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Nishizaki D, Kurzrock R, Miyashita H, Adashek JJ, Lee S, Nikanjam M, Eskander RN, Patel H, Botta GP, Nesline MK, Pabla S, Conroy JM, DePietro P, Sicklick JK, Kato S. Viewing the immune checkpoint VISTA: landscape and outcomes across cancers. ESMO Open 2024; 9:102942. [PMID: 38503143 DOI: 10.1016/j.esmoop.2024.102942] [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: 09/01/2023] [Revised: 12/18/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Optimizing immune checkpoint inhibitor (ICI) therapy may require identification of co-targetable checkpoint pathways via immune profiling. Herein, we analyzed the transcriptomic expression and clinical correlates of V-domain immunoglobulin suppressor of T-cell activation (VISTA), a promising targetable checkpoint. PATIENTS AND METHODS RNA sequencing was carried out on 514 tissues reflecting diverse advanced/metastatic cancers. Expression of eight immune checkpoint markers [lymphocyte-activation gene 3 (LAG-3), tumor necrosis factor receptor superfamily 14 (TNFRSF14), programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), programmed death-ligand 2 (PD-L2), B- and T-lymphocyte attenuator (BTLA), T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), cytotoxic T-lymphocyte antigen 4 (CTLA-4)], in addition to VISTA, was analyzed, along with clinical outcomes. RESULTS High VISTA RNA expression was observed in 32% of tumors (66/514) and was the most common highly expressed checkpoint among the nine assessed. High VISTA expression was independently correlated with high BTLA, TIM-3, and TNFRSF14, and with a diagnosis of pancreatic, small intestine, and stomach cancer. VISTA transcript levels did not correlate with overall survival (OS) from metastatic/advanced disease in the pan-cancer cohort or with immunotherapy outcome (progression-free survival and OS from the start of ICI) in 217 ICI-treated patients. However, in ICI-treated pancreatic cancer patients (n = 16), median OS was significantly shorter (from immunotherapy initiation) for the high- versus not-high-VISTA groups (0.28 versus 1.21 years) (P = 0.047); in contrast, VISTA levels were not correlated with OS in 36 pancreatic cancer patients who did not receive ICI. CONCLUSION High VISTA expression correlates with high BTLA, TIM-3, and TNFRSF14 checkpoint-related molecules and with poorer post-immunotherapy survival in pancreatic cancer, consistent with prior literature indicating that VISTA is prominently expressed on CD68+ macrophages in pancreatic cancers and requiring validation in larger prospective studies. Immunomic analysis may be important for individualized precision immunotherapy.
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Affiliation(s)
- D Nishizaki
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla.
| | - R Kurzrock
- MCW Cancer Center and Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, USA; WIN Consortium, Paris, France
| | - H Miyashita
- Dartmouth Cancer Center, Hematology and Medical Oncology, Lebanon
| | - J J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore
| | - S Lee
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - M Nikanjam
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - R N Eskander
- Center for Personalized Cancer Therapy and Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla
| | - H Patel
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | - G P Botta
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla
| | | | | | | | | | - J K Sicklick
- Division of Surgical Oncology, Department of Surgery, Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, USA
| | - S Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla.
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Bailey JA, Morton AJ, Jones J, Chapman CJ, Oliver S, Morling JR, Patel H, Humes DJ, Banerjea A. 'Low' faecal immunochemical test (FIT) colorectal cancer: a 4-year comparison of the Nottingham '4F' protocol with FIT10 in symptomatic patients. Colorectal Dis 2024; 26:309-316. [PMID: 38173125 DOI: 10.1111/codi.16848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024]
Abstract
AIM The aim of this work was to evaluate colorectal cancer (CRC) outcomes after 'low' (sub-threshold) faecal immunochemical test (FIT) results in symptomatic patients tested in primary care. METHOD This work comprised a retrospective audit of 35 289 patients with FIT results who had consulted their general practitioner with lower gastrointestinal symptoms and had subsequent CRC diagnoses. The Rapid Colorectal Cancer Diagnosis pathway was introduced in November 2017 to allow incorporation of FIT into clinical practice. The local '4F' protocol combined FIT results with blood tests and digital rectal examination (DRE): FIT, full blood count, ferritin and finger [DRE]. The outcome used was detection rates of CRC, missed CRC and time to diagnosis in local 4F protocols for patients with a subthreshold faecal haemoglobin (fHb) result compared with thresholds of 10 and 20 μg Hb/g faeces. RESULTS A single threshold of 10 μg Hb/g faeces identifies a population in whom the risk of CRC is 0.2%, but this would have missed 63 (10.5%) of 599 CRCs in this population. The Nottingham 4F protocol would have missed fewer CRCs [42 of 599 (7%)] despite using a threshold of 20 μg Hb/g faeces for patients with normal blood tests. Subthreshold FIT results in patients subsequently diagnosed with a palpable rectal tumour yielded the longest delays in diagnosis. CONCLUSION A combination of FIT with blood results and DRE (the 4F protocol) reduced the risk of missed or delayed diagnosis. Further studies on the impact of such protocols on the diagnostic accuracy of FIT are expected. The value of adding blood tests to FIT may be restricted to specific parts of the fHb results spectrum.
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Affiliation(s)
- J A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - A J Morton
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Queens Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - J Jones
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Oliver
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - J R Morling
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK
| | - H Patel
- NHS Nottingham and Nottinghamshire Integrated Care Board, Nottingham, UK
| | - D J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - A Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Bainbridge EV, Griffiths JD, Patel H, Clunan J, Docker P. Passive doubly curved structures for determining clamping forces applied to X-ray optic assemblies. J Synchrotron Radiat 2023; 30:1143-1148. [PMID: 37815376 PMCID: PMC10624039 DOI: 10.1107/s1600577523007579] [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] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
Clamping of indirectly cryogenically cooled X-ray optics is required to ensure effective heat transfer between the optic and heat exchanger. However, clamping forces can result in distortion of the optical surface of monochromators and mirror systems, which causes angular distortions of the subsequent beam. As such, there is a need for greater understanding of how these optics are assembled and how this affects their performance throughout their life cycle. In this paper, the potential for non-contact, in-process monitoring of the clamping force both during and after assembly using an additively manufactured passive structure based on a doubly curved hyperbolic paraboloid and designed for application to the first crystal for the I20 monochromator at Diamond Light Source is investigated numerically and experimentally. The performance of the passive structure both pre- and post-cryogenic quenching is characterized experimentally. Laser displacement measurements reveal approximately 9 µm total displacement in the passive structure per 100 N of bolt preload, corresponding to an effective magnification of the preload adjustment of approximately 2.5×.
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Affiliation(s)
| | - Jonathan David Griffiths
- School of Engineering, University of Lincoln, Brayford Way, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Hiten Patel
- Diamond Light Source, Diamond House, Harwell Science and Innovation Campus, Fermi Ave, Didcot OX11 0DE, United Kingdom
| | - Jessica Clunan
- School of Engineering, University of Lincoln, Brayford Way, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Peter Docker
- Diamond Light Source, Diamond House, Harwell Science and Innovation Campus, Fermi Ave, Didcot OX11 0DE, United Kingdom
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Stout TE, McElree IM, Smith AC, Rac G, Patel H, Gupta G, Gellhaus PT. Multi-institutional feasibility and safety outcomes of retroperitoneal robot-assisted partial nephrectomy in morbidly obese patients. Transl Androl Urol 2023; 12:700-707. [PMID: 37305642 PMCID: PMC10251096 DOI: 10.21037/tau-22-829] [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: 12/12/2022] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Background Robotic-assisted partial nephrectomy (RAPN) is an established treatment modality for small renal masses. While retroperitoneal RAPN (rRAPN) has the benefit of avoiding the peritoneal cavity and provides more direct access to the renal hilum and posterior kidney, there is concern about the feasibility of rRAPN particularly in morbidly obese [body mass index (BMI) ≥40 kg/m2] patients. We present a large scale multi-institutional study on the outcomes of rRAPN in morbidly obese patients. Methods A retrospective review of a cohort of morbidly obese patients who underwent rRAPN at two academic institutions was performed. Patient characteristics, operative data, and postoperative complication rates were assessed. Results A total of 22 morbidly obese patients were included for analysis, with a median follow-up duration of 52 months. Median patient age was 61 years and median BMI was 44.9 kg/m2. Based on nephrometry score, 55% of the masses had low complexity and 32% had intermediate complexity. Median operative time was 186.0 minutes and median warm ischemia time was 23.5 minutes. Median postoperative length of stay was 2 days, and only one patient experienced a high-grade complication within 30 days of surgery. Conclusions rRAPN in select morbidly obese patients appears to have acceptable operative and postoperative outcomes. Further studies and follow-up are needed to better generalization and understand long-term impacts.
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Affiliation(s)
| | | | | | - Goran Rac
- Department of Urology, Loyola University Medical Center, Chicago, IL, USA
| | - Hiten Patel
- Department of Urology, Loyola University Medical Center, Chicago, IL, USA
| | - Gopal Gupta
- Department of Urology, Loyola University Medical Center, Chicago, IL, USA
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5
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Geurten C, Errington J, Barnett S, Patel H, Noor S, Saraff V, Veal GJ, Gatz SA. Spontaneous fractures during 13-cis retinoic acid therapy for neuroblastoma. Pediatr Blood Cancer 2023:e30430. [PMID: 37243423 DOI: 10.1002/pbc.30430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Claire Geurten
- Department of Paediatric Haematology/Oncology, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
- Department of Paediatric Haematology/Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Julie Errington
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Shelby Barnett
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Hiten Patel
- Department of Paediatric Radiology, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | - Saqib Noor
- Department of Paediatric Orthopaedic Surgery, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | - Vrinda Saraff
- Department of Paediatric Endocrinology, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Susanne A Gatz
- Department of Paediatric Haematology/Oncology, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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6
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in LVAD Utilization: A NIS Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Racial and Regional Disparities in Lvad Utilization: A Nis Database Analysis 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Faisaluddin M, Ahmed AIZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Heart Transplant: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Burden of Arrythmias and Hospital Outcomes Among Patients with Left Ventricular Assisted Device Patients: A Nis Database Analysis from 2015-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Faisaluddin M, Ahmed AZ, Patel H, Thakkar S, Dani S, Alweis R, Feitell S. Gender Disparities in the Heart Transplant Implantation: A Nationwide Study from 2009-2020. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Hussein K, Patel H, Drew T. Total spinal anaesthesia and respiratory arrest during patient transfer following unrecognised subdural catheter placement during labour. Int J Obstet Anesth 2023; 53:103621. [PMID: 36634447 DOI: 10.1016/j.ijoa.2022.103621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Affiliation(s)
- K Hussein
- The Rotunda Hospital, Dublin, Ireland.
| | - H Patel
- The Rotunda Hospital, Dublin, Ireland
| | - T Drew
- The Rotunda Hospital, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland
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12
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Bollenbecker S, Patel Z, Punjani Z, Charania A, Patel H, Saleh M, Budhwani K. PP054 Simultaneous rapid preclinical therapeutic evaluation in a novel ex vivo bioreactor. ESMO Open 2022. [DOI: 10.1016/j.esmoop.2022.100729] [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: 12/31/2022] Open
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13
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Patel H, Skok C, DeMarco A. Peripheral Edema: Evaluation and Management in Primary Care. Am Fam Physician 2022; 106:557-564. [PMID: 36379502] [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: 12/14/2022]
Abstract
Edema is a common clinical sign that may indicate numerous pathologies. As a sequela of imbalanced capillary hemodynamics, edema is an accumulation of fluid in the interstitial compartment. The chronicity and laterality of the edema guide evaluation. Medications (e.g., antihypertensives, anti-inflammatory drugs, hormones) can contribute to edema. Evaluation should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing, brain natriuretic peptide levels, and a urine protein/creatinine ratio. Validated decision rules, such as the Wells and STOP-Bang (snoring, tired, observed, pressure, body mass index, age, neck size, gender) criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and obstructive sleep apnea, respectively. Acute unilateral lower-extremity edema warrants immediate evaluation for deep venous thrombosis with a d-dimer test or compression ultrasonography. For patients with chronic bilateral lower-extremity edema, duplex ultrasonography with reflux can help diagnose chronic venous insufficiency. Patients with pulmonary edema or elevated brain natriuretic peptide levels should undergo echocardiography to assess for heart failure. Lymphedema is often a clinical diagnosis; lymphoscintigraphy can be performed if the diagnosis is unclear. Treatment of edema is specific to the etiology. Diuretics are effective but should be used only for systemic causes of edema. Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency. Compression therapy is effective for most causes of edema.
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Affiliation(s)
- Hiten Patel
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Anthony DeMarco
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Gill J, Jeelani H, Patel H. The utilization and mortality benefits of pulmonary artery catheterization in patients with cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Pulmonary artery catheterization (PAC) can provide essential hemodynamic data to assist in managing critical patients with cardiogenic shock. The use of PAC has been controversial as clinical studies have shown a lack of benefit. However, with the recent widespread availability of mechanical circulatory assists devices, the application and benefits of PAC are expected to rise.
Purpose
To determine the impact of PAC on inpatient outcomes and the utilization of advanced heart failure devices in these patients.
Methods
The National Inpatient Sample from 2016 to 2018 was queried to identify patients with cardiogenic shock. Of these patients, we compared those who received invasive hemodynamic monitoring (IHM) with PAC to those who did not receive PAC. Patients under age 18 and those undergoing surgical or transcatheter cardiac procedures during the same admission were excluded. Multivariate logistic regression was used to select matched samples between groups accounting for patient/hospital demographics and medical comorbidities. The primary endpoint was a comparison of in-hospital mortality, length of hospitalization, and medical costs. The secondary endpoints compared the utilization of mechanical circulatory assists devices: percutaneous ventricular assist devices (pVAD), extracorporeal membrane oxygenation (ECMO), and left ventricular assist device (LVAD), and the incidence of post-PAC complications: pneumothorax, sepsis, and hemorrhage/hematoma.
Results
We identified a total of 279,619 patients admitted with cardiogenic shock, of these patients 25,166 (9%) received IHM with PAC. Patients who had PAC had decreased in-hospital mortality (22.3% vs 29.7%; p<0.001), increased length of hospitalization (12 days vs 9 days; p<0.001), and increased medical costs ($65,884 vs $47,983; p<0.001). Furthermore, in patients with PAC there was increased utilization of pVAD (4.5% vs 1.9%; p<0.001), ECMO (0.07% vs 0.01%; p<0.001), and LVAD (2.2% vs 0.3%; p<0.001). There was no difference in the prevalence of post-PAC complications between both groups.
Conclusions
The use of IHM with PAC was associated with improved mortality and utilization of mechanical circulatory assist devices in patients with cardiogenic shock without increasing risk for post-procedural complications. Therefore, the increased average duration and medical costs of hospitalization with PAC patients likely resulted from improved patient survival. Therefore, the present study indicated that IHM with PAC is safe and beneficial for patients with cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Gill
- Rosalind Franklin University , North Chicago , United States of America
| | - H Jeelani
- Rosalind Franklin University , North Chicago , United States of America
| | - H Patel
- Rosalind Franklin University , North Chicago , United States of America
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Victor V, Thakkar S, Patel H, Deshmukh A, Desimone C, Feitell SC, Blankstein R. A nationwide analysis of cardiac sarcoidosis and related in-hospital outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be.
Purpose
With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US).
Methods
We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses.
Results
A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993).
Conclusion
Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Victor
- Aultman Hospital , Canton , United States of America
| | - S Thakkar
- Rochester General Hospital, Internal Medicine , Rochester , United States of America
| | - H Patel
- Louis A. Weiss Memorial Hospital, Internal Medicine , Chicago , United States of America
| | - A Deshmukh
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - C Desimone
- Mayo Clinic, Electrophysiology , Rochester , United States of America
| | - S C Feitell
- Rochester General Hospital, Advanced Heart Failure and Transplant Cardiology , Rochester , United States of America
| | - R Blankstein
- Brigham and Women'S Hospital, Harvard Medical School, Cardiology , Boston , United States of America
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Elbatarny M, Trimarchi S, Korach A, Di Eusanio M, Pacini D, Bekeredijan R, Myrmel T, Bavaria J, Desai N, Sultan I, Patel H, Peterson M. OUTCOMES OF AXILLARY VS FEMORAL ARTERIAL CANNULATION IN ACUTE TYPE A DISSECTION REPAIR: AN INTERNATIONAL MULTICENTRE STUDY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.193] [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: 11/02/2022] Open
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17
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Allam A, Alfahmi O, Patel H, Sugino C, Harding M, Ruzzene M, Erturk A. Ultrasonic testing of thick and thin Inconel 625 alloys manufactured by laser powder bed fusion. Ultrasonics 2022; 125:106780. [PMID: 35716606 DOI: 10.1016/j.ultras.2022.106780] [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] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Additive manufacturing of alloys enables low-volume production of functional metallic components with complex geometries. Ultrasonic testing can ensure the quality of these components and detect typical defects generated during laser powder bed fusion (LPBF). However, it is difficult to find a single ultrasonic inspection technique that can detect defects in the large variety of geometries generated using LPBF. In this work, phased array ultrasonic testing (PAUT) is suggested to inspect thick LPBF components, while guided waves are explored for thin curved ones. PAUT is used to detect cylindrical lack of fusion defects in thick LPBF rectangular parts. Practical defects are generated by reducing the laser power at prespecified locations in the samples. The defects' shape and density are verified using optical microscopy and X-ray computed tomography. Partially fused defects down to 0.25 mm in diameter are experimentally detected using a 10 MHz PAUT probe with the total focusing method post-processing. The experimental results are compared to defect images predicted by finite element simulations. For thin components with curved geometry, guided waves are used to detect powder-filled cylindrical defects. The waves are generated using piezoelectric transducers, and the spatiotemporal wavefield is measured using a scanning laser Doppler vibrometer. Using root-mean-square imaging of the wavefield, defects down to 1 mm are clearly detected despite the complex internal features in the samples.
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Affiliation(s)
- A Allam
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA.
| | - O Alfahmi
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - H Patel
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - C Sugino
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
| | - M Harding
- Tronosjet Manufacturing, Charlottetown, C1C 1N2, PE, Canada
| | - M Ruzzene
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, 80309, CO, USA
| | - A Erturk
- G.W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, 30332, GA, USA
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Mittal A, Hegde U, Rajapurkar M, Gang S, Konnur A, Patel H. POS-076 PARVOVIRUS B19 DISEASE POST-RENAL TRANSPLANT PRESENTING AS REFRACTORY ANEMIA - CASE SERIES OF 20 PATIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.094] [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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19
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Akinbobola O, Faris N, Smeltzer M, Ray M, Fehnel C, Pacheco A, Saulsberry A, Dortch K, Wiggins H, Talton D, Eubanks R, Stevenson D, Valaulikar G, Patel H, Wolf B, Koury A, Levy P, Ng T, Robbins T, Osarogiagbon R. EP02.03-022 Evolution of Lung Cancer Resection Quality: A Prospective Staggered Implementation Quality Improvement Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Hughes D, Ng SM, Smyth D, Patel H, Kent S, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P. Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study. Ann R Coll Surg Engl 2022; 105:461-468. [PMID: 35904336 PMCID: PMC10149241 DOI: 10.1308/rcsann.2022.0063] [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: 11/22/2022] Open
Abstract
INTRODUCTION Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures. METHODS A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications. RESULTS Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p=0.000) with no differences in readmission, antibiotic usage or surgical complications (p=1.000, RR 1.030). CONCLUSION Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.
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Affiliation(s)
| | - SM Ng
- Kings College Hospital, UK
| | | | | | - S Kent
- University Hospital of Wales, UK
| | - A Henry
- Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, UK
| | | | - D Kumar
- Liverpool Medical School, UK
| | | | - P Kyzas
- East Lancashire Hospitals NHS Trust, UK
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21
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Burris N, Nguyen C, Deeb G, Yang B, Patel H, Kim K, Fukuhara S. 447 Early Experience With Ct Evaluation Of Valve Incorporation Prior To Tavr Explant. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Reinhard C, Drakopoulos M, Charlesworth CM, James A, Patel H, Tutthill P, Crivelli D, Deyhle H, Ahmed SI. Flexible positioning of a large area detector using an industrial robot. J Synchrotron Radiat 2022; 29:1004-1013. [PMID: 35787567 PMCID: PMC9255586 DOI: 10.1107/s1600577522006300] [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] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
The DIAD beamline for Dual Imaging and Diffraction at Diamond Light Source has opted to use an industrial robot to position its Dectris Pilatus 2M CdTe diffraction detector. This setup was chosen to enable flexible positioning of the detector in a quarter-sphere around the sample position whilst reliably holding the large weight of 139 kg of detector, detector mount and cabling in a stable position. Metrology measurements showed that the detector can be positioned with a linear repeatability of <19.7 µm and a rotational repeatability of <16.3 µrad. The detector position stays stable for a 12 h period with <10.1 µm of movement for linear displacement and <3.8 µrad for rotational displacement. X-ray diffraction from calibration samples confirmed that the robot is sufficiently stable to resolve lattice d-spacings within the instrumental broadening given by detector position and beam divergence.
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Affiliation(s)
- Christina Reinhard
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | | | | | - Andrew James
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | - Hiten Patel
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | - Paul Tutthill
- YASKAWA, Walworth Road, Newton Aycliffe DL5 6XF, United Kingdom
| | - Davide Crivelli
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | - Hans Deyhle
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
| | - Sharif I. Ahmed
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, United Kingdom
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23
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Sharma M, Patel H. Case Report: Delayed Diagnosis of a High-Grade Spindle Cell Sarcoma Presenting as a Thigh Mass. Am Fam Physician 2022; 105:Online. [PMID: 35704834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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24
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Laich A, Patel H, Zarantonello A, Sim R, Inal J. C2 by-pass: cross-talk between the complement classical and alternative pathways. Immunobiology 2022; 227:152225. [DOI: 10.1016/j.imbio.2022.152225] [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] [Received: 02/20/2022] [Revised: 04/12/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
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25
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Patel H, Rafiq Q, Archibald P. Gene Editing/Gene Therapies: DEVELOPING A NOVEL FEEDING STRATEGY FOR ENHANCED LENTIVIRAL VECTOR PRODUCTION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00378-4] [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: 11/03/2022]
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26
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Movassaghi M, Ahmed F, Patel H, Luk L, Hyams E, Wenske S, Shaish H. Association of Patient and Imaging-Related Factors with False Negative MRI-Targeted Prostate Biopsies of Suspicious PI-RADS 4 and 5 Lesions. Urology 2022; 167:165-170. [DOI: 10.1016/j.urology.2022.04.026] [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] [Received: 10/31/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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27
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Girase R, Ahmad I, Pawara R, Patel H. Optimizing cardio, hepato and phospholipidosis toxicity of the Bedaquiline by chemoinformatics and molecular modelling approach. SAR QSAR Environ Res 2022; 33:215-235. [PMID: 35225110 DOI: 10.1080/1062936x.2022.2041724] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
The FDA granted expedited approval for Johnson and Johnson's Bedaquiline to treat pulmonary multidrug resistant tuberculosis on 28 December 2012 which is more common in China, Russian Federation and India. Bedaquiline is the first anti-tubercular drug approved by the FDA in the last 40 years, and it has become a cynosure in the circles of synthetic chemists researching new anti-tubercular drugs. Bedaquiline's highly lipophilic nature raises major concerns like suppression of the hERG gene, hepatotoxicity, and phospholipidosis despite its potential antitubercular profile. To address these toxicity concerns, in the present work, we have employed the structural optimization of Bedaquiline using the ADMETopt web server, which optimizes lead with scaffold hopping and ADMET screening. The ADMETopt web server yielded the 476 structures through optimization of three sites in Bedaquiline. Further, we have validated the optimized structures for their activity by performing molecular docking and molecular dynamics (MD) simulations against the mycobacterial ATP synthase enzyme and density functional theory (DFT) study further provides insight into the reactivity of the compounds. After screening and analysis, compound #449 was observed to be the most promising mycobacterial ATP synthase inhibitor with minimal cardiotoxicity, hepatotoxicity and phospholipidosis.
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Affiliation(s)
- R Girase
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - I Ahmad
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - R Pawara
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
| | - H Patel
- Division of Computer Aided Drug Design, Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur Maharashtra, India
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Low S, Tan Y, Patel H, Johnson K. Four-year experience of paediatric penetrating injuries: findings from a paediatric major trauma centre in the UK. Clin Radiol 2022; 77:244-254. [DOI: 10.1016/j.crad.2022.01.037] [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] [Received: 02/02/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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29
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Fender K, Bautista M, Patel H, Ostro B, Boulger C. Fungal Endophthalmitis on Ocular Ultrasound: A Case Report. Clin Pract Cases Emerg Med 2022; 6:37-40. [PMID: 35226845 PMCID: PMC8885216 DOI: 10.5811/cpcem.2021.10.53797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Endophthalmitis is a rare intraocular infection caused by numerous organisms
from several possible sources. Fungal endophthalmitis is a rare subset of
this pathology with limited diagnostics available. One of the few options to
make this diagnosis is vitreous sampling, which is invasive, and results are
not immediately available. Case Report This case report describes the successful use of point-of-care ultrasound to
visualize an intraocular fungal mass in a 60-year-old male who presented to
the emergency department (ED) with two weeks of left eye pain and erythema
approximately two months postoperative from a cataract extraction
surgery. Conclusion Fungal endophthalmitis is a rare and challenging diagnosis. Methods of
diagnosing this pathology are not readily available in the ED. Point-of-care
ultrasound may be a useful adjunct for the prompt diagnosis of fungal
endophthalmitis.
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Affiliation(s)
- Kimberly Fender
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Merrick Bautista
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Hiten Patel
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Benjamin Ostro
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Creagh Boulger
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
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30
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Patel H, Skok C, Maxwell D, Sheikh S. Importance of asking a social history: atypical pulmonary infections and occupational hazards. BMJ Case Rep 2022; 15:e246567. [PMID: 35039362 PMCID: PMC8768500 DOI: 10.1136/bcr-2021-246567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Accepted: 11/30/2021] [Indexed: 11/03/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are ubiquitous in the environment, but NTM infection is limited to individuals with risk factors. We present a case of a 62-year-old man who presented with a 1 year history of cough and shortness of breath. History was notable for significant tobacco use and work as a sandblaster without the use of personal protective equipment. His chest X-ray showed bilateral upper lobe cavitary lesions, which were redemonstrated on chest CT. A sputum Gram stain was positive for acid-fast bacilli, but his tuberculosis QuantiFERON was negative. He was started on empiric tuberculosis treatment. Sputum cultures ultimately returned for Mycobacterium avium intracellulare complex, and treatment was narrowed to azithromycin, rifampin and ethambutol. The case highlights risk factors for NTM infection, notably for this patient, occupational exposures that likely lead to the development of pneumoconiosis. Healthcare providers should ask about occupational history and counsel patients about protection from occupational hazards.
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Affiliation(s)
- Hiten Patel
- Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher Skok
- Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dana Maxwell
- Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Selim Sheikh
- Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Jumaah H, Kistler P, Mariani J, Patel H, Hare J, Kaye D, Taylor A, Voskoboinik A. Cardiac MRI Findings in Patients presenting With Advanced Conduction System Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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32
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Vedelago L, Wardell J, Kempe T, Patel H, Amlung M, MacKillop J, Keough M. Getting high to cope with COVID-19: Modelling the associations between cannabis demand, coping motives, and cannabis use and problems. Addict Behav 2022; 124:107092. [PMID: 34469783 PMCID: PMC8555961 DOI: 10.1016/j.addbeh.2021.107092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022]
Abstract
During the COVID-19 pandemic, people may use substances like cannabis for enhancement or coping purposes. Behavioral economic demand for a substance is a key determinant of its use and misuse and can be measured via hypothetical purchase tasks. Previous research suggests that motivations to use a substance play a mediational role between elevated substance demand and problems, but comparable mechanistic research has yet to be done in the COVID-19 context and on the effects of cannabis demand on cannabis use patterns. Participants (n = 137) were recruited via the online crowdsourcing platform Prolific. Participants completed measures of cannabis use and problems, motivations for cannabis use, and the Marijuana Purchase Task. Two indices of demand, Persistence (i.e., sensitivity to increasing cost of cannabis) and Amplitude (i.e., consumption of cannabis at unrestricted cost), were related to increased cannabis problems via the use motive of coping during the COVID-19 pandemic. This model did not support the mediational role of enhancement motives. Those with increased cannabis demand who tend to use cannabis to cope are at increased risk of experiencing negative cannabis-related consequences during the COVID-19 pandemic.
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Shirwaiker A, William J, Mariani J, Kistler P, Patel H, Voskoboinik A. Long-term implications of pacemaker insertion in younger adults: a single centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0395] [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
The long-term implications of pacemaker insertion in younger adults are poorly described in the literature.
Methods
We performed a retrospective analysis of consecutive younger adult patients (18–50 years) undergoing pacemaker implantation at a quaternary hospital between 1986–2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed.
Results
81 patients (39.5±9.6 years, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.6 (IQR=0.6–14.8) years follow-up, 9 patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation (n=11), device infection (n=1) and pocket revision (n=1)). Five of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further 9 patients (11%) experienced significant symptoms from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in 2 patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and 7 of these patients required subsequent biventricular upgrade. Furthermore, 4 patients (5%) developed new tricuspid regurgitation (≥ moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients.
Conclusions
Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shirwaiker
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - J William
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - J Mariani
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - P Kistler
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - H Patel
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - A Voskoboinik
- The Alfred Hospital, Heart Centre, Melbourne, Australia
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Dagan M, Lankaputhra M, Yeung T, Tee S, Bader I, Easton K, Linton A, McLean C, Taylor A, Bergin P, Kaye D, Leet A, Hare J, Patel H. Incidence and predictors of eosinophilic myocardial hypersensitivity in patients receiving home dobutamine. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Home inotropes are utilised in those with end-stage heart failure as a bridge to cardiac transplantation. The use of intravenous dobutamine has been linked to cases of eosinophilic myocardial hypersensitivity (EMH), however, little is known about incidence and predictors.
Purpose
We sought to examine the incidence and possible predictors of eosinophilic myocardial hypersensitivity in a cohort of patients on home inotrope therapy at a cardiac transplant centre.
Methods
Patients enrolled in the home inotrope program with progression to heart transplantation or ventricular assist device (VAD) with available myocardial tissue for histopathology, from January 2000 to May 2020 were included. EMH was defined by a pathologist reporting eosinophilic infiltrate with hypersensitivity on myocardial histopathology.
Results
From a cohort of 74 patients, 58% (43) were on dobutamine and 42% (31) were on milrinone. There were zero cases of EMH in those on milrinone. EMH was identified in 14% (6/43) of patients receiving dobutamine. In the dobutamine cohort, the mean age was 52-±12 years, with 22% being female. Non-ischaemic dilated cardiomyopathy encompassed 62%, the remaining 38% were ischaemic cardiomyopathy. Median dobutamine dose (250 [200–282] mcg/min vs. 225 [200–291] mcg/min) and duration of therapy (41 [23–79] days vs. 53 [24–91] days) were similar between those with and without EMH. Rates of known allergy (27% vs. 33%) and asthma (1 patient in each group) were also similar between those with and without EMH. Those with EMH had a median peak eosinophil count of 0.40×109/L (IQR 0.21–0.66×109/L) compared to a peak of only 0.10×109/L (IQR 0.06–0.29×109/L) in the non-EMH cohort. There was a significant difference in the change in absolute eosinophil count between groups; over the duration of dobutamine therapy the median change in eosinophil count was 0.31×109/L (IQR 0.21–0.59×109/L) in the EMH group compared to 0.03×109/L (IQR 0.00–0.14×109/L) in the non-EMH cohort (p=0.02). Peak C-reactive protein was similar between groups (42±46mg/L vs. 44±45mg/L). Mean left ventricular ejection fraction (LVEF) reduced from 19% (±7%) to 17% (±2%) in those with EMH, while LVEF increased from 20% (±7%) to 22% (±9%) in non-EMH patients (Figure 1), p=NS. Re-presentation with heart failure requiring hospitalisation occurred in 83% in the EMH group compared to only 59% in the non-EMH group (p=0.26). The majority of patients with EMH (83%) required VAD as bridge to transplant, compared to only 41% of non-EMH (p=0.05).
Conclusion(s)
EMH occurred in 14% of patients receiving home dobutamine. Patients who developed EMH were more likely to require escalation in treatment to VAD as a bridge to heart transplant. In patients receiving dobutamine a reduction in LVEF, hospitalisation with decompensated heart failure and rising eosinophil count should prompt physicians to consider EMH.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Dagan
- The Alfred Hospital, Melbourne, Australia
| | | | - T Yeung
- The Alfred Hospital, Melbourne, Australia
| | - S.L Tee
- The Alfred Hospital, Melbourne, Australia
| | - I Bader
- The Alfred Hospital, Melbourne, Australia
| | - K Easton
- The Alfred Hospital, Melbourne, Australia
| | - A Linton
- The Alfred Hospital, Melbourne, Australia
| | - C McLean
- The Alfred Hospital, Melbourne, Australia
| | - A Taylor
- The Alfred Hospital, Melbourne, Australia
| | - P Bergin
- The Alfred Hospital, Melbourne, Australia
| | - D.M Kaye
- The Alfred Hospital, Melbourne, Australia
| | - A Leet
- The Alfred Hospital, Melbourne, Australia
| | - J Hare
- The Alfred Hospital, Melbourne, Australia
| | - H Patel
- The Alfred Hospital, Melbourne, Australia
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Kim S, Buss N, Qiao C, Patel H, Yang L, Elliott K, Qian R, Ye L, Fiscella M, Danos O. DMD – ANIMAL MODELS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Horter S, Daftary A, Keam T, Bernays S, Bhanushali K, Chavan D, Denholm J, Furin J, Jaramillo E, Khan A, Lin YD, Lobo R, Loveday M, Majumdar SS, Mistry N, Patel H, Rane S, Swaminathan A, Triasih R, Venkatesan N, Viney K, du Cros P. Person-centred care in TB. Int J Tuberc Lung Dis 2021; 25:784-787. [PMID: 34615573 DOI: 10.5588/ijtld.21.0327] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Horter
- Burnet Institute, Melbourne, VIC, Australia
| | - A Daftary
- Dahdaleh Institute of Global Health Research, York University, Toronto, ON, Canada, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - T Keam
- Burnet Institute, Melbourne, VIC, Australia
| | - S Bernays
- School of Public Health, University of Sydney, Sydney, NSW, Australia, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - D Chavan
- Survivors Against TB, Mumbai, India
| | - J Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia, Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - E Jaramillo
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - A Khan
- Stop TB Partnership, Geneva, Switzerland
| | - Y D Lin
- Burnet Institute, Melbourne, VIC, Australia
| | | | - M Loveday
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - S S Majumdar
- Burnet Institute, Melbourne, VIC, Australia, Department of Paediatrics, University of Melbourne and Murdoch Children´s Research Institute, Melbourne, VIC, Australia
| | - N Mistry
- Foundation for Medical Research, Mumbai, India
| | - H Patel
- Survivors Against TB, Mumbai, India
| | - S Rane
- Survivors Against TB, Mumbai, India
| | | | - R Triasih
- Centre for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Department of Paediatric, Dr Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - N Venkatesan
- Blavatnik School of Government, Oxford University, Oxford, UK
| | - K Viney
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - P du Cros
- Burnet Institute, Melbourne, VIC, Australia
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Egeberg A, Iversen L, Kimball AB, Kelly S, Grace E, Patel H, Xu W, Gallo G, Riedl E, Feldman SR. Pregnancy outcomes in patients with psoriasis, psoriatic arthritis, or axial spondyloarthritis receiving ixekizumab. J DERMATOL TREAT 2021; 33:2503-2509. [PMID: 34547967 DOI: 10.1080/09546634.2021.1976375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psoriasis, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are chronic inflammatory diseases that often affect women of childbearing age. Detailed information about pregnancy and related outcomes across these indications in patients exposed to ixekizumab is lacking. OBJECTIVES To evaluate pregnancy outcomes after maternal or paternal exposure to ixekizumab in patients with psoriasis, PsA, or axSpA. METHODS Pregnancy cases from clinical trials and post-marketing reports, associated with either maternal or paternal exposure to ixekizumab cumulatively through 22 March 2019, were identified in the Eli Lilly Global Safety Database and described separately. RESULTS One hundred and ninety-three ixekizumab-exposed pregnancies were identified. Maternal exposure occurred in 51.3% of pregnancies (clinical trials: n = 58; post-marketing: n = 41). The majority of paternal exposure pregnancies occurred in clinical trials (91 of 94). Live births were reported for 53.8 and 61.1% of known outcomes in maternal exposure pregnancies during clinical trials and post-marketing surveillance, respectively. No congenital malformations resulting from maternal exposure were reported in clinical trials: one case, not causally related to ixekizumab therapy, was recorded in the post-marketing setting. CONCLUSIONS This integrated safety analysis provides relevant information for clinicians treating patients with psoriasis, PsA, or axSpA with ixekizumab. No new safety signals were identified in patients receiving ixekizumab.
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Affiliation(s)
- A Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Hospital, Boston, MA, USA
| | - S Kelly
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Grace
- Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - G Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Riedl
- Eli Lilly and Company, Indianapolis, IN, USA
| | - S R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Koehne E, Patel H, Rojas LP, Reyes MD, Belshoff A, Elliott N, Gorbonos A, Woods M, Quek M, Gupta G, Guevara-Patino J. MP66-16 EX-VIVO ASSESSMENT OF T CELL RESPONSE TO CHECKPOINT INHIBITION IN BLADDER AND KIDNEY TUMORS. J Urol 2021. [DOI: 10.1097/ju.0000000000002106.16] [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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Blauvelt A, Ramharter M, Cohen AD, Xu W, Patel H, Schuster C, Riedl E, Puig L. An integrated safety analysis of treatment-emergent fungal infections in patients with psoriasis treated with ixekizumab from 16 clinical studies. J Eur Acad Dermatol Venereol 2021; 35:e828-e831. [PMID: 34310771 DOI: 10.1111/jdv.17554] [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: 11/30/2022]
Affiliation(s)
- A Blauvelt
- Oregon Medical Research Center, Portland, OR, USA
| | - M Ramharter
- Bernhard Nocht Institute for Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University, Be'er Sheva, Israel
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Schuster
- Eli Lilly and Company, Indianapolis, IN, USA
| | - E Riedl
- Eli Lilly and Company, Indianapolis, IN, USA
| | - L Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Toigo V, Marcuzzi D, Serianni G, Boldrin M, Chitarin G, Bello SD, Grando L, Luchetta A, Pasqualotto R, Zaccaria P, Zanotto L, Agnello R, Agostinetti P, Agostini M, Antoni V, Aprile D, Barbisan M, Battistella M, Berton G, Bigi M, Brombin M, Candeloro V, Canton A, Casagrande R, Cavallini C, Cavazzana R, Cordaro L, Cruz N, Palma MD, Dan M, De Lorenzi A, Delogu R, De Muri M, Denizeau S, Fadone M, Fellin F, Ferro A, Gaio E, Gasparini F, Gasparrini C, Gnesotto F, Jain P, Krastev P, Lopez-Bruna D, Lorenzini R, Maistrello A, Manduchi G, Manfrin S, Marconato N, Martines E, Martini G, Martini S, Milazzo R, Patton T, Pavei M, Peruzzo S, Pilan N, Pimazzoni A, Poggi C, Pomaro N, Pouradier-Duteil B, Recchia M, Rigoni-Garola A, Rizzolo A, Sartori E, Shepherd A, Siragusa M, Sonato P, Sottocornola A, Spada E, Spagnolo S, Spolaore M, Taliercio C, Terranova D, Tinti P, Tomsič P, Trevisan L, Ugoletti M, Valente M, Vignando M, Zagorski R, Zamengo A, Zaniol B, Zaupa M, Zuin M, Cavenago M, Boilson D, Rotti C, Veltri P, Decamps H, Dremel M, Graceffa J, Geli F, Urbani M, Zacks J, Bonicelli T, Paolucci F, Garbuglia A, Agarici G, Gomez G, Gutierrez D, Kouzmenko G, Labate C, Masiello A, Mico G, Moreno JF, Pilard V, Rousseau A, Simon M, Kashiwagi M, Tobari H, Watanabe K, Maejima T, Kojima A, Oshita E, Yamashita Y, Konno S, Singh M, Chakraborty A, Patel H, Singh N, Fantz U, Bonomo F, Cristofaro S, Heinemann B, Kraus W, Wimmer C, Wünderlich D, Fubiani G, Tsumori K, Croci G, Gorini G, McCormack O, Muraro A, Rebai M, Tardocchi M, Giacomelli L, Rigamonti D, Taccogna F, Bruno D, Rutigliano M, D'Arienzo M, Tonti A, Panin F. On the road to ITER NBIs: SPIDER improvement after first operation and MITICA construction progress. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112622] [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: 10/21/2022]
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Koo K, Winoker JS, Patel H, Faisal F, Gupta N, Metcalf M, Mettee L, Meyer A, Pavlovich C, Pierorazio P, Matlaga BR. Evidence-Based Recommendations for Opioid Prescribing after Endourological and Minimally Invasive Urological Surgery. J Endourol 2021; 35:1838-1843. [PMID: 34107778 DOI: 10.1089/end.2021.0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Procedure-specific guidelines for postsurgical opioid use can decrease overprescribing and facilitate opioid stewardship. Initial recommendations were based on feasibility data from limited pilot studies. This study aims to refine opioid prescribing recommendations for endourological and minimally invasive urological procedures by integrating emerging clinical evidence with a panel consensus. METHODS A multistakeholder panel was convened with broad subspecialty expertise. Primary literature on opioid prescribing after 16 urological procedures was systematically assessed. Using a modified Delphi technique, the panel reviewed and revised procedure-specific recommendations and opioid stewardship strategies based on additional evidence. All recommendations were developed for opioid-naïve adult patients after uncomplicated procedures. RESULTS Seven relevant studies on postsurgical opioid prescribing were identified: four studies on ureteroscopy, two studies on robotic prostatectomy including a combined study on robotic nephrectomy, and one study on transurethral prostate surgery. The panel affirmed prescribing ranges to allow tailoring quantities to anticipated need. The panel noted that zero opioid tablets would be potentially appropriate for all procedures. Following evidence review, the panel reduced the maximum recommended quantities for 11 of the 16 procedures; the other 5 procedures were unchanged. Opioids were no longer recommended following diagnostic endoscopy and transurethral resection procedures. Finally, data on prescribing decisions supported expanded stewardship strategies for first-time prescribing and ongoing quality improvement. CONCLUSION Reductions in initial opioid prescribing recommendations are supported by evidence for most endourological and minimally invasive urological procedures. Shared decision-making prior to prescribing and periodic reevaluation of individual prescribing patterns are strongly recommended to strengthen opioid stewardship.
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Affiliation(s)
- Kevin Koo
- Mayo Clinic, 6915, 200 First St SW, Rochester, Minnesota, United States, 55905;
| | - Jared S Winoker
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Hiten Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Farzana Faisal
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Natasha Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | - Meredith Metcalf
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
| | | | - Alexa Meyer
- Johns Hopkins Medical Institutions, James Buchanan Brady Urological Institute, Baltimore, Maryland, United States;
| | - Christian Pavlovich
- Johns Hopkins, Urology , Suite 3200, Bldg 301, 4940 Eastern Ave, Baltimore, Maryland, United States, 21224;
| | - Philip Pierorazio
- Johns Hopkins Medical Institutions, James Buchanan Brady Urological Institute, 600 N. Wolfe Street, Marburg 134, Baltimore, Maryland, United States, 21287;
| | - Brian R Matlaga
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States;
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Brunner PM, Conrad C, Vender R, Grond S, Schuster C, Patel H, Xu W, Carrascosa Carrillo JM. Integrated safety analysis of treatment-emergent eczematous reactions in patients with moderate-to-severe psoriasis treated with ixekizumab, etanercept and ustekinumab. Br J Dermatol 2021; 185:865-867. [PMID: 34076896 PMCID: PMC8518506 DOI: 10.1111/bjd.20527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 05/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- P M Brunner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - R Vender
- Dermatrials Research Inc, Hamilton, ON, Canada
| | - S Grond
- Eli Lilly and Company, Indianapolis, IN, USA
| | - C Schuster
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Eli Lilly and Company, Indianapolis, IN, USA
| | - H Patel
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Carrascosa Carrillo
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sesin C, Gallo G, Gellett A, Kronbergs A, Sprabery AT, Xu W, Patel H, Deodhar A, Combe B, Burmester GR. POS1033 SAFETY OF IXEKIZUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS: AN INTEGRATED ANALYSIS OF 4 CLINICAL TRIALS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with psoriatic arthritis (PsA) require long-term treatment, which may lead to adverse events (AEs). Ixekizumab, an interleukin-17A antagonist, is approved for the treatment of adults with active PsA.Objectives:We report a summary of safety outcomes for patients enrolled in 4 PsA studies with up to 3 years of exposure to ixekizumab.Methods:This integrated safety analysis included all patients with PsA who received at least 1 dose of ixekizumab (80 mg every 2 or 4 weeks) in 4 clinical trials (NCT01695239, NCT02349295, NCT02584855, NCT03151551). Safety outcomes included treatment-emergent adverse events (TEAEs), serious AEs (SAEs), discontinuations due to AEs, deaths, and AEs of special interest.Results:A total of 1401 patients were included in this safety analysis (51.5% female; mean age 49 years), with 2247.6 patient-years of exposure (Table 1). In all, 1131 patients (80.7%) reported ≥1 TEAE (exposure-adjusted incidence rate per 100 patient-years [IR] 50.3, 95% CI 47.5–53.3), mostly mild (32.9%) or moderate (39.7%) in severity. The most common TEAEs were nasopharyngitis (n=202, IR 9.0), upper respiratory infections (n=186, IR 8.3), and injection site reaction (n=156, IR 6.9). SAEs were reported by 134 patients (IR 6.0, 95% CI 5.0–7.1). 115 (8.2%) patients discontinued due to AEs (IR 5.1, 95% CI 4.3–6.1). Six deaths were reported (IR 0.3, 95% CI 0.1–0.6). Allergic reactions/hypersensitivity were reported in 102 patients (IR 4.5, 95% CI 3.7–5.5). Three cases were adjudicated as de novo inflammatory bowel disease (IR 0.13, 95% CI 0.04–0.41); 1 was ulcerative colitis (IR 0.04, 95% CI 0.01–0.32), 2 were Crohn’s disease (IR 0.09, 95% CI 0.02–0.36). Major adverse cardiac events occurred in 12 patients (IR 0.5) and malignancies in 15 (IR 0.7), 9 of which were non-melanoma skin cancer. Opportunistic infections occurred in 40 (2.9%) patients (IR 1.8, 95% CI 1.3–2.4). Candidiasis occurred in 24 patients (oral: IR 0.7, 95% CI 0.4–1.2; oral fungal infection: IR 0.3, 95% CI 0.1–0.6; esophageal infection: IR 0.1, 95% CI 0.0–0.4). No active or reactive cases of tuberculosis were reported. Other opportunistic infections included hepatitis B (IR 0.0, 95% CI 0.0–0.3), herpes simplex (IR 1.8, 95% CI 1.3–2.5), and herpes zoster (IR 0.7, 95% CI 0.4–1.2).Conclusion:The safety profile of ixekizumab across 4 clinical trials and up to 3 years of continuous treatment in patients with active PsA was consistent with the known safety profile reported in previous studies for psoriasis and PsA. No new safety events were found in this analysis.Pooled Ixekizumab(N=1401; Total Patient-Years=2247.6)n (IR)95% CIYear 0–1(n=1401)n (IR)95% CIYear 1–2(n=946)n (IR)95% CIYear 2–3(n=510)n (IR)95% CIYear ≥3(n=89)n (IR)95% CITotal Patient-Years2247.71207.3689.8347.72.9Patients with ≥1 TEAE1131 (50.3)1050 (87.0)496 (71.9)234 (67.3)6 (206.2)47.5–53.381.9–92.465.9–78.559.2–76.592.6–458.9SAEs134 (6.0)72 (6.0)53 (7.7)19 (5.5)1 (34.4)5.0–7.14.7–7.55.9–10.13.5–8.64.8–243.9Discontinuations due to AEs115 (5.1)61 (5.1)37 (5.4)17 (4.9)0 (0)4.3–6.13.9–6.53.9–7.43.0–7.90.0–274.7Hepatic reactions112 (5.0)80 (6.6)32 (4.6)14 (4.0)0 (0)4.1–6.05.3–8.33.3–6.62.4–6.80.0–274.7Allergic reaction/hypersensitivity102 (4.5)83 (6.9)23 (3.3)5 (1.4)0 (0)3.7–5.55.5–8.52.2–5.00.6–3.50.0–274.7Serious infection28 (1.2)18 (1.5)9 (1.3)3 (0.9)0 (0)0.9–1.80.9–2.40.7–2.50.3–2.70.0–274.7Malignancies15 (0.7)4 (0.3)8 (1.2)4 (1.2)0 (0)0.4–1.10.1–0.90.6–2.30.4–3.10.0–274.7Major adverse cardiac events12 (0.5)3 (0.2)8 (1.2)1 (0.3)0 (0)0.3–0.90.1–0.80.6–2.30.0–2.00.0–274.7Inflammatory bowel disease3 (0.1)3 (0.2)1 (0.1)0 (0.0)0 (0.0)0.0–0.40.1–0.80.0–1.00.0–2.30.0–274.7 Ulcerative colitis1 (0.0)1 (0.1)1 (0.1)0 (0.0)0 (0.0)0.0–0.30.0–0.60.0–1.00.0–2.30.0–274.7 Crohn’s disease2 (0.1)2 (0.2)0 (0.0)0 (0.0)0 (0.0)0.0–0.40.0–0.70.0–1.20.0–2.30.0–274.7AE, adverse event; CI, confidence interval; IR, exposure-adjusted incidence rate per 100 patient-years; SAE, serious adverse event; TEAE, treatment-emergent adverse event.Disclosure of Interests:Carlos Sesin Speakers bureau: Amgen, AbbVie, Sanofi, Radius, Pfizer, Eli Lilly and Company, Novartis, Gaia Gallo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Amanda Gellett Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Aubrey Trevelin Sprabery Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Wen Xu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Himanshu Patel Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly and Company, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Bernard Combe Speakers bureau: AbbVie, BMS, Gilead-Galapagos, Eli Lilly and Company, MSD, Pfizer, Roche Chugai, Consultant of: AbbVie, Bayer, Gilead-Galapagos, Janssen, Eli Lilly and Company, Novartis, Roche Chugai, Grant/research support from: AbbVie, Eli Lilly and Company, Pfizer, Roche Chugai, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Janssen, Novartis, Eli Lilly and Company, MSD, Pfizer, Consultant of: AbbVie, Janssen, Novartis, Eli Lilly and Company, MSD, Pfizer.
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Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, Fruauff A, Loeb G, Maddocks A, Borowski A, Lala S, Nguyen P, Lignelli A, D'souza B, Desperito E, Ruzal-Shapiro C, Salvatore MM. Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review. Acad Radiol 2021; 28:595-607. [PMID: 33583712 PMCID: PMC7859715 DOI: 10.1016/j.acra.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032.
| | - H Yang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E West
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - G Loeb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Maddocks
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Borowski
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - P Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Lignelli
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - B D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - C Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - M M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
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Joshi GS, Patel H, Sanchez-Garcia W, Mazek H, Bhandari M, Jyothidasan A, Patel D, Bahekar A. UNICUSPID AORTIC VALVE CONCOMITANT WITH INFECTIVE ENDOCARDITIS AND SEVERE AORTIC REGURGITATION IN A PATIENT WITH COVID-19. J Am Coll Cardiol 2021. [PMCID: PMC8091275 DOI: 10.1016/s0735-1097(21)03382-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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daSilva-deAbreu A, Alhafez B, Garikapati K, Curbelo-Pena Y, Wooldridge J, Desai S, Eiswirth C, Krim S, Patel H, Loro-Ferrer J, Lavie C, Ventura H, Mandras S. Preoperative Body Mass Index < 45 Kg/m2 Predicts Clinical Success after Bariatric Surgery in Patients with Ventricular Assist Devices. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1162] [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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47
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Hegde U, Prabhakar A, Gang S, Rajapurkar M, Patel H, Konnur A. POS-759 HISTOLOGICAL ANALYSIS OF 3 AND 6 MONTH PROTOCOL BIOPSIES AND OUTCOME SIN ABO INCOMPATIBLE RENAL TRANSPLANTS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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48
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SURESH S, Hegde U, Konnur A, Gang S, Rajapurkar M, Patel H. POS-396 A RANDOMIZED CONTROL TRIAL OF RITUXIMAB VS MODIFIED PONTICELLI REGIMEN IN THE TREATMENT OF PRIMARY MEMBRANOUS NEPHROPATHY – A PILOT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.414] [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: 10/21/2022] Open
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49
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SURESH S, Konnur A, Gang S, Hegde U, Patel H, Rajapurkar M. POS-163 A RANDOMIZED CONTROL TRIAL OF RITUXIMAB VERSUS MODIFIED PONTICELLI REGIMEN IN THE TREATMENT OF PRIMARY MEMBRANOUS NEPHROPATHY – A PILOT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.173] [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: 10/21/2022] Open
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50
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Hegde U, Soni P, Rajapurkar M, Gabg S, Konnur A, Patel H. POS-732 A STUDY OF ANGIOTENSIN ii TYPE II RECEPTOR ANTIBODY IN RENAL ALLOGRAFT REJECTION. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.764] [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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