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Shah HP, Shah R, Lockwood D, Yang N, Rohrbaugh T, Rutter MJ, Maurrasse SE. Assessing National Trends and Perceived Safety of Off-Label Ciprofloxacin-Dexamethasone Use by Pediatric Otolaryngologists. Laryngoscope 2024; 134:2922-2930. [PMID: 38149706 DOI: 10.1002/lary.31211] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES Off-label use of Ciprodex® (ciprofloxacin-dexamethasone: CPD), an antibiotic-steroid combination solution, in the airway has been reported by pediatric otolaryngologists with anecdotal success. We examined national trends regarding off-label CPD use including prevalence, common indications, prescriber patterns, adverse events, and accessibility. METHODS 15-item cross-sectional survey was distributed to American Society of Pediatric Otolaryngology members from January-April 2022. Univariate analyses were performed to compare responses for users of off-label CPD versus non-users. Ease of access was compared across geographies and practice types using multivariate logistic regressions. RESULTS Of the 163 complete responses (26.6% response rate), 156 (95.7%) reported using off-label CPD. Most common indications for off-label CPD were tracheal granulation (87.8%, n = 137) and choanal atresia (82.1%, n = 128). Ease of access was significantly increased in the Midwest (OR:18.79, 95%CI:3.63-1.24, p = 0.001) and West (OR:29.92, 95%CI:3.55-682.00, p = 0.006). Ease of access was significantly lower at tertiary referral centers (OR:0.11, 95%CI:0.01-0.64, p = 0.041) and private practices (OR:0.04, 95%CI:0.002-0.33, p = 0.009) compared to academic free-standing children's hospitals. Two-thirds of respondents reported feeling "Very Comfortable" with the safety profile of off-label CPD; 99.4% (n = 156) felt that the benefits outweighed the risks of off-label use. Seven respondents (4.5%) reported adverse events (e.g., local allergic reaction, cushingoid symptoms) from off-label use. CONCLUSIONS Our findings (26.6% response rate) suggest that off-label CPD is commonly used by pediatric otolaryngologists, many of whom reported feeling that the benefits of off-label CPD outweigh the risks. Our results establish a baseline for future efforts to assess the efficacy and safety of off-label CPD and to improve its accessibility. LEVEL OF EVIDENCE V Laryngoscope, 134:2922-2930, 2024.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, New Haven, Connecticut, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, U.S.A
| | - Rema Shah
- Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Donovan Lockwood
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Nan Yang
- Yale University School of Public Health, New Haven, Connecticut, U.S.A
| | - Tagan Rohrbaugh
- Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Sarah E Maurrasse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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Salehi PP, Shah HP, Torabi SJ, Heiser A, Salehi P, Peng GL, Nassif P, Lee YH, Azizzadeh B. Characterizing the Rhinoplasty Outcomes Most Important to Patients, Surgeons, and the General Population. J Craniofac Surg 2024:00001665-990000000-01481. [PMID: 38688025 DOI: 10.1097/scs.0000000000010150] [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] [Received: 11/03/2023] [Accepted: 01/24/2024] [Indexed: 05/02/2024] Open
Abstract
Understanding rhinoplasty characteristics important to patients, physicians, and society is essential for evaluating outcomes and designing optimal treatment plans. The authors aimed to elucidate specific rhinoplasty-related outcomes that are most important to patients, surgeons, and the general population. A cross-sectional survey comprising 11 rhinoplasty-specific characteristics, was distributed to patients, facial plastic surgeons, and the general population. Adult patients presenting for rhinoplasty consideration or follow-up after undergoing rhinoplasty were recruited. Characteristics rankings were compared between the 3 respondent groups using Spearman's rank correlation coefficient (ρ). Responses from 150 surgeons, 111 patients, and 102 lay individuals from the general population were included for analysis. When ranking rhinoplasty-specific characteristics in order of importance, patients and the general population ranked "ability to breathe through nose while awake" first and "overall appearance of nose" as second. Surgeons ranked "overall appearance of nose" first and "ability to breathe through nose while awake" second. There were strong correlations between patients' and surgeons' rankings (Spearman's ρ=0.836, P=0.002), between patients' and the general population's rankings (Spearman's ρ=0.773, P=0.007), and between surgeons' and the general population's rankings (Spearman's ρ=0.782, P=0.006). Our results highlight a significant correlation between characteristics of the "ideal" nose as determined by patients, surgeons, and the general population.
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Affiliation(s)
- Parsa P Salehi
- Department of Facial Plastic Surgery, Newport Beach
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Hemali P Shah
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Alyssa Heiser
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
| | - Pauniz Salehi
- Department of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY
| | | | | | - Yan H Lee
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, CA
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Shah HP, Cohen O, Bourdillon AT, Burtness BA, Boffa DJ, Young M, Judson BL, Mehra S. Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility. Otolaryngol Head Neck Surg 2024. [PMID: 38606669 DOI: 10.1002/ohn.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region. STUDY DESIGN Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Single health system and region. METHODS Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence. RESULTS A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18-0.70, P = .003). CONCLUSION Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region.
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Affiliation(s)
- Hemali P Shah
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
| | - Oded Cohen
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, Ben Gurion University of the Negev Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Alexandra T Bourdillon
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine, San Francisco, California, USA
| | - Barbara A Burtness
- Yale Cancer Center, New Haven, Connecticut, USA
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel J Boffa
- Yale Cancer Center, New Haven, Connecticut, USA
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Young
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Weitzman RE, Shah HP, Modi VK, Maurrasse SE. Type 3 Laryngeal Clefts Presenting with Upper Airway Obstruction without Aspiration. Laryngoscope 2024; 134:977-980. [PMID: 37436152 DOI: 10.1002/lary.30849] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/07/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
Traditionally, otolaryngologists are taught that the defining clinical feature of a laryngeal cleft is aspiration. However, in a small subset of patients-even those with extensive clefts-the sole presenting feature may be airway obstruction. Here, we report two cases of type III laryngeal clefts that presented with upper airway obstruction without aspiration. The first patient was a 6-month-old male with history of tracheoesophageal fistula (TEF) who presented with noisy breathing, initially thought to be related to tracheomalacia. Polysomnogram (PSG) demonstrated moderate OSA and modified barium swallow (MBS) was negative for aspiration. In-office laryngoscopy was notable for a mismatch of tissue in the interarytenoid region. A type III laryngeal cleft was identified on bronchoscopy, and airway symptoms resolved after endoscopic repair. The second patient was a 4-year-old male with a diagnosis of asthma who presented with progressive exercise-induced stridor and airway obstruction. In-office flexible laryngoscopy revealed redundant tissue in the posterior glottis and MBS was negative for aspiration. He was found to have a type III laryngeal cleft on bronchoscopy and his stridor and upper airway obstruction resolved after endoscopic repair. While aspiration is the most common presenting symptom of a laryngeal cleft, it is important to consider that patients can have a cleft in the absence of dysphagia. Laryngeal cleft should be included in the differential diagnosis for patients with obstructive symptoms not explained by other etiologies and in those with suspicious features on flexible laryngoscopy. Laryngeal cleft repair is recommended to restore normal anatomy and relieve obstructive symptoms. Laryngoscope, 134:977-980, 2024.
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Affiliation(s)
- Rachel E Weitzman
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, New York, USA
| | - Hemali P Shah
- Department of Surgery, Section of Pediatric Otolaryngology-Head & Neck Surgery, Yale School of Medicine, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Vikash K Modi
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, New York, USA
| | - Sarah E Maurrasse
- Department of Surgery, Section of Pediatric Otolaryngology-Head & Neck Surgery, Yale School of Medicine, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
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Wilkins SG, Shah R, Safranek CW, Shah HP, Mehra S. The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer. Laryngoscope 2024. [PMID: 38294283 DOI: 10.1002/lary.31319] [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] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE While tobacco use is understood to negatively impact HPV+ oropharyngeal squamous cell carcinoma (OPSCC) outcomes, debate remains as to how this impact differs between cohorts. Multiple smoking metrics have been identified as having the greatest prognostic significance, and some recent works have found smoking to have no significant impact. Herein, we show through an analysis of four common smoking metrics that while smoking impacts overall survival (OS), it has a limited impact on recurrence-free survival (RFS) in our cohort. METHODS We conducted a retrospective review of patients treated for HPV+ OPSCC in our health system from 2012 to 2019. Patients with metastatic disease or concurrent second primaries were excluded. Four metrics of tobacco use were assessed: current/former/never smokers, ever/never smokers, and smokers with >10 or >20 pack-year (PY) smoking histories. Our main outcomes were 3-year RFS and OS. RESULTS Three hundred and sixty-seven patients met inclusion criteria. 37.3% of patients (137/367) were never-smokers; 13.8% of patients (51/367) were currently smoking at diagnosis and 48.8% of patients (179/367) were former smokers. No tobacco-use metric significantly impacted 3-year RFS. On univariate analysis, all smoking metrics yielded inferior OS. On multivariate analysis, current and ever smoking status significantly impacted 3-year OS. CONCLUSION The impact of tobacco use on HPV+ OPSCC outcomes is not universal, but may instead be modulated by other cohort-specific factors. The impact of smoking may decrease as rates of tobacco use decline. LEVEL OF EVIDENCE III (Cohort and case-control studies) Laryngoscope, 2024.
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Affiliation(s)
- Sarah G Wilkins
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Rema Shah
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Conrad W Safranek
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Hemali P Shah
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Saral Mehra
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Yale Cancer Center, Yale University, New Haven, Connecticut, U.S.A
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Long AS, Junn AH, Shah HP, Almeida MN, Rivera JC, Nguyen HP, Persing JA, Alperovich M. Gaps in Access to Reconstruction Compared with Audiologic Care among Children with Microtia. J Pediatr 2023; 262:113340. [PMID: 36736584 DOI: 10.1016/j.jpeds.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Reconstruction for microtia decreased psychosocial morbidity; timely referral for surgery is crucial. We evaluated specialist referrals for microtia at a major academic medical center. Only one-half of patients were evaluated at any point by a reconstructive craniofacial surgeon. Patients followed early for audiologic concerns may not be receiving timely referred for reconstruction.
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Affiliation(s)
- Aaron S Long
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Adam H Junn
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Hemali P Shah
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Mariana N Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jean Carlo Rivera
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Hang P Nguyen
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - John A Persing
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
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Shah HP, Salehi PP, Torabi SJ, Bourdillon AT, Wu K, Mehra S. Trends in Private Equity Acquisitions of US Otolaryngology Practices. Otolaryngol Head Neck Surg 2023; 169:1094-1097. [PMID: 37003295 DOI: 10.1002/ohn.342] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/25/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Abstract
With the increasing consolidation of physician practices, private equity (PE) firms have been playing a growing role in healthcare delivery and recently began entering the otolaryngology-head and neck surgery space. To date, no studies have examined the extent of PE investment in otolaryngology. We assessed trends and geographic distribution of US otolaryngology practices acquired by PE using Pitchbook (Seattle, WA), a comprehensive market database. From 2015 to 2021, 23 otolaryngology practices were acquired by PE. The number of PE acquisitions increased over time: 1 practice was acquired in 2015 versus 4 practices in 2019 versus 8 practices in 2021. Nearly half (43.5%, n = 10) of acquired practices were in the South Atlantic region. The median number of otolaryngologists at these practices was 5 (interquartile range: 3-7). As PE investment in otolaryngology continues to grow, further research is needed to assess its impact on clinical decision-making, healthcare costs, physician job satisfaction, clinical efficiency, and patient outcomes.
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Affiliation(s)
- Hemali P Shah
- Yale School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Alexandra T Bourdillon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kane Wu
- Yale School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, New Haven, Connecticut, USA
| | - Saral Mehra
- Yale School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, New Haven, Connecticut, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Shah R, Liu C, Shah HP, Judson BL. Prognostic value of absolute lymphocyte count in oral cavity squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2023; 8:870-875. [PMID: 37621277 PMCID: PMC10446262 DOI: 10.1002/lio2.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives Absolute lymphocyte count (ALC) has been shown to be a prognostic indicator in other solid tumors. Given this, we aimed to evaluate the prognostic value of ALC in oral cavity squamous cell carcinoma (OSCC). Methods Using our institutional tumor registry data, we identified patients ≥18 years old who were diagnosed with OSCC between 2012 and 2018. Preoperative ALC values within 30 days of surgery were collected through retrospective chart review. American Joint Committee on Cancer, 7th-edition best stage was used to categorize cancers as early stage (stages 1 and 2) or late-stage (stages 3 and 4). Primary outcomes were likelihood of recurrence and survival rates after 3 years. Results Of the 412 patients identified, 262 patients had available ALC data and met inclusion criteria. Early stage cancer patients who had lymphopenia did not have any significant difference in their rate of death ([OR], 1.71, CI: 0.54-5.45, p = .36) or likelihood recurrence ([OR], 0.60, CI: 0.06-5.87, p = .66) after controlling for age, tobacco use, alcohol use, positive margins, and adjuvant therapy. Late-stage cancer patients who had lymphopenia also showed no difference in their rate of death ([OR], 2.74, CI: 0.65-11.6, p = .17) or likelihood of recurrence ([OR], 0.38, CI: 0.04-3.36, p = .38). Conclusions and Relevance This study evaluates the prognostic value of ALC in oral cavity cancers. Our findings demonstrate that pretreatment ALC is not significantly associated with recurrence and survival outcomes patients with OSCC. Level of Evidence III. Lay Summary Absolute lymphocyte count (ALC) has been associated with prognosis in several cancers. We found that preoperative ALC was not associated with likelihood of survival or recurrence in patients with early stage or late-stage oral cavity cancer.
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Affiliation(s)
- Rema Shah
- Yale University School of MedicineNew HavenConnecticutUSA
- Division of Otolaryngology‐Head and Neck SurgeryYale University School of MedicineNew HavenConnecticutUSA
- Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Christina Liu
- Yale University School of MedicineNew HavenConnecticutUSA
- Division of Otolaryngology‐Head and Neck SurgeryYale University School of MedicineNew HavenConnecticutUSA
- Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Hemali P. Shah
- Yale University School of MedicineNew HavenConnecticutUSA
- Division of Otolaryngology‐Head and Neck SurgeryYale University School of MedicineNew HavenConnecticutUSA
- Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Benjamin L. Judson
- Division of Otolaryngology‐Head and Neck SurgeryYale University School of MedicineNew HavenConnecticutUSA
- Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
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Shah R, Shah HP, Rohrbaugh T, Reeder A, Kohli N, Maurrasse SE. Comparing nationally reported adverse events associated with coblation vs. PlasmaBlade for tonsillectomy. Am J Otolaryngol 2023; 44:103894. [PMID: 37178539 DOI: 10.1016/j.amjoto.2023.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE(S) Coblation, or radiofrequency ablation, and pulsed-electron avalanche knife (PEAK) plasmablade are newer approaches for tonsillectomy that reduce exposure to thermal heat. This study aims to describe and compare adverse events related to these devices for tonsillectomy. STUDY DESIGN Retrospective cross-sectional study. SETTING The US Food and Drug Administration's Manufacture and User Facility Device Experience (MAUDE) database. METHODS The MAUDE database was queried for reports involving coblation devices and the PEAK plasmablade from 2011 to 2021. Data were extracted from reports pertaining to tonsillectomy with and without adenoidectomy. RESULTS There were 331 reported adverse events for coblation and 207 for the plasmablade. For coblation, 53 (16.0 %) of these involved patients and 278 (84.0 %) were device malfunctions. Similarly for the plasmablade, 22 (10.6 %) involved patients and 185 (89.4 %) were device malfunctions. The most frequent patient-related adverse event was burn injury, which was significantly more common with the plasmablade compared to coblation (77.3 % vs. 50.9 %, respectively, p = 0.042). For both the coblator and plasmablade, the most common device malfunction was intraoperative tip or wire damage (16.9 % vs. 27.0 %, respectively, p = 0.010). The Plasmablade tip caught fire in five reports (2.7 %) with one causing burn injury. CONCLUSIONS While coblation devices and the plasmablade have demonstrated utility in tonsillectomy with or without adenoidectomy, they are associated with adverse events. Plasmablade use may require greater caution for intraoperative fires and patient burn injuries compared to coblation use. Interventions to improve physician comfort with these devices may help reduce adverse events and inform preoperative discussions with patients.
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Affiliation(s)
- Rema Shah
- Yale University School of Medicine, New Haven, CT, USA.
| | - Hemali P Shah
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Allison Reeder
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nikita Kohli
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Maurrasse
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Shah HP, Bourdillon AT, Panth N, Ihnat J, Kohli N. Long-term laryngological sequelae and patient-reported outcomes after COVID-19 infection. Am J Otolaryngol 2023; 44:103780. [PMID: 36592551 PMCID: PMC9798664 DOI: 10.1016/j.amjoto.2022.103780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We examine prevalence, characteristics, quality of life (QOL) assessments, and long-term effects of interventions for laryngeal dysfunction after recovery from COVID-19 infection. MATERIALS AND METHODS 653 patients presenting to Yale's COVID clinic from April 2020 to August 2021 were identified retrospectively. Patients with PCR-positive COVID-19 who underwent evaluation by fellowship-trained laryngologists were included. Patient demographics, comorbidities, intubation/tracheostomy, strobolaryngoscopy, voice metrics, and management data were collected. Patient-reported QOL indices were Dyspnea Index (DI), Cough Severity Index (CSI), Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), and Reflux Symptom Index (RSI). RESULTS 57 patients met inclusion criteria: 37 (64.9 %) were hospitalized for COVID-19 infection and 24 (42.1 %) required intubation. Mean duration between COVID-19 diagnosis and presentation to laryngology was significantly shorter for patients who were intubated compared to non-intubated (175 ± 98 days versus 256 ± 150 days, respectively, p = 0.025). Dysphonia was diagnosed in 40 (70.2 %) patients, dysphagia in 14 (25.0 %) patients, COVID-related laryngeal hypersensitivity in 13 (22.8 %), and laryngotracheal stenosis (LTS) in 10 (17.5 %) patients. Of the 17 patients who underwent voice therapy, 11 (64.7 %) reported improvement in their symptoms and 2 (11.8 %) patients reported resolution. VHI scores decreased for patients who reported symptom improvement. 7 (70 %) patients with LTS required >1 procedural intervention before symptom improvement. Improvement across QOL indices was seen in patients with LTS. CONCLUSIONS Laryngeal dysfunction commonly presents and is persistent for months after recovery from COVID-19 in non-hospitalized and non-intubated patients. Voice therapy and procedural interventions have the potential to address post-COVID laryngeal dysfunction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, New Haven, CT, United States of America.
| | | | - Neelima Panth
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jacqueline Ihnat
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Nikita Kohli
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
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11
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Shah HP, Kafle S, Lee JY, Cardella J, Alperovich M, Lee YH. Livestream surgeries enhance preclinical medical students' exposure to surgical specialties. Am J Surg 2023; 225:432-435. [PMID: 36280449 PMCID: PMC9840906 DOI: 10.1016/j.amjsurg.2022.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Hemali P Shah
- Yale School of Medicine, New Haven, CT, United States
| | - Samipya Kafle
- Yale School of Medicine, New Haven, CT, United States
| | - Jonathan Y Lee
- Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical School-Baystate, Baystate Medical Center, Springfield, MA, United States
| | - Jonathan Cardella
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Yan Ho Lee
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States.
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12
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Shah HP, Salehi PP, Ihnat J, Kim DD, Salehi P, Judson BL, Azizzadeh B, Lee YH. Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change. Otolaryngol Head Neck Surg 2023; 168:165-179. [PMID: 35133919 DOI: 10.1177/01945998221076482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties. DATA SOURCES Ovid Medline, Embase, and article reference lists. REVIEW METHODS A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years. CONCLUSIONS Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties. IMPLICATIONS FOR PRACTICE Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.
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Affiliation(s)
- Hemali P Shah
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jacqueline Ihnat
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David D Kim
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Pauniz Salehi
- College of Human Ecology, Department of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Benjamin L Judson
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.,Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Yan Ho Lee
- Connecticut Department of Surgery, Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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13
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Hauc SC, Junn AH, Long AS, Rivera JC, Littlefield TR, Ihnat JM, Shah HP, Pondugula N, Almeida MN, Alper DP, Persing JA, Alperovich M. Orthotic Helmet Therapy for Deformational Plagiocephaly: Stratifying Outcomes by Insurance. Cleft Palate Craniofac J 2023:10556656231152517. [PMID: 36655295 DOI: 10.1177/10556656231152517] [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: 01/20/2023] Open
Abstract
OBJECTIVE Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status. DESIGN This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014-2020 across 21 states. PATIENTS, PARTICIPANTS There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy. MAIN OUTCOMES MEASURES Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success. RESULTS Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51-1.65, p < 0.001 and OR: 1.21, CI: 1.15-1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70-3.92, p < 0.001). CONCLUSIONS Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here.
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Affiliation(s)
- Sacha C Hauc
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Adam H Junn
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Aaron S Long
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Jean Carlo Rivera
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | | | - Jacqueline M Ihnat
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Hemali P Shah
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Nishita Pondugula
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Mariana N Almeida
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - David P Alper
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - John A Persing
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Michael Alperovich
- Division of Plastic Surgery, 12228Yale School of Medicine, New Haven, CT, USA
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Shah HP, Brawley CC, Maurrasse S, Schumacher J, Ganesh M, Thompson DM, Ida J, Valika T. Pediatric laryngeal cleft repair with coblation: Functional comparison of a novel technique with traditional methods. Int J Pediatr Otorhinolaryngol 2022; 163:111378. [PMID: 36371939 DOI: 10.1016/j.ijporl.2022.111378] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/17/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The traditional endoscopic techniques for surgical management of laryngeal clefts are carbon dioxide (CO2) laser or microlaryngeal instruments (cold steel). This study compares the functional efficacy and safety of coblation, or "cold" radiofrequency ablation, to traditional approaches for endoscopic laryngeal cleft repair. METHODS Patients who underwent endoscopic laryngeal cleft repair with CO2 laser, cold steel, or coblator at two tertiary academic centers from 2015 to 2021 were retrospectively identified. The primary outcome studied was swallowing function: pre- and postoperative swallow studies were scored according to the International Dysphagia Diet Standardization Initiative with higher scores indicating worse swallow function. Secondary outcomes included surgical complications and rates of dehiscence. RESULTS Of the 53 patients included, 14 underwent repair with CO2 laser, 23 with cold steel, and 16 with the coblator. Mean age at surgery was 2.2 ± 1.1 years for the laser group, 4.3 ± 4.0 years for cold steel, and 1.9 ± 1.4 years for the coblator group. In the laser group, 100% of clefts were type I; for the cold steel group, 82.6% of clefts were type I and 17.4% were type II; for the coblator group, 93.8% of clefts were type I and 6.3% were type II. Pre- and postoperative swallow study scores were 6.3 ± 2.8 and 4.3 ± 3.2, respectively, (p = 0.001) for the laser group, 6.9 ± 2.8 and 5.3 ± 3.1 (p = 0.071) for the cold steel group, and 7.5 ± 1.5 and 4.0 ± 2.9 (p < 0.001) for the coblator group. Mean change in swallow study scores were similar across the three groups (p = 0.212). No patients experienced postoperative dehiscence at the surgical site or complications; no revisions were required. CONCLUSIONS Cleft repair with the novel coblation technique showed significant improvements in swallow study scores without any occurrences of postoperative dehiscence or revisions. Coblation is a safe and efficacious approach for laryngeal cleft repair.
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Affiliation(s)
- Hemali P Shah
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Craig Cameron Brawley
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah Maurrasse
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jane Schumacher
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Meera Ganesh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dana Mara Thompson
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jonathan Ida
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Taher Valika
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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15
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Shah HP, Sheth AH, Abdou H, Lerner MZ. Initiatives for Early Medical Student Engagement with the Field of Otolaryngology - Head and Neck Surgery. J Laryngol Otol 2022; 137:577-581. [PMID: 36169118 DOI: 10.1017/s0022215122002122] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early exposure and mentorship in surgical specialties like otolaryngology - head and neck surgery are critical for medical students. This paper presents initiatives implemented at our institution to engage early-career medical students with the field. METHODS A hands-on laryngoscope workshop was organised, and a centralised online platform was created for research and mentorship opportunities using a collaborative project management tool. Both measures were advertised via e-mail to student interest groups and campus diversity groups. At the end of the workshop, participating students completed an online distributed survey. RESULTS Students' perception of their knowledge of airway anatomy and related clinical scenarios significantly improved after the laryngoscopy workshop (p = 0.001 and p = 0.002, respectively). All attendees indicated that the workshop increased their comfort level with procedures and that they would recommend the workshop to colleagues. Nearly half of participants reported becoming 'very interested' in exploring otolaryngology - head and neck surgery through future elective courses. CONCLUSION Implementation of such initiatives at other institutions can generate medical student interest and may improve diversity in otolaryngology - head and neck surgery.
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Affiliation(s)
- H P Shah
- Yale University School of Medicine, New Haven, CT, USA
| | - A H Sheth
- Yale University School of Medicine, New Haven, CT, USA
| | - H Abdou
- Yale University School of Medicine, New Haven, CT, USA
| | - M Z Lerner
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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16
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Shah HP, Cohen O, Sukys J, Dibble J, Mehra S. The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-A retrospective study using two independent frailty scores. Oral Oncol 2022; 132:106006. [PMID: 35835056 DOI: 10.1016/j.oraloncology.2022.106006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, no studies have investigated potential associations between frailty and adjuvant treatment delivery after reconstructive surgery. We examine the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after reconstructive surgery for head and neck cancers (HNCs). METHODS A retrospective review of patients who underwent free flap reconstruction for HNC at a single institution from 2015 to 2021 and received adjuvant radiation was performed. Frailty was assessed using two independent scales: the 11-item modified frailty index (mFI) score and binary Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Timely adjuvant initiation (within six weeks of surgery), duration of adjuvant treatment, and completion were compared between frail and non-frail patients. RESULTS Of the 163 patients included for analysis, 52 (31.9%) were identified as frail by the ACG indicator and 24 (14.7%) were identified as frail with an mFI score ≥ 3. Frail patients (mFI score ≥ 3) were significantly less likely than non-frail patients to initiate adjuvant treatment within six weeks (OR:0.21, CI:0.04-0.85, p = 0.046). Frailty designated by either frailty scale was not significantly associated with adjuvant treatment duration. Likelihood of adjuvant treatment completion was significantly lower for frail compared to non-frail patients by both scales: ACG indicator (OR 0.02, CI:9.05 × 10-4-0.25, p = 0.007) and mFI score ≥ 3 (OR:0.01, CI:6.85 × 10-4-0.13, p = 0.007). CONCLUSIONS Frailty is associated with decreased likelihood of timely adjuvant treatment initiation and completion in patients with HNCs after free flap reconstruction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Oded Cohen
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jordan Sukys
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jacqueline Dibble
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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17
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Bourdillon AT, Salehi PP, Wride M, Salehi P, Torabi S, Heiser A, Shah HP, Azizzadeh B, Judson B, Lee YH. Trends in Residency Applicant Volume in Otolaryngology-Head and Neck Surgery and Peer Specialties. Ann Otol Rhinol Laryngol 2022:34894221120303. [PMID: 36031814 DOI: 10.1177/00034894221120303] [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: 11/17/2022]
Abstract
OBJECTIVE To evaluate the 2020 to 2021 Otolaryngology residency application cycle in the context of recent trends. STUDY DESIGN Retrospective data analysis. SETTING Disruptions caused by the COVID-19 pandemic may significantly alter trends among residency applicants, especially in highly competitive and/or smaller specialties. METHODS Applicant and residency statistics from Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) were extracted from the 2016 to 2021 and 2011 to 2021, respectively. Trends in Otolaryngology-Head and Neck Surgery (OHNS) were compared to peer specialties (PS) including Dermatology, Neurological Surgery, Orthopedic Surgery, and Integrated Pathway for Plastic and Reconstructive Surgery (PRS). The ratio of the number of applicants per positions (APP) was used to reflect the degree of competition. RESULTS Between 2011 and 2021, the number of OHNS programs and positions expanded less than those of PS and General Surgery. The increase in the APP ratio was significantly greater for OHNS compared to those Dermatology, Orthopedic Surgery, General Surgery and all PGY1 residency positions for both US MD and all applicants (P < .01 for each). OHNS expansion of US MD (P = .046), but not all applicants (P = .169), outgrew that of Neurosurgery. CONCLUSION The 2020 to 2021 cycle affected by the COVID-19 pandemic saw a continuation of the recent trend in the expanding OHNS applicant pool. OHNS remains one of the specialties with the highest APP ratio and has observed a significant growth compared to PS since 2018. Understanding and anticipating trends in residency application cycles is critical for designing processes to optimize the best fit between applicants and programs.
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Affiliation(s)
| | - Parsa P Salehi
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | - Mitchel Wride
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Pauniz Salehi
- Department of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Sina Torabi
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Alyssa Heiser
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Hemali P Shah
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA.,Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | - Yan Ho Lee
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
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Bourdillon AT, Shah HP, Cohen O, Hajek MA, Mehra S. Novel Machine Learning Model to Predict Interval of Oral Cancer Recurrence for Surveillance Stratification. Laryngoscope 2022. [DOI: 10.1002/lary.30351] [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] [Received: 05/04/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Hemali P. Shah
- Yale University School of Medicine New Haven Connecticut U.S.A
| | - Oded Cohen
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Michael A. Hajek
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery Yale University School of Medicine New Haven Connecticut U.S.A
| | - Saral Mehra
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery Yale University School of Medicine New Haven Connecticut U.S.A
- Yale Cancer Center New Haven Connecticut U.S.A
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19
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Shah HP, Tormey CA, Siddon AJ. Automated analysers underestimate atypical basophil count in myeloid neoplasms. Int J Lab Hematol 2022; 44:831-836. [PMID: 35609868 DOI: 10.1111/ijlh.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recent data suggest basophils can adopt an atypical appearance in myeloid disorders including myeloproliferative neoplasms (MPNs) and myeloproliferative/myelodysplastic disease. We hypothesized that automated analysers may not accurately quantitate basophils in myeloid neoplasms based on scatter properties. This study examined basophil counts and properties in myeloid disorders by automated cell analyser, manual differential, and flow cytometry. METHODS Patients with myeloid neoplasms and control patients with no myeloid disorder diagnosis at a tertiary care centre were identified. Basophil percentage was compared for automated analyser counts (Sysmex XN9000), manual differential, and flow cytometry. Basophil scatter properties in MPNs were examined using flow cytometry. RESULTS Thirty-one patients with myeloid neoplasms were included: 58% were male, mean age was 70.2 (±20.7) years, 32% had a diagnosis of chronic myeloid leukaemia with the remaining patients divided among various other forms of myeloid disease (including: essential thrombocythemia, polycythemia vera, unclassifiable MPN, myelodysplastic syndromes). For these patients, mean basophil percentage by automated analyser was significantly lower than manual differential (2.7 ± 2.9 vs. 7.1 ± 4.6, respectively, p < 0.001). No significant difference was found between automated versus manual differential for basophils in control subjects (p = 0.373). For myeloid neoplasm patients, mean basophil percentage was not significantly different between manual differential and flow cytometry (p = 0.116); mean basophil percentage by automated analyser was significantly lower than flow cytometry (2.7 ± 2.9 vs. 5.3 ± 3.7, respectively, p = 0.003). CONCLUSION Automated analysers underestimate basophil counts in patients with myeloid neoplasms. Manual differential and flow cytometry are recommended for more accurate quantitation and characterization of aberrant basophils.
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Affiliation(s)
- Hemali P Shah
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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20
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Gyimah MB, Shah HP, Lee YH. Maximizing the effectiveness of scribes in surgical practices. Am J Surg 2021; 223:208-210. [PMID: 34392911 DOI: 10.1016/j.amjsurg.2021.07.037] [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: 06/09/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
Surgeons are spending increasing amounts of time on non-patient facing responsibilities such as electronic health record (EHR) documentation, coding, and inter-office communication. The burden of documentation is a significant contributor to burnout, which adversely affects surgeons' work satisfaction, productivity, and personal wellness. Scribes can help reduce the clerical burden experienced by surgeons. Studies have shown that scribes increase work satisfaction, reduce EHR documentation time, improve provider productivity, and increase work relative value units (wRVUs). That being said, surgeons must learn how to work with scribes effectively in order to yield these benefits. We outline considerations and strategies for optimizing the role of scribes in a surgical practice. Scribes can be valuable members of the surgeon's healthcare team by 1) learning the language and pathologies specific to a surgical specialty, 2) efficiently documenting prior to, during, and after clinical encounters, and 3) assisting with coding and inter-office communication.
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Affiliation(s)
| | - Hemali P Shah
- Yale University School of Medicine, New Haven, CT, USA.
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Using a recently discovered precatalyst, the first Pd-catalyzed Suzuki-Miyaura reactions using aryl sulfamates that occur at room temperature are reported. In complementary work, it is demonstrated that a related precatalyst can facilitate the coupling of aryl silanolates, which are less toxic and reactive nucleophiles than boronic acids with aryl chlorides. By combining our results using modern electrophiles and nucleophiles, the first Hiyama-Denmark reactions using aryl sulfamates are reported.
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Affiliation(s)
- Patrick R. Melvin
- Department of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Nilay Hazari
- Department of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Megan Mohadjer Beromi
- Department of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Hemali P. Shah
- Department of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Michael J. Williams
- Department of Process Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065, United States
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22
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Melvin PR, Hazari N, Lant HMC, Peczak IL, Shah HP. Comparison of the catalytic activity for the Suzuki-Miyaura reaction of (η(5)-Cp)Pd(IPr)Cl with (η(3)-cinnamyl)Pd(IPr)(Cl) and (η(3)-1-t-Bu-indenyl)Pd(IPr)(Cl). Beilstein J Org Chem 2015; 11:2476-86. [PMID: 26732227 PMCID: PMC4685905 DOI: 10.3762/bjoc.11.269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/27/2015] [Indexed: 11/23/2022] Open
Abstract
Complexes of the type (η(3)-allyl)Pd(L)(Cl) and (η(3)-indenyl)Pd(L)(Cl) are highly active precatalysts for the Suzuki-Miyaura reaction. Even though allyl and indenyl ligands are similar to cyclopentadienyl (Cp) ligands, there have been no detailed comparative studies exploring the activity of precatalysts of the type (η(5)-Cp)Pd(L)(Cl) for Suzuki-Miyaura reactions. Here, we compare the catalytic activity of (η(5)-Cp)Pd(IPr)(Cl) (IPr = 1,3-bis(2,6-diisopropylphenyl)-1,3-dihydro-2H-imidazol-2-ylidene, Cp) with two commercially available catalysts (η(3)-cinnamyl)Pd(IPr)(Cl) (Cin) and (η(3)-1-t-Bu-indenyl)Pd(IPr)(Cl) ( (tBu) Ind). We show that Cp gives slightly better catalytic activity than Cin, but significantly inferior activity than (tBu) Ind. This order of activity is rationalized by comparing the rates at which the precatalysts are activated to the monoligated Pd(0) active species along with the tendency of the starting precatalysts to comproportionate with monoligated Pd(0) to form inactive Pd(I) dimers. As part of this work the Cp supported Pd(I) dimer (μ-Cp)(μ-Cl)Pd2(IPr)2 (Cp (Dim) ) was synthesized and crystallographically characterized. It does not readily disproportionate to form monoligated Pd(0) and consequently Cp (Dim) is a poor catalyst for the Suzuki-Miyaura reaction.
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Affiliation(s)
- Patrick R Melvin
- The Department of Chemistry, Yale University, P. O. Box 208107, New Haven, Connecticut, 06520, USA
| | - Nilay Hazari
- The Department of Chemistry, Yale University, P. O. Box 208107, New Haven, Connecticut, 06520, USA
| | - Hannah M C Lant
- The Department of Chemistry, Yale University, P. O. Box 208107, New Haven, Connecticut, 06520, USA
| | - Ian L Peczak
- The Department of Chemistry, Yale University, P. O. Box 208107, New Haven, Connecticut, 06520, USA
| | - Hemali P Shah
- The Department of Chemistry, Yale University, P. O. Box 208107, New Haven, Connecticut, 06520, USA
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Melvin PR, Nova A, Balcells D, Dai W, Hazari N, Hruszkewycz DP, Shah HP, Tudge MT. Design of a Versatile and Improved Precatalyst Scaffold for Palladium-Catalyzed Cross-Coupling: (η3-1-tBu-indenyl)2(μ-Cl)2Pd2. ACS Catal 2015. [DOI: 10.1021/acscatal.5b00878] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Patrick R. Melvin
- Department
of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Ainara Nova
- Centre
for Theoretical and Computational Chemistry (CTCC), Department of
Chemistry, University of Oslo, P.O. Box 1033, Blindern, 0315 Oslo, Norway
| | - David Balcells
- Centre
for Theoretical and Computational Chemistry (CTCC), Department of
Chemistry, University of Oslo, P.O. Box 1033, Blindern, 0315 Oslo, Norway
| | - Wei Dai
- Department
of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Nilay Hazari
- Department
of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Damian P. Hruszkewycz
- Department
of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Hemali P. Shah
- Department
of Chemistry, Yale University, P.O. Box 208107, New Haven, Connecticut 06520, United States
| | - Matthew T. Tudge
- Department
of Process
Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065, United States
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Cao W, Shah HP, Glushakov AV, Mecca AP, Shi P, Sumners C, Seubert CN, Martynyuk AE. Efficacy of 3,5-dibromo-L-phenylalanine in rat models of stroke, seizures and sensorimotor gating deficit. Br J Pharmacol 2010; 158:2005-13. [PMID: 20050189 DOI: 10.1111/j.1476-5381.2009.00498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Abnormal glutamatergic activity is implicated in neurologic and neuropsychiatric disorders. Selective glutamate receptor antagonists were highly effective in animal models of stroke and seizures but failed in further clinical development because of serious side effects, including an almost complete set of symptoms of schizophrenia. Therefore, the novel polyvalent glutamatergic agent 3,5-dibromo-L-phenylalanine (3,5-DBr-L-Phe) was studied in rat models of stroke, seizures and sensorimotor gating deficit. EXPERIMENTAL APPROACH 3,5-DBr-L-Phe was administered intraperitoneally as three boluses after intracerebral injection of endothelin-1 (ET-1) adjacent to the middle cerebral artery to cause brain injury (a model of stroke). 3,5-DBr-L-Phe was also given as a single bolus prior to pentylenetetrazole (PTZ) injection to induce seizures or prior to the administration of the N-methyl-D-aspartate (NMDA) receptor antagonist dizocilpine (MK-801) to cause disruption of prepulse inhibition (PPI) of startle (sensorimotor gating deficit). KEY RESULTS Brain damage caused by ET-1 was reduced by 52%, which is comparable with the effects of MK-801 in this model as reported by others. 3,5-DBr-L-Phe significantly reduced seizures induced by PTZ without the significant effects on arterial blood pressure and heart rate normally caused by NMDA antagonists. 3,5-DBr-L-Phe prevented the disruption of PPI measured 3 days after the administration of ET-1. 3,5-DBr-L-Phe also eliminated sensorimotor gating deficit caused by MK-801. CONCLUSION AND IMPLICATIONS The pharmacological profile of 3,5-DBr-L-Phe might be beneficial not only for developing a therapy for the neurological and cognitive symptoms of stroke and seizures but also for some neuropsychiatric disorders.
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Affiliation(s)
- W Cao
- Department of Anesthesiology, University of Florida, Gainesville, FL 32610-0254, USA
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25
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Blackburn GF, Shah HP, Kenten JH, Leland J, Kamin RA, Link J, Peterman J, Powell MJ, Shah A, Talley DB. Electrochemiluminescence detection for development of immunoassays and DNA probe assays for clinical diagnostics. Clin Chem 1991. [DOI: 10.1093/clinchem/37.9.1534] [Citation(s) in RCA: 446] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Electrochemiluminescence (ECL) has been developed as a highly sensitive process in which reactive species are generated from stable precursors (i.e., the ECL-active label) at the surface of an electrode. This new technology has many distinct advantages over other detection systems: no radioisotopes are used; detection limits for label are extremely low (200 fmol/L); the dynamic range for label quantification extends over six orders of magnitude; the labels are extremely stable compared with those of most other chemiluminescent systems; the labels, small molecules (approximately 1000 Da), can be used to label haptens or large molecules, and multiple labels can be coupled to proteins or oligonucleotides without affecting immunoreactivity, solubility, or ability to hybridize; because the chemiluminescence is initiated electrochemically, selectivity of bound and unbound fractions can be based on the ability of labeled species to access the electrode surface, so that both separation and nonseparation assays can be set up; and measurement is simple and rapid, requiring only a few seconds. We illustrate ECL in nonseparation immunoassays for digoxin and thyrotropin and in separation immunoassays for carcinoembryonic antigen and alpha-fetoprotein. The application of ECL for detection of polymerase chain reaction products is described and exemplified by quantifying the HIV1 gag gene.
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Affiliation(s)
| | | | | | | | | | - J Link
- IGEN, Inc., Rockville, MD 20852
| | | | | | - A Shah
- IGEN, Inc., Rockville, MD 20852
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Blackburn GF, Shah HP, Kenten JH, Leland J, Kamin RA, Link J, Peterman J, Powell MJ, Shah A, Talley DB. Electrochemiluminescence detection for development of immunoassays and DNA probe assays for clinical diagnostics. Clin Chem 1991; 37:1534-9. [PMID: 1716534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Electrochemiluminescence (ECL) has been developed as a highly sensitive process in which reactive species are generated from stable precursors (i.e., the ECL-active label) at the surface of an electrode. This new technology has many distinct advantages over other detection systems: no radioisotopes are used; detection limits for label are extremely low (200 fmol/L); the dynamic range for label quantification extends over six orders of magnitude; the labels are extremely stable compared with those of most other chemiluminescent systems; the labels, small molecules (approximately 1000 Da), can be used to label haptens or large molecules, and multiple labels can be coupled to proteins or oligonucleotides without affecting immunoreactivity, solubility, or ability to hybridize; because the chemiluminescence is initiated electrochemically, selectivity of bound and unbound fractions can be based on the ability of labeled species to access the electrode surface, so that both separation and nonseparation assays can be set up; and measurement is simple and rapid, requiring only a few seconds. We illustrate ECL in nonseparation immunoassays for digoxin and thyrotropin and in separation immunoassays for carcinoembryonic antigen and alpha-fetoprotein. The application of ECL for detection of polymerase chain reaction products is described and exemplified by quantifying the HIV1 gag gene.
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27
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Fotsis T, Shah HP, Härkönen M, Adlercreutz H. Fluoroenzymatic cycling assay (FECA) for the determination of catechol estrogen monomethyl ethers in human urine. Neurochem Res 1987; 12:507-13. [PMID: 3037406 DOI: 10.1007/bf01000234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the present study a method is described for the quantitative determination of the methylated metabolites of catechol estrogens in human urine. Following initial enzymatic hydrolysis the urine samples are extracted with ethyl acetate. The monomethyl ethers of catechol estrogens are then selectively fractionated with straight phase chromatography on Lipidex-5000 gel. Finally, samples are quantitated using enzymatic cycling with 17 beta-estradiol dehydrogenase combined with fluorometry. The method is sensitive, reproducible and reasonably rapid for routine analysis and avoids the hazards of radioisotopes. Preliminary values of normal males and non-pregnant females are presented.
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Abstract
Using penicillinase (E.C. 3.5.2.6) as marker and microtitre ELISA plates for immunoadsorption, sensitive and specific assays for two steroid hormones viz. testosterone in plasma and estrone-3-glucuronide in urine were developed. The entire assay can be performed in 4 h and requires simple laboratory equipment such as an incubator and a colorimeter. The enzyme labelled steroids have a shelf life of more than 3 years.
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Khatkhatay MI, Shah HP, Joshi UM. A simplified ELISA for quantitation of human placental lactogen. Indian J Med Res 1982; 76:578-82. [PMID: 7152567] [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: 01/23/2023] Open
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30
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Shah HP, Joshi UM. A simple, rapid and reliable enzyme-linked immunosorbent assay (ELISA) for measuring estrone-3-glucuronide in urine. J Steroid Biochem 1982; 16:283-6. [PMID: 7043092 DOI: 10.1016/0022-4731(82)90177-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A rapid, simple and sensitive enzyme-linked immunosorbent assay for the estimation of estrone-3-glucuronide (E1G) in diluted unprocessed urine has been developed using E1G-penicillinase (E.C.3.5.2.6.) prepared via carbodiimide linkage. Polyvinyl chloride ELISA plate (Dynatech) coated with antibody was used for separation of the antibody bound ligand. A complete assay could be performed within 4 hours with good precision (C.V. less than 17%). Minimum detectable amount of E1G was 25 pg/well. Parallelism was observed between sample dilution curve and standard curve. Recovery of E1G from urine ranged between 85-105%. Results obtained on 29 urine samples by the ELISA procedure were comparable to those obtained with an established RIA procedure (r = 0.96). The present method may thus provide a useful tool for the assessment of ovarian function.
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31
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Joshi UM, Roy R, Sheth AR, Shah HP. A simple and sensitive color test for the detection of human chorionic gonadotropin. Obstet Gynecol 1981; 57:252-4. [PMID: 7007940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A simple, rapid, sensitive, and reliable ELISA test for the detection of urinary human chorionic gonadotropin (hCG) has been developed using penicillinase (EC no. 3.5.2.6) as the label and a microtiter ELISA plate as a solid support for antibody. The results of the test is assessed visually for the dark blue that indicates the presence of hCG. A minimum of 500 mU of hCG/ml of urine can be detected easily and the test can be completed in 2 hours with good precision. Accurate negative results are obtained in urine samples of normally ovulatory women, postmenopausal women, and adult males, suggesting that the physiologic concentrations of luteinizing hormone do not influence the assay results. In samples referred for pregnancy detection 95.5% accurate results were obtained when compared with histopathologic and/or clinical findings. There were 2 false-negative results, and only in 4 of 132 subjects studied were false-positive results obtained. This test, if properly performed, should prove a valuable tool in the detection of hCG as early as 30 to 35 days from the last menstrual period.
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Abstract
A very sensitive enzymeimmunoassay for testosterone was developed using testosterone-penicillinase conjugate and an antibody to testosterone-3-(O-carboxymethyl)oxime-bovine serum albumin. The specificity of the assay was demonstrated by the fact that estradiol-17 beta, estrone, estriol, progesterone, 17 alpha-hydroxy-progesterone, dehydroepiandrosterone, androstenedione, cortisol and cortisone were ineffective in crossreacting with testosterone while dihydrotestosterone was 8 times less crossreactive as compared to testosterone. The minimum detectable amount of testosterone was 10-15 pg per assay tube. Intra-assay and inter-assay coefficients of variation for samples containing 0.3-6ng/ml of testosterone were 6-8% and 8-10%, respectively. A high degree of correlation (r = 0.97) was observed between serum testosterone values obtained by enzymeimmunoassay and radioimmunoassay. The levels of testosterone in the sera of normal men and women and those in hypogonadal males following stimulation with human chorionic gonadotropin determined by this enzymeimmunoassay appear similar to those reported by other investigators.
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