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Gupta K, Nguyen DD, Kennedy KF, Chan PS. Time to bystander cardiopulmonary resuscitation by patient sex for out-of-hospital cardiac arrest. Resuscitation 2024; 196:110126. [PMID: 38280509 DOI: 10.1016/j.resuscitation.2024.110126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Delays in bystander cardiopulmonary resuscitation (CPR) are associated with worse out-of-hospital cardiac arrest (OHCA) outcomes. Whether disparities exist in time to CPR between women and men is unknown. METHODS We included witnessed OHCAs treated with bystander CPR from the Cardiac Arrest Registry Enhancing Survival between 2013-2021. The primary outcome was time to first bystander CPR, and secondary outcomes were survival to hospital discharge and favorable neurological survival. Hierarchical ordinal regression was used to model time to first CPR, which estimates the odds of having a 2-minute longer delay (from 0 to ≥10 minutes) in receiving bystander CPR. The model included sex, age, race, location of arrest, cardiac arrest etiology, day of week, and season as fixed effects and EMS agency as a random effect to account for clustering of patients within an agency. RESULTS Of 78,043 patients with a witnessed OHCA that received bystander CPR, 25,197 (32.3%) were women. The median [IQR] time to first bystander CPR was 2 [1,5] minutes for both women and men. In adjusted analysis, time to bystander CPR was similar in men and women (p = 0.26). Moreover, there was a statistically significantly graded inverse association between time to bystander CPR and survival. CONCLUSION For patients with witnessed OHCA that received bystander CPR, women and men had similar times to CPR, although 5-minute or greater delays in initiating CPR was not uncommon. Delays in bystander CPR in OHCA were associated with worse survival outcomes.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Dan D Nguyen
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Kevin F Kennedy
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
| | - Paul S Chan
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States; University of Missouri-Kansas City, Kansas City, MO, United States
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Gupta K, Sauer AJ, VAN Spall HGC. Heart Failure Risk Under Covers: Sleeping With the Enemy. J Card Fail 2024; 30:449-451. [PMID: 38000733 DOI: 10.1016/j.cardfail.2023.10.484] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Kashvi Gupta
- University of Missouri Kansas City, Kansas City, MO, USA
| | - Andrew J Sauer
- University of Missouri Kansas City, Kansas City, MO, USA; Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | - Harriette G C VAN Spall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Baim Institute for Clinical Research, Boston, MA, USA.
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Nguyen DD, Spertus JA, Kennedy KF, Gupta K, Uzendu AI, McNally BF, Chan PS. Association Between Delays in Time to Bystander CPR and Survival for Witnessed Cardiac Arrest in the United States. Circ Cardiovasc Qual Outcomes 2024; 17:e010116. [PMID: 38146663 PMCID: PMC10923150 DOI: 10.1161/circoutcomes.123.010116] [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: 04/06/2023] [Accepted: 10/23/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Prompt initiation of bystander cardiopulmonary resuscitation (CPR) is critical to survival for out-of-hospital cardiac arrest (OHCA). However, the association between delays in bystander CPR and OHCA survival is poorly understood. METHODS In this observational study using a nationally representative US registry, we identified patients who received bystander CPR from a layperson for a witnessed OHCA from 2013 to 2021. Hierarchical logistic regression was used to estimate the association between time to CPR (<1 minute versus 2-3, 4-5, 6-7, 8-9, and ≥10-minute intervals) and survival to hospital discharge and favorable neurological survival (survival to discharge with cerebral performance category of 1 or 2 [ie, without severe neurological disability]). RESULTS Of 78 048 patients with a witnessed OHCA treated with bystander CPR, the mean age was 63.5±15.7 years and 25, 197 (32.3%) were women. The median time to bystander CPR was 2 (1-5) minutes, with 10% of patients having a≥10-minute delay before initiation of CPR. Overall, 15 000 (19.2%) patients survived to hospital discharge and 13 159 (16.9%) had favorable neurological survival. There was a graded inverse relationship between time to bystander CPR and survival to hospital discharge (P for trend <0.001). Compared with patients who received CPR within 1 minute, those with a time to CPR of 2 to 3 minutes were 9% less likely to survive to discharge (adjusted odds ratio, 0.91 [95% CI, 0.87-0.95]) and those with a time to CPR 4 to 5 minutes were 27% less likely to survive (adjusted odds ratio, 0.73 [95% CI, 0.68-0.77]). A similar graded inverse relationship was found between time to bystander CPR and favorable neurological survival (P for trend <0.001). CONCLUSIONS Among patients with witnessed OHCA, there was a dose-response relationship between delays in bystander initiation of CPR and lower survival rates.
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Affiliation(s)
- Dan D. Nguyen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Kashvi Gupta
- University of Missouri-Kansas City, Kansas City, MO
| | - Anezi I. Uzendu
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Paul S. Chan
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
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Gupta K, Mastoris I, Sauer AJ. Remote Monitoring Devices and Heart Failure. Heart Fail Clin 2024; 20:1-13. [PMID: 37953016 DOI: 10.1016/j.hfc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Remote patient monitoring (RPM) in patients with heart failure (HF) involves transmitting physiological data from devices to a health-care provider via a wireless connection with targeted interventions when values exceed the preset threshold. Devices used in telemonitoring range from weighing scales, blood pressure cuffs, and pulse oximeters to devices used to measure cardiac filling pressure and intrathoracic impedance using cardiac implantable electronic devices and wearables. Accordingly, RPM devices can potentially engage patients in their cardiovascular care and reduce the burden of HF in society.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
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Mastoris I, Gupta K, Sauer AJ. The War Against Heart Failure Hospitalizations: Remote Monitoring and the Case for Expanding Criteria. Cardiol Clin 2023; 41:557-573. [PMID: 37743078 DOI: 10.1016/j.ccl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Successful remote patient monitoring depends on bidirectional interaction between patients and multidisciplinary clinical teams. Invasive pulmonary artery pressure monitoring has been shown to reduce heart failure (HF) hospitalizations, facilitate guideline-directed medical therapy optimization, and improve quality of life. Cardiac implantable electronic device-based multiparameter monitoring has shown encouraging results in predicting future HF-related events. Potential expanded indications for remote monitoring include guideline-directed medical therapy optimization, application to specific populations, and subclinical detection of HF. Voice analysis, inferior vena cava diameter monitoring, and artificial intelligence-based remote electrocardiogram show potential to gain some merit in remote patient monitoring in HF.
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Affiliation(s)
- Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Kashvi Gupta
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA.
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Gupta K, Raj R, Asaki SY, Kennedy K, Chan PS. Comparison of Out-of-Hospital Cardiac Arrest Outcomes Between Asian and White Individuals in the United States. J Am Heart Assoc 2023; 12:e030087. [PMID: 37493009 PMCID: PMC10547294 DOI: 10.1161/jaha.123.030087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/12/2023] [Indexed: 07/27/2023]
Abstract
Background Disparities in bystander cardiopulmonary resuscitation (CPR) and survival have been reported for Black and Hispanic individuals with out-of-hospital cardiac arrest (OHCA). Whether Asian individuals have lower rates of bystander CPR and survival for OHCA, as compared with White individuals, remains unknown. Methods and Results Within the US-based CARES (Cardiac Arrest Registry to Enhance Survival), we identified 278 989 OHCAs in Asian and White individuals during 2013 to 2021. Using hierarchical Poisson logistic regression with emergency medical service agency modeled as a random effect and patient and OHCA characteristics as fixed effects, we compared rates of bystander CPR, survival to discharge, and favorable neurological survival between Asian and White individuals with OHCA. Overall, 14 835 (5.3%) OHCAs occurred in Asian individuals. Compared with White individuals with OHCA, Asian individuals were older (67.0±17.6 versus 62.8±16.9 years) and were less likely to have drug overdose as the cause of OHCA (1.3% versus 6.6%) and a shockable arrest rhythm (19.2% versus 22.4%). Layperson bystander CPR rates were similar between Asian and White individuals (42.6% versus 42.1%; adjusted relative risk for Asian individuals, 0.99 [95% CI, 0.97-1.02]; P=0.69). However, rates of survival to discharge were lower in Asian individuals with OHCA (8.2% versus 10.3%; adjusted relative risk 0.92 [0.86-0.98] P=0.006). Similarly, the rate of favorable neurological survival was lower for Asian individuals (6.5% versus 8.7%; adjusted relative risk, 0.85 [0.79-0.91]; P<0.001). Conclusions Despite similar rates of bystander CPR, Asian individuals with OHCA have lower survival rates than White individuals with OHCA. The reasons for the lower survival rate deserve further study to determine whether there are disparities in resuscitation care between Asian and White individuals with OHCA.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
- University of Missouri Kansas CityKansas CityMOUSA
| | - Rohan Raj
- Pembroke Hill High SchoolKansas CityMOUSA
| | | | - Kevin Kennedy
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
| | - Paul S. Chan
- Saint Luke’s Mid America Heart InstituteKansas CityMOUSA
- University of Missouri Kansas CityKansas CityMOUSA
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Golbus JR, Gupta K, Stevens R, Jeganathan VSE, Luff E, Shi J, Dempsey W, Boyden T, Mukherjee B, Kohnstamm S, Taralunga V, Kheterpal V, Murphy S, Klasnja P, Kheterpal S, Nallamothu BK. A randomized trial of a mobile health intervention to augment cardiac rehabilitation. NPJ Digit Med 2023; 6:173. [PMID: 37709933 PMCID: PMC10502072 DOI: 10.1038/s41746-023-00921-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Mobile health (mHealth) interventions may enhance positive health behaviors, but randomized trials evaluating their efficacy are uncommon. Our goal was to determine if a mHealth intervention augmented and extended benefits of center-based cardiac rehabilitation (CR) for physical activity levels at 6-months. We delivered a randomized clinical trial to low and moderate risk patients with a compatible smartphone enrolled in CR at two health systems. All participants received a compatible smartwatch and usual CR care. Intervention participants received a mHealth intervention that included a just-in-time-adaptive intervention (JITAI) as text messages. The primary outcome was change in remote 6-minute walk distance at 6-months stratified by device type. Here we report the results for 220 participants enrolled in the study (mean [SD]: age 59.6 [10.6] years; 67 [30.5%] women). For our primary outcome at 6 months, there is no significant difference in the change in 6 min walk distance across smartwatch types (Intervention versus control: +31.1 meters Apple Watch, -7.4 meters Fitbit; p = 0.28). Secondary outcomes show no difference in mean step counts between the first and final weeks of the study, but a change in 6 min walk distance at 3 months for Fitbit users. Amongst patients enrolled in center-based CR, a mHealth intervention did not improve 6-month outcomes but suggested differences at 3 months in some users.
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Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA.
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Rachel Stevens
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - V Swetha E Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jieru Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI, USA
| | | | - Sarah Kohnstamm
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Susan Murphy
- Departments of Statistics & Computer Science, Harvard University, Boston, MA, USA
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI, USA
- The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
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Flammini D, Chaudhary A, Colangeli A, Fonnesu N, Guirao J, Gupta K, Kalwale S, Mariano G, Moro F, Previti A, Quatrevaux M, Shigin P, Udintsev V, Villari R. Neutronic analyses for the equatorial diagnostic port plug #12 in ITER. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113639] [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: 04/07/2023]
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9
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Gupta R, Gupta P, Gupta K, Chandra D, Singh MK, Arora N, Rahman K. Nodular lymphocyte predominant Hodgkin lymphoma: An unusual case with peripheral blood atypical T-cell lymphocytosis. Int J Lab Hematol 2023; 45:586-588. [PMID: 36710455 DOI: 10.1111/ijlh.14027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Affiliation(s)
- R Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - P Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - K Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - D Chandra
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - M K Singh
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - N Arora
- Unipath Specialty Laboratory, Ahmedabad, India
| | - K Rahman
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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10
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Gupta K, Spertus JA, Birmingham M, Gosch KL, Husain M, Kitzman DW, Pitt B, Shah SJ, Januzzi JL, Lingvay I, Butler J, Kosiborod M, Lanfear DE. Racial Differences in Quality of Life in Patients With Heart Failure Treated With Sodium-Glucose Cotransporter 2 Inhibitors: A Patient-Level Meta-Analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF Trials. Circulation 2023; 148:220-228. [PMID: 37191040 PMCID: PMC10523916 DOI: 10.1161/circulationaha.122.063263] [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: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Health status outcomes, including symptoms, function, and quality of life, are worse for Black compared with White patients with heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular mortality and improve health status in patients with heart failure, but whether the health status benefit of SGLT2is is similar across races is not established. The objective of this study was to compare the treatment effect of SGLT2is (versus placebo) on health status for Black compared with White patients with heart failure. METHODS We combined patient-level data from 3 randomized clinical trials of SGLT2is: DEFINE-HF (Dapagliflozin Effect on Symptoms and Biomarkers in Patients With Heart Failure; n=263), PRESERVED-HF (Dapagliflozin in Preserved Ejection Fraction Heart Failure; n=324), and CHIEF-HF (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure; n=448). These 3 United States-based trials enrolled a substantial proportion of Black patients, and each used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure health status at baseline and after 12 weeks of treatment. Among 1035 total participants, selecting self-identified Black and White patients with complete information yielded a final analytic cohort of 935 patients. The primary endpoint was KCCQ Clinical Summary score. Twelve-week change in KCCQ with SGLT2is versus placebo was compared between Black and White patients by testing the interaction between race and treatment using multivariable linear regression models adjusted for trial, baseline KCCQ (as a restricted cubic spline), race, and treatment. The data that support the findings of this study are available from the corresponding author upon reasonable request. RESULTS Among 935 participants, 236 (25%) self-identified as Black, and 469 (50.2%) were treated with an SGLT2i. Treatment with an SGLT2i, compared with placebo, resulted in KCCQ Clinical Summary score improvements at 12 weeks of +4.0 points (95% CI, 1.7-6.3; P=0.0007) in White patients and +4.7 points (95% CI, 0.7-8.7; P=0.02) in Black patients, with no significant interaction by race and treatment (P=0.76). Other KCCQ scales showed similar results. CONCLUSIONS Treatment with an SGLT2i resulted in consistent and significant improvements in health status for both Black and White patients with heart failure.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | | | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
| | - Mansoor Husain
- Ted Rogers Centre for Heart Research, Toronto, Canada (M.H.)
| | - Dalane W Kitzman
- Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor (B.P.)
| | | | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston (J.L.J.)
| | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas (I.L.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- University of Mississippi Medical Center, Jackson (J.B.)
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (K.G., J.A.S., K.L.G., M.K.)
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Patel M G, Nidhi , Gupta K, Gupta M, Gupta S, Krupa S. THE IMPACT OF CLIMATE CHANGE ON INFECTIOUS DISEASES: A COMPREHENSIVE ANALYSIS OF VECTOR-BORNE DISEASES, WATER-BORNE DISEASES, AND PUBLIC HEALTH STRATEGIES. Georgian Med News 2023:136-142. [PMID: 37805887] [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: 10/09/2023]
Abstract
Climate change is long-term modifications to weather patterns and a rise in extreme weather events. It might modify the hazard to human health and exacerbate current problems. The article explores the scientific data in a description of the effects of Infectious diseases in humans and climate change. It identifies scientific advancements and gaps in potential responses from human civilization and how it might prepare for the changes that come with it by adjusting to them. The impact reflects three aspects, such as climate variables, selected infectious diseases, and infectious disease components. This study demonstrates how vulnerable people are to any ill consequences that climate change may have on their health. Humans can actively influence controllable correlated health impacts by taking proactive measures, such as increasing our understanding of the detrimental effects associated with specific diseases and the patterns in climate change. We can also carefully distribute technology and resources, encouraging exercise and public awareness. It is advised to take the following adaption measures: Considering how infectious diseases and climate change are not the only things that science has discovered and create locally efficient early warning systems for those effects to produce more scientific justifications and go beyond scientific reports. Improve prediction of the spatiotemporal processes behind climate change and changes in infectious illnesses connected at different temporal and spatial scales.
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Affiliation(s)
- G Patel M
- 1Department of Community Medicine, Parul University, PO Limda, Tal.Waghodia, District Vadodara, Gujarat, India
| | - - Nidhi
- 2Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - K Gupta
- 3Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - M Gupta
- 4Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - S Gupta
- 5Department of Community Medicine, TeerthankerMahaveer University, Moradabad, Uttar Pradesh, India
| | - S Krupa
- 6Department of Chemistry & Biochemistry, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
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Gupta K, Shah N, Gausper A, Wooldridge D. CLINICAL CONUNDRUM OF SAVR VS TAVR IN A TRIAD OF HEYDE SYNDROME, CORONARY ARTERY DISEASE, AND ULCERATIVE COLITIS FLARE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04180-3] [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: 03/06/2023]
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13
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Maraey A, Gupta K, Abdelmottaleb W, Khalil M, Ullah W, Hajduczok AG, Elsharnoby H, Elzanaty A, Elgendy IY. National Trends of Structural Heart Disease Interventions from 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic. Curr Probl Cardiol 2023; 48:101526. [PMID: 36455795 PMCID: PMC9701641 DOI: 10.1016/j.cpcardiol.2022.101526] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The Coronavirus Disease-2019 (COVID-19) pandemic placed an enormous strain on the healthcare system. Data on the impact of COVID-19 on the utilization and outcomes of structural heart disease interventions in the United States are scarce. The National Inpatient Sample from 2016 to 2020 was queried to identify adult admissions for transcatheter aortic valve replacement (TAVR), left atrial appendage occlusion (LAAO), and transcatheter end-to-end repair (TEER). The primary outcome was temporal trends of procedure utilization rate per 100,000 admissions over quarters from 2016 to 2020. The secondary outcomes were adjusted rates of in-hospital mortality, major complications, and length of stay (LOS). Among 434,630 weighted admissions (TAVR: 305,550; LAAO: 89,300; TEER: 40,160), 95,010 admissions (22%) were during the COVID-19 era. There was a decline during the second quarter of 2020 followed by an increase to the pre pandemic levels (TAVR: 220 to 253, LAAO: 57 to 109, and TEER: 31 to 36 per 100,000 admissions, Ptrend<0.001). There were no differences in the mortality or major complication rates. Median LOS has decreased in TAVR (4 days-1 day) and in TEER (3 days-1 day) but remained stable in LAAO (1 day). This nationwide analysis showed that structural heart disease interventions decreased during the early waves of COVID-19 pandemic. There was a significant reduction in hospital LOS without differences in in-hospital mortality or complication rates during the pandemic. These data suggest that hospitals adapted to the unprecedent challenges during the pandemic to provide advanced cardiac care to patients.
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Affiliation(s)
- Ahmed Maraey
- Department of Internal Medicine, CHI St. Alexius Health, University of North Dakota Southwest Campus, Bismarck, ND,Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL,Corresponding Author. Ahmed Maraey MD, Department of Internal Medicine, CHI St. Alexius Health, University of North Dakota Southwest Campus, 900 E Broadway Ave, Bismarck, ND, 58501
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Wael Abdelmottaleb
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY
| | - Mahmoud Khalil
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY
| | - Waqas Ullah
- Jefferson Heart Institute, Sidney Kimmel School of Medicine/Thomas Jefferson University, Philadelphia, PA
| | - Alexander G. Hajduczok
- Jefferson Heart Institute, Sidney Kimmel School of Medicine/Thomas Jefferson University, Philadelphia, PA
| | - Hadeer Elsharnoby
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL
| | - Ahmed Elzanaty
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY
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14
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Morsy MA, Gupta S, Dora CP, Jhawat V, Dhanawat M, Mehta D, Gupta K, Nair AB, El-Daly M. Venoms classification and therapeutic uses: a narrative review. Eur Rev Med Pharmacol Sci 2023; 27:1633-1653. [PMID: 36876699 DOI: 10.26355/eurrev_202302_31408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The mere glimpse of venomous animals has always terrified humans because of the devastating effects of their venoms. However, researchers across the globe have isolated therapeutically active ingredients from these venoms and continue to explore them for drug leads. These efforts lead to the discovery of therapeutic molecules that the US-FDA has approved to treat different diseases, such as hypertension (Captopril), chronic pain (Ziconotide), and diabetes (Exenatide). The main active constituents of most venoms are proteins and peptides, which gained more attention because of advancements in biotechnology and drug delivery. The utilization of newer screening approaches improved our understanding of the pharmacological complexity of venom constituents and facilitated the development of novel therapeutics. Currently, with many venom-derived peptides undergoing different phases of clinical trials, more are in pre-clinical drug development phases. This review highlights the various sources of venoms, their pharmacological actions, and the current developments in venom-based therapeutics.
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Affiliation(s)
- M A Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
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15
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Maraey A, Gupta K, Abdelmottaleb W, Khalil M, Ullah W, Hajduczok AG, Elsharnoby H, Elzanaty A, Elgendy IY. CRT-200.02 National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic. JACC Cardiovasc Interv 2023. [PMCID: PMC9940746 DOI: 10.1016/j.jcin.2023.01.154] [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: 02/22/2023]
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16
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Chugh Y, Gupta K, Krishna HB, Ayala RQ, Zepeda I, Grushko M, Faillace RT. Safety and efficacy of apixaban, dabigatran and rivaroxaban in obese and morbidly obese patients with heart failure and atrial fibrillation: A real-world analysis. Pacing Clin Electrophysiol 2023; 46:50-58. [PMID: 36419246 DOI: 10.1111/pace.14623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atrial fibrillation and heart failure are combined risk factors for thromboembolic events. Obese and morbidly obese individuals have been underrepresented in clinical trials studying safety and efficacy of direct oral anticoagulants (DOACs). OBJECTIVES Study the comparative safety and efficacy of DOACs in obese and morbidly obese patients with atrial fibrillation or flutter, and concomitant congestive heart failure. METHODS In the present single-center retrospective observational study, patients with an ICD-9 code of atrial fibrillation or atrial flutter, and congestive heart failure on a DOAC (apixaban[n = 155], rivaroxaban[n = 335], dabigatran[n = 393]) were followed for a median 12.5 months (IQR: 22.1 months). Obesity was defined as a body mass index, BMI ≥ 30 and < 40 kg/m2 [n = 614], and morbid obesity as BMI ≥ 40 kg/m2 [n = 269]. Clinical endpoints were grouped into safety (composite of intracranial-hemorrhage, gastrointestinal-bleeds, hemorrhagic-stroke, and other bleeds), and efficacy (composite of ischemic-stroke and systemic-embolism) endpoints. Cox proportional hazard models were used to compare safety, efficacy, and all-cause mortality outcomes. RESULTS In obese patients, no statistical difference was observed in efficacy of DOACs. A statistical difference was observed in the safety of DOACs in obese patients. Apixaban was found to be safer than dabigatran [hazard ratio [HR] 0.37 (0.16-0.87), p = .02] and rivaroxaban [HR 0.29 (0.12-0.67), p = .004]. In morbidly obese patients, there was no overall statistical difference in the efficacy or safety of DOACs. CONCLUSION In obese patients with congestive heart failure and atrial fibrillation or atrial flutter on DOACs, apixaban has the most favorable safety profile compared to rivaroxaban and dabigatran.
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Affiliation(s)
- Yashasvi Chugh
- Baylor Heart and Vascular Hospital, Dallas, Texas, USA.,Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kashvi Gupta
- University of Missouri at Kansas City, Kansas City, Missouri, USA
| | | | - Renato Quispe Ayala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ignacio Zepeda
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Grushko
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert T Faillace
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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17
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Sharma M, Marodia Y, Singh AK, Kurdia K, Gupta K, Sandhu MS. Gastrointestinal: An unusual cause of biliary obstruction in a case of Peutz-Jeghers syndrome. J Gastroenterol Hepatol 2023; 38:8. [PMID: 35643980 DOI: 10.1111/jgh.15890] [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: 04/06/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Affiliation(s)
- M Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Y Marodia
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Kurdia
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M S Sandhu
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Gupta K, Zahedi S, Kakar TS, Zweig B. Independent prognostic value of ventricular premature complexes during exercise and recovery in asymptomatic patients: a meta-analysis of observational studies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Ventricular premature contractions (VPCs) are a common finding during a cardiac stress test. The independent prognostic value of these findings in asymptomatic participants is not clear.
Purpose
To investigate the cumulative independent prognostic value of VPC for adverse outcomes.
Methods
We conducted a systematic review and meta-analysis of observational studies in the following databases: MEDLINE, Embase®, and Cochrane Central from inception till January 28, 2022. The primary outcome was the cumulative hazard of all-cause mortality with VPCs during exercise or recovery in asymptomatic participants. The secondary outcome was cardiovascular mortality. We stratified results based on VPC during exercise or recovery.
We included studies with participants with no known CV disease and known CV disease. If there was known CV disease at baseline, the study should have adjusted for at least ≥1 known confounder. If a study reported low risk or higher risk VPCs, we included outcomes with higher risk VPCs to make the data comparable across literature. Random effect meta-analyses were used to predict cumulative hazard ratios. The review was registered with PROSPERO (registration number CRD42022297028)
Results
We found 10 studies with 47,497 participants that met our inclusion criteria (8 studies with all-cause and CV mortality, 2 studies with CV mortality only). Three studies included patients with baseline CV disease (proportion 12–33%). Follow-up duration ranged from 5.3 to 20.3 years. Definition of VPCs differed in the individual studies.
Both VPCs during exercise and recovery were associated with a higher hazard of all-cause mortality (HR 1.21, 95% confidence interval [CI] 1.07, 1.34 and 1.32, 95% CI 1.06, 1.58, p<0.001 and low heterogeneity for both, respectively, Figure 1A). There was no small study treatment effect bias.
Similarly, both VPCs during exercise and recovery were associated with a higher hazard of CV mortality (HR 1.63, 95% CI 1.30, 1.96 and 1.68, 95% CI 1.00, 2.35, p<0.001, and low heterogeneity for both, respectively, Figure 1B).
The presence of VPC had a numerically stronger association with CV mortality than all-cause mortality. VPCs during recovery seem to have more prognostic value than VPC during rest.
Conclusion
After adjusting for known confounders, VPCs during exercise and recovery predict a higher risk of all-cause and CV mortality. The risk is higher with VPCs during recovery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Gupta
- Henry Ford Hospital , Detroit , United States of America
| | - S Zahedi
- Henry Ford Hospital , Detroit , United States of America
| | - T S Kakar
- Henry Ford Hospital , Detroit , United States of America
| | - B Zweig
- Henry Ford Hospital , Detroit , United States of America
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19
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Beine A, Albano Y, Deischter J, Gupta K, Palkovits R. Flexible conversion of sorbitol to the diols ethylene/propylene glycol and isosorbide – Catalysis over solid acids and bases. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255379] [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: 11/09/2022]
Affiliation(s)
- A. K. Beine
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - Y. Albano
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - J. Deischter
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - K. Gupta
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - R. Palkovits
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
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20
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Strickland G, Qu R, Gupta K, Jiang Y, Dong D, Saez C, Weng P, Taketo M, Klugar Y, Myung P. 704 Decomposing a deterministic path to hair follicle dermal niche formation: The intersection of two morphogen gradients. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.716] [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: 10/17/2022]
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21
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Gupta K, Chopra R, Kulkarni P. Use of pulse oximetry during nitrous oxide- oxygen inhalation sedation: mandatory or recommended? Eur Arch Paediatr Dent 2022; 23:647-652. [PMID: 35655051 DOI: 10.1007/s40368-022-00717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
AIM There is skepticism amongst many dentists about the interference of nitrous oxide with the physiological parameters. This commentary attempts to make clear recommendations on the use of pulse oximeter during nitrous oxide inhalation sedation. BACKGROUND Nitrous oxide is used commonly in dentistry as a tool to reduce fear/ anxiety and build a positive dental attitude. Dentists use pulse oximeter to monitor oxygen saturation during the period of administration of nitrous oxide. There is no consensus amongst various guidelines across the world on the necessity of using pulse oximeter during the period of administration of nitrous oxide CONCLUSION: Pulse oximetry may not be considered mandatory when nitrous oxide gas is being administered for minimal sedation to a healthy patient having no pre- existing diseases/illness.
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Affiliation(s)
- K Gupta
- Children's Dental Center, 8, FF, MGF Megacity Mall, MG Road, Gurugram, 122002, India.
- Sharad Pawar Dental College, Wardha, India.
- Peoples College of Dental Sciences, Bhopal, India.
| | - R Chopra
- Children's Neurology and Dentistry, Ghaziabad, India
| | - P Kulkarni
- Peoples College of Dental Sciences, Bhopal, India
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22
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Hoang K, Win S, Gupta K. Abstract No. 147 Comparison of Celect inferior vena cava filter thrombus incidence based on filter position at time of filter retrieval. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.228] [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] Open
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23
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Jeganathan VS, Golbus JR, Gupta K, Luff E, Dempsey W, Boyden T, Rubenfire M, Mukherjee B, Klasnja P, Kheterpal S, Nallamothu BK. Virtual AppLication-supported Environment To INcrease Exercise (VALENTINE) during cardiac rehabilitation study: Rationale and design. Am Heart J 2022; 248:53-62. [PMID: 35235834 DOI: 10.1016/j.ahj.2022.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In-person, exercise-based cardiac rehabilitation improves physical activity and reduces morbidity and mortality for patients with cardiovascular disease. However, activity levels may not be optimized and decline over time after patients graduate from cardiac rehabilitation. Scalable interventions through mobile health (mHealth) technologies have the potential to augment activity levels and extend the benefits of cardiac rehabilitation. METHODS The VALENTINE Study is a prospective, randomized-controlled, remotely-administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low- and moderate-risk patients (ClinicalTrials.gov NCT04587882). Participants are randomized to the control or intervention arms of the study. Both groups receive a compatible smartwatch (Fitbit Versa 2 or Apple Watch 4) and usual care. Participants in the intervention arm of the study additionally receive a just-in-time adaptive intervention (JITAI) delivered as contextually tailored notifications promoting low-level physical activity and exercise throughout the day. In addition, they have access to activity tracking and goal setting through the mobile study application and receive weekly activity summaries via email. The primary outcome is change in 6-minute walk distance at 6-months and, secondarily, change in average daily step count. Exploratory analyses will examine the impact of notifications on immediate short-term smartwatch-measured step counts and exercise minutes. CONCLUSIONS The VALENTINE study leverages innovative techniques in behavioral and cardiovascular disease research and will make a significant contribution to our understanding of how to support patients using mHealth technologies to promote and sustain physical activity.
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Affiliation(s)
- V Swetha Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI.
| | - Kashvi Gupta
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Walter Dempsey
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, Grand Rapids, MI
| | - Melvyn Rubenfire
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, Ann Arbor, MI
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24
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Golbus JR, Gupta K, Stevens R, Jeganathan VS, Luff E, Boyden T, Mukherjee B, Klasnja P, Kheterpal S, Kohnstamm S, Nallamothu BK. Understanding Baseline Physical Activity in Cardiac Rehabilitation Enrollees Using Mobile Health Technologies. Circ Cardiovasc Qual Outcomes 2022; 15:e009182. [PMID: 35559648 DOI: 10.1161/circoutcomes.122.009182] [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: 11/16/2022]
Abstract
Background: Baseline physical activity in patients when they initiate cardiac rehabilitation is poorly understood. We used mobile health (mHealth) technology to understand baseline physical activity of patients initiating cardiac rehabilitation within a clinical trial to potentially inform personalized care. Methods: The Virtual AppLication-Supported ENvironment To INcrease Exercise During Cardiac Rehabilitation Study (VALENTINE) Study is a prospective, randomized-controlled, remotely administered trial designed to evaluate an mHealth intervention to supplement cardiac rehabilitation for low and moderate risk patients. All participants receive a smartwatch and usual care. Baseline physical activity was assessed remotely after enrollment and included 1) 6-minute walk distance, 2) daily step count, and 3) daily exercise minutes, both over 7 days and for compliant days, defined by ≥8 hours of watch wear time. Multivariable linear regression identified patient-level features associated with these 3 measures of baseline physical activity. Results: From October 2020 to March 2022, 220 participants enrolled in the study. Participants are mostly White [184 (83.6%)]; 67 (30.5%) are female and 84 (38.2%) are ≥ 65 years old. Most participants enrolled in cardiac rehabilitation after percutaneous coronary intervention [105 (47.7%)] or coronary artery bypass surgery [39 (17.7 %)]. Clinical diagnoses include coronary artery disease (78.6%), heart failure (17.3%), and valve repair or replacement (26.4%). Baseline mean 6-minute walk distance was 489.6 (standard deviation [SD], 143.4) meters, daily step count was 6845 (SD, 3353), and exercise minutes was 37.5 (SD, 33.5). In a multivariable model, 6-minute walk distance was significantly associated with age and sex, but not cardiac rehabilitation indication. Sex but not age or cardiac rehabilitation indication was significantly associated with daily step count and exercise minutes. Conclusions: Baseline physical activity varies substantially in low and moderate risk patients enrolled in cardiac rehabilitation. Future studies are warranted to explore whether personalizing cardiac rehabilitation programs using mHealth technologies could optimize recovery. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT04587882.
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Affiliation(s)
- Jessica R Golbus
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, MI
| | - Kashvi Gupta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO
| | - Rachel Stevens
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - V Swetha Jeganathan
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Evan Luff
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Thomas Boyden
- Division of Cardiovascular Diseases, Department of Internal Medicine, Spectrum Health, MI
| | | | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI
| | | | - Sarah Kohnstamm
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, MI; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, MI; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI
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Singla A, Madan R, Kumar N, Goyal S, Tripathi M, Gupta K, Gupta D, Kapoor R. PO-1149 Clinico-pathological and prognostic factors of Medulloblastoma - Tertiary care centre in India. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03113-9] [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: 10/18/2022]
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26
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Golbus JR, Gupta K, Stevens R, Jeganathan VS, Luff E, Kohnstamm S, Nallamothu BK. Abstract 159: Understanding Baseline Physical Activity In Cardiac Rehabilitation Enrollees Using Mobile Health Technologies. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.159] [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: 11/16/2022]
Abstract
Background:
Cardiac rehabilitation (CR) improves physical activity (PA) and reduces morbidity for patients with cardiovascular disease. We understand little of baseline PA as patients initiate CR, particularly when outside of CR. We used mobile health (mHealth) technology to understand baseline PA of patients initiating CR within a clinical trial to potentially inform personalized care.
Methods:
The Virtual AppLication-Supported Environment to INcrease Exercise During Cardiac Rehabilitation Study (VALENTINE) Study is a prospective, randomized-controlled, remotely administered trial designed to evaluate an mHealth intervention to supplement CR for low- and moderate-risk patients. Participants are randomized after 2 CR sessions; all receive a smartwatch and usual care. Remotely administered baseline PA outcomes include 6-minute walk distance, step count, and exercise minutes. Baseline PA was assessed for 7-days after study enrollment for compliant days, defined by
>
8 hours of watch wear/day. Multivariable linear regression identified features associated with baseline PA.
Results:
From October 19, 2020 to January 31, 2022, 180 participants enrolled. Participants are mostly White [156 (86.7%)]; 59 (32.8%) are female and 69 (38.3%) are
>
65 years old. Most enrolled in CR after coronary revascularization [114 (64.4%)] or valve intervention [40 (22.2%)]. Comorbidities include hypertension (65.0%), valve disease (35.6%), and heart failure (17.8%). Participants were compliant for 91.4% of days with 15.3 (4.0) hours/compliant day. Baseline PA included 6-minute walk distance of 491.8 (147.8) meters, daily step count of 6818 (3386), and exercise minutes of 36.0 (33.4). Substantial variation in baseline PA assessed by 6-minute walk distance was noted across age and gender but not CR indication.
Conclusions:
Understanding baseline PA as participants enroll in CR may be useful in personalizing CR programs at initiation and designing mHealth interventions.
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Gupta K, Jansen EC, Campos H, Baylin A. Associations between sleep duration and Mediterranean diet score in Costa Rican adults. Appetite 2022; 170:105881. [PMID: 34942284 PMCID: PMC8761173 DOI: 10.1016/j.appet.2021.105881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/26/2022]
Abstract
Both insufficient and excessive sleep duration have been associated with lower-quality diets in adult populations. However, investigations in Latin America, where different sleep norms may exist (e.g., daily napping), are scarce. Therefore, we examined whether weekday sleep duration and inconsistencies between weekday and weekend sleep duration were related to adherence to the Mediterranean diet among Costa Rican adults. The study population included 2169 controls (74% men) from a population-based case-control study. Usual sleep duration (weekday versus weekend) was self-reported and defined as short, recommended, and long (<7 h, 7-9 h, >9 h, respectively). Inconsistent weekday-weekend sleep duration was defined as >1-h difference. Diet was assessed with a food frequency questionnaire, and adherence to the Mediterranean diet was calculated with the Alternative Mediterranean Diet Score (AMED). Sex-stratified linear regression models were conducted with AMED score as a continuous outcome and sleep variables as categorical or dichotomous exposures (in separate models). Models were adjusted for age, area of residence, education, napping, caffeine intake, smoking status, type 2 diabetes mellitus, hypertension, and physical activity. Average (SD) hours of sleep per night reported were 7.0 (1.4) on weekdays and 7.3 (1.6) on weekends for men, and 7.0 (1.5) on weekdays and 7.2 (1.6) on weekends for women. Among women, sleep duration <7-h per night was associated with a lower AMED score compared to those with recommended sleep duration (β: -0.35, CI: -0.63 to -0.07). Unstratified models showed a suggestive association between inconsistent weekday-weekend sleep and lower AMED scores that did not vary by sex (β: -0.08, CI: -0.16, 0.006; P, interaction with sex = 0.93). Lastly, the napping frequency was not associated with AMED scores in any model. In conclusion, short and inconsistent sleep duration may affect the dietary patterns of Costa Ricans.
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Affiliation(s)
- Kashvi Gupta
- Department of Medicine, University of Michigan, Ann Arbor, USA
| | - Erica C. Jansen
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Hannia Campos
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Singh R, Kaur J, Gupta K, Singh M, Kanaoujiya R, Kaur N. Recent advances and applications of polymeric materials in healthcare sector and COVID-19 management. Materials Today: Proceedings 2022; 62:2878-2882. [PMID: 35251941 PMCID: PMC8882420 DOI: 10.1016/j.matpr.2022.02.472] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The coronavirus disease pandemic is considered at its worst and all nations are collectively fighting to improve global public health. In this outlook, polymers and their related materials (including plastics) are the primary sources in the manufacturing of medical and personal protective equipment. Plastics can be mass-produced, economical, and sterilized, which makes them an inevitable material in the medical and healthcare sector. Along with plastics, antibacterial and antiviral coatings, polymeric nanomaterials and nanocomposites, and functional polymers have become excellent materials for COIVD-19. This review centres on the applications of polymer materials in managing the COVID-19 outbreak. Moreover, the utilization of plastics with its healthcare applications are reviewed. Apart from this, major challenges and future directions of these materials have also been discussed. This review will help aspiring researchers to develop the basic understanding of polymeric materials currently employed in medical sector.
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Gupta K, Thapa B, Gupta S, Sharma S. Lung Function Tests in Hairdressers of Gangtok: A Cross-Sectional Study. Indian J Occup Environ Med 2022; 26:91-94. [PMID: 35991197 PMCID: PMC9384880 DOI: 10.4103/ijoem.ijoem_264_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
Background Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways. Aim The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok. Method This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720. Results All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342). Conclusion Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function.
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Affiliation(s)
- K. Gupta
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - B. Thapa
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India,Address for correspondence: Dr. B. Thapa, Department of Physiology, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, Sikkim, India. E-mail:
| | - S. Gupta
- Sikkim Manipal College of Physiotherapy, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - S. Sharma
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Kumar S, Akif S, Parmar K, Singh P, Thummala Y, Panda I, Gupta K. Metachronous isolated inferior vena cava tumour thrombus in renal cell cancer: a rare aftermath. Ann R Coll Surg Engl 2021; 104:e139-e142. [PMID: 34941460 DOI: 10.1308/rcsann.2021.0230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal cell cancer (RCC) accounts for 3% of all solid malignancies. Synchronous tumour thrombus in the renal vein or inferior vena cava is reported in 4-10% cases and is a surgical challenge. Contemporary imaging modalities that are used to define the presence and extent of venous thrombus include colour Doppler, contrast-enhanced computed tomography and magnetic resonance venography. Surgical management depends upon the degree of tumour thrombus. We report isolated recurrence of RCC in the inferior vena cava 2 years after radical nephrectomy, and discuss its pathophysiology and management.
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Affiliation(s)
- S Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Akif
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Parmar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P Singh
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Y Thummala
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - I Panda
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Gupta
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Survival Outcomes of Patients With Unresectable Hepatocellular Carcinoma Secondary to Viral vs. Non-Viral Etiologies Treated with Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.398] [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: 12/01/2022]
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Comparing Acute Toxicities of Patients With Unresectable Hepatocellular Carcinoma Treated With Definitive Proton vs. Photon-Based Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Avolio E, Carrabba M, Kavanagh Williamson M, Milligan R, Gupta K, Gamez M, Foster R, Berger I, Caputo M, Davidson A, Hill D, Madeddu P. The SARS-CoV-2 Spike protein alters human cardiac pericyte function and interaction with endothelial cells through a non-infective mechanism involving activation of CD147 receptor signalling. Eur Heart J 2021. [PMCID: PMC8524576 DOI: 10.1093/eurheartj/ehab724.3383] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Human cardiac pericytes (PC) were proposed as the main cellular target for SARS-CoV-2 in the heart due to high transcriptional levels of the angiotensin-converting enzyme 2 (ACE2) receptor. Emerging reports indicate CD147/Basigin (BSG), highly expressed in endothelial cells (EC), is an alternative SARS-CoV-2 receptor. To date, the mechanism by which the virus infects and disrupts the heart vascular cells was not identified yet. Moreover, cleaved Spike (S) protein molecules could be released into the bloodstream from the leaking pulmonary epithelial-endothelial barrier in patients with severe COVID-19, opening to the possibility of non-infective diseases in organs distant from the primary site of infection.
Purposes
(1) to confirm that human primary cardiac PC express ACE2 and CD147; (2) to verify if PC are permissible to SARS-CoV-2 infection; (3) to investigate if the recombinant SARS-CoV-2 S protein alone, without the other viral elements, can trigger molecular signalling and induce functional alterations in PC; (4) to explore which viral receptor is responsible for the observed events.
Methods and results
Cardiac PC express both the ACE2 and CD147 receptors at mRNA and protein level. Incubation of PC for up to 5 days with SARS-CoV-2 expressing the green fluorescent protein (GFP) did not show any evidence of cell infection or viral replication. Next, we exposed the PC to the recombinant S protein (5.8 nM) and confirmed that the protein engaged with cellular receptors (western blot analysis of S protein in treated and control PC). Incubation with the S protein increased PC migration (wound closure assay, P<0.01 vs ctrl) and reduced the formation of tubular structures between PC and EC in a Matrigel assay (P<0.01 vs ctrl). Moreover, the S protein promoted the production of pro-inflammatory factors typical of the cytokine storm in PC (ELISA measurement of MCP1, IL-6, IL-1β, TNFα, P<0.05 vs ctrl), and induced the secretion of pro-apoptotic factors responsible for EC death (Caspase 3/7 assay, P<0.05 vs ctrl). Signalling studies revealed that the S protein triggers the phosphorylation/activation of the extracellular signal-regulated kinase 1/2 (ERK1/2) through the CD147 receptor, but not ACE2, in cardiac PC. The neutralization of CD147, using a blocking antibody, prevented ERK1/2 activation in PC, and was reflected into a partial rescue of the cell functional behaviour (migration and pro-angiogenic capacity). In contrast, blockage of CD147 failed to prevent the pro-inflammatory response in PC.
Conclusions
We propose the novel hypothesis that COVID-19 associated heart's microvascular dysfunction is prompted by circulating S protein molecules rather than by the direct coronavirus infection of PC. Besides, we propose CD147, and not ACE2, as the leading receptor mediating S protein signalling in cardiac PC.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): BHF project grant “Targeting the SARS-CoV-2 S-protein binding to the ACE2 receptor to preserve human cardiac pericytes function in COVID-19” BHF Centre for Vascular Regeneration II
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Affiliation(s)
- E Avolio
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - M Carrabba
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - M Kavanagh Williamson
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - R Milligan
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - K Gupta
- University of Bristol, School of Biochemistry, Bristol, United Kingdom
| | - M Gamez
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - R Foster
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - I Berger
- University of Bristol, School of Biochemistry, Bristol, United Kingdom
| | - M Caputo
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - A Davidson
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - D Hill
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - P Madeddu
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
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Singh N, Gupta K, Khan T, Rahman E, Singh-Ranger D. 516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.588] [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: 11/14/2022]
Abstract
Abstract
Aim
Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.
Method
All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.
Results
There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).
Conclusions
Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.
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Affiliation(s)
- N Singh
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K Gupta
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - T Khan
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - E Rahman
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - D Singh-Ranger
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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Balai E, Bhamra N, Gupta K, Jolly K, Barraclough J. Implementation of an acute tonsillitis management protocol within a clinical decisions unit. Ann R Coll Surg Engl 2021; 103:690-693. [PMID: 34436947 DOI: 10.1308/rcsann.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department. METHODS Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy. RESULTS The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304-1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380-0.972; p = 0.038). CONCLUSIONS Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.
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Affiliation(s)
- E Balai
- The Royal Wolverhampton NHS Trust, UK
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, UK
| | - K Gupta
- The Royal Wolverhampton NHS Trust, UK
| | - K Jolly
- The Royal Wolverhampton NHS Trust, UK
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Gupta K, Saraiyia KJ, Jha S. Ironic Currency. AMA J Ethics 2021; 23:E660-661. [PMID: 34459737 DOI: 10.1001/amajethics.2021.660] [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: 11/14/2022]
Abstract
A 3-panel comic illustrates an offer of data to pay for health care services.
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Affiliation(s)
- Kashvi Gupta
- First-year resident at University of Missouri-Kansas City
| | - Kehaan J Saraiyia
- Artist and the founder of the Blue Matchbox Studio in Bangalore, India
| | - Saurabh Jha
- Associate professor at the University of Pennsylvania in Philadelphia
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Datta SS, Basu S, Reddy M, Gupta K, Sinha S. Comparative evaluation of the conventional tube test and column agglutination technology for ABO antibody titration in healthy individuals: a report from India. Immunohematology 2021; 37:25-32. [PMID: 33962486 DOI: 10.21307/immunohematology-2021-006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25-32 . Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25–32 .
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Affiliation(s)
- S S Datta
- Transfusion Medicine, Tata Medical Center , 14 Middle Arterial Road (EW), Rajarhat, New Town, Kolkata 700160 , India
| | - S Basu
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - M Reddy
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - K Gupta
- Transfusion Medicine, Tata Medical Center , Kolkata , India
| | - S Sinha
- Tata Medical Center , Kolkata , India
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Al-Hity S, Bhamra N, Kumar R, Gupta K, Howard J, Jolly K, Darr A. 908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors. Br J Surg 2021. [PMCID: PMC8135915 DOI: 10.1093/bjs/znab134.174] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction March 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades. Method A nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms. Results Data collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties." Conclusions Ensuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.
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Affiliation(s)
- S Al-Hity
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - N Bhamra
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - R Kumar
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K Gupta
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - J Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - K Jolly
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - A Darr
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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Mahajan R, Gulati S, Gupta K, Jain K, Bloria S, JItendra M. Ultrasound-guided sacral multifidus plane block for analgesia following excision of sacrococcygeal teratoma in two neonates. Anaesth Rep 2021; 9:81-84. [PMID: 33937779 DOI: 10.1002/anr3.12116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/07/2022] Open
Abstract
Peri-operative pain management in the neonate with a sacrococcygeal teratoma poses significant challenges to the anaesthetist. Involvement of the sacrococcygeal area by the tumour often prevents the use of conventional regional anaesthetic techniques such as caudal or epidural analgesia, with a subsequent reliance on intravenous opioids and paracetamol. Since opioids are associated with respiratory depression, constipation and urinary retention, there is high incidence of opiophobia with consequent inappropriate dosage prescription, particularly in the paediatric population. We describe the use of an ultrasound-guided sacral multifidus plane block in two neonates undergoing surgical excision of sacrococcygeal teratoma. The block is technically easy to perform and also avoids traversing critical structures. Hence, it may be regarded as a promising analgesic technique for painful interventions in the sacrococcygeal area.
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Affiliation(s)
- R Mahajan
- Department of Anesthesia, ICU and Pain Medicine Government Medical College Jammu India
| | - S Gulati
- Department of Anesthesia, ICU and Pain Medicine Government Medical College Jammu India
| | - K Gupta
- Department of Radiodiagnosis and Imaging Government Medical College Jammu India
| | - K Jain
- Department of Anesthesia and ICU Postgraduate Institution of Medical Education and Research Chandigarh India
| | - S Bloria
- Department of Anesthesia, ICU and Pain Medicine Government Medical College Jammu India
| | - M JItendra
- Department of Anesthesia, ICU and Pain Medicine Government Medical College Jammu India
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Maheshwari A, Varshney M, Gupta K, Bajpai M. Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation. Transfus Clin Biol 2021; 28:254-257. [PMID: 33895379 PMCID: PMC8061783 DOI: 10.1016/j.tracli.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/07/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
Background Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life. Methodology This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale. Results A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience. Conclusion Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour.
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Affiliation(s)
- A Maheshwari
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - M Varshney
- Department of Psychiatry, Institute of Liver and Biliary Sciences, New Delhi, India
| | - K Gupta
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - M Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.
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Gupta K, Omil-Lima D, Mahran A, Callegari M, Muncey W, Thirumavalavan N. 062 Comparison of Patient Demographics and Surgical Trends in Peyronie's Disease: A NSQIP Study. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.032] [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]
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Callegari M, Jella T, Mahran A, Muncey W, Gupta K, Omil-Lima D, Loeb A, Thirumavalavan N. 033 Trends in Testosterone Prescription Modalities Amongst Medical Specialties: A 5-year CMS Data Analysis (2013-2017). J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.102] [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]
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Gupta K, Shivabalan, Kumar V, Vyas S, Pandey RM, Jagannathan NR, Sinha S. Cognitive Performance and Neuro-Metabolites in HIV Using 3T Magnetic Resonance Spectroscopy: A Cross-Sectional Study from India. Curr HIV Res 2021; 19:147-153. [PMID: 33106144 DOI: 10.2174/1570162x18666201026141729] [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: 06/19/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive impairment in patients with human immunodeficiency virus (HIV) is associated with higher morbidity. The prevalence of the metabolite changes in the brain associated with cognitive impairment in anti-retroviral therapy naïve patients with HIV is unknown. OBJECTIVE To estimate the prevalence of the neurometabolites associated with cognitive impairment in antiretroviral therapy (ART) naïve patients with HIV. METHODS We conducted a cross-sectional study among ART naïve patients with HIV aged 18-50 years in a tertiary care center in India. Cognition was tested using the Post Graduate Institute battery of brain dysfunction across five domains; memory, attention-information processing, abstraction executive, complex perceptual, and simple motor skills. We assessed the total N-acetyl aspartyl (tNAA), creatine (tCr) and glutamate + glutamine (Glx) using 3T magnetic resonance spectroscopy. Cognitive impairment was defined as an impairment in ≥2 domains. RESULTS Among 43 patients eligible for this study, the median age was 32 years (IQR 29, 40) and 30% were women. Median CD4 count and viral load were 317 cells/μL (IQR 157, 456) and 9.3 copies/ μL (IQR 1.4, 38), respectively. Impairment in at least one cognitive domain was present in 32 patients (74.4%). Impairment in simple motor skills and memory was present in 46.5% and 44% of patients, respectively. Cognitive impairment, defined by impairment in ≥2 domains, was found in 22 (51.2%) patients. There was a trend towards higher concentration of tNAA (7.3 vs. 7.0 mmol/kg), tGlx (9.1 vs. 8.2 mmol/kg), and tCr (5.5 vs. 5.2 mmol/kg) in the frontal lobe of patients with cognitive impairment vs. without cognitive impairment but it did not reach statistical significance (p>0.05 for all). There was no difference in the concentration of these metabolites in the two groups in the basal ganglia. CONCLUSION There is a high prevalence of cognitive impairment in ART naïve patients with HIV. There is no difference in metabolites in patients with or without cognitive impairment. Further studies, with longitudinal follow-up are required to understand the underlying pathophysiological mechanisms.
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Affiliation(s)
- K Gupta
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivabalan
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - V Kumar
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - S Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - N R Jagannathan
- Department of Nuclear Magnetic Resonance and Magnetic Resonance Imaging Facility, All India Institute of Medical Sciences, New Delhi, India
| | - S Sinha
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kumar N, Madan R, Gupta K, Chatterjee D, Uppal DK, Goyal S, Ballari N, Khosla D, Sahoo SK, Ahuja CK. Embryonal tumors with multilayered rosettes: A tertiary care centre experience. Clin Neurol Neurosurg 2021; 202:106508. [PMID: 33556852 DOI: 10.1016/j.clineuro.2021.106508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Embryonal tumors with multilayered rosettes (ETMR) is an extremely rare and highly aggressive tumor. It includes three distinct entities i.e, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL). Here, we present our institutional experience of seven ETMR cases treated over a period of five years. MATERIALS AND METHODS Patients' records from 2015 to 2019 were reviewed manually and electronically to retrieve the data. Clinicopathological and outcome details of ETMR cases were entered in a predesigned proforma. RESULTS A total of seven cases of ETMR were registered from 2015 to 2019 with a median age at presentation of four years (range 3-7 years). All patients underwent surgery. However, only three patients completed the planned adjuvant treatment, comprising of focal radiotherapy (RT) alone, craniospinal irradiation (CSI) alone and CSI followed by six cycles of chemotherapy in one patient each respectively. Two patients commenced CSI but deteriorated during RT and thereafter needed best supportive care. Two patients could not be started on any adjuvant treatment. Unfortunately, six patients succumbed to their disease within one year of their diagnosis. Only one patient who received both CSI and adjuvant chemotherapy is alive at 15 months of diagnosis. CONCLUSION ETMR is a rare and aggressive entity. Majority of the patients die within one year of the diagnosis despite multimodality treatment.
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MESH Headings
- Brain Neoplasms/diagnostic imaging
- Brain Neoplasms/mortality
- Brain Neoplasms/pathology
- Brain Neoplasms/therapy
- Chemoradiotherapy, Adjuvant
- Child
- Child, Preschool
- Female
- Humans
- Male
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/mortality
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/therapy
- Neuroectodermal Tumors, Primitive/diagnostic imaging
- Neuroectodermal Tumors, Primitive/mortality
- Neuroectodermal Tumors, Primitive/pathology
- Neuroectodermal Tumors, Primitive/therapy
- Neurosurgical Procedures
- Radiotherapy, Adjuvant
- Tertiary Care Centers
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Affiliation(s)
- N Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - K Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D K Uppal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N Ballari
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - C K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ashwath R, Rauthan A, Patil P, Gupta K. 416P A single institute study evaluating the additional benefit of blood NGS testing over conventional molecular testing in metastatic adenocarcinoma lung. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Suresh Kumar VC, Harne PS, Mukherjee S, Gupta K, Masood U, Sharma AV, Lamichhane J, Dhamoon AS, Sapkota B. Transaminitis is an indicator of mortality in patients with COVID-19: A retrospective cohort study. World J Hepatol 2020; 12:619-627. [PMID: 33033568 PMCID: PMC7522557 DOI: 10.4254/wjh.v12.i9.619] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since its discovery in Wuhan, China in December of 2019, the novel coronavirus has progressed to become one of the worst pandemics seen in the last 100 years. Recently, there has been an increased interest in the hepatic manifestations of coronavirus disease 19 (COVID-19).
AIM To describe the demographic and clinical characteristics of COVID-19 positive patients and study the association between transaminitis and all-cause mortality.
METHODS This is a descriptive retrospective cohort study of 130 consecutive patients with a positive COVID PCR test admitted between March 16, 2020 to May 14, 2020 at a tertiary care University-based medical center. The Wilcoxon-rank sum test and paired t-test were used for comparing non-parametric and parametric continuous variables respectively and a multivariable logistic regression models to study the association between transaminitis and mortality using SAS version 9.4 (SAS Institute, Cary, NC, United States).
RESULTS Out of the 130 patients, 73 (56%) patients were found to have transaminitis and 57 (44%) did not. When compared to patients without transaminitis, the transaminitis group was found to have a higher median body mass index (30.2 kg/m2vs 27.3 kg/m2, P = 0.04). In the multivariate analysis those with transaminitis were found to have 3.4 times higher odds of dying as compared to those without transaminitis adjusting for gender, the Age-adjusted Charlson Comorbidity Index and admission to the intensive care unit (P = 0.03).
CONCLUSION Our study showed that transaminitis on admission was associated with severe clinical outcomes such as admission to the intensive care unit, need for mechanical ventilation, and mortality.
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Affiliation(s)
| | - Prateek Suresh Harne
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Samiran Mukherjee
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Kashvi Gupta
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, United States
| | - Umair Masood
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Anuj Vikrant Sharma
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Jivan Lamichhane
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Amit Singh Dhamoon
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY 13202, United States
| | - Bishnu Sapkota
- Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, NY 13202, United States
- Division of Gastroenterology, Syracuse VA medical Center, Syracuse, NY 13202, United States
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Abstract
We describe the case of a 67-year-old asymptomatic man who was referred to our hospital for abnormal laboratory results. He was incidentally found to have a massive empyema without underlying bronchopulmonary pneumonia. Following thoracentesis, he was diagnosed with chronic Streptococcus anginosus empyema. Therapeutic thoracentesis and treatment with tissue plasminogen activator and deoxyribonuclease failed to resolve the empyema, and there was residual loculated pleural fluid that was surrounded by a thick rind. The patient was referred to thoracic surgery for decortication of the pleural space via video-assisted thoracoscopic surgery. At 2-month follow-up, the patient had complete re-expansion of the lung tissue.
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Affiliation(s)
- Kashvi Gupta
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elena Stuewe
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Marianne Barry
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Abstract
Plant genetic resources (PGR) are the foundation of agriculture as well as food and nutritional security.
The ICAR-NBPGR is the nodal institution at national level for management of PGR in India under the umbrella
of Indian Council of Agricultural Research (ICAR), New Delhi. India being one of the gene-rich countries faces a
unique challenge of protecting its natural heritage while evolving mutually beneficial strategies for germplasm
exchange with other countries. The Bureaus activities include PGR exploration, collection, exchange, characterization,
evaluation, conservation and documentation. It also has the responsibility to carry out quarantine of
all imported PGR including transgenics meant for research purposes. The multifarious activities are carried out
from ICAR-NBPGR headquarters and its 10 regional stations located in different agro-climatic zones of India. It
has linkages with international organizations of the Consultative Group on International Agricultural Research
(CGIAR) and national crop-based institutes to accomplish its mandated activities. NBPGR collects and acquires
germplasm from various sources, conserves it in the Genebank, characterizes and evaluates it for different traits
and provides ready material for breeders to develop varieties for farmers. ICAR-NBPGR encompasses the National
Genebank Network and at present, the National Genebank conserves more than 0.40 million accessions. NBPGR
works in service-mode for effective utilization of PGR in crop improvement programmes which depends mainly
on its systematic characterization and evaluation, and identification of potentially useful germplasm. NBPGR is
responsible for identifying trait-specific pre-adapted climate resilient genotypes, promising material with disease
resistance and quality traits which the breeders use for various crop improvement programmes. The system has
contributed immensely towards safeguarding the indigenous and introducing useful exotic PGR for enhancing
the agricultural production. Presently, our focus is on characterization of ex situ conserved germplasm and
detailed evaluation of prioritized crops for enhanced utilization; assessment of impact of on-farm conservation
practices on genetic diversity; genome-wide association mapping for identification of novel genes and alleles for
enhanced utilization of PGR; identification and deployment of germplasm/landraces using climate analog data;
validation of trait-specific introduced germplasm for enhanced utilization.
Key words: plant genetic resources; gene banks; wild relatives; biotic and abiotic stresses; marker-assisted
selection.
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Affiliation(s)
- K Singh
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - K Gupta
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - V Tyagi
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - S Rajkumar
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
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Madan R, Kumar N, Gupta A, Gupta K, Salunke P, Khosla D, Yadav BS, Kapoor R. Effect of prophylactic granulocyte-colony stimulating factor (G-CSF) on acute hematological toxicity in medulloblastoma patients during craniospinal irradiation (CSI). Clin Neurol Neurosurg 2020; 196:105975. [PMID: 32505868 DOI: 10.1016/j.clineuro.2020.105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/24/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Haematological toxicity and treatment breaks are common during cranio-spinal irradiation (CSI) due to irradiation of large volume of bone marrow. We conducted this study to see the effect of prophylactic granulocyte colony stimulating factor (GCSF) in reducing treatment breaks. PATIENTS AND METHODS The study was conducted over a period of 15 months from August 2017 to November 2018. Histopathologically proven Medulloblastoma patients received prophylactic GCSF during CSI. Acute hematological toxicities and treatment breaks were noted and effect of age and pretreatment blood counts were analyzed by SPSS (Statistical Package for Social Sciences) version 23. RESULTS A total of 28 patients were included in the study. During CSI, hematological toxicity leading to treatment breaks was observed in 11 (39.3 %) patients, of which grade 3 and 2 toxicities were seen in ten and one patients respectively. Younger age (<10 years) at diagnosis was significantly associated with the development of hematological toxicity (p = 0.028, Chi-Square). No correlation was found with pre-treatment blood counts. CONCLUSION Prophylactic use of GCSF may be effective in preventing radiation induced hematological toxicity and treatment breaks.
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Affiliation(s)
- R Madan
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - N Kumar
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India.
| | - A Gupta
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - K Gupta
- Department of Pathology, PGIMER, Chandigarh, India
| | - P Salunke
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - D Khosla
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - B S Yadav
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - R Kapoor
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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