follow-up, there were no significant differences in HbA(1c) (mean difference -0.08%, 95% confidence interval -0.35% to 0.18%), systolic blood pressure (-3.9 mm Hg, -8.9 to 1.1 mm Hg), total cholesterol concentration (-0.03 mmol/L, -0.28 to 0.22 mmol/L), or wellbeing scores (-0.7, -2.3 to 0.8). While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up, particularly for systolic blood pressure (52% (87/166) >130 mm Hg in intervention v 61% (103/169) >130 mm Hg in control), these changes were not significant. The process evaluation indicated that the intervention was generally delivered as intended, though 18% (35) of patients in the intervention group never attended any group meetings. CONCLUSIONS A group based peer support intervention is feasible in general practice settings, but the intervention was not effective when targeted at all patients with type 2 diabetes. While there was a trend towards improvements of clinical outcomes, the results do not support the widespread adoption of peer support. Trial registration Current Controlled Trials ISRCTN42541690.
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Affiliation(s)
- S M Smith
- Department of Public Health and Primary Care, Trinity College, Dublin, Republic of Ireland.
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Paul G, Pal T, Manna I. Thermo-physical property measurement of nano-gold dispersed water based nanofluids prepared by chemical precipitation technique. J Colloid Interface Sci 2010; 349:434-7. [DOI: 10.1016/j.jcis.2010.05.086] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 05/25/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
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Abstract
Antihistamines are easily available over-the-counter medications, which are frequently involved in overdoses. The usual course is accompanied by the anticholinergic effects of these agents. We report a case of a suicide attempt in a young male, where ingestion of antihistamine pheniramine maleate was complicated by nontraumatic rhabdomyolysis and oliguric acute renal failure. Rhabdomyolysis and acute renal failure is a rarely reported but potentially serious complication among patients who present to the emergency after intentional overdoses making recognition and prompt intervention essential. We also describe the potential mechanism of muscle injury in antihistamine overdose.
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Affiliation(s)
- G Paul
- Critical Care Team, Dyanand Medical College and Hospital, Ludhiana, India.
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Mohan M, Paul G, Thomas S, Jaber M. Evaluation of neck node metastasis from oral cancer in an Indian population: A comparative pilot study. Ibnosina Journal of Medicine and Biomedical Sciences 2010. [DOI: 10.4103/1947-489x.210964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: Cervical node metastasis in oral cancer is an indicator of advanced disease. It is therefore important to evaluate neck node involvement as a predictor of progression and treatment planning.Materials & Methods: Eleven patients with age range between 38 to 63 years (median age 54 years) undergoing neck dissection simultaneously with the resection of primary intraoral squamous cell carcinoma formed the basis of the present study. A pre-operative assessment of neck by clinical examination, ultrasonography and computed tomography scan was done, which was then compared to the histopathological assessment. The histopathological examination formed the reference.Results: The percentage of sensitivity by clinical examination was 46%. The percentage of sensitivity by ultrasonogram was 69%. The percentage of sensitivity by computed tomography (CT scan) was 85%. These were against the histopathological examination.Conclusion: The study reported an error of almost 50% for the clinical examination alone. The margin of error decreases when combining ultrasonography or CT scan in the examination. However, in the existing economic condition in India, even the use of CT scan can be prohibitive. Nevertheless, it is advised to combine other diagnostic modalities during the clinical examination of cervical metastasis.
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Affiliation(s)
- M Mohan
- Mirudhuu Dental and Maxillofacial Clinic, Koyambedu, Chennai, India
| | - G Paul
- Paulose Dental and Oral Surgery Centre, Fairlands, Salem, India
| | - S Thomas
- Department of Surgical Sciences, College of Dentistry, Ajman University of Science & Technology
| | - M Jaber
- Department of Surgical Sciences, College of Dentistry, Ajman University of Science & Technology
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Maiti AK, Paul G, Maity B, Mazumdar D, Saha NC. Chromium III exposure inhibits brain Na+K+ATPase activity of Clarias batrachus L. involving lipid peroxidation and deficient mitochondrial electron transport chain activity. Bull Environ Contam Toxicol 2009; 83:479-483. [PMID: 19626263 DOI: 10.1007/s00128-009-9827-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 07/08/2009] [Indexed: 05/28/2023]
Abstract
The present study elucidated the role of lipid peroxidation and diminished mitochondrial electron transport chain activity in partial dysfunction of brain Na+K+ATPase of Clarias batrachus exposed to chromium III ions. The fish were exposed to 10% and 20% of the derived 96 h LC50 value, 5.69 mg/L and 11.38 mg/L, respectively, and sampled on 20, 40 and 60 days. Exposure to chromium III on fish brain demonstrated an increased lipid peroxidation, production of protein carbonyl and reactive oxygen species and loss of protein thiol groups in synaptosomal fraction with decreased activity of Na+K+ATPase, partial inactivation of mitochondrial electron transport chain activity and energy depletion.
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Affiliation(s)
- A K Maiti
- Environmental Physiology Laboratory, Department of Physiology, University of Kalyani, Nadia, West Bengal 741235, India
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Paul G, Heuser H. ANFORDERUNGEN AN DATENNETZE BEI TELEMEDIZINISCHEN SZENARIEN. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.2000.45.s1.337] [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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Paul G. The remote prayer delusion: clinical trials that attempt to detect supernatural intervention are as futile as they are unethical. J Med Ethics 2008; 34:e18. [PMID: 18757618 DOI: 10.1136/jme.2007.023432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Extreme rates of premature death prior to the advent of modern medicine, very low rates of premature death in First World nations with low rates of prayer, and the least flawed of a large series of clinical trials indicate that remote prayer is not efficacious in treating illness. Mass contamination of sample cohorts renders such clinical studies inherently ineffectual. The required supernatural and paranormal mechanisms render them implausible. The possibility that the latter are not benign, and the potentially adverse psychological impact of certain protocols, renders these medical trials unethical. Resources should no longer be wasted on medical efforts to detect the supernatural and paranormal.
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Veasey RA, Large JK, Silberbauer J, Paul G, Taggu W, Ellery S, Rathore VS, Lloyd GW, Patel NR, Sulke AN. A randomised controlled trial comparing StarClose and AngioSeal vascular closure devices in a district general hospital--the SCOAST study. Int J Clin Pract 2008; 62:912-8. [PMID: 18479284 DOI: 10.1111/j.1742-1241.2008.01761.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS AngioSeal and StarClose are vascular closure devices (VCDs) that can be used following cardiac catheterisation via the femoral artery to achieve haemostasis. Both devices have been demonstrated to be superior to conventional manual pressure, which reduce time to haemostasis and time to patient ambulation. We sought to compare these devices in a prospective, randomised trial. METHODS Patients undergoing elective coronary angiography were randomised to receive either AngioSeal VIP or StarClose VCD with immediate postprocedure mobilisation. Bruising was recorded at 30 min, 60 min and at 1 week postprocedure. Patient satisfaction surveys were taken at 1 h and 1 week postprocedure. Complications for both groups were compared. RESULTS Four hundred and one patients were included. Arteriotomy closure was achieved in 144 of 208 (69.2%) patients randomised to AngioSeal and 134 of 193 (69.3%) patients randomised to StarClose (p = ns). There was no significant bruising in either group at either 30 or 60 min postprocedure. However, at 1 week, there was significantly more bruising in the AngioSeal group than the StarClose group (63.1 vs. 38.5cm2, p = 0.02). Patient satisfaction and pain perception with the procedure at closure were not significantly different between the groups. Deployment success and instant mobilisation rates were significantly lower for junior, as compared with senior, operators. CONCLUSION Achievement of haemostasis is similar with both AngioSeal and StarClose. The StarClose vascular closure device results in significantly less bruising at 1 week postprocedure as compared with AngioSeal, with no significant differences in complication rates. Patients' pain perception and satisfaction are similar with both VCDs.
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Affiliation(s)
- R A Veasey
- Cardiac Department, Eastbourne District General Hospital, King's Drive, Eastbourne, UK
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