1
|
Porter B, Bishop M, Gould J, Sieniewicz B, Sidhu B, Rinaldi CA, Taggart P, Gill JS. P793Ventricular action potential duration variability is enhanced in heart failure patients with spontaneous ventricular tachycardia or fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.397] [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: 11/12/2022] Open
Affiliation(s)
- B Porter
- King's College London, Cardiovascular, London, United Kingdom
| | - M Bishop
- King's College London, Cardiovascular, London, United Kingdom
| | - J Gould
- King's College London, Cardiovascular, London, United Kingdom
| | - B Sieniewicz
- King's College London, Cardiovascular, London, United Kingdom
| | - B Sidhu
- King's College London, Cardiovascular, London, United Kingdom
| | - C A Rinaldi
- St Thomas' Hospital, Cardiovascular , London, United Kingdom
| | - P Taggart
- University College London, Cardiovascular, London, United Kingdom
| | - J S Gill
- St Thomas' Hospital, Cardiovascular , London, United Kingdom
| |
Collapse
|
2
|
Hanson BM, Gill JS, Taggart P, Rodriguez B, Bueno-Orovio A. Slow Adaptation of Ventricular Repolarization as a Cause of Arrhythmia? Methods Inf Med 2018; 53:320-3. [DOI: 10.3414/me13-02-0039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/12/2014] [Indexed: 11/09/2022]
Abstract
SummaryIntroduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Biosignal Interpretation: Advanced Methods for Studying Cardiovascular and Respiratory Systems”.Background: Adaptation of the QT-interval to changes in heart rate reflects on the body-surface electrocardiogram the adaptation of action potential duration (APD) at the cellular level. The initial fast phase of APD adaptation has been shown to modulate the arrhythmia substrate. Whether the slow phase is potentially proarrhythmic remains unclear.Objectives: To analyze in-vivo human data and use computer simulations to examine effects of the slow APD adaptation phase on dispersion of repolarization and reentry in the human ventricle.Methods: Electrograms were acquired from 10 left and 10 right ventricle (LV/RV) endocardial sites in 15 patients with normal ventricles during RV pacing. Activation-recovery intervals, as a surrogate for APD, were measured during a sustained increase in heart rate. Observed dynamics were studied using computer simulations of human tissue electrophysiology.Results: Spatial heterogeneity of rate adaptation was observed in all patients. Inhomogeneity in slow APD adaptation time constants (ΔTs) was greater in LV than RV (ΔTs LV = 31.8 ± 13.2, ΔTs RV = 19.0 ± 12.8 s, P < 0.01). Simulations showed that altering local slow time constants of adaptation was sufficient to convert partial wavefront block to block with successful reentry.Conclusions: Using electrophysiological data acquired in-vivo in human and computer simulations, we identify heterogeneity in the slow phase of APD adaptation as an important component of arrhythmogenesis.
Collapse
|
3
|
Gill JS, Tinckam K, Fortin MC, Rose C, Shick-Makaroff K, Young K, Lesage J, Cole EH, Toews M, Landsberg DN, Gill J. Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation. Am J Transplant 2017; 17:1723-1728. [PMID: 28321984 DOI: 10.1111/ajt.14275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 01/19/2017] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.
Collapse
Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada.,Division of Nephrology, Tuft-New England Medical Center, Boston, MA
| | - K Tinckam
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Canada
| | - M C Fortin
- Department of Nephrology and Transplantation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre de Recherché du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - C Rose
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | | | - K Young
- Canadian Blood Services, Ottawa, Canada
| | - J Lesage
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - E H Cole
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
| | - M Toews
- Health Law Institute, Faculty of Law, University of Alberta, Alberta, Canada
| | - D N Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| |
Collapse
|
4
|
Gill JS, Delmonico F, Klarenbach S, Capron AM. Providing Coverage for the Unique Lifelong Health Care Needs of Living Kidney Donors Within the Framework of Financial Neutrality. Am J Transplant 2017; 17:1176-1181. [PMID: 27888569 DOI: 10.1111/ajt.14147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/21/2016] [Accepted: 11/08/2016] [Indexed: 01/25/2023]
Abstract
Organ donation should neither enrich donors nor impose financial burdens on them. We described the scope of health care required for all living kidney donors, reflecting contemporary understanding of long-term donor health outcomes; proposed an approach to identify donor health conditions that should be covered within the framework of financial neutrality; and proposed strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are donation related or that may compromise postdonation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise postdonation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow the creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve postdonation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lives. Providing coverage for this care should thus be cost-effective, even without considering the health care cost savings that occur for living donor transplant recipients.
Collapse
Affiliation(s)
- J S Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - F Delmonico
- Harvard Medical School, Massachusetts General Hospital Transplant Center, Boston, MA
| | - S Klarenbach
- University of Alberta, Edmonton, Alberta, Canada
| | - A M Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
5
|
Newell KA, Formica RN, Gill JS, Schold JD, Allan JS, Covington SH, Wiseman AC, Chandraker A. Integrating APOL1 Gene Variants Into Renal Transplantation: Considerations Arising From the American Society of Transplantation Expert Conference. Am J Transplant 2017; 17:901-911. [PMID: 27997071 DOI: 10.1111/ajt.14173] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 10/14/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 01/25/2023]
Abstract
Thirteen percent of individuals of African ancestry express two variant copies of the gene encoding apolipoprotein 1 (APOL1) that has been associated with an increased risk of end-stage renal disease (ESRD) in the general population. Limited studies suggest that the survival of transplanted kidneys from donors expressing two APOL1 risk alleles is inferior to that of kidneys from donors with zero or one risk allele. In living kidney donation, two case reports describe donors expressing two APOL1 risk alleles who developed ESRD. Given the potential impact of APOL1 variants on the utility and safety of kidney transplantation and living kidney donation, the American Society of Transplantation convened a meeting with the goals of summarizing the current state of knowledge with respect to transplantation and APOL1, identifying knowledge gaps and studies to address these gaps, and considering approaches to integrating APOL1 into clinical practice. The authors recognize that current data are not sufficient to support traditional evidence-based guidelines but also recognize that it may require several years to generate the necessary data. Thus, approaches as to how APOL1 might currently be integrated into the clinical decision-making process were considered. This report summarizes the group's deliberations.
Collapse
Affiliation(s)
- K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - R N Formica
- Department of Medicine, Yale University School of Medicine, New Haven, CN
| | - J S Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - J D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - J S Allan
- Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA
| | | | | | - A Chandraker
- Schuster Family Transplantation Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
6
|
Gill JS, Halloran P, Jevnikar T, Cole E, Rush D, Knoll G. Costimulation Blockade Holds Emerging Hope for Patients in Large Markets Only. Am J Transplant 2017; 17:1147. [PMID: 28039954 DOI: 10.1111/ajt.14193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - P Halloran
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - T Jevnikar
- Division of Nephrology and Transplantation, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - E Cole
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - D Rush
- Internal Medicine/Nephrology, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - G Knoll
- Division of Nephrology, Department of Medicine, Ottawa General Hospital, Ottawa, ON, Canada
| |
Collapse
|
7
|
Wiseman AC, Gill JS. Financial Incompatibility and Paired Kidney Exchange: Walking a Tightrope or Blazing a Trail? Am J Transplant 2017; 17:597-598. [PMID: 28024109 DOI: 10.1111/ajt.14183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 01/25/2023]
Affiliation(s)
- A C Wiseman
- Division of Renal Diseases and Hypertension, Transplant Center, University of Colorado Denver, Aurora, CO
| | - J S Gill
- Division of Nephrology, Department of Medicine and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC
| |
Collapse
|
8
|
Gill JS, Wright AJ, Delmonico FL, Newell KA. Towards Improving the Transfer of Care of Kidney Transplant Recipients. Am J Transplant 2017; 17:54-59. [PMID: 27495956 DOI: 10.1111/ajt.13997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/02/2016] [Revised: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 01/25/2023]
Abstract
Kidney transplant recipients require specialized medical care and may be at risk for adverse health outcomes when their care is transferred. This document provides opinion-based recommendations to facilitate safe and efficient transfers of care for kidney transplant recipients including minimizing the risk of rejection, avoidance of medication errors, ensuring patient access to immunosuppressant medications, avoidance of lapses in health insurance coverage, and communication of risks of donor disease transmission. The document summarizes information to be included in a medical transfer document and includes suggestions to help the patient establish an optimal therapeutic relationship with their new transplant care team. The document is intended as a starting point towards standardization of transfers of care involving kidney transplant recipients.
Collapse
Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - A J Wright
- Division of Infectious Disease, University of British Columbia, Vancouver, British Columbia, Canada
| | - F L Delmonico
- Department of Surgery, Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - K A Newell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
9
|
Gill JS. Kidney Transplant iBook, edited by Leonardo V. Riella. 2015. 274 pages, http://www.leoriella.com/book. Am J Transplant 2016. [DOI: 10.1111/ajt.14002] [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)
- J. S. Gill
- University of British Columbia; St. Paul's Hospital; Vancouver Canada
| |
Collapse
|
10
|
Rose C, Gill J, Zalunardo N, Johnston O, Mehrotra A, Gill JS. Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure. Am J Transplant 2016; 16:2360-7. [PMID: 26946063 DOI: 10.1111/ajt.13773] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 01/25/2023]
Abstract
The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.
Collapse
Affiliation(s)
- C Rose
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - N Zalunardo
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - O Johnston
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Mehrotra
- Division of Nephrology, Mount Sinai School of Medicine, New York, NY
| | - J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.,Tufts-New England Medical Center, Boston, MA
| |
Collapse
|
11
|
Gordon EJ, Gill JS. US Transplant Policy Should Strengthen Bridges, Not Build Walls. Am J Transplant 2016; 16:1645-6. [PMID: 26752683 DOI: 10.1111/ajt.13713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - J S Gill
- University of British Columbia, Research Scientist Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
Newell KA, Formica RN, Gill JS. Engaging Living Kidney Donors in a New Paradigm of Postdonation Care. Am J Transplant 2016; 16:29-32. [PMID: 26639020 DOI: 10.1111/ajt.13524] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/06/2015] [Accepted: 07/26/2015] [Indexed: 01/25/2023]
Abstract
Recent studies have highlighted the need for better understanding of the long-term health outcomes of living donors. Barriers to establishment of a dedicated long-term donor follow-up data system in the United States include infrastructure costs and donor retention. We propose providing all previous and future living donors with a lifelong health insurance benefit for the primary purpose of facilitating acquisition of health information after donation as an alternative to establishment of a dedicated donor follow-up data system. Donors would consent to allow collection and analysis of their medical data, and continuation of insurance coverage would require completion of regular health assessments. The extension of health insurance would be analogous to the established practice of paying people for participation in a research study and would provide a mechanism to engage donors in a new paradigm of postdonation care in which donors are actively involved in their own health maintenance. Rather than acting as an inducement for donation, providing donors with the ability to easily contribute information about their health status represents a practical strategy to acquire the long-term medical information necessary to better inform future generations of living kidney donors.
Collapse
Affiliation(s)
- K A Newell
- Department of Surgery, Emory University, Atlanta, GA
| | - R N Formica
- Department of Nephrology, Yale University, New Haven, CT
| | - J S Gill
- University of British Columbia, Division of Nephrology, Vancouver, BC, Canada
| |
Collapse
|
13
|
Brown DJ, Swan AA, Gill JS, Ball AJ, Banks RG. Genetic parameters for liveweight, wool and worm resistance traits in multi-breed Australian meat sheep. 1. Description of traits, fixed effects, variance components and their ratios. Anim Prod Sci 2016. [DOI: 10.1071/an14787] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sheep breeders in Australia that focus on lamb production simultaneously breed sheep that have higher growth rate, improved carcass quality and are resistant to internal parasites. The objective of this study was to estimate genetic parameters for 11 traits recorded in Australian meat sheep, covering liveweight, carcass and internal parasite resistance traits. As the population of meat sheep in this database have become increasingly crossbred this study also investigates the genetic variation within and between breeds. The data comprised 1 046 298 animals from 149 Poll Dorset, 17 Suffolk, 24 Texel and 118 White Suffolk flocks. The results are averages of analyses of 10 datasets constructed by randomly sampling 25% of these flocks. There was considerable genetic variation in all traits analysed: the lowest heritabilities (0.12) were found for weaning weight and the highest heritabilities (0.31–0.32) for eye muscle depth. There were also significant differences between breeds for most traits, which breeders appear to be utilising through crossbreeding. Direct heterosis effects were small and only significant for the liveweight traits ranging from 2% to 3.4% of the phenotypic means. Maternal heterosis was not significant for any trait studied. The inclusion of heterosis effects in the model did not significantly influence the estimated genetic parameters. The results from this study have been used to review the genetic parameters used in the LAMBPLAN routine genetic evaluations conducted by Sheep Genetics.
Collapse
|
14
|
Gill JS, Arora S, Khanna SP, Kumar KH. Prevalence of Multidrug-resistant, Extensively Drug-resistant, and Pandrug-resistant Pseudomonas aeruginosa from a Tertiary Level Intensive Care Unit. J Glob Infect Dis 2016; 8:155-159. [PMID: 27942195 PMCID: PMC5126754 DOI: 10.4103/0974-777x.192962] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Infection by Pseudomonas aeruginosa is common in the Intensive Care Unit (ICU), leading to increased morbidity and mortality. The organism is classified into various phenotypes based on the drug resistance pattern, namely, drug-resistant (DR), multi-DR (MDR), extensively DR (XDR), and pan-DR (PDR). We aim to study the incidence of P. aeruginosa phenotypes in a tertiary level ICU. Materials and Methods: We conducted this prospective, observational study for 2 years (January 2014-December 2015) and collected appropriate clinical samples (blood, urine, wound discharge, etc.,) from all the patients admitted to ICU. We excluded patients with known septicemia and P. aeruginosa infection. Group 1 comprised a total 1915 patient samples and Group 2 comprised 100 active surveillance samples, collected from the medical staff and the hospital environment. The data were analyzed using appropriate statistical methods, and a P < 0.05 was considered statistically significant. Results: We isolated 597 pathogenic bacteria out of 1915 specimens, giving a culture positivity rate of 31.2%. Klebsiella (43%), Acinetobacter (22%), and P. aeruginosa (15%) were the top three isolated bacteria. None of the surveillance samples grew P. aeruginosa. Antibiotic resistance studies revealed that 47.7% of P. aeruginosa isolates were DR, 50% were MDR, and 2.3% were XDR phenotype. None of the strains showed PDR phenotype. Conclusion: Our data revealed a high prevalence of DR phenotypes of P. aeruginosa in the ICU. Judicious use of antibiotics and strict infection control measures are essential to reduce the prevalence of drug resistance.
Collapse
Affiliation(s)
- J S Gill
- Department of Microbiology, AFMC, Pune, India
| | - Sunil Arora
- Department of Pathology, Command Hospital, Chandimandir, Haryana, India
| | - S P Khanna
- Department of Pathology, Command Hospital, Chandimandir, Haryana, India
| | - Kvs Hari Kumar
- Department of Endocrinology, Army Hospital (R and R), Delhi, India
| |
Collapse
|
15
|
Strijack B, Gill JS. Transplantation Ethics. Second edition. Robert M.Veatch and Lainie F.Ross. Washington, DC: Georgetown University Press, 2015. 434 pp. Am J Transplant 2015. [DOI: 10.1111/ajt.13547] [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)
- B. Strijack
- Department of Medicine; Division of Nephrology; University of British Columbia; Vancouver Canada
| | - J. S. Gill
- Department of Medicine; Division of Nephrology; University of British Columbia; Vancouver Canada
| |
Collapse
|
16
|
Barbour S, Gill JS. Advances in the understanding of complement mediated glomerular disease: implications for recurrence in the transplant setting. Am J Transplant 2015; 15:312-9. [PMID: 25612487 DOI: 10.1111/ajt.13042] [Citation(s) in RCA: 18] [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: 07/01/2014] [Revised: 09/15/2014] [Accepted: 10/01/2014] [Indexed: 01/25/2023]
Abstract
Recent advances in the understanding of the role of complement in glomerular disease allow for more accurate assessment of the risk of disease recurrence after transplantation, and inform the development of targeted treatment strategies to overcome specific defects in the alternate pathway of the complement system. These advances along with remaining knowledge deficits are reviewed with specific relevance to membranoproliferative glomerulonephritis (MPGN) and C3 glomerulopathy, a heterogenous group of diseases with a high rate of recurrence leading to allograft failure. Recommendations to establish an accurate diagnosis and inform therapeutic decision making in transplant candidates with a histologic diagnosis of MPGN are provided.
Collapse
Affiliation(s)
- S Barbour
- Division of Nephrology, University of British Columbia, Vancouver, Canada; BC Provincial Renal Agency, Vancouver, Canada; Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
17
|
Gordon EJ, Gill JS. Reply (invited response to 2 letters re Iran editorial). Am J Transplant 2014; 14:1226. [PMID: 24707777 DOI: 10.1111/ajt.12679] [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: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities and Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | |
Collapse
|
18
|
Klarenbach S, Gill JS, Knoll G, Caulfield T, Boudville N, Prasad GVR, Karpinski M, Storsley L, Treleaven D, Arnold J, Cuerden M, Jacobs P, Garg AX. Economic consequences incurred by living kidney donors: a Canadian multi-center prospective study. Am J Transplant 2014; 14:916-22. [PMID: 24597854 PMCID: PMC4285205 DOI: 10.1111/ajt.12662] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [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: 05/14/2013] [Revised: 12/24/2013] [Accepted: 12/26/2013] [Indexed: 01/25/2023]
Abstract
Some living kidney donors incur economic consequences as a result of donation; however, these costs are poorly quantified. We developed a framework to comprehensively assess economic consequences from the donor perspective including out-of-pocket cost, lost wages and home productivity loss. We prospectively enrolled 100 living kidney donors from seven Canadian centers between 2004 and 2008 and collected and valued economic consequences ($CAD 2008) at 3 months and 1 year after donation. Almost all (96%) donors experienced economic consequences, with 94% reporting travel costs and 47% reporting lost pay. The average and median costs of lost pay were $2144 (SD 4167) and $0 (25th-75th percentile 0, 2794), respectively. For other expenses (travel, accommodation, medication and medical), mean and median costs were $1780 (SD 2504) and $821 (25th-75th percentile 242, 2271), respectively. From the donor perspective, mean cost was $3268 (SD 4704); one-third of donors incurred cost >$3000, and 15% >$8000. The majority of donors (83%) reported inability to perform usual household activities for an average duration of 33 days; 8% reported out-of-pocket costs for assistance with these activities. The economic impact of living kidney donation for some individuals is large. We advocate for programs to reimburse living donors for their legitimate costs.
Collapse
Affiliation(s)
- S Klarenbach
- Department of Medicine, Institute of Health EconomicsEdmonton, AB, Canada,
*Corresponding author: Scott Klarenbach,
| | - J S Gill
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
| | - G Knoll
- Department of Medicine, University of OttawaOttawa, ON, Canada
| | - T Caulfield
- Faculty of Law, School of Population and Public Health, University of AlbertaEdmonton, AB, Canada
| | - N Boudville
- School of Medicine, University of Western AustraliaCrawley, WA, Canada
| | - G V R Prasad
- Department of Medicine, University of TorontoToronto, ON, Canada
| | - M Karpinski
- Department of Medicine, University of ManitobaWinnipeg, MB, Canada
| | - L Storsley
- Department of Medicine, University of ManitobaWinnipeg, MB, Canada
| | - D Treleaven
- Department of Medicine, McMaster UniversityHamilton, ON, Canada
| | - J Arnold
- University of Western OntarioLondon, ON, Canada
| | - M Cuerden
- University of Western OntarioLondon, ON, Canada
| | - P Jacobs
- Department of Medicine, Institute of Health EconomicsEdmonton, AB, Canada
| | - A X Garg
- Department of Medicine and Department of Epidemiology and Biostatistics, University of Western OntarioLondon, ON, Canada,Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
| | | |
Collapse
|
19
|
|
20
|
Muirhead N, Zaltman JS, Gill JS, Churchill DN, Poulin-Costello M, Mann V, Cole EH. Hypercalcemia in renal transplant patients: prevalence and management in Canadian transplant practice. Clin Transplant 2013; 28:161-5. [PMID: 24329899 DOI: 10.1111/ctr.12291] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/11/2022]
Abstract
Hypercalcemia, occurring in up to 25% of patients within 12 months following renal transplantation, and persistent hyperparathyroidism were evaluated following renal transplantation, by retrospective chart review of 1000 adult patients transplanted between January 1, 2003 and January 31, 2008 with at least six months follow-up. Serum calcium, parathyroid hormone, and phosphate levels were recorded at 12, 24, 36, and 48 months. Average follow-up was 766 (535) d (mean (SD); median 668 d). Majority were first transplants (85%); deceased donor 57%. Point prevalence of hypercalcemia (serum Ca(2+) > 2.6 mM) was 16.6% at month 12, 13.6% at month 24, 9.5% at month 36, and 10.1% at month 48. Point prevalence of serum parathyroid hormone (PTH) > 10 pM was 47.6% at month 12, 51.1% at month 24, 43.4% at month 36, and 39.3% at month 48. Estimated glomerular filtration rate (GFR) was maintained throughout and was not different between patients with or without hypercalcemia or elevated PTH. Cinacalcet was prescribed in 12% of patients with hypercalcemia and persistent hyperparathyroidism; parathyroidectomy was performed in 112/1000 patients, 15 post-transplant. Persistent hyperparathyroidism, often accompanied by hypercalcemia, is common following successful renal transplantation, but the lack of clear management suggests the need for further study and development of evidence-based guidelines.
Collapse
Affiliation(s)
- N Muirhead
- London Health Sciences Centre, London, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
21
|
Gordon EJ, Gill JS. Where there is smoke there is fire: the Iranian system of paid donation. Am J Transplant 2013; 13:3063-4. [PMID: 24224692 DOI: 10.1111/ajt.12486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 01/25/2023]
Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Institute for Public Health and Medicine, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | |
Collapse
|
22
|
Gowers KR, Millard SG, Gill JS, Gill RP. Programmable Linear Polarisation Meter for Determination of Corrosion Rate of Reinforcement in Concrete Structures. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/000705994798267999] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
23
|
Gill JS, Lan J, Dong J, Rose C, Hendren E, Johnston O, Gill J. The survival benefit of kidney transplantation in obese patients. Am J Transplant 2013; 13:2083-90. [PMID: 23890325 DOI: 10.1111/ajt.12331] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/03/2013] [Accepted: 05/07/2013] [Indexed: 01/25/2023]
Abstract
Obese patients have a decreased risk of death on dialysis but an increased risk of death after transplantation, and may derive a lower survival benefit from transplantation. Using data from the United States between 1995 and 2007 and multivariate non-proportional hazards analyses we determined the relative risk of death in transplant recipients grouped by body mass index (BMI) compared to wait-listed candidates with the same BMI (n = 208 498). One year after transplantation the survival benefit of transplantation varied by BMI: Standard criteria donor transplantation was associated with a 48% reduction in the risk of death in patients with BMI ≥ 40 kg/m(2) but a ≥ 66% reduction in patients with BMI < 40 kg/m2. Living donor transplantation was associated with ≥ 66% reduction in the risk of death in all BMI groups. In sub-group analyses, transplantation from any donor source was associated with a survival benefit in obese patients ≥ 50 years, and diabetic patients, but a survival benefit was not demonstrated in Black patients with BMI ≥ 40 kg/m(2). Although most obese patients selected for transplantation derive a survival benefit, the benefit is lower when BMI is ≥ 40 kg/m(2), and uncertain in Black patients with BMI ≥ 40 kg/m(2).
Collapse
Affiliation(s)
- J S Gill
- Division Of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | |
Collapse
|
24
|
Chen Z, Kotecha T, Crichton S, Shetty A, Sohal M, Arujuna A, Kirubakaran S, Bostock J, Cooklin M, O'Neill M, Wright M, Gill JS, Rinaldi CA. Lower incidence of inappropriate shock therapy in patients with combined cardiac resynchronisation therapy defibrillators (CRT-D) compared with patients with non-CRT defibrillators (ICDs). Int J Clin Pract 2013; 67:733-9. [PMID: 23869676 DOI: 10.1111/ijcp.12033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A significant number of patients experience inappropriate shock therapy (IST) from implantable cardioverter-defibrillators (ICD). An increasing number of patients with advanced heart failure receive combined ICD and cardiac resynchronisation therapy devices (CRT-D). The incidence of IST in this group is less well described. We aimed to assess the incidence and predictors of IST in CRT-D patients. METHODS A retrospective cohort study of prospectively collected data on patients who received an ICD and CRT-D between October 2007 and January 2009 at our institution were studied. The primary outcome measures were the IST event rate and all-cause mortality. RESULTS A total of 185 patients with ICD/CRT-D (100/85) were included in the analysis. Eighteen patients experienced 35 episodes of IST during the follow-up (21 ± 13 months). There was a significantly lower IST cumulative event rate in the CRT-D vs. ICD group, 5% (CI: 1-13%) vs. 19% (95% CI: 11-30%) by 24 months, (p = 0.017). The majority of the IST was caused by atrial arrhythmias with atrial fibrillation accounting for 28 episodes of IST in nine patients. Multivariate analysis using Cox hazard model including baseline characteristics and coexisting appropriate shock therapy showed that a history of atrial fibrillation/flutter was the strongest independent predictor of IST with a hazard ratio of 3.53 (p = 0.019). CONCLUSION Patients with CRT-D had a significantly lower incidence of IST compared with patients receiving an ICD. Given that atrial arrhythmia remained the commonest trigger for IST, our finding lends support to the hypothesis that CRT may reduce atrial fibrillation burden in patients receiving CRT-D.
Collapse
Affiliation(s)
- Z Chen
- Kings College London, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Gill JS, Schaeffner E, Chadban S, Dong J, Rose C, Johnston O, Gill J. Quantification of the early risk of death in elderly kidney transplant recipients. Am J Transplant 2013; 13:427-32. [PMID: 23167257 DOI: 10.1111/j.1600-6143.2012.04323.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/04/2012] [Accepted: 09/26/2012] [Indexed: 01/25/2023]
Abstract
To inform decision making regarding transplantation in patients ≥ 65 years, we quantified the early posttransplant risk of death by determining the time to equal risk and equal survival between transplant recipients and wait-listed dialysis patients in the United States between 1995 and 2007 (total n = 25 468). Survival was determined using separate multivariate nonproportional hazards analyses in low-, intermediate- and high-risk cardiovascular risk patients. Compared to wait-listed patients with similar cardiovascular risk, standard criteria (SCD) and expanded criteria (ECD) recipients had a higher risk of death in the perioperative and early-posttransplant period. In contrast, low and intermediate risk living donor (LD) recipients had an immediate survival advantage compared to similar risk wait-listed patients. In all risk groups, transplantation was associated with a long-term survival advantage compared to dialysis, but there were marked differences in time to equal risk of death, and time to equal survival by donor type. For example, survival in high-risk recipients of an LD, SCD and ECD transplant became equal to that in similar risk wait-listed patients 130, 368 and 521 days after transplantation. Early posttransplant mortality risk is eliminated in low- and intermediate-risk patients, and markedly reduced in high-risk patients with LD transplantation.
Collapse
Affiliation(s)
- J S Gill
- Division Of Nephrology, University of British Columbia, Vancouver, Canada; Tufts-New England Medical Center, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Singh D, Gill JS, Gumber RK, Singh R, Singh S. Yield and fibre quality associated with cotton leaf curl disease of Bt-cotton in Punjab. J Environ Biol 2013; 34:113-116. [PMID: 24006816] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cotton leaf curl disease (CLCuD), caused by Gemini virus and transmitted through whitefly (Bemisia tabaci) is a serious problem in Northern India, affecting the productivity to a great extent. Depending upon the severity of infection in susceptible varieties, the disease can cause upto 90.0 % yield losses besides this, it also causes deterioration in fibre quality. The objective of the present study was to determine the effect of cotton leaf curl disease on seed cotton yield and fibre characters of two popular Bt-cotton hybrids in Punjab. The disease caused 52.7% reduction in number of bolls and 54.2 % in boll weight in Bt cotton hybrid RCH 134. Similarly, it reduced the fibre length from 29.1 to 26.2 mm (9.9%); fibre uniformity from 68.9 to 68.1% (1.1%); fibre strength from 29.1 to 26.9 g per texture (7.5%) and miconaire value from 5.2 to 5.0 g inch(-1) (3.8%). Similar results were reported in Bt cotton hybrid MRC 6304, where the disease reduced the boll number and boll weight by 46.1 and 43.4%, respectively. However, to the fibre quality was not much affected by varying level of disease severity. The studies clearly reflect the adverse impact of CLCuD on yield and fibre quality especially 2.5% span length. Thus suggesting the management of disease using integrated disease management strategies to avoid quantitative and qualitative losses.
Collapse
Affiliation(s)
- Daljeet Singh
- Punjab Agricultural University, Regional Station, Faridkot-151 203, India.
| | | | | | | | | |
Collapse
|
27
|
Gill JS, Gill J, Barnieh L, Dong J, Rose C, Johnston O, Tonelli M, Klarenbach S. Income of living kidney donors and the income difference between living kidney donors and their recipients in the United States. Am J Transplant 2012; 12:3111-8. [PMID: 22882723 DOI: 10.1111/j.1600-6143.2012.04211.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Disincentives for living kidney donation are common but are poorly understood. We studied 54 483 living donor kidney transplants in the United States between 2000 and 2009, limiting to those with valid zip code data to allow determination of median household income by linkage to the 2000 U.S. Census. We then determined the income and income difference of donors and recipients. The median household income in donors and recipients was $46 334 ±$17 350 and $46 439 ±$17 743, respectively. Donation-related expenses consume ≥ 1 month's income in 76% of donors. The mean ± standard deviation income difference between recipients and donors in transplants involving a wealthier recipient was $22 760 ± 14 792 and in 90% of transplants the difference was <$40 000 dollars. The findings suggest that the capacity for donors to absorb the financial consequences of donation, or of recipients to reimburse allowable expenses, is limited. There were few transplants with a large difference in recipient and donor income, suggesting that the scope and value of any payment between donors and recipients is likely to be small. We conclude that most donors and recipients have similar modest incomes, suggesting that the costs of donation are a significant burden in the majority of living donor transplants.
Collapse
Affiliation(s)
- J S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Sohal M, Williams SE, Chen Z, Bostock J, Hamid S, Patel N, Bucknall C, Gill JS, Rinaldi CA. 060 The practice and perception of transvenous lead extraction in the UK: lessons from a nationwide survey. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Gill JS, Strijack B. Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life by F. Miller and R. Truog. Am J Transplant 2012. [DOI: 10.1111/j.1600-6143.2012.04063.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Gill JS, Salafia CM, Grebenkov D, Vvedensky DD. Modeling oxygen transport in human placental terminal villi. J Theor Biol 2011; 291:33-41. [PMID: 21959313 DOI: 10.1016/j.jtbi.2011.09.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/12/2011] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
Abstract
Oxygen transport from maternal blood to fetal blood is a primary function of the placenta. Quantifying the effectiveness of this exchange remains key in identifying healthy placentas because of the great variability in capillary number, caliber and position within the villus-even in placentas deemed clinically "normal". By considering villous membrane to capillary membrane transport, stationary oxygen diffusion can be numerically solved in terminal villi represented by digital photomicrographs. We aim to provide a method to determine whether and if so to what extent diffusional screening may operate in placental villi. Segmented digital photomicrographs of terminal villi from the Pregnancy, Infection and Nutrition study in North Carolina 2002 are used as a geometric basis for solving the stationary diffusion equation. Constant maternal villous oxygen concentration and perfect fetal capillary membrane absorption are assumed. System efficiency is defined as the ratio of oxygen flux into a villus and the sum of the capillary areas contained within. Diffusion screening is quantified by comparing numerical and theoretical maximum oxygen fluxes. A strong link between various measures of villous oxygen transport efficiency and the number of capillaries within a villus is established. The strength of diffusional screening is also related to the number of capillaries within a villus. Our measures of diffusional efficiency are shown to decrease as a function of the number of capillaries per villus. This low efficiency, high capillary number relationship supports our hypothesis that diffusional screening is present in this system. Oxygen transport per capillary is reduced when multiple capillaries compete for diffusing oxygen. A complete picture of oxygen fluxes, capillary and villus areas is obtainable and presents an opportunity for future work.
Collapse
Affiliation(s)
- J S Gill
- The Blackett Laboratory, Imperial College London, London SW7 2AZ, United Kingdom.
| | | | | | | |
Collapse
|
32
|
Bakshi SS, Vishal K, Kalia V, Gill JS. Aggressive renal angiomyolipoma extending into the renal vein and inferior vena cava - an uncommon entity. Br J Radiol 2011; 84:e166-8. [PMID: 21750135 DOI: 10.1259/bjr/98449202] [Citation(s) in RCA: 13] [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: 11/05/2022] Open
Abstract
Renal angiomyolipoma is recognised as a benign hamartomatous lesion with no obvious malignant potential. However, the tumour may show extrarenal/perinephric extension at times. Rarely, the lesion may extend into the renal vein and inferior vena cava (IVC) indicating aggressive behaviour. We present a case of an angiomyolipoma of the kidney with sonographic, CT and MRI evidence of extension into the renal vein and IVC.
Collapse
Affiliation(s)
- S S Bakshi
- Delta Heart Centre, 70-K, Sarabha Nagar, Ludhiana, India
| | | | | | | |
Collapse
|
33
|
Browne S, Gill J, Dong J, Rose C, Johnston O, Zhang P, Landsberg D, Gill JS. The impact of pancreas transplantation on kidney allograft survival. Am J Transplant 2011; 11:1951-8. [PMID: 21749643 DOI: 10.1111/j.1600-6143.2011.03627.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Whether pancreas after kidney transplantation (PAK) compromises kidney allograft survival, and what pre-PAK glomerular filtration rate (GFR) should be used to select patients for PAK is unclear. We analyzed all (n = 2776) PAK recipients in the United States between 1989 and 2007 and compared their risk of kidney failure to a comparator group of n = 13 635 young adult diabetic kidney only transplant recipients during the same time after accounting for selection bias by the use of a propensity score for PAK in a multivariate time to event analysis. In a secondary analysis, we determined the association of pre-PAK GFR with subsequent kidney allograft survival. Despite an increased risk of death early after pancreas transplantation, PAK recipients had a decreased long-term risk of kidney allograft failure compared to diabetic kidney only transplant recipients HR = 0.89; 95% CI: [0.78-1.00]; p = 0.05. An association of pre-PAK GFR with kidney survival was not evident until 3 years after pancreas transplantation, and patients with a pre-PAK GFR of 30-39 mL/min still attained 10-year post-PAK kidney survival of 69%. We conclude that PAK is associated with improved kidney allograft survival, and pre-PAK GFR 30-39 mL/min should not preclude PAK. Expanded use of PAK is warranted.
Collapse
Affiliation(s)
- S Browne
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Duckett SG, Camara O, Ginks MR, Bostock J, Chinchapatnam P, Sermesant M, Pashaei A, Lambiase PD, Gill JS, Carr-White GS, Frangi AF, Razavi R, Bijnens BH, Rinaldi CA. Relationship between endocardial activation sequences defined by high-density mapping to early septal contraction (septal flash) in patients with left bundle branch block undergoing cardiac resynchronization therapy. Europace 2011; 14:99-106. [DOI: 10.1093/europace/eur235] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
Duckett SG, Camara O, Ginks M, Bostock J, Chinchapatnam P, Sermesant M, Pashaei A, Gill JS, Carr-White G, Frangi AF, Razavi RS, Bijnens BH, Rinaldi CA. 89 Electromechanical interaction in patients undergoing cardiac resynchronisation therapy: comparison of intracardiac activation maps and early septal contraction in left bundle branch block. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Duckett SG, Ginks M, Shetty A, Bostock J, Gill JS, Hamid SG, Kapetanakis S, Cunliffe E, Razavi RS, Carr-White G, Rinaldi CA. 90 Invasive acute haemodynamic response to guide LV lead implantation predicts chronic remodelling in patients undergoing cardiac resynchronisation therapy. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
37
|
Gill JS, O'May FP. Is It My Job? Alcohol Brief Interventions: Knowledge and Attitudes among Future Health-care Professionals in Scotland. Alcohol Alcohol 2011; 46:441-50. [DOI: 10.1093/alcalc/agr049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
38
|
Clemens K, Boudville N, Dew MA, Geddes C, Gill JS, Jassal V, Klarenbach S, Knoll G, Muirhead N, Prasad GVR, Storsley L, Treleaven D, Garg AX, Garg A. The long-term quality of life of living kidney donors: a multicenter cohort study. Am J Transplant 2011; 11:463-9. [PMID: 21342446 DOI: 10.1111/j.1600-6143.2010.03424.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Previous studies that described the long-term quality of life of living kidney donors were conducted in single centers, and lacked data on a healthy nondonor comparison group. We conducted a retrospective cohort study to compare the quality of life of 203 kidney donors with 104 healthy nondonor controls using validated scales (including the SF36, 15D and feeling thermometer) and author-developed questions. Participants were recruited from nine transplant centers in Canada, Scotland and Australia. Outcomes were assessed a median of 5.5 years after the time of transplantation (lower and upper quartiles of 3.8 and 8.4 years, respectively). 15D scores (scale of 0 to 1) were high and similar between donors and nondonors (mean 0.93 (standard deviation (SD) 0.09) and 0.94 (SD 0.06), p = 0.55), and were not different when results were adjusted for several prognostic characteristics (p = 0.55). On other scales and author-developed questions, groups performed similarly. Donors to recipients who had an adverse outcome (death, graft failure) had similar quality of life scores as those donors where the recipient did well. Our findings are reassuring for the practice of living transplantation. Those who donate a kidney in centers that use routine pretransplant donor evaluation have good long-term quality of life.
Collapse
Affiliation(s)
- K Clemens
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Primary ureteric involvement in sarcoidosis is very rare; to our knowledge, only a few cases have been reported in the literature. We present here a rare case of ureteric sarcoidosis presenting with obstructive uropathy.
Collapse
Affiliation(s)
- V Kalia
- Delta Heart Center 70-K, Sarabha Nagar Ludhiana, 141001 Punjab, India.
| | | | | | | |
Collapse
|
40
|
Kannan K, Pillai SK, Gill JS, Hui KO, Swami V. Religious beliefs, coping skills and responsibility to family as factors protecting against deliberate self-harm. S Afr J Psychiatr 2010. [DOI: 10.4102/sajpsychiatry.v16i4.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<p><strong>Background.</strong> Deliberate self-harm (DSH) ranges from behaviours aiming to communicate distress or relieve tension, but where suicide is not intended, to actual suicide. Not all individuals are prone to DSH, which suggests that there are factors that protect against it. Identifying these could play an important role in the management and prevention of DSH.</p><p><strong>Objectives.</strong> This study examined whether religious beliefs, coping skills and responsibility to family serve as factors protecting against DSH in Kota Kinabalu, Sabah, Malaysia. <strong></strong></p><p><strong>Method.</strong> A cross-sectional comparative study assessed DSH patients consecutively admitted or directly referred to Queen Elizabeth General Hospital and Hospital Mesra Bukit Padang during the period December 2006 - April 2007. DSH patients (N=42) were matched with controls (N=42) for gender, age, religion, race, occupation and marital status. The DSH and control groups were compared using psychosocial tests that assess coping skills, religious beliefs and responsibility to family.</p><p><strong>Results.</strong> There were significant differences in religious beliefs (p=0.01) and responsibility to family (p=0.03) between the DSH patients and the control group. There were also significant differences in coping skills, DSH patients tending to use emotion-orientated coping (p=0.01) as opposed to task- and avoidance-orientated coping.<strong> </strong></p><p><strong>Conclusion.</strong> Consistent with international studies, coping skills (i.e. task-orientated skills), religious beliefs and responsibility to family were more evident in patients who did not attempt DSH than in those who did. These findings imply that treating DSH should not start only at the point of contact. Protective factors such as religious beliefs, responsibility to family and coping strategies can be inculcated from a very young age. However, caution is required in generalising the results owing to limitations of the study. Further extensive research on religious and psychotherapeutic interventions and prospective studies on protective factors will be helpful.</p>
Collapse
|
41
|
|
42
|
Abstract
The health insurance system for living donors is derived from insurance policies designed to cover accidental death or dismemberment. The system covers only the direct consequences of organ removal, and recoups the costs of related medical services from the transplant recipient's health insurance provider. The system forces transplant programs to differentiate between health services that are, or are not directly attributable to donation and may compromise the pretransplant evaluation, postoperative care and long-term care of living donors. The system is particularly problematic in the United States, where a significant proportion of donors do not have medical insurance. The requirement to assign donor costs to a particular recipient is poorly suited to facilitate advances in living donation such as the use of nondirected donors and living-donor paired exchange programs. We argue that given the current understanding regarding the long-term risks of living donation, the provision of basic medical insurance is a necessity for living donation and that the system of attributing donor costs to the recipient's insurance is inefficient, has the potential to undermine the care of living donors and is a disincentive to the expansion of living donation.
Collapse
Affiliation(s)
- E S Ommen
- Mount Sinai Medical Center, New York, NY
| | - J S Gill
- University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| |
Collapse
|
43
|
Brown DJ, Swan AA, Gill JS. Within- and across-flock genetic relationships for breech flystrike resistance indicator traits. Anim Prod Sci 2010. [DOI: 10.1071/an10102] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Flystrike is a major cost for the Australian sheep industry. The industry is currently implementing selection strategies for flystrike resistance to reduce the need for breech flystrike prevention. The following indicator traits are used to select for breech flystrike resistance: wool cover, skin wrinkle on the body and breech, scouring (dags) and wool colour. The aims of this study were to estimate genetic correlations between these indicator traits and production traits using the Sheep Genetics database, to distinguish between within- and across-flock genetic relationships, and to quantify responses to selection using indexes that include breech wrinkle as a proxy trait for flystrike resistance. Breech flystrike indicator traits are all heritable; however, there are significant antagonisms between wrinkle score and some production traits, primarily fleece weight and fibre diameter. Thus, simultaneous improvement in both flystrike resistance and production will be most efficient when index selection is used. Our results show that, depending on the level of emphasis placed on breech wrinkle in the index, reductions in breech wrinkle score of 0.4–0.9 units can be achieved over a 10-year period. As across-flock relationships are generally stronger than within-flock relationships, breeders will be able to take advantage of this additional variation, depending on the relative merit of their flocks. Therefore, ram breeders should combine within-flock selection with across-flock selection where possible. Sheep Genetics released early breech wrinkle Australian Sheep Breeding Values in September 2009 to assist Merino breeders in making faster progress towards reducing breech wrinkle by using flock selection.
Collapse
|
44
|
Abstract
Immunosuppression is associated with an increased risk of cancer in kidney transplant recipients compared to the general population. It is less clear whether standardized cancer mortality ratios (SMRs) are also increased. This study's hypothesis is that SMRs are not increased because of competing risks of death. During the median follow-up of 5.05 years (Q1-Q3: 2.36-8.62), there were 1937 cancer deaths and 36 619 noncancer deaths among 164 078 first kidney-only transplant recipients captured in the United States Renal Data System between January 1990 and December 2004. The observed cancer death rate was 206 per 100 000 patient-years compared to an expected rate of 215 per 100,000 patient-years in the general population. The overall age- and sex-adjusted SMR was only 0.96 (95% CI 0.92-1.00). However, patients <50 years had SMRs significantly greater than unity while patients >60 had SMRs lower than unity. Up to 25% of cancer-related deaths occurred after allograft failure. These findings challenge the notion that cancer is a major cause of premature death in all kidney transplant recipients and has implications for design of cancer prevention strategies in kidney transplant recipients.
Collapse
Affiliation(s)
- B A Kiberd
- Department of Medicine, Dalhousie University, Halifax Nova Scotia, British Columbia, Canada.
| | | | | |
Collapse
|
45
|
Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, Pierratos A, Chan CT. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant 2009; 24:2915-9. [DOI: 10.1093/ndt/gfp295] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
Iordanous Y, Seymour N, Young A, Johnson J, Iansavichus AV, Cuerden MS, Gill JS, Poggio E, Garg AX. Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice. Am J Transplant 2009; 9:1558-73. [PMID: 19459792 DOI: 10.1111/j.1600-6143.2009.02671.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Older individuals or those with medical complexities are undergoing living donor nephrectomy more than ever before. Transplant outcomes for recipients of kidneys from these living expanded criteria donors are largely uncertain. We systematically reviewed studies from 1980 to June 2008 that described transplant outcomes for recipients of kidneys from expanded criteria living donors. Results were organized by the following criteria: older age, obesity, hypertension, reduced glomerular filtration rate (GFR), proteinuria and hematuria. Pairs of reviewers independently evaluated each citation and abstracted data on study and donor characteristics, recipient survival, graft survival, serum creatinine and GFR. Transplant outcomes for recipients of kidneys from older donors (> or =60 years) were described in 31 studies. Recipients of kidneys from older donors had poorer 5-year patient and graft survival than recipients of kidneys from younger donors [meta-analysis of 12 studies, 72% vs. 80%, unadjusted relative risk (RR) of survival 0.89, 95% confidence interval (CI) 0.83-0.95]. In meta-regression, this association diminished over time (1980s RR 0.79, 95% CI 0.65-0.96 vs. 1990s RR 0.91, 95% CI 0.85-0.99). Few transplant outcomes were described for other expanded criteria. This disconnect between donor selection and a lack of knowledge of recipient outcomes should give transplant decision-makers pause and sets an agenda for future research.
Collapse
Affiliation(s)
- Y Iordanous
- Division of Nephrology, University of Western Ontario, London, Ontario, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Fertility is one of the potential benefits for women undergoing kidney transplantation; however, population-based information about the likelihood of pregnancy and successful fetal outcome is not available. In this observational study of 16 195 female kidney transplant recipients aged 15-45 years in the United States between 1990 and 2003, we determined the pregnancy rate and live birth rate using Medicare claims data from the first three posttransplant years. The pregnancy rate was 33 per thousand female transplant recipients between 1990 and 2003 and progressively declined from 59 in 1990 to 20 in 2000. The live birth rate between 1990 and 2003 was 19 per thousand female transplant recipients and declined in parallel with the pregnancy rate. Despite a decrease in therapeutic abortions over time, the proportion of pregnancies resulting in fetal loss (45.6%) remained constant during the study due to an increase in spontaneous abortions and other causes of fetal loss. The pregnancy rate in kidney transplant recipients was markedly lower and declined more rapidly than reported in the general American population during the same period. The live birth rate was substantially lower than reported in voluntary registries of transplant recipients, and the proportion of pregnancies resulting in unexpected fetal loss increased over time.
Collapse
Affiliation(s)
- J S Gill
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | | | | | | |
Collapse
|
48
|
Virdee MS, Cooklin M, Gill JS. WolffParkinsonWhite syndrome and persistent azygous drainage of the inferior vena cava. Case Reports 2009; 2009:bcr2006101022. [DOI: 10.1136/bcr.2006.101022] [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: 11/04/2022] Open
|
49
|
Gill JS, Jha AK, Puri VM. Distributions of Fines during Percolation Segregation for Varying Bed Depths in Binary Size Mixtures of Potash. Particulate Science and Technology 2009. [DOI: 10.1080/02726350802612067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
50
|
King AP, Boubertakh R, Rhode KS, Ma YL, Chinchapatnam P, Gao G, Tangcharoen T, Ginks M, Cooklin M, Gill JS, Hawkes DJ, Razavi RS, Schaeffter T. A subject-specific technique for respiratory motion correction in image-guided cardiac catheterisation procedures. Med Image Anal 2009; 13:419-31. [PMID: 19223220 DOI: 10.1016/j.media.2009.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 01/07/2009] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
Abstract
We describe a system for respiratory motion correction of MRI-derived roadmaps for use in X-ray guided cardiac catheterisation procedures. The technique uses a subject-specific affine motion model that is quickly constructed from a short pre-procedure MRI scan. We test a dynamic MRI sequence that acquires a small number of high resolution slices, rather than a single low resolution volume. Additionally, we use prior knowledge of the nature of cardiac respiratory motion by constraining the model to use only the dominant modes of motion. During the procedure the motion of the diaphragm is tracked in X-ray fluoroscopy images, allowing the roadmap to be updated using the motion model. X-ray image acquisition is cardiac gated. Validation is performed on four volunteer datasets and three patient datasets. The accuracy of the model in 3D was within 5mm in 97.6% of volunteer validations. For the patients, 2D accuracy was improved from 5 to 13mm before applying the model to 2-4mm afterwards. For the dynamic MRI sequence comparison, the highest errors were found when using the low resolution volume sequence with an unconstrained model.
Collapse
Affiliation(s)
- A P King
- Interdisciplinary Medical Imaging Group, Division of Imaging Sciences, King's College, St. Thomas' Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|