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Sadangi S, Saraiya H, Salunke AA, Bharwani N, Patel K, Pandya S, Warikoo V, Pandya S. The surgical management and oncologic outcomes of patients with fungating soft tissue sarcoma treated at a tertiary cancer centre and review of literature. J Orthop 2024; 53:94-100. [PMID: 38495576 PMCID: PMC10940886 DOI: 10.1016/j.jor.2024.02.013] [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: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
Background Currently there is limited literature available on fungating soft tissue sarcoma and its effect of outcomes. In the current study we evaluated the surgical management and oncologic outcomes of patient with fungating soft tissue sarcoma. Materials and methods This was a retrospective observational study of patients with fungating sarcoma between January 2015 till January 2019 at a tertiary cancer care centre. A total of 59 patients were considered of which 16 had metastasis at presentation. The duration of symptoms prior to presentation averaged 10.2 months (median, 7.2months; range, 1-57 months). Median tumor length was 10 cm. Results 56% patients underwent amputation and 44% were treated with limb salvage. Following limb salvage surgery in10 cases primary closure of defect was performed and 6 cases required skin grafting for closure of defect. In 6 patients local flap was used for coverage of defect and 4 patients required free flap surgery. Two-year overall survival (OS) of the study cohort were 52.2% and 58% respectively. Two-year disease free survival (DFS) and OS in 43 non metastatic patients at presentation was seen in 58%(95% CI,38%-74%) and 66.5%(95% CI,42%-81%) respectively. The two-year disease OS in 16 patients with metastasis at presentation was 33.2 %. On univariate analysis, tumor size and metastatic at presentation had significant effect on survival. Conclusion Tumor size and metastatic at presentation has significant impact on survival in these patients. The oncologic outcomes including Disease free survival, overall survival and local recurrence rates similar amongst the two surgical modalities (amputation versus limb salvage). Amputation rates are more amongst fungating soft tissue sarcoma but limb salvage can be attempted whenever feasible keeping tumor free surgical margins under consideration.
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Affiliation(s)
- Sudam Sadangi
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Hemant Saraiya
- Department of Onco-Plastic Surgery, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shivam Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI) Ahmedabad, Gujarat, India
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Banala TR, Salunke AA, Bharwani N, Patel K, Maharjan D, Patel S, Warikoo V, Sharma M, Pandya S. Distal Ulna Giant Cell Tumor treated by Resection without Reconstruction: What were the functional outcomes and review of literature. J Orthop 2024; 53:118-124. [PMID: 38495577 PMCID: PMC10940127 DOI: 10.1016/j.jor.2024.02.040] [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: 12/06/2023] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Giant Cell Tumours (GCT) are benign tumours with aggressive potential that disrupt the local bony architecture, which can be especially problematic in peri-articular locations. Our aim was to assess the outcomes of patients with GCT of the distal ulna who were treated by resection without reconstruction. Methods The study included 21 patients with distal ulna GCT that were treated with resection without reconstruction. There were 12 males and 9 females, with a mean age of 30.4years (range 14-45 years). The patients mean follow-up period was 4.4 years, with a two-year minimum follow-up. Results Painful swelling was the presenting symtom in all cases. Nineteen patients had Campanacci grade 3 and two had Campanacci grade 2. The mean resected length of the distal ulna was 6.8 cm (range 4-10) cm. The Musculoskeletal Tumor Society score (MSTS) was 26.1. (range 22-28). Grip strength of the affected hand was reduced by 10.5% on average. (range 0%-16%). Two patients were having multi-centric disease on presentation and none of the cases had pathological fracture on presentation. One case had a local recurrence which was treated with surgery. Conclusion Based on current study, GCT of the distal ulna, en bloc resection without reconstruction can be recommended as a valuable treatment option for Campanacci grades 2 and 3 tumours. Resection of the distal end of the ulna without reconstruction results in excellent functional outcomes, with forearm rotational movement and hand function preserved. According to review of literature this is the largest series of GCT Ulna and we recommend a multicentre and comparitive studies on this topic.
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Affiliation(s)
- Tarun Reddy Banala
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Dipendra Maharjan
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shailesh Patel
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Vikas Warikoo
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mohit Sharma
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, The Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
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Salunke AA, Nandy K, Kamani M, Parmar R, Bharwani N, Pathak S, Patel K, Pandya S. Is polypropylene mesh reconstruction functionally superior to non reconstructive group following total scapular resection? A retrospective analysis of 16 patients and a systematic review of the literature. J Orthop 2024; 52:37-48. [PMID: 38404696 PMCID: PMC10891286 DOI: 10.1016/j.jor.2024.02.019] [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: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Background Various reconstruction methods have been described in medical literature on scapular tumor resection depending on the type of resection and other factors. However the ideal method of reconstructions has been still debatable. The purpose of the current study was to assess whether polypropylene mesh reconstruction is superior as compared to non reconstructive group following total scapular resection.We also evaluated how our method of reconstruction fare as compared to reported reconstruction methods in the published literature. Methods During 2014 to 2019; Total scapulectomy (Type III scapular resection) was performed in 16 patients for malignant tumor involving scapula bone. Reconstruction with polyprolene mesh(Group I) was performed in 56 % patient and non reconstruction technique (Group II) was observed in 44 % patient. The mean follow-up duration of current study was 28.3 months (range 13-67 months). The search method of PubMed and Cochrane databases provided 121 articles; of which 5 studies having 144 cases were utilised for final analysis. The reconstruction method used were dynamic humeral suspension (39.5%), non reconstruction method (35 %), scapular prosthesis (18 %) and static humeral suspension (5.5%). Results The mean Musculoskeletal tumor society score (MSTS) of the study cohort was 19.8(0-23); and that in polyprolene mesh or static suspension method (Group I) and non reconstructive technique (Group II) was 67 % and 61% respectively. The emotional acceptance score in group I was 4.5 and that in group II was 4.2 points. There was no difference in the shoulder movements in both the groups. The mean surgical durations in group I and group II was was 186 min and 140 min respectively. The systematic review showed the mean Musculoskeletal tumor society score (MSTS) of dynamic suspension and non reconstruction method were 63 % and 63.5% respectively. The mean Musculoskeletal tumor society score (MSTS) of scapula prosthesis tended to be higher than those with dynamic suspension (77 % vs 65 %). Conclusions The reconstruction with polypropylene mesh had better functional outcome and emotional acceptance as compared to non-reconstructive group in patients with total scapular resection surgery. The findings of systematic review suggest that; patients treated by reconstruction with polypropylene mesh and non-reconstructive group as compared to scapular prosthesis had limited shoulder movements with no difference in hand position, manual dexterity and lifting ability.
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Affiliation(s)
- Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Rahul Parmar
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | | | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Caudle MM, Dugas NN, Patel K, Moore RC, Thomas ML, Bomyea J. Repetitive negative thinking as a unique transdiagnostic risk factor for suicidal ideation. Psychiatry Res 2024; 334:115787. [PMID: 38367453 DOI: 10.1016/j.psychres.2024.115787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/27/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - N N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - K Patel
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - R C Moore
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - M L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO 80525, United States
| | - J Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States.
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Murphy CP, Patel K, Hope E, North JS. Early identification of the opposition shot taker characterises elite goalkeepers' ability to read the game. SCI MED FOOTBALL 2024:1-8. [PMID: 38530231 DOI: 10.1080/24733938.2024.2329466] [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] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
Researchers investigating expertise in soccer goalkeepers have overwhelmingly focused on anticipating penalty kicks and identifying kinematic cues that are used to anticipate action outcomes. In this study, we took a novel approach to exploring 'game reading' skills in soccer goalkeepers. Specifically, we investigated whether and by what point during an attacking sequence in open play, elite goalkeepers can identify the opposition shot taker, a skill that is likely to facilitate organisation of the defensive line and interception of forward creative attacking passes. We used a moving window temporal occlusion paradigm to present elite, sub-elite, and amateur goalkeepers with 11-vs-11 attacking sequences that were divided into progressive segments. After viewing each segment, participants identified the player they thought would shoot at goal at the end of the attacking sequence. Elite goalkeepers identified the opposition shot taker earlier and more accurately than sub-elite and amateur participants. Findings suggest that elite goalkeeping is underpinned not only by anticipation of action outcomes but also game-reading skill that enables identification of the player most likely to carry out those actions.
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Affiliation(s)
- Colm P Murphy
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Keval Patel
- Performance Department, Queens Park Rangers Football Club, London, UK
- Research Centre for Applied Performance Sciences, St Mary's University, Twickenham, London, UK
| | - Ed Hope
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jamie S North
- Research Centre for Applied Performance Sciences, St Mary's University, Twickenham, London, UK
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Toren P, Wilkins A, Patel K, Burley A, Gris T, Kockelbergh R, Lodhi T, Choudhury A, Bryan RT. The sex gap in bladder cancer survival - a missing link in bladder cancer care? Nat Rev Urol 2024; 21:181-192. [PMID: 37604983 DOI: 10.1038/s41585-023-00806-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/23/2023]
Abstract
The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.
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Affiliation(s)
- Paul Toren
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospitals NHS Trust, London, UK
| | - Keval Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy Burley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Typhaine Gris
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Roger Kockelbergh
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Action Bladder Cancer UK, Tetbury, UK
| | - Taha Lodhi
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Richard T Bryan
- Action Bladder Cancer UK, Tetbury, UK.
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK.
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Hope ER, Patel K, Feist J, Runswick OR, North JS. Examining the importance of local and global patterns for familiarity detection in soccer action sequences. Perception 2024; 53:149-162. [PMID: 38200709 PMCID: PMC10858626 DOI: 10.1177/03010066231223825] [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: 07/26/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
Pattern recognition is a defining characteristic of expertise across multiple domains. Given the dynamic interactions at local and global levels, team sports can provide a vehicle for investigating skilled pattern recognition. The aims of this study were to investigate whether global patterns could be recognised on the basis of localised relational information and if relations between certain display features were more important than others for successful pattern recognition. Elite (n = 20), skilled (n = 34) and less-skilled (n = 37) soccer players completed three recognition paradigms of stimuli presented in point-light format across three counterbalanced conditions: 'whole-part'; 'part-whole'; and 'whole-whole'. 'Whole' clips represented a 11 vs. 11 soccer match and 'part' clips presented the same passages of play with only two central attacking players or two peripheral players shown. Elite players recognised significantly more accurately than the skilled and less-skilled groups. Participants were significantly more accurate in the 'whole-whole' condition compared to others, and recognised stimuli featuring the two central attacking players significantly more accurately than those featuring peripheral players. Findings provide evidence that elite players can encode localised relations and then extrapolate this information to recognise more global macro patterns.
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Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, Bharwani N, Trivedi P, Pandya S. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop 2024; 48:13-19. [PMID: 38059219 PMCID: PMC10696180 DOI: 10.1016/j.jor.2023.11.039] [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: 08/09/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Opinion remains divided as to whether excision of needle biopsy tract is beneficial and affect the prognosis. The aim of the study was to compare the outcomes in patients of primary malignant bone tumor who had undergone surgery with or without biopsy tract excision. Methods From January 2017 to June 2020, 240 patients with primary malignant bone tumors who underwent percutaneous needle biopsy followed by surgery were included. We categorized patients into Biopsy tract excision (Group1:185 patients) and Non Biopsy tract excision (Group 2:55 patients). Median follow-up of patients was 58.6 months (range; 12-61.8months). Results Demographics, histopathological type, tumor location, type of surgery were similar in biopsy tract excision and non excision group. We found biopsy tract seeding in two cases out of 185 (1.1 %). Local recurrence in biopsy tract excision and non excision group was observed in 3.2 % and 1.8 % respectively with p value 0.58. The mean local recurrence free survival rate in group 1 and 2 was 60 and 44 months respectively. Limb salvage was performed in 71.6 % and in amputation in 28.3 % cases. The local recurrence in limb-salvage and amputation group was observed in 3.4 % (6/172) and 1.4 % (1/68) respectively. Conclusion There was no significant difference in the rate of local recurrence between patients who were treated by biopsy tract excision or non tract excision. Percutenous needle bone biopsy tract leads to minimal risk of tumor seeding during surgical resection of primary bone tumors.We recommend the further multi centre studies with more number of patients to reach a consensus on resection of needle biopsy tract during surgical management of primary bone tumors.
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Affiliation(s)
- Amisha Gami
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Ashini Shah
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | | | - Abhijeet Ashok Salunke
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Jahnavi Gandhi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Nandlal Bharwani
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Department of Onco Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Shashank Pandya
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
- Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Suthar R, Bharwani N, Pareek P, Salunke AA, Patel K, Shukla S, Aron J, Kapoor K, Yalla P, Rathod P, Pandya S, Pandya S. Role of bone scintigraphy (bone scan) in skeletal osteosarcoma: A retrospective audit and review from tertiary oncology centre. J Orthop 2024; 48:20-24. [PMID: 38059218 PMCID: PMC10696193 DOI: 10.1016/j.jor.2023.11.038] [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: 08/12/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Bone scan is a investigation which uses radionuclide phosphonate compound for whole skeletal survey. In this current study we have done the analysis of the role of bone scan in skeletal osteosarcoma at tertiary oncology care centre. Material & methods This is a retrospective study conducted in a tertiary oncology centre from January 2022 to February 2023. A total of 92 patients with skeletal OGS were included in our study undergone 99 mTCcMDP whole body bone scan. 99 mTc MDP was prepared freshly every morning and dose for each patient were calculated as per EANM guidelines. Images were acquired 2-3 h of post injection. All images were acquired at GE infinia dual head machine with peak setting at 140Kev and LEAP collimator. Suspicious lesions on planer bone scan were correlated with SPECT fused with CT. All the bone scans were reviewed retrospectively by two independent nuclear medicine physicians. Results In this study group, 86 patients with biopsy proven skeletal OGS underwent 99 mTCcMDP bone scan of which 63 were males and 23 were females (2.7:1) with age of study group ranging from 7years to 48years. Patients referred for bone scan were retrospectively categorized in two groups, first group patients (52) were referred for initial staging of disease and second group of patients (34) were referred for follow-up or re-staging of the disease. Total 09 patients showed distant skeletal metastases on bone scan, out of which 05 were in initial staging group and 04 in follow up group. Conclusion Osteosarcoma has propensity to metastasize to many sites in the body however most common site being lung followed by skeletal, nodal and rarely soft tissue metastasis. Bone scan enjoys a optimal sensitivity in case of osteosarcoma to detect skeletal metastasis but have low specificity. However being a cost effective and faster investigation makes it a wise investigation of choice in case of osteosarcoma for skeletal metastasis evaluation.
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Affiliation(s)
- Ritesh Suthar
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Nandlal Bharwani
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Pravin Pareek
- Nuclear Medicine, Gujarat Cancer Research Institute(GCRI), Ahemdabad, Gujarat, India
| | - Abhijeet Ashok Salunke
- Orthopedic Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Keval Patel
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivang Shukla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Jebin Aron
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Kanika Kapoor
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Poojitha Yalla
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Priyank Rathod
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shivam Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
| | - Shashank Pandya
- Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
- Gujarat Cancer Research Institute (GCRI), Ahemdabad, Gujarat, India
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Sarwar A, Syed L, Patel K, Reid I, Abonyi E, Banas N, Lowe G, Bryant L, Hoskin P. Image-guided Interstitial Brachytherapy in the Treatment of Primary and Recurrent Vulvovaginal Gynaecological Malignancies. Clin Oncol (R Coll Radiol) 2024; 36:6-11. [PMID: 37923687 DOI: 10.1016/j.clon.2023.10.051] [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: 09/22/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIMS To evaluate the use, outcomes and toxicities of high dose rate brachytherapy (HDRB) to the vulvovaginal region in previously irradiated and radiotherapy-naïve patients for primary or recurrent gynaecological malignancies. MATERIALS AND METHODS From January 2010 to December 2020, 94 women with a median age of 64 years (range 31-88 years) were treated with interstitial HDRB for vulvovaginal disease. Treatment details, including cumulative radiotherapy doses, were recorded together with reported toxicity, using Common Terminology Criteria for Adverse Events (CTCAE) grading. Dosimetric parameters, including D90, V100 and V150 together with treatment response at 3 months, overall survival, relapse-free survival and long-term toxicity data, were collated from referring centres. RESULTS The median follow-up was 78 months (range 2-301). Primary sites of disease included vagina (37), endometrium (29), vulva (16), ovary (7) and cervix (5). Eighty-six (91.5%) patients were treated with curative intent, eight (8.5%) were palliative treatments. Fifty patients received HDRB for recurrent disease, 39 patients for primary disease and five as part of adjuvant treatment. The anatomical site of disease treated with HDRB ranged from vagina (76), vulva (14) and peri-urethral sites (four). The 2- and 5-year local relapse-free survival rates were 76% and 72%, respectively; 15 patients experienced local failure only, whereas six patients had local and nodal/distant failure. The median time to local recurrence was 8 months (range 2-88 months). The 2- and 5-year overall survival rates for all patients were 67% and 47%, respectively; the median overall survival was 59 months. Seventy-nine (84%) patients had a complete response measured with imaging at 3 months. Grade 3 toxicity was reported in 14 patients (14.8%). CONCLUSION This retrospective series suggests the use of interstitial brachytherapy for vulvovaginal gynaecological malignancy to be an effective and safe treatment option. Good local control was achieved with a tolerable toxicity profile; it is a valuable treatment modality.
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Affiliation(s)
- A Sarwar
- Mount Vernon Cancer Centre, Northwood, UK.
| | - L Syed
- Mount Vernon Cancer Centre, Northwood, UK
| | - K Patel
- Mount Vernon Cancer Centre, Northwood, UK
| | - I Reid
- Mount Vernon Cancer Centre, Northwood, UK
| | - E Abonyi
- Mount Vernon Cancer Centre, Northwood, UK
| | - N Banas
- Mount Vernon Cancer Centre, Northwood, UK
| | - G Lowe
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Bryant
- Mount Vernon Cancer Centre, Northwood, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
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Mithi MT, Sharma M, Puj K, Devarajan JA, Joshi N, Pandya SJ, Patel S, Warikoo V, Rathod P, Pandya S, Salunke A, Patel K, Garg V. Surgery for lung cancer: insight from a state cancer centre in India. Indian J Thorac Cardiovasc Surg 2024; 40:50-57. [PMID: 38125328 PMCID: PMC10728424 DOI: 10.1007/s12055-023-01590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Lung cancer is one of the most common cancers in India. However, less than half receive treatment with a curative intent and very few undergo surgery amongst them. We present our surgical experience with non-small cell lung cancer. Methods A retrospective analysis of a cohort of 92 non-small cell lung cancer patients operated with curative intent. Results Less than 2% patients of lung cancer were operated on at our centre. Adenocarcinoma was the most common histological subtype. Right upper lobectomy was the most common surgery performed. Two- and 3-year overall survival was 74.3% and 70.6% respectively. Two- and 3- year disease-free survival was 65.4% and 60.8% respectively. Conclusion The fraction of patients who are operated for lung cancer is very less. There is a definite missed window of opportunity. We have comparable survival to international data.
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Affiliation(s)
- Mohamed Taher Mithi
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Mohit Sharma
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ketul Puj
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Jebin Aaron Devarajan
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Nilang Joshi
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shashank J. Pandya
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shailesh Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Vikas Warikoo
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Priyank Rathod
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shivam Pandya
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Abhijeet Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Vasudha Garg
- Department of Medicine, BJ Medical College, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Trivedi SD, Shukla S, Pandya SV, Mehta JS, Pandya SJ, Sharma M, Patel S, Warikoo V, Rathod P, Puj KS, Salunkhe A, Patel K, Thottiyen S, Aaron J, Pawar A. Mucosal Malignant Melanoma of Head and Neck: A Case Series from a Single Institute and Review of Literature Abstract. Indian J Otolaryngol Head Neck Surg 2023; 75:3415-3420. [PMID: 37974828 PMCID: PMC10646126 DOI: 10.1007/s12070-023-04001-y] [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: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 11/19/2023] Open
Abstract
Malignant melanoma is an aggressive malignancy of melanocytes which is usually found on sun exposed areas of the body. A rare variant of this disease with no etiological association is the mucosal malignant melanoma found on all mucosal surfaces of the body including the oral cavity, respiratory mucosa and anorectal region. In the head and neck region, this disease is almost always diagnosed at an advanced stage and requires a very high index of suspicion for diagnosis. It is more commonly found in females than males.Indians are more prone to this disease as compared to Caucasians.Due to the obscure location within the oral and nasal cavity, it is clinically found at an advanced stage and requires surgical resection with adequate margins for complete eradication. This may be achieved either endoscopically in the nasal cavity or with wide local resection in the oral cavity. this in certain cases may not be feasible due to vicinity of vital structures. In such cases, adjuvant radiotherapy helps in the local control of disease. Histopathological evaluation of the specimen helps to determine aggressive biology of tumor with factors such as presence of ulceration, nodular morphology and perineural invasion being high risk features for development of local and regional recurrence. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04001-y.
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Affiliation(s)
- Sonal Dilip Trivedi
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Shivang Shukla
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Shivam V Pandya
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Jeet Sandeep Mehta
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Shashank J. Pandya
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Mohit Sharma
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Shailesh Patel
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Vikas Warikoo
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Priyank Rathod
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Ketul S. Puj
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Abhijeet Salunkhe
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Keval Patel
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | | | - Jebin Aaron
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
| | - Ajinkya Pawar
- Department of surgical oncology, GCRI, Haripura, Asarwa, Ahmedabad 380016 India
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Trivedi S, Salahuddin T, Mithi MT, Rathod P, Bandi A, Pandya SJ, Sharma M, Patel S, Warikoo V, Puj K, Salunkhe A, Patel K, Pandya S. Medullary Thyroid Carcinoma: A Single Institute Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:2884-2889. [PMID: 37974849 PMCID: PMC10645935 DOI: 10.1007/s12070-023-03867-2] [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: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
Medullary thyroid carcinoma is a rare tumour that is anatomically located in the thyroid gland but is functionally a neuroendocrine tumour. It is usually a disease of older age group but manifests in a young patient in familial form. It is derived from parafollicular c cells and has a predilection for lymph node metastasis. It is associated with slow growth in thyroid gland with early nodal metastasis. Serum calcitonin is useful as a preoperative marker of disease burden and prognosis. In the preoperative period serum levels of calcitonin can guide regarding the need for compartment wise lymph node dissection and the possibility of distant metastasis. It is used as a tool of surveillance in the postoperative period. The levels of serum CEA and calcitonin and their doubling time is a useful guide in the detection of early recurrence or distant metastasis. Imaging modality useful for diagnosis is USG in a majority of patients. Thus, the initial diagnosis and preoperative assessment of medullary thyroid carcinoma is similar to other forms of thyroid cancer but further management of disease differs significantly form other forms of differentiated thyroid carcinoma or even anaplastic carcinoma. Prognosis however differs according to age, gender, presence or absence of lymph node metastasis at presentation, metastatic disease at presentation and levels of biochemical markers.
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Affiliation(s)
- Sonal Trivedi
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - T. Salahuddin
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Mohamed Taher Mithi
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Priyank Rathod
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Arpit Bandi
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shashank J. Pandya
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Mohit Sharma
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shailesh Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Vikas Warikoo
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ketul Puj
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Abhijeet Salunkhe
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Keval Patel
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shivam Pandya
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Patel K, Cuervo-Pardo L, Cresoe S, Cavero-Chavez V. An Unusual Transition from Cutaneous to Systemic Mastocytosis in a Pediatric Patient. Pediatr Allergy Immunol Pulmonol 2023; 36:150-152. [PMID: 38134319 DOI: 10.1089/ped.2023.0073] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Background: Cutaneous mastocytosis (CM) occurs when abnormal mast cells accumulate in the skin, whereas in systemic mastocytosis (SM), accumulation also occurs in other tissues. A transition from CM to SM is an atypical occurrence in pediatric patients. Case Presentation: An 8-month-old female presented with a 3-month history of whole body hyperpigmented macules with a normal serum tryptase level, consistent with a diagnosis of CM. At age 2.5 years, cutaneous lesions increased and repeat serum tryptase levels were elevated. Subsequent positive peripheral blood KIT D816V mutation testing furthered concern for a monoclonal mast cell disorder; therefore, prompting a bone marrow biopsy which was consistent with a diagnosis of SM. Conclusion: Our case depicts the possible transition from CM to SM in a pediatric patient. Despite an initial presentation consistent with a diagnosis of CM, watchful monitoring for signs and symptoms indicative of systemic involvement may be warranted in some pediatric patients.
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Affiliation(s)
- Keval Patel
- Department of Medicine, University of Florida Gainesville, Florida, USA
| | - Lyda Cuervo-Pardo
- Department of Pediatrics, University of Florida Gainesville, Florida, USA
| | - Samantha Cresoe
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida Gainesville, Florida, USA
| | - Vanessa Cavero-Chavez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Florida Gainesville, Florida, USA
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15
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Khatri H, Pathak R, Yadav R, Patel K, Jyothi R R, Singh A. DENTAL CAVITIES IN PEOPLE WITH TYPE 2 DIABETES MELLITUS: AN ANALYSIS OF RISK INDICATORS. Georgian Med News 2023:140-145. [PMID: 38325313] [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: 02/09/2024]
Abstract
Diabetes is associated with a greater number of dental cavities. It is unclear, therefore, how potential risk factors such as salivary glucose, glycemic control and blood sugar could impact the onset of dental caries between people that have type 2 diabetes (T2D). Aim of the study - analyzing the risk factors for oral cavity disease in T2D patients. We analyzed the patient data including their dietary habits, dental hygiene practices, age and control of glycemic. The Indian dataset was used. Individual patient observations include the patient's diabetes classification as a range of medical attributes such as age, pregnancy, pedigree, glucose, body mass index, skin, blood pressure and insulin. The research discovered a significant correlation between poorly managed glycemic levels and dental caries are more prevalent in people with T2DM. High sugar consumption and poor oral hygiene habits have been identified as risk factors. These results highlight the need for integrating diabetes treatment measures with dental care to reduce dental caries in this susceptible group. Utilizing dental cavities into account improves oral health and has a positive impact on health outcomes for those with type 2 diabetes.
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Affiliation(s)
- H Khatri
- 1Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - R Pathak
- 2Department of Periodontology, TMDC&RC, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - R Yadav
- 3Department of Pharmacy, Noida Institute of Engineering and Technology (Pharmacy Institute), Uttar Pradesh, India
| | - K Patel
- 4Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - R Jyothi R
- 5Department of Life Sciences, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - A Singh
- 6School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, India
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16
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Kumar B, Tanwar S, Ganta S, Saxena K, Patel K, Asha K. INVESTIGATING THE EFFECT OF NICOTINE FROM CIGARETTES ON THE GROWTH OF ABDOMINAL AORTIC ANEURYSMS: REVIEW. Georgian Med News 2023:183-188. [PMID: 38325321] [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: 02/09/2024]
Abstract
Separating aneurysmal arterial disease from atherosclerosis and further occlusive artery conditions, it is a vascular degenerative disorder. Within the vascular tree, there is a regionalization of the propensity to produce aneurysms and the different locations result in different clinical processes. As the predominant risk factor for ubrenal abdominal aortic aneurysm (AAA), smoking is one of the most common manifestations of aneurysmal illness. For AAA compared to atherosclerosis, smoking is a far bigger risk factor. Along with contributing to the pathophysiology of AAA, smoking raises the likelihood that established AAA will rupture as well as its rate of expansion. The development of improved models for animals that are reliant on smoke or smoke constituents is helping to determine the mechanistic connection between AAA and smoking. According to the processes, there are long-lasting changes in the function of inflammatory and vascular smooth muscle cells. Focused on AAA, this review looks at the medical, epidemiology and mechanical evidence that links smoking to aneurysms.
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Affiliation(s)
- B Kumar
- 1School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - S Tanwar
- 2Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - Sh Ganta
- 3Department of Community Medicine, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - K Saxena
- 4Department of Computer Science and Engineering, Noida Institute of Engineering and Technology, Greater Noida, Uttar Pradesh, India
| | - K Patel
- 5Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - K Asha
- 6Department of Life Sciences, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
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Amos HM, Skaff NK, Uz SS, Policelli FS, Slayback D, Macorps E, Jo MJ, Patel K, Keller CA, Abue P, Buchard V, Werner AK. Public Health Data Applications Using the CDC Tracking Network: Augmenting Environmental Hazard Information With Lower-Latency NASA Data. Geohealth 2023; 7:e2023GH000971. [PMID: 38098874 PMCID: PMC10719610 DOI: 10.1029/2023gh000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
Exposure to environmental hazards is an important determinant of health, and the frequency and severity of exposures is expected to be impacted by climate change. Through a partnership with the U.S. National Aeronautics and Space Administration, the U.S. Centers for Disease Control and Prevention's National Environmental Public Health Tracking Network is integrating timely observations and model data of priority environmental hazards into its publicly accessible Data Explorer (https://ephtracking.cdc.gov/DataExplorer/). Newly integrated data sets over the contiguous U.S. (CONUS) include: daily 5-day forecasts of air quality based on the Goddard Earth Observing System Composition Forecast, daily historical (1980-present) concentrations of speciated PM2.5 based on the modern era retrospective analysis for research and applications, version 2, and Moderate Resolution Imaging Spectroradiometer (MODIS) daily near real-time maps of flooding (MCDWD). Data integrated into the CDC Tracking Network are broadly intended to improve community health through action by informing both research and early warning activities, including (a) describing temporal and spatial trends in disease and potential environmental exposures, (b) identifying populations most affected, (c) generating hypotheses about associations between health and environmental exposures, and (d) developing, guiding, and assessing environmental public health policies and interventions aimed at reducing or eliminating health outcomes associated with environmental factors.
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Affiliation(s)
- H. M. Amos
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- Science Systems and Applications, Inc.LanhamMDUSA
| | - N. K. Skaff
- National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaGAUSA
| | - S. Schollaert Uz
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
| | - F. S. Policelli
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
| | - D. Slayback
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- Science Systems and Applications, Inc.LanhamMDUSA
| | - E. Macorps
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- NASA Postdoctoral Program, NASA Goddard Space Flight CenterGreenbeltMDUSA
| | - M. J. Jo
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- University of Maryland Baltimore CountyBaltimoreMDUSA
| | - K. Patel
- Science Systems and Applications, Inc.LanhamMDUSA
- University of TexasAustinTXUSA
| | - C. A. Keller
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- Morgan State UniversityBaltimoreMDUSA
| | - P. Abue
- Science Systems and Applications, Inc.LanhamMDUSA
- University of TexasAustinTXUSA
| | - V. Buchard
- Earth Science DivisionGoddard Space Flight CenterNational Aeronautics and Space AdministrationGreenbeltMDUSA
- University of Maryland Baltimore CountyBaltimoreMDUSA
| | - A. K. Werner
- National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaGAUSA
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18
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Kumar S, Yadav S, Patel K, Jyothi R, Kumar B, Patidar V. EARLY IMPLANT OUTCOMES IN ADULTS WITH DENTAL DECAY TREATED WITH PHOTODYNAMIC TREATMENT. Georgian Med News 2023:19-26. [PMID: 38236093] [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: 01/19/2024]
Abstract
A fast implant is a kind of implant to place in the cavity right away after dental extraction. These implants are shown to maintain cervical marrow and reduce the number of surgery operations required for patients. The Photodynamic treatment (PDT) uses antimicrobial processes to supplement nonsurgical periodontal therapy. Combined through the scaling and root planning (SRP), and PDT is more effective. This study aims to assess the effects of PDT on initial findings with dental implants (DI) placed in patients having gum disease with SRP against patients who do not at the 12-month follow-up point. An aggregate of 25 implants were inserted in 16 patients, 12 of whom were in the test group (TG) and 13 of whom were in the control group (CG). SRP is conducted toward rapid implant assignment in the control site, while PDT as an adjunct to SRP (SRP + PDT) is executed prior to instant implant insertion in test sites. At the beginning, 4 months, 8 months, and 12 months, gingival index, radiovisiographs, inquiring pocket intensity, clinical attachment level, and plaque index were obtained. Basic durability was assessed after implant insertion, and the recovery index was measured a week later. In this analysis, Analysis of Variance (ANOVA) technique is used to predict tooth decay earlier. The CG experienced 1.10 mm of mean marginal bone loss after the 12-month research period, compared to 0.97 mm for the (SRP + PDT) group. After reaching the CG and TG, the differences in plaque score and probe depth were noteworthy. Clinical indicators compared to the basis in a year revealed unquestionable improvement, including the probing depth gingival index, plaque index and clinical attachment level. Twelve months were spent monitoring the implants in both groups. The little bone loss improved, although it isn't clinically important. The endurance rate for rapid implants in the PDT grouping is the same as that of the group that underwent SRP. The impact of PTD is utilized as a supplement to SRP. Yet, the consequence is marginal. Because of the improved results with PDT, it is used successfully as an addition to SRP.
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Affiliation(s)
- Sh Kumar
- 1Department of prosthodontics and crown & bridge, TMDC & RC, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - S Yadav
- 2Department of Pharmacy, Noida Institute of Engineering and Technology (Pharmacy Institute), Uttar Pradesh, India
| | - K Patel
- 3Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - R Jyothi
- 4Department of Life Sciences, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - B Kumar
- 5School of Pharmacy & Research, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - V Patidar
- 6Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
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19
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Jain G, Patel K, Shah U, Sasi M, Sarna S, Singh S. INNOVATIONS IN FOCUS: MECHANISTIC DISEASE THEORIES, CLIMATE DYNAMICS, AND HOST-PARASITE ADAPTATIONS. Georgian Med News 2023:186-192. [PMID: 38096538] [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: 12/18/2023]
Abstract
Infectious illnesses are predicted to experience a range of intricate responses from climate change, with some likely to rise, others to fall and many expected to undergo changes in prevalence. The study uses extensive data on global temperature variations and infectious illness transmission in people and animals. We now know a lot more about how the temperature changes across the world and whether or not the spread of infectious diseases impacts people as well as animals. Three primary topics of research are investigated in this paper: improving mechanical disease modelling, investigating the role of environmental variation in sickness dynamics, and understanding the consequences of temperature imbalances between parasites and hosts. By incorporating the latest data stemming from these advancements into weather-disease models and bridging critical knowledge gaps, enhancing our ability to forecast the probable effect of rising temperatures on the prevalence of diseases among both human and animal communities is possible. Through the establishment of important information gaps and the incorporation of new findings into models of climate-disease relationships, it will be possible to predict the effects of changes in climatic averages, variations and extremes on people and wildlife health.
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Affiliation(s)
- G Jain
- 1Department of Computer Science and Business Systems, Noida Institute of Engineering and Technology, Greater Noida, Uttar Pradesh, India
| | - K Patel
- 2Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - U Shah
- 3Department of Genetics, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - M Sasi
- 4School of Agriculture, Dev Bhoomi Uttarakhand University, Dehradun, India
| | - S Sarna
- 5Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, India
| | - S Singh
- 6Department of Microbiology, TMMC&RC, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
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20
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Patel K, Rydzewski NR, Schott EE, Cooley-Zgela TC, Ning H, Cheng JY, Pinto PA, Salerno KE, Lindenberg L, Mena E, Turkbey B, Choyke P, Citrin DE. A Phase I Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e426-e427. [PMID: 37785396 DOI: 10.1016/j.ijrobp.2023.06.1587] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Locally recurrent prostate cancer after radiotherapy (RT) is an increasingly recognized entity with no standard management. NCT03253744 was a phase I trial with a primary objective of identifying the maximally tolerated dose (MTD) of a course of image-guided, focal, salvage stereotactic body radiotherapy (SBRT) for patients with local recurrence after prior definitive RT. Additional objectives included biochemical control and imaging response on mpMRI and 18F-DCFPyL (PSMA) PET/CT. MATERIALS/METHODS SBRT was prescribed to three dose levels (DLs): 40Gy (DL1), 42.5Gy (DL2), and 45Gy (DL3) in 5 fractions. The prescription dose was delivered to a PTV defined by mpMRI and PSMA imaging and biopsy confirmed tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities above baseline were scored using CTCAE v5.0 criteria for two years after completion of SBRT. Escalation was halted if 2 dose limiting toxicities (DLTs) were observed. DLTs were defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT, and any grade 3 GU or grade 4 GI toxicity thereafter. Imaging response was compared between baseline and 6-months by the Wilcoxon signed rank test. RESULTS Between 08/2018 and 05/2022, 8 patients underwent salvage SBRT to 11 intraprostatic lesions with a median follow-up of 27 months. No DLTs were observed on DL1. Two patients were enrolled on DL2 and both experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) on DL1, the MTD. The most common toxicities were grade 2 GU toxicities: acute urinary urgency/frequency, acute weak urinary stream, and noninfective cystitis. One patient at DL1 had a self-limited episode of grade 2 GI toxicity (proctitis). No grade 3 GI toxicities were observed. All but two patients achieved an undetectable PSA nadir. Only one of these experienced biochemical failure (nadir + 2.0) at 33 months with suspicion of distant metastatic failure on restaging PET/CT. Imaging response was demonstrated by MRI in all lesions with heterogeneity in volumetric response (6% to 100%). A significant (p<0.01) response on PSMA PET/CT was observed for all measured parameters (SUVMax, SUVMean, GTVPSMA, Total Lesion PSMA [SUVMean × GTVPSMA]). Of the 11 lesions, 1 (9%) demonstrated a complete response (CR) by MRI and 9 (82%) by PSMA PET/CT. A single lesion increased in volume by 0.06 cc (16%) at 6-month PSMA PET/CT compared to baseline in the only patient who did not achieve an undetectable PSA nadir and did not have imaging suggestive of distant failure. CONCLUSION On this phase I dose escalation study of salvage SBRT for isolated intraprostatic local failure after definitive RT, the MTD was 40Gy in 5 fractions. producing a 100% 24-month bPFS, with one late failure at 33 months occurring after the 24-month study period. The most frequent clinically significant toxicity was late grade 2 GU toxicity. Imaging response was demonstrated in all lesions on MRI and PSMA PET/CT with exception of a single lesion.
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Affiliation(s)
- K Patel
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - N R Rydzewski
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - E E Schott
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - T C Cooley-Zgela
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - H Ning
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - J Y Cheng
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - P A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - K E Salerno
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - L Lindenberg
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - E Mena
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - B Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD
| | - P Choyke
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - D E Citrin
- Radiation Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
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21
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Ponce SEB, Small CJ, Ahmad T, Patel K, Tsai S, Kamgar M, George B, Kharofa JR, Saeed H, Dua KS, Clarke C, Aldakkak M, Evans DB, Christians K, Paulson ES, de Choudens SO, Erickson BA, Hall WA. Patterns of Locoregional Pancreatic Cancer Recurrence after Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e284-e285. [PMID: 37785058 DOI: 10.1016/j.ijrobp.2023.06.1270] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Neoadjuvant treatment for patients with localized pancreatic adenocarcinoma (PDAC) has improved survival duration. As survival increases, local disease control becomes even more important. We sought to understand the patterns of locoregional recurrence following total neoadjuvant therapy (TNT) and determine the impact of treatment volumes on recurrence. MATERIALS/METHODS Patients with PDAC managed with neoadjuvant chemotherapy and chemoradiation (TNT) followed by surgery who developed an isolated locoregional or simultaneously locoregional and distant recurrence were identified. Locoregional recurrences were individually contoured utilizing commercially available software. When available, original neoadjuvant dose distributions were registered to the scans on which the locoregional recurrences were contoured. Recurrences where then classified as in-field (> 95% of prescription dose), marginal (50-95% of prescription dose), or out of field (< 50% of prescription dose). Target volumes were created using four commonly utilized PDAC contouring guidelines to characterize the relationship of the local recurrence to the RT dose distribution. RESULTS Of 474 patients treated with TNT and surgery, 80 (17%) patients developed a locoregional recurrence with or without distant recurrence, visible on diagnostic imaging. Of the 80 patients, 56 (70%) had tumors in the pancreatic head; 46 (57.5%) were borderline resectable, 23 (28.8%) locally advanced, and 11 (13.6%) resectable. The most common initial neoadjuvant therapies were FOLFIRINOX (57.5%) and gemcitabine/nab-paclitaxel (18.8%). Chemoradiation included concurrent gemcitabine (47.5%) or 5-fluorouracil (26.3%). RT dose distributions were available for 38 patients; 22 (57.9%) had in-field failures, 9 (23.7%) marginal failures, and 7 (18.4%) out of field failures. Each published contouring atlas covered a relatively low percentage of recurrences, which are summarized in Table 1. Regions at particularly high likelihood of recurrence that were under covered on existing atlases included: aortic-diaphragmic junction, retro-pancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery (SMA). CONCLUSION We present the largest series (to our knowledge) of mapped locoregional recurrences for patients being treated with TNT in PDAC. These recurrences differ substantially from established atlases and highlight anatomical regions of highest priority for RT coverage. A novel visual contouring volume highlighting these regions will be presented which will strive to advance the use of RT in the TNT setting.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C J Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Ahmad
- Medical College of Wisconsin, Milwaukee, WI
| | - K Patel
- Medical College of Wisconsin, Milwaukee, WI
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Kamgar
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - B George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J R Kharofa
- University of Cincinnati, Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, OH
| | - H Saeed
- Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL
| | - K S Dua
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI
| | - C Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - D B Evans
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - K Christians
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - S Ortiz de Choudens
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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22
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Raja H, Patel K. Functional endoscopic sinus surgery: assessing the readability and quality of online information. Ann R Coll Surg Engl 2023; 105:639-644. [PMID: 36374281 PMCID: PMC10471431 DOI: 10.1308/rcsann.2022.0123] [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] [Accepted: 08/11/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the readability and quality of online information on functional endoscopic sinus surgery (FESS). METHODS The term 'functional endoscopic sinus surgery' was entered into the Google, Bing and Yahoo search engines. The first 30 websites for each search engine were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade (FKG), Simple Measure of Gobbledygook (SMOG) Index, and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated. RESULTS Thirty-three websites met the inclusion criteria. The mean and standard deviations for the FRES, FKG, SMOG, GFI, and DISCERN scores were 49 (13.1), 10.9 (2.5), 10.2 (1.9), 13.6 (2.4), and 51.1 (12.8), respectively. A positive correlation was noted between the FRES and DISCERN (R=0.357, p=0.041). CONCLUSIONS Online information on FESS is generally written above the recommended reading levels and of fair quality.
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Affiliation(s)
- H Raja
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - K Patel
- University Hospitals Birmingham NHS Foundation Trust, UK
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23
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Boretto P, Patel NH, Patel K, Rana M, Saglietto A, Soni M, Ahmad M, Sin Ying Ho J, De Filippo O, Providencia RA, Hyett Bray JJ, D’Ascenzo F. Prognosis prediction in cardiac amyloidosis by cardiac magnetic resonance imaging: a systematic review with meta-analysis. Eur Heart J Open 2023; 3:oead092. [PMID: 37840586 PMCID: PMC10575621 DOI: 10.1093/ehjopen/oead092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.
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Affiliation(s)
- Paolo Boretto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Neal Hitesh Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Keval Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mannat Rana
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Andrea Saglietto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Manas Soni
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Jamie Sin Ying Ho
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Ovidio De Filippo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Rui Andre Providencia
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
| | - Jonathan James Hyett Bray
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
- Institute of Life Sciences-2, Swansea Bay University Health Board and
Swansea University Medical School, Swansea University, 4
Mumbles Rd, Sketty, SA3 5AU Swansea, UK
| | - Fabrizio D’Ascenzo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
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24
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Khan Z, Krishna D, Daga S, Rastogih N, Rekha M, Patel K. ADVANCEMENTS IN MINIMALLY INVASIVE SURGERY: A COMPREHENSIVE ANALYSIS OF ROBOTIC SURGERY, ENDOSCOPIC TECHNIQUES, AND NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY. Georgian Med News 2023:87-92. [PMID: 37805880] [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
The term "Natural Orifice Transluminal Endoscopic Surgery" (NOTES) defines a surgical approach that leverages the body's natural orifices to access the abdominal cavity, presenting a patient-centric perspective by highlighting its potential to eliminate abdominal wall aggression, mitigate postoperative discomfort, and offer benefits comparable to laparoscopic surgery. This comprehensive paper aims to not only review the existing landscape of NOTES techniques but also to propose advancements in flexible tools augmenting established endoscopic platforms, while also exploring the revolutionary concept of robotic structures grounded in micromechatronics and communication technologies. The thorough analysis encompasses the assessment of advantages and limitations associated with flexible devices and robotic platforms, coupled with an in-depth evaluation of the current array of devices used in NOTES, informed by pertinent literature. The authors' comprehensive approach entails scrutinizing technological breakthroughs and offering viable solutions, fostering a comprehensive understanding. Furthermore, the study encompasses an exhaustive evaluation and juxtaposition of state-of-the-art NOTES devices, supplemented by a nuanced discourse on the merits and demerits of flexible devices and robotic platforms, with a focused emphasis on their inherent strengths and weaknesses. Within this context, the discourse extends to strategic suggestions aimed at refining extant designs and cultivating robust, dependable autonomous robotic platforms purpose-built for NOTES. This narrative encapsulates the multifaceted exploration of benefits, challenges, and potential remedies directed towards enhancing prevailing designs and forging a dependable foundation for the future of NOTES.
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Affiliation(s)
- Z Khan
- 1Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - D Krishna
- 2Department of Ayurveda, Sanskrit University, Mathura, Uttar Pradesh, India
| | - S Daga
- 3Department of Forensic Science, Vivekananda Global University, Jaipur, India
| | - N Rastogih
- 4Department of General Surgery, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - M Rekha
- 5Department of Chemistry & Biochemistry, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - K Patel
- 6Department of Gynaecology, Parul University, PO Limda, Tal.Waghodia, District Vadodara, Gujarat, India
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25
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Kumar V, Bhongade R, Kumar V, Mathur P, Patel K, Jyothi R R. POSTCHOLECYSTECTOMY SYNDROME: UNDERSTANDING THE CAUSES AND DEVELOPING TREATMENT STRATEGIES FOR PERSISTENT BILIARY SYMPTOMS AFTER GALLBLADDER REMOVAL. Georgian Med News 2023:290-296. [PMID: 37805914] [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
Persistent biliary symptoms following gallbladder removal, known as postcholecystectomy (PCS), can significantly impact patients' quality of life. The term PCS describes biliary symptoms that emerge or continue after the surgical removal of the gallbladder. Cholecystectomy is generally a safe procedure; however, some individuals may still experience symptoms of the biliary system thereafter. Biliary stones are more likely to be retained in patients who arrive later. Many of those people won't have a known reason for their condition. Therefore, this group will have fewer therapy alternatives. After a cholecystectomy, up to 10% of individuals may develop PCS. Patients with cholecystectomy procedures can appear with extra-biliary and associated biological illnesses. A wide range of therapeutic options are available for PCS, each having a different chance of being the cause of the condition. The purpose of this study is to present an overview of the many causes of PCS, as well as the effectiveness and prevalence of various treatments. PCS has a variety of etiologies, many of which may be related to extra-biliary reasons that may exist before the operation. From the beginning, an endoscopy of the upper gastrointestinal tract may be necessary when symptoms first appear. Biliary rocks are more likely to be retained in patient presentations that are postponed. PCS has various causes, including extra-biliary conditions that could have existed before operations. Initial symptoms might involve higher digestive problems. As a result, this group will only have a few therapeutic alternatives.
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Affiliation(s)
- V Kumar
- 1Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - R Bhongade
- 2Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - V Kumar
- 3Department of General Surgery, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
| | - P Mathur
- 4Department of General Surgery, Jaipur National University, Jaipur, India
| | - K Patel
- 5Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - R Jyothi R
- 6Department of Life Science, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
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Yadkikar S, Patel K, Jyothi R R, Swami R, Bhargavan S, Bishnoi S. INNOVATIONS IN ORTHOPEDIC SURGERY: MINIMALLY INVASIVE TECHNIQUES FOR JOINT REPLACEMENT AND REPAIR. Georgian Med News 2023:165-169. [PMID: 37805892] [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
The scientists compared the outcomes of a minimally invasive operation approach (MIO) to a conventional poster lateral (PL) method in overall hip replacement (OHR) in terms of itchiness, damage to muscles, and bleeding. The factors that researchers examined were the levels of Haemoglobin (Hg), a marker for oxygen depletion, the quantity of Interleukin-6 (IL6), a marker for inflammation, the heart-type fatty acid binding protein (HTFABP), and the health of the muscles. The study's findings showed that IL6 content increased beyond pre-operative levels as a result of the two surgeries. At 6 hours after surgery, the mean IL6 concentration in the PL group was 79.6 pg/ml while in the MIO group it was 76.4 pg/ml. The highest values after 24 hours of therapy were 100 pg/ml in the PL group and 92.3 pg/ml in the MIO category. In each category, IL6 levels had dropped up to this point. The post-operative mean HTFABP concentration in the MIO organization was greater (12.5 mg/l) than in the PL organization (18.3 mg/l) in terms of muscle damage. One day after surgery, however, it reached an apex and began to decline in both groups. The amounts of Hg lost throughout the procedure decreased for both sets. 12.5 g/dl of mercury was present. The MIO grouping had PL 72 hours following a procedure, while the PL grouping had 10.3 g/dl. Between the two surgical methods, there were no obvious differences in bleeding, muscle damage, or edema. These results led the researchers to draw the conclusion that there were little differences between the MIO anterior method and the traditional PL technique in terms of muscle damage, blood loss, or irritability. The lack of a learning curve in the study may account for the lack of alterations seen, they hypothesized, rendering the use of the term "MIO" in describing the approach as less traumatizing dubious. The study's methodology, sample sizes, and all other relevant material were left out, making it impossible to evaluate the study's validity and generalizability in its entirety.
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Affiliation(s)
- S Yadkikar
- 1Department of Orthopedics, Jaipur National University, Jaipur, India
| | - K Patel
- 2Department of Gynaecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - R Jyothi R
- 3Department of Life Science, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - R Swami
- 4Department of Allied Health Science, IIMT University, Meerut, Uttar Pradesh, India
| | - S Bhargavan
- 5Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - S Bishnoi
- 6Department of Orthopaedics, TeerthankerMahaveer University, Moradabad, Uttar Pradesh, India
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Jain S, Patel K, Ganapathy K, Khan F, Sahu S, Singh A. LAPAROSCOPIC APPROACH TO A GIANT RUPTURED SPLENIC CYST: A CHALLENGING CASE REPORT. Georgian Med News 2023:280-283. [PMID: 37805912] [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
Splenic cysts are rare; their absence of an epithelial wall determines whether they're real cysts or pseudocysts. Spontaneous nonparasitic actual tumors are those that develop early in life at the anterior pole of the splenic and are typically epidermoid, dermoid, or endodermal. Surgical therapy is suggested for symptomatic, large (more than 5 cm) cysts or complicated. Inhaling splenic excision is a substitute for surgery, depending on the quantity, location, connection to the hilus, and dimension of the tumors. With an emphasis on less invasive treatments that preserve the spleen, laparoscopic methods have already established themselves as the accepted method for treating numerous disorders, including splenic cysts. They describe the effective decapsulation of a massive epidermoid spleen tumor under a prolonged, partially endoscopic technique. Laparoscopy, an operation commonly referred to as surgery with minimally invasive or keyhole surgery, is a technique that makes many tiny incisions in the belly to carry out different surgical procedures.
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Affiliation(s)
- S Jain
- 1Department of General Surgery, Jaipur National University, Jaipur, India
| | - K Patel
- 2Department of Gynecology, Parul University, PO Limda, Tal. Waghodia, District Vadodara, Gujarat, India
| | - K Ganapathy
- 3Department of Biotechnology, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
| | - F Khan
- 4Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - S Sahu
- 5Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - A Singh
- 6Department of General Surgery, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India
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28
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Murray MJ, Bradley E, Ng Y, Thomas O, Patel K, Angus C, Atkinson C, Reeves MB. In silico interrogation of the miRNAome of infected hematopoietic cells to predict processes important for human cytomegalovirus latent infection. J Biol Chem 2023; 299:104727. [PMID: 37080390 PMCID: PMC10206818 DOI: 10.1016/j.jbc.2023.104727] [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] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023] Open
Abstract
Human cytomegalovirus (HCMV) latency in CD34+ progenitor cells is the outcome of a complex and continued interaction of virus and host that is initiated during very early stages of infection and reflects pro- and anti-viral activity. We hypothesized that a key event during early infection could involve changes to host miRNAs, allowing for rapid modulation of the host proteome. Here, we identify 72 significantly upregulated miRNAs and three that were downregulated by 6hpi of infection of CD34+ cells which were then subject to multiple in silico analyses to identify potential genes and pathways important for viral infection. The analyses focused on the upregulated miRNAs and were used to predict potential gene hubs or common mRNA targets of multiple miRNAs. Constitutive deletion of one target, the transcriptional regulator JDP2, resulted in a defect in latent infection of myeloid cells; interestingly, transient knockdown in differentiated dendritic cells resulted in increased viral lytic IE gene expression, arguing for subtle differences in the role of JDP2 during latency establishment and reactivation of HCMV. Finally, in silico predictions identified clusters of genes with related functions (such as calcium signaling, ubiquitination, and chromatin modification), suggesting potential importance in latency and reactivation. Consistent with this hypothesis, we demonstrate that viral IE gene expression is sensitive to calcium channel inhibition in reactivating dendritic cells. In conclusion, we demonstrate HCMV alters the miRNAome rapidly upon infection and that in silico interrogation of these changes reveals new insight into mechanisms controlling viral gene expression during HCMV latency and, intriguingly, reactivation.
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Affiliation(s)
- M J Murray
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom.
| | - E Bradley
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - Y Ng
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - O Thomas
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - K Patel
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - C Angus
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - C Atkinson
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom
| | - M B Reeves
- Institute of Immunity & Transplantation, Division of Infection & Immunity, Royal Free Campus, UCL, London, United Kingdom.
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Patel K. Introducing clinical mindlines: A discussion of professional knowledge sharing in clinical radiography education. Radiography (Lond) 2023; 29:577-581. [DOI: 10.1016/j.radi.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
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Banday M, Qureshi M, Patel K, Movval N, Sharma N. Endothelial Derived IL-33 Induces Fibrogenesis and is Associated with CLAD. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Thalia N, Patel K, Patel N. Nationwide Utilization, Cost, and Outcome of Temporary Mechanical Circulatory Support in Takotsubo Cardiomyopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Perry C, Budweg JB, Stein AP, Harder J, Gupta S, Nusbickel AJ, Smoot M, Patel K, Winchester DE. Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities. Am J Med 2023; 136:350-354. [PMID: 36566899 DOI: 10.1016/j.amjmed.2022.12.003] [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: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
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Affiliation(s)
| | | | | | | | - Shishir Gupta
- University of Florida College of Medicine, Gainesville
| | | | | | - Keval Patel
- University of Florida College of Medicine, Gainesville
| | - David E Winchester
- University of Florida College of Medicine, Gainesville; Cardiology Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla.
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Huddleston S, Hertz M, Loor G, Garcha P, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. Impact of National OCS Lung Procurement & Management Program on Post-Transplant Survival - Real World Data from the Thoracic Organ Perfusion (TOP) Post-Approval Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Banday M, Patel K, Qureshi M, Movval N, Sharma N. Distinct Airway Virome Signatures are Associated with CLAD and Modulate Airway Interferon Responses. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Patel K, Nguyen D, Graviss E, Bhimaraj A, Kassi M, Kim J, Guha A. The Impact of Donation after Circulatory Death Heart Transplants on Waitlist Time: A UNOS Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Patel K, Yadalam A, DeStefano R, Almuwaqqat Z, Desai S, Alkhoder A, Ejaz K, Alvi Z, Book W, Gupta D, Quyyumi A. Lipoprotein(a) Levels Predict Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Logan A, Heiman E, Qureshi M, Patel K. Evaluation of Immunosuppressant Drug Tolerability and Infections in Lung Transplant Recipients with Short Telomere Syndrome. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Loor G, Garcha P, Huddleston S, Hertz M, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. Impact of OCS Lung Warm Perfusion Times on Post-Transplant Survival - "Real-World" Experience from Thoracic Organ Perfusion (TOP) Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Patel K, Gupta N, Prajapati BJ, Prajapati A, Sharma S, Rathava D. Study on Effects of Sublingual Immunotherapy in Allergic Rhinitis Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:804-808. [PMID: 37206799 PMCID: PMC10188826 DOI: 10.1007/s12070-022-03366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
Allergic Rhinitis is one of the most common allergic disease and characterized by sneezing, rhinorrhea, nasal congestion and nasopharyngeal itching. The initial management includes pharmacological treatment and the patients who are refractory to pharmacological treatment are then reffered for immunotherapy. SLIT has been widely used for treatment of allergic rhinitis and has proven its clinical efficacy. The objective of the present study was to assess the clinical effects, safety and tolerability of sublingual immunotherapy (SLIT) among the patients suffering from allergic rhinitis. The study was conducted from Aug 2018 to April 2021 and 40 patients with convincing history, positive skin prick test to one or more allergen extracts were recruited. SLIT was conducted with antigens (mix), namely dust mites, tree pollens, grass pollens and weed pollens in patients of allergic rhinitis for 1 year. There was significant improvement in quality of life and symptoms severity(Nasal and Non-Nasal) from base line to end of 1 year. SLIT lowers the total IgE, absolute eosinophilic count and medication requirement. Sublingual Immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and sensitivity to multiple allergen.
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Affiliation(s)
- Keval Patel
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Nandini Gupta
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Bela J. Prajapati
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Arpit Prajapati
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Shweta Sharma
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
| | - Dhara Rathava
- Department of OtoRhinoLaryngology Civil Hospital, Ahmedabad, Gujarat India
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Loor G, Garcha P, Huddleston S, Hertz M, Hartwig M, Snyder L, Siddique A, Strah H, Kukreja J, Song T, Jablonski R, Smith M, Walia R, Arjuna A, Lozonschi L, Patel K, Katlaps G, Nemeh H, Suarez E, Huang H, Langer N, Madsen J, Lee A, Dhillon G, MacArthur J, Keshavamurthy S, Nandavaram S, Daneshmand M, Neujahr D, Bush E, Joyce D, Ardehali A, Budev M, McCurry K. First Report of the Organ Care System (OCS) Thoracic Organ Perfusion (TOP) Post-Approval Registry. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Zheng K, Onofrio F, Xu C, Chen S, Xu W, Vyas M, Bingham K, Patel K, Lilly L, Selzner N, Jaeckel E, Tsien C, Gulamhusein A, Hirschfield GM, Bhat M. A42 LIVE DONOR LIVER TRANSPLANTATION IN PRIMARY SCLEROSING CHOLANGITIS: AN INDICATOR OF AN ORGAN ALLOCATION SYSTEM NOT ADDRESSING PATIENT NEED. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991265 DOI: 10.1093/jcag/gwac036.042] [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: 03/09/2023] Open
Abstract
Background Liver transplantation is frequently lifesaving for people living with primary sclerosing cholangitis (PSC). However, patients are waitlisted for liver transplant (LT) according to the MELD-Na score, which may not accurately reflect the burden of living with PSC. Purpose We sought to describe and analyze the clinical trajectory for patients with PSC referred for LT, in a mixed deceased donor/live donor transplant programme. Method This was a retrospective cohort study from November 2012 to December 2019 including all patients with PSC referred for assessment at the University Health Network Liver Transplant Clinic. Patients who required multiorgan transplant or re-transplantation were excluded. Liver symptoms, hepatobiliary malignancy, MELD-Na progression, and death were abstracted from chart review. Competing Risk analysis was used for timing of LT, transplant type, and death. Result(s) Of 172 PSC patients assessed, 144 (84%) were listed, of whom 106/144 (74%) were transplanted. Mean age was 47.6 years and 66% were male. During follow-up through to 2021, 23/144 (16%) were removed from the waitlist due to infection, clinical deterioration, liver-related mortality or new cancer; 3 had clinical improvement. At the time of listing, 118/144 (81.95%) had a potential Living Donor (pLD) of whom 94 were transplanted: 64 live donor and 30 deceased donor. Patients with pLD had 79% lower mortality (p<0.001), and higher rates of transplantation (80% vs 46%). Exception points were granted to 13/172 (7.5%) patients. Conclusion(s) In a high-volume North American liver transplant centre, most patients with PSC assessed for transplant were listed and subsequently transplanted. However, this was a consequence of patients engaging in live donor transplantation. Our findings support the concern from patients with PSC that MELD-Na allocation does not adequately address their needs. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; This study was supported by PSC Partners Canada, Canadian Institutes of Health Research (CIHR), Toronto General and Western Hospital Foundation. Disclosure of Interest None Declared
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Affiliation(s)
- K Zheng
- Faculty of Medicine, University of Toronto
| | - F Onofrio
- Ajmera Transplant Program, University Health Network,
| | - C Xu
- Ajmera Transplant Program, University Health Network
| | - S Chen
- Biostatistics Department, Princess Margaret Cancer Center
| | - W Xu
- Biostatistics Department, Princess Margaret Cancer Center
| | | | | | - K Patel
- Ajmera Transplant Program, University Health Network,
| | - L Lilly
- Ajmera Transplant Program, University Health Network,
| | - N Selzner
- Ajmera Transplant Program, University Health Network
| | - E Jaeckel
- Ajmera Transplant Program, University Health Network,
| | - C Tsien
- Ajmera Transplant Program, University Health Network
| | - A Gulamhusein
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Canada
| | - G M Hirschfield
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Canada
| | - M Bhat
- Ajmera Transplant Program, University Health Network,,Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Canada
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Bredenoord AJ, Dellon ES, Lucendo AJ, Collins MH, Khodzhayev A, Sun X, Patel K, Beazley B, Shabbir A. A141 DUPILUMAB IMPROVES CLINICAL, SYMPTOMATIC, ENDOSCOPIC, AND HISTOLOGIC ASPECTS OF EOE, REGARDLESS OF PRIOR SWALLOWED TOPICAL STEROID USE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991093 DOI: 10.1093/jcag/gwac036.141] [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: 03/09/2023] Open
Abstract
Background Swallowed topical corticosteroids (STC) are a first-line treatment for eosinophilic esophagitis (EoE) but are not uniformly effective. Dupilumab (DPL), a fully human monoclonal antibody, blocks the shared receptor component for IL-4/IL-13, key and central drivers of type 2 inflammation. In Parts A and B of the phase 3 LIBERTY-EoE-TREET (NCT03633617) study, weekly DPL 300mg improved clinical, symptomatic, histologic, and endoscopic aspects of EoE and was generally well tolerated in adult and adolescent patients (pts) with EoE. Purpose To assess the efficacy of weekly DPL 300mg vs placebo (PBO) at Week 24 in pts from Parts A and B with/without prior history of STC use, and from Part B with/without a history of inadequate response, intolerance, or contraindication to STCs. Method Pts who received STCs for EoE within 8 weeks prior to baseline were excluded from the study. Co-primary endpoints at Week 24 were the proportion achieving peak eosinophil count (PEC) ≤6/high-power field (hpf) and the absolute change in Dysphagia Symptom Questionnaire (DSQ) score. Other secondary endpoints at Week 24 included: % change in PEC; absolute change in Histologic Scoring System (HSS) grade and stage scores and Endoscopic Reference Score (EREFS); % change in DSQ score. Result(s) At baseline, in Parts A and B combined, 84/122 (69%) and 87/118 (74%) of DPL- and PBO-treated pts had history of STC use. For pts treated with DPL vs PBO PEC≤6/hpf was achieved by 59.5% vs 3.4% of pts with, and 57.9% vs 12.9% without, prior STC use. Difference vs PBO (95% CI) in the absolute change in DSQ score was −13.27 (−18.03, −8.50) vs −5.21 (−12.41, 2.00) for pts with/without prior STC use. Difference vs PBO (95% CI) for pts with/without prior STC use were: % change in PEC −80.76 (−97.77, −63.75)/−84.87 (−112.16, −57.58); absolute change in EoE-HSS grade −0.77 (−0.87, −0.66)/−0.57 (−0.77, −0.38) and stage −0.77 (−0.87, −0.66)/−0.55 (−0.73, −0.36); absolute change in EREFS −3.86 (−4.70, −3.02)/−2.59 (−4.16, −1.02); % change in DSQ −34.5 (−47.75, −21.22)/-14.9 (−35.21, 5.36). DPL was generally well tolerated in the intent-to-treat population; the most common TEAEs for DPL/PBO were injection-site reactions (37.7/33.3%). In Part B, 38/80 (48%) and 39/79 (49%) of DPL- and PBO-treated pts had inadequate response/intolerance/contraindication to STCs. For DPL vs PBO PEC≤6/hpf was achieved by 55.3% vs 7.7% with, and 61.9% vs 5.0% of pts without, inadequate response/intolerance/contraindication to STC. Difference vs PBO (95% CI) for absolute change in DSQ score was −11.55 (−19.06, −4.04)/−7.08 (−13.75, −0.42) for pts with/without inadequate response/intolerance/contraindication to STCs. Conclusion(s) Conclusion: Regardless of prior STC use, in this pooled analysis from Part A and Part B of the EoE TREET Phase 3 Study, weekly DPL 300mg demonstrated substantial improvements in clinical, histologic, and endoscopic study endpoints at Week 24 in adults and adolescents with EoE. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Research sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Disclosure of Interest A. Bredenoord Shareholder of: SST, Grant / Research support from: Bayer, Nutricia, SST, Consultant of: Arena Pharmaceuticals, AstraZeneca, Calypso Biotech, Dr Falk, EsoCap, Gossamer Bio, Laborie, Medtronic, RB Pharma, Regeneron Pharmaceuticals, Inc., Robarts Clinical Trials, E. Dellon Grant / Research support from: Research funding; Adare Pharma Solutions, Allakos, GSK, Meritage Pharma, Miraca Life Sciences, Nutricia, Receptos/BMS, Regeneron Pharmaceuticals, Inc., Shire. Educational grant; Allakos, Banner Pharmaceuticals, Holoclara, Consultant of: Abbott, Adare Pharma Solutions, Aimmune Therapeutics, Alivio Therapeutics, Allakos, Arena Pharmaceuticals, AstraZeneca, Banner Pharmaceuticals, Biorasi, Calypso Biotech, Enumeral, EsoCap, Gossamer Bio, GSK, Receptos/BMS, Regeneron Pharmaceuticals, Inc., Robarts Clinical Trials, Salix Pharmaceuticals, Shire/Takeda, A. Lucendo Grant / Research support from: Dr Falk, Regeneron Pharmaceuticals, Inc., Consultant of: Dr Falk, EsoCap, M. Collins Grant / Research support from: Receptos/BMS, Regeneron Pharmaceuticals, Inc., Shire, Consultant of: Allakos, AstraZeneca, BMS, EsoCap, Regeneron Pharmaceuticals, Inc., Shire, A. Khodzhayev Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., X. Sun Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., K. Patel Employee of: Sanofi, B. Beazley Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., A. Shabbir Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc.
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Affiliation(s)
- A J Bredenoord
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - E S Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - A J Lucendo
- Hospital General de Tomelloso, Tomelloso, Spain
| | - M H Collins
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - X Sun
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - K Patel
- Sanofi, Bridgewater, NJ, United States
| | - B Beazley
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
| | - A Shabbir
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY
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Patel K, Eissa M, Nguyen VV, Abraldes JG, Shaheen AA, Theal J, Johnson E, Hyde A, Tandon P. A64 THE UPTAKE AND IMPACT OF AN ELECTRONIC CIRRHOSIS ADMISSION ORDER SET: AN EARLY EXPERIENCE AT A SINGLE CENTRE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991358 DOI: 10.1093/jcag/gwac036.064] [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: 03/09/2023] Open
Abstract
Background Cirrhosis is a chronic disease that confers high morbidity and mortality. It is a leading cause for hospital admissions and leads to significant healthcare resource utilization. Several guidelines outline recommendations to provide best practice to hospitalized patients with cirrhosis. Despite studies supporting a reduction in mortality when guideline based care is followed, this is achieved in less than 50% of hospitalized patients with cirrhosis1. Standardized electronic order sets can be a potential tool to improving clinical outcomes and bridging this gap in care. Purpose Since March 2021, an electronic cirrhosis admission order set has been available for at our hospital site. Using administrative data, we aimed to describe our early experience with: a) order set uptake by various services, b) characteristics of the population in which the order set was used versus not used, and explore c) the impact of order set use on in-hospital mortality. Method In this single centre cohort study, patients with cirrhosis were identified based an administrative data algorithm containing codes for cirrhosis and complications. This data was used to retrieve parameters such as patient age, sex, primary admitting service, resource intensity weight (RIW), Charlson comorbidity index (CCI) and in-hospital mortality. The chi-squared test and independent samples t-test were used to compare characteristics of patients in whom the order set was used versus not used. Multivariable logistic regression was used to determine the impact of order set use on in-hospital mortality. P value significance was established at <0.05. Result(s) A total of 825 patients were included in the analysis. The overall mean age (standard deviation) of patients was 58.5 (14.2) years with 57.5% being male. Average length of stay was 11.3 days with a mean CCI of 3.2 (2.3) and RIW of 3.3 (7.2). The primary admitting service was Gastroenterology in 36.1%, Internal Medicine in 35.6% and other services in 28.3% of cases. Of those admitted, the order set was used in 27.2% of cases. The overall in-hospital mortality of patients was 14.2%. Mean age, sex and CCI were not significantly different in patients admitted with the order set versus without. In patients admitted with the order set compared to without, RIW was significantly lower (2.06 (2.62) versus 3.80 (8.2), p<0.001), as was length of stay (9.5 (11.8) days compared to 12.0 (18.6) days, p =0.03) and in-hospital mortality (8.5% versus 16.3%, p =0.003). On multivariable regression analysis (Table 1), after adjustment for age, RIW and CCI, use of the order set was associated with lower in-hospital mortality (odds ratio 0.53 (95% CI 0.3 to 0.9), p=0.02). Image ![]()
Conclusion(s) Uptake of the electronic cirrhosis admission order set was modest at only 27% of eligible admissions. Although it appears to be associated with lower in-hospital mortality, a chart review is in process to assess if this association still holds after accounting for the impact of additional confounders. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- K Patel
- Department of Medicine, Division of Gastroenterology
| | - M Eissa
- Department of Medicine, University of Alberta, Edmonton
| | - V V Nguyen
- Department of Medicine, University of Alberta, Edmonton
| | - J G Abraldes
- Department of Medicine, Division of Gastroenterology
| | - A -A Shaheen
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - J Theal
- Department of Medicine, Division of Gastroenterology
| | - E Johnson
- Department of Medicine, Division of Gastroenterology
| | - A Hyde
- Department of Medicine, Division of Gastroenterology
| | - P Tandon
- Department of Medicine, Division of Gastroenterology
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Tay LJ, Makin R, Saxionis I, Dokubo I, Patel K, Sivathasan S, Smart S, Warren A, Shah N, Lamb BW. Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon. Journal of Clinical Urology 2023. [DOI: 10.1177/20514158231156314] [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: 03/05/2023]
Abstract
Introduction: The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). Patients and methods: All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Results: Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p < 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels < 0.1 ng/mL (85% versus 93%). Conclusion: Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. Level of evidence: 2.
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Affiliation(s)
- Li June Tay
- Department of Urology, Cambridge University Hospitals, UK
| | - Robert Makin
- Department of Urology, Cambridge University Hospitals, UK
| | | | - Ibi Dokubo
- Department of Urology, Cambridge University Hospitals, UK
| | - Keval Patel
- Department of Urology, University Hospitals Birmingham, UK
| | | | - Sonny Smart
- Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Anne Warren
- Department of Pathology, Cambridge University Hospitals, UK
| | - Nimish Shah
- Department of Urology, Cambridge University Hospitals, UK
| | - Benjamin W Lamb
- Department of Urology, University College London Hospitals NHS Trust, London, UK
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, UK
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45
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Jha S, Patel K. EXERCISE INDUCED COMPLETE HEART BLOCK- A DREADFUL CARDIAC MANIFESTATION OF SARCOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00588-0] [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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46
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Jha S, Patel K, Singal DK. EARLY DISSEMINATED LYME DISEASE PRESENTS WITH VARIABLE SEVERITY OF ATRIOVENTRICULAR BLOCK. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00689-7] [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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47
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Kalathia J, Patel K, Vala G, Agrawal S, Chipde S, Valiya A, Khetarpal A. Supine percutaneous nephrolithotomy under segmental epidural block in high risk compromised cardiovascular patients: A prospective analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00987-9] [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: 02/12/2023]
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48
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Zaman T, Patel K, Saricilar E, Lee V, Lurie B, Puttaswamy V. Evaluation of Endoleak After Endovascular Aortic Aneurysm Repair Using Subtraction Iodine Mapping. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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49
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Patel K, Davidson J, Walker R. Percutaneous threaded pin reduction of Bosworth fracture: a novel surgical technique. Ann R Coll Surg Engl 2023; 105:78-79. [PMID: 35446719 PMCID: PMC9773245 DOI: 10.1308/rcsann.2021.0363] [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] [Accepted: 11/05/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- K Patel
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - J Davidson
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - R Walker
- Guy's and St Thomas' NHS Foundation Trust, UK
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Beckmann R, Ning H, Cheng J, Zhuge Y, Patel K, Guion P, Zgela TC, Nathan D, Schott E, Citrin D, Salerno K. Comparison of Nodal CTV Coverage with Alignment to Bladder-Rectal Interface vs. Pelvic Bone in Post-Prostatectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1147] [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: 10/31/2022]
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