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Zou Y, Laothamatas K, Sonett J, Lemaitre P, Stanifer B, Magda G, Grewal H, Shah L, Robbins H, Patel S, Miller A, Anderson M, Costa J, D'Ovidio F, Arcasoy S, Benvenuto L. Effect of Age and Transplant Type on Survival and Hospital-Free Days in COPD Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1462] [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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Greissman S, Laothamatas K, Costa J, D'Ovidio F, Grewal H, Lemaitre P, Magda G, Miller A, Patel S, Robbins H, Shah L, Sonnett J, Stanifer B, Arcasoy S, Benvenuto L. Comparison of Post-Transplant Survival Between Lung-Kidney and Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1463] [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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Greissman S, Laothamatas K, Costa J, D'Ovidio F, Grewal H, Lemaitre P, Magda G, Miller A, Patel S, Robbins H, Shah L, Sonett J, Stanifer B, Arcasoy S, Benvenuto L. Lung Transplant Waitlist Outcomes Before and after 2021 LAS Revision. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1445] [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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Benvenuto L, Grewal H, Laothamatas K, Anderson M, Snyder M, Greissman S, Costa J, Shah L, Robbins H, Magda G, Sonett J, Lemaitre P, D'Ovidio F, Arcasoy S. Rapidly Declining Rates of Single Lung Transplant for COPD and ILD in the U.S. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1457] [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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Ribbits A, Bowyer C, Kori R, Uddin S, Subramanian A, Shah L. 703 Is the Grass Always Greener on the Other Side? – How Do Breast Cancer Patients Feel About Moving to a ‘Green Hub’? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
Between January and September 2020 our base hospital recorded zero COVID-19 incidence in breast surgery patients, in 30 days post-op, with stringent admission protocols including 14 days self-isolation, PCR testing, ‘green’ wards and designated ‘green’ theatres. However, as the UK entered its third lockdown in January 6th2021 the decision was made to move breast cancer surgery off-site to a ‘green hub’ 43 miles away. The aim of this study was to assess the impact this had on patients.
Method
Patients who had surgery moved off-site were requested to anonymously complete a questionnaire which was either posted or handed to them at follow-up. The questionnaire contained 11 Multiple Choice questions and a comments section.
Results
16 of 19 patients (84.21%) responded to the questionnaire. 16 of 16 (100%) understood the reason for the move. 2 (12.5%) stated that it increased anxiety/stress levels while 3 (18.75%) reported the opposite, and the remainder were neutral. 14 (87.5%) said the move made them feel safer, 1 (6.25%) did not feel safer, with the remaining 1 (6.25%) unsure. 15 (93.75%) felt they received enough information at base and 16 (100%) received sufficient discharge information at the ‘green hub’. All 16 (100%) were satisfied with the move off-site but only 15 (93.75%) supported the decision.
Conclusions
The responses indicate that the decision to move breast surgery off-site was supported and well understood. And while for a minority of patients this increased pre-operative anxiety/stress levels, it did make the majority feel safer.
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Affiliation(s)
- A Ribbits
- East Sussex NHS Trust , Hastings , United Kingdom
- Guy's and St Thomas’ NHS Trust , London , United Kingdom
| | - C Bowyer
- East Sussex NHS Trust , Hastings , United Kingdom
| | - R Kori
- East Sussex NHS Trust , Hastings , United Kingdom
| | - S Uddin
- East Sussex NHS Trust , Hastings , United Kingdom
| | | | - L Shah
- East Sussex NHS Trust , Hastings , United Kingdom
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Leiva-Juarez M, Briganti D, Urso A, Russum S, Benvenuto L, Robbins H, Shah L, Costa J, Gomez EA, Arcasoy S, Sonett J, D'Ovidio F. Large Airway Bronchial Wash Lipidomics as Novel Biomarkers for Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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7
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Shamanna P, Joshi S, Shah L, Dharmalingam M, Vadavi A, Damodaran S, Mohammed J, Mohamed M, Poon T, Keshavamurthy A, Mohamed T, Bhonsley S. Remission of T2DM by digital twin technology with reduction of cardiovascular risk: interim results of randomised controlled clinical trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): TWIN HEALTH INC
Background
Twin Precision Treatment (TPT) is a novel intervention designed to improve glycemia and reverse T2D using a Whole-Body Digital Twin (WBDT) platform powered by Artificial Intelligence and the Internet of Things. Technology enabled precision nutrition, a combination of macro, micro and biota nutrients, along with Continuous Glucose Monitoring (CGM) have been demonstrated to be a key for reversal of diabetes. WBDT platform captures 174 health markers and 3000 daily data points through a panel of blood tests and connected devices that measure weight, physical activity, sleep and BP. CGM is used initially and then the algorithm predicts personalized glucose responses from multiple inputs. Nutritional, physical activity and sleep counseling is through an app or phone to provide individualized meal plans that balance 87 macro, micro and probiotic nutrients to reduce glucotoxicity and lipotoxicity. Program physicians titrate medications and monitor metabolic outcomes.
Purpose
To assess the initial change, in glycemic, extra glycemic, cardiovascular parameters for patients who completed 3 months longitudinal follow up.
Methods
We performed an interim analysis [n = 173, 139 TWIN Intervention arm (T), 34 Control group (C)] of ongoing randomized controlled trial of TPT across India
Results
The mean age (years) in the T was 43.04 (±8.6, 95% CI 41.57 to 44.52) which was significantly less as compared to the C 51.4 (±9.6, 95% CI 48.3 to 54.5); p < 0.0001. The mean duration of diabetes (years) in the T was 3.5 (±2.6) which was comparable to the C 4.3 (±2.6); p = 0.12 ns. In the T there were 113 male (84.3%) and 21 female (15.6%) as compared to C, 15 male (38.4%) and 24 female (61.5%); p < 0.0001. The difference of change for HbA1c (%), small dense LDL-C sdLDL (mg/dL), TG/HDL Ratio, HOMA 2IR (%), Visceral Adiposity Index (VAI), Systolic BP (mmHg), BMI (kg/m2), Framingham Risk Score (%), in T when compared to C, were significant. The mean reduction HbA1c, sdLDL, HOMA 2IR, VAI, SBP, BMI, FRS in T was -3.2 % (8.8 to 5.6), -14.1 mg/dL, (52.6 to 38.5), -0.9 % (1.9 to 1), -2.3 (4.6 to 2.3), -10.3mmHg (128.4 to 118.1), -2.9 kg/m2 (27.1 to 24.2), -7.9% (16 to 8.1), respectively. (figure) At baseline in T, mean daily intake of medication was 1.7 which reduced significantly (p < 0.0001) to 0.05. 96 patients in T were able to stop anti-diabetic medications
Discussion
The initial results are an early indicator for the translation of the scientific rationale for the technological intervention, through digital twin technology, powered by Internet of Things and Artificial Intelligence, as a modality to enable reversal of diabetes. TPT appears to have potential to mitigate the cardiovascular risk as assessed by Framingham Risk Score and modulate the non glycemic parameters, including BMI and SBP. However, larger, long-term studies would yield precise insights for the durability of the significant change that has been observed in this study Abstract Figure. Comparison for the Change in the Glycemi
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Affiliation(s)
| | - S Joshi
- Joshi Clinic, Lilavati and Bhatia Hospital, Endocrinology, Mumbai, India
| | - L Shah
- Twin Health, Mountain View, United States of America
| | - M Dharmalingam
- RAMAIAH MEDICAL COLLEGE AND HOSPITALS, Endocrinology, Bangalore, India
| | - A Vadavi
- Sudha Prevention Center, Diabetes, Bangalore, India
| | - S Damodaran
- Sri Ramakrishna Hospital, Endocrinology, Coimbatore, India
| | - J Mohammed
- Twin Health, Mountain View, United States of America
| | - M Mohamed
- Twin Health, Bangalore, India, India
| | - T Poon
- Twin Health, Mountain View, United States of America
| | | | - T Mohamed
- Twin Health, Bangalore, India, India
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Kayastha S, Shah L, Mainali S. Histological Examination of Tissue Obtained in Early Pregnancy Loss. Kathmandu Univ Med J (KUMJ) 2021; 19:305-308. [PMID: 36254414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background It is a routine practice to send histological sample after surgical evacuation of early pregnancy loss. Objective This study was carried out to see the justification of regular histological study by carrying out the histological study of early pregnancy loss and to find the prevalence of gestational trophoblastic disease in early pregnancy loss. Method It was a descriptive prospective study, conducted in Nepal medical college teaching hospital from February to October 2020 in Obstetrics and Gynaecology department. Clinical data such as age, parity, gestational age and diagnosis were collected of 130 patient of early pregnancy loss. Then histological study were sent after surgical evacuation. Result Among the age group, 21-30 age group was maximum. (64.61%), more than half of the patient was primigravida (53.07%) and most of the cases were between 6 to 9 weeks of gestation. Incomplete abortions were maximum (43.07%), missed abortions 38.46%, blighted abortions 16.15%, enevitable abortions 1.53% and septic abortion was 0.76%. Among histological finding, 72.30% were product of conception, 15.38% of the cases had no product of conception, decidual tissue only in 6.92%, partial mole in one case (0.76%), complete mole in one case (0.76%) and hydrophic changes in one case (0.76%). The total cases of Gestational trophoblastic diseases (GTD) were 3(2.30%). Conclusion In our study we found 2.3% of cases of GTD, which was quite high in compare to Western word. So it is a good practice to do histological study of all cases of EPL in our country to detect GTD, determining cause for recurrent pregnancy loss and detecting unexpected fetal pathology.
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Affiliation(s)
- S Kayastha
- Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu
| | - L Shah
- Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu
| | - S Mainali
- Department of Obstetrics and Gynecology, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu
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Leiva-Juarez M, Benvenuto L, Costa J, Urso A, Stanifer B, Lemaitre P, Sonett J, Aversa M, Robbins H, Shah L, Arcasoy S, D'Ovidio F. Histologic Phenotypes and Outcomes in Single vs Double Lung Transplantation among Recipients with Interstitial Lung Disease. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Mahoney I, Anderson M, Leiva-Juarez M, Costa J, Stanifer B, Lemaitre P, Sonett J, Aversa M, Robbins H, Qayum S, Shah L, D'Ovidio F, Arcasoy S, Benvenuto L. Mortality and Development of Cancer in Lung Transplant Recipients with Advanced Age. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Furfaro D, Aversa M, Shah L, Robbins H, Anderson M, Sonett J, D'Ovidio F, Stanifer B, Kim H, Costa J, Arcasoy S, Benvenuto L. Low Lung Allocation Score Predicts Poor Waitlist Outcomes for Patients on Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.852] [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: 10/24/2022] Open
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Shah L, Fogden S, Majumdar A. Use of a chalazion clamp for intraoral biopsies: a technical note. Br J Oral Maxillofac Surg 2019; 58:105-106. [PMID: 31718917 DOI: 10.1016/j.bjoms.2019.10.307] [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: 05/17/2019] [Accepted: 10/15/2019] [Indexed: 11/24/2022]
Abstract
Oral biopsies are common diagnostic and therapeutic procedures in oral and maxillofacial surgical (OMFS) outpatient departments. The chalazion clamp is similar to a pair of forceps. One extension has a flat, solid, oval plate, the other, a ring-like structure that is used to clamp and retract soft tissues. We highlight the benefits of using this simple, widely-available tool during oral biopsies. We find that the clamp increases effectiveness and efficiency for the clinician and assistant. We recommend its use in daily OMFS practice.
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Affiliation(s)
- L Shah
- Milton Keynes University Hospital, UK.
| | - S Fogden
- Milton Keynes University Hospital, UK.
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Snyder M, Weisberg S, Connors T, Benvenuto L, Shah L, Robbins H, Hook J, D'Ovidio F, Sonett J, Arcasoy S, Farber D. Persisting Donor Alveolar Macrophages Have Increased Expression of Scavenger Receptor CD206 Compared to Graft-Infiltrating Recipient-Derived Macrophages Following Lung Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mecadon K, Scheffert J, Shah L, Robbins H, Aversa M, Arcasoy S, Benvenuto L. Time to Therapeutic Tacrolimus Serum Concentrations and the Impact on Early Acute Cellular Rejection in Adult Lung Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Benvenuto L, Aversa M, Shah L, Carroll M, D'Ovidio F, Stanifer B, Sonett J, Robbins H, Arcasoy S. Single Lung Transplant Compared with Double Lung Transplant in Older Adults with Interstitial Lung Disease. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Benvenuto L, Anderson D, Kim H, Hook J, Shah L, Robbins H, D'Ovidio F, Bacchetta M, Sonett J, Arcasoy S. Geographic Disparities in Donor Lung Availability Impact Waitlist Outcomes in Lung Transplant Candidates: A Retrospective Cohort Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Urso A, Briganti D, Costa J, Nandakumar R, Robbins H, Shah L, Sonett J, Cremers S, Arcasoy S, D'Ovidio F. Bile Acid Aspiration is Associated with Airway Infections: A Targeted Metabolomic Approach. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Snyder M, Connors T, Benvenuto L, Shah L, Robbins H, Hook J, D'Ovidio F, Bacchetta M, Sonett J, Arcasoy S, Farber D. Impact of Primary Graft Dysfunction on Allograft T Cell Chimerism Following Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sincore A, Cook J, Tan F, El Halawany A, Riggins A, McDaniel S, Cook G, Martyshkin DV, Fedorov VV, Mirov SB, Shah L, Abouraddy AF, Richardson MC, Schepler KL. High power single-mode delivery of mid-infrared sources through chalcogenide fiber. Opt Express 2018; 26:7313-7323. [PMID: 29609288 DOI: 10.1364/oe.26.007313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
Mechanically robust and low loss single-mode arsenic sulfide fibers are used to deliver high power mid-infrared sources. Anti-reflection coatings were deposited on the fiber facets, enabling 90% transmission through 20 cm length fibers. 10.3 W was transmitted through an anti-reflection coated fiber at 2053 nm, and uncoated fibers sustained 12 MW/cm2 intensities on the facet without failure. A Cr:ZnSe laser transmitted >1 W at 2520 nm, and a Fe:ZnSe laser transmitted 0.5 W at 4102 nm. These results indicate that by improving the anti-reflection coatings and using a high beam quality mid-infrared source, chalcogenide fibers can reliably deliver ≥10 W in a single mode, potentially out to 6.5 µm.
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Shah L, Powell JL, Zaritsky JJ. A case of Fanconi syndrome due to a deferasirox overdose and a trial of plasmapheresis. J Clin Pharm Ther 2017; 42:634-637. [DOI: 10.1111/jcpt.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L. Shah
- Sidney Kimmel Medical College-Thomas Jefferson University School of Medicine; Philadelphia PA USA
- Alfred I. duPont Hospital for Children; Wilmington DE USA
| | - J. L. Powell
- Alfred I. duPont Hospital for Children; Wilmington DE USA
| | - J. J. Zaritsky
- Alfred I. duPont Hospital for Children; Wilmington DE USA
- Thomas Jefferson School of Medicine; Philadelphia PA USA
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Champaneria R, Shah L, Wilson M, Daniels J. Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis. Int J Obstet Anesth 2016; 28:45-60. [DOI: 10.1016/j.ijoa.2016.07.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
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Costa J, Sreekanth S, Shah L, Robbins H, Raza K, Arcasoy S, Sonett J, D'Ovidio F. P-257ORGAN DONORS FROM ASPHYXIATION ARE VALUABLE SOURCE OF LUNG ALLOGRAFTS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wittek S, Bustos Ramirez R, Alvarado Zacarias J, Sanjabi Eznaveh Z, Bradford J, Lopez Galmiche G, Zhang D, Zhu W, Antonio-Lopez J, Shah L, Amezcua Correa R. Mode-selective amplification in a large mode area Yb-doped fiber using a photonic lantern. Opt Lett 2016; 41:2157-2160. [PMID: 27176951 DOI: 10.1364/ol.41.002157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We demonstrate selective spatial mode amplification in a few mode, double-clad Yb-doped large mode area (LMA) fiber, utilizing an all-fiber photonic lantern. Amplification to multi-watt output power is achieved while preserving high spatial mode selectivity. We observe gain values of over 12 dB for all modes: LP01, LP11a, and LP11b, when amplified individually. Additionally, we investigate the simultaneous amplification of LP01+LP11a and LP11a+LP11b, and the resultant mode competition. The proposed architecture allows for the reconfigurable excitation of spatial modes in the LMA fiber amplifiers, and represents a promising method that could enable dynamic spatial mode control in high power fiber lasers.
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Chaudhary S, Singh RR, Shah GS, Agrawal J, Kafle S, Shah L. Outcome of Twin Deliveries at a Tertiary Care Centre of Eastern Nepal. J Nepal Health Res Counc 2016; 14:128-131. [PMID: 27885296] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Twins, compared to singletons, have higher perinatal mortality and morbidity. The aim of this study was to describe the twinning rate, epidemiological variables and hospital outcome of twin deliveries and to find out ways of better management of twins in our part. METHODS A retrospective evaluation of the outcome of 92 twin pregnancies during one year study period (1st January 2014 to 31st December 2014) was conducted at BPKIHS. Twins delivered within the institution were included but cases less than 28 weeks gestation were excluded. Maternal and neonatal data were retrieved and analysed. RESULTS The twinning rate was 9.2/1000 (92/10,031). The mean birth weight was 1636.30 ±339.21 grams and mean gestational age 34.31±2.67 weeks(28 - 40 weeks). One hundred eighty-two babies (98.9%) were low birth weight (LBW) while 32.1% were small for gestational age (SGA). There was mild, moderate and severe growth discordance in 63 (68.5%)22 (23.9%)and 7 (7.6%) respectively. Three (3.26%) of 92 pairs had twin-to-twin transfusion syndrome. The hospital mortality rate was 10.87% (20/184) and 69 (37.5%) babies had complications. The clinical causes of death were hyaline membrane disease in 7 (3.3%), severe birth asphyxia in 5 (2.7%), congenital malformations in 3(1.6%) and sepsis in 3 (1.6%) babies. CONCLUSIONS Twin deliveries are common in this hospital and have poor hospital outcome with more complications and mortality. Hence there is a need for further studies with long term follow-ups to plan for better management of twins in our part.
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Affiliation(s)
- S Chaudhary
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - R R Singh
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - G S Shah
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - J Agrawal
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Kafle
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - L Shah
- Department of Pediatrics and Adolescent Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Briganti D, Kim C, Aramini B, Chan R, Zhou B, Sreekanth S, Raza K, Robbins H, Shah L, Arcasoy S, Sonett J, Meloni F, Paolo GD, D’Ovidio. Bronchial & Alveolar Lipidomic Profile as a Marker of the Immunological and Functional Status of the Lung Allograft. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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26
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Hammad S, Shah L, Restivo M, Robbins H, Scheffert J. Outcomes Associated with Ganciclovir-Resistant Cytomegalovirus in Lung Transplant Recipients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Costa J, Singh G, Sreekanh S, Raza K, Lederer D, Robbins H, Shah L, Sonett J, Arcasoy S, D'Ovidio F. F-075DONOR LUNG ASSESSMENT USING SELECTIVE PULMONARY VEIN GASES. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shah L, Choi HW, Berrang-Ford L, Henostroza G, Krapp F, Zamudio C, Heymann SJ, Kaufman JS, Ciampi A, Seas C, Gotuzzo E, Brewer TF. Geographic predictors of primary multidrug-resistant tuberculosis cases in an endemic area of Lima, Peru. Int J Tuberc Lung Dis 2015; 18:1307-14. [PMID: 25299862 DOI: 10.5588/ijtld.14.0011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Peru reports among the highest multidrug-resistant tuberculosis (MDR-TB) rates in the Americas, with a growing proportion in previously untreated tuberculosis (TB) cases. The identification of clusters of primary MDR-TB compared with drug-susceptible TB (DS-TB) could help prioritize interventions. OBJECTIVE To examine the clustering of primary MDR-TB case residences and their proximity to high-risk locations in San Juan de Lurigancho District, Lima, Peru. DESIGN Enrolled primary MDR-TB and primary DS-TB cases were interviewed and their primary residence was recorded using handheld Global Positioning System devices. Kuldorff's spatial scan statistic was used for cluster detection (SaTScan(TM), v. 9.1.1). Identified clusters were visualized in Quantum Geographic Information Systems software (v1.8.0). The following cluster centers were tested: a health centre with the highest TB and MDR-TB rates (Clinic X), a hospital and two prisons. Using regression analyses, we examined predictors of primary MDR-TB cases. RESULTS A statistically significant cluster of primary MDR-TB cases was identified within a 2.29 km radius around Clinic X. Proximity to Clinic X remained a significant predictor of primary MDR-TB in adjusted regression analyses. CONCLUSION We identified a hotspot of primary MDR-TB cases around Clinic X in a TB-endemic area. Causes of this clustering require investigation; targeted interventions for this high-risk area should be considered.
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Affiliation(s)
- L Shah
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - H W Choi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - L Berrang-Ford
- Department of Geography, McGill University, Montreal, Quebec, Canada
| | - G Henostroza
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - F Krapp
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - C Zamudio
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S J Heymann
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, USA
| | - J S Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - A Ciampi
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - C Seas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - E Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - T F Brewer
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Naroji S, Aramini B, Kim C, Chan R, Zhou B, Raza K, Robbins H, Shah L, Lederer D, Arcasoy S, Sonett J, Di Paolo G, D’Ovidio F. Surfactant Phospholipids as a Marker of Chronic Lung Allograft Dysfunction: A Targeted Lipidomics Approach. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.709] [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: 10/23/2022] Open
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Singer J, Diamond J, Gries C, McDonnough J, Blanc P, Shah R, Dean M, Hersch B, Dolan J, Arcasoy S, Greenland J, Smith N, Patterson S, Shah L, Golden J, Blumenthal N, Sonett J, Hays S, Oyster M, D’Ovidio F, Katz P, Robbins H, Brown M, Leard L, Kukreja J, Bacchetta M, Rushefski M, Raza K, Christie J, Lederer D. Frailty Is Associated With Pre-Operative Delisting and Death in Lung Transplant Candidates. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shah SK, Shah L, Bhattarai S, Giri M. Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis. JNMA J Nepal Med Assoc 2015; 53:137-140. [PMID: 26994037] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.
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Affiliation(s)
- S K Shah
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - L Shah
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Bhattarai
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - M Giri
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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de Havenon A, Joos Z, Longenecker L, Shah L, Ansari S, Digre K. Posterior reversible encephalopathy syndrome with spinal cord involvement. Neurology 2014; 83:2002-6. [DOI: 10.1212/wnl.0000000000001026] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Costa J, Sonett J, Singh G, Bacchetta M, LaVelle M, Lederer D, Shah L, Robbins H, Raza K, Arcasoy S, D'Ovidio F. Lung Transplantation Using Allografts From Donation After Cardiac Death Donors. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Aramini B, Kim C, Peterson E, Lederer D, Costa J, Shah L, Robbins H, Raza K, Arcasoy S, Sonett J, D’Ovidio F. Donor Surfactant Protein A2 Gene Polymorphisms Are Associated With Early Lung Transplant Survival. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wadood A, Ahmed N, Shah L, Ahmad A, Hassan H, Shams S. In-silico drug design: An approach which revolutionarised the drug discovery process. ACTA ACUST UNITED AC 2013. [DOI: 10.13172/2054-4057-1-1-1119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aramini B, Kim C, DiAngelo S, Petersen E, Lederer D, Shah L, Robbins H, Floros J, Arcasoy SM, Sonett JR, D’Ovidio F. Donor surfactant protein D (SP-D) polymorphisms are associated with lung transplant outcome. Am J Transplant 2013; 13:2130-6. [PMID: 23841811 PMCID: PMC3819598 DOI: 10.1111/ajt.12326] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 04/20/2013] [Accepted: 04/26/2013] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is the major factor limiting long-term success of lung transplantation. Polymorphisms of surfactant protein D (SP-D), an important molecule within lung innate immunity, have been associated with various lung diseases. We investigated the association between donor lung SP-D polymorphisms and posttransplant CLAD and survival in 191 lung transplant recipients consecutively transplanted. Recipients were prospectively followed with routine pulmonary function tests. Donor DNA was assayed by pyrosequencing for SP-D polymorphisms of two single-nucleotide variations altering amino acids in the mature protein N-terminal domain codon 11 (Met(11) Thr), and in codon 160 (Ala(160) Thr) of the C-terminal domain. CLAD was diagnosed in 88/191 patients, and 60/191 patients have died. Recipients of allografts that expressed the homozygous Met(11) Met variant of aa11 had significantly greater freedom from CLAD development and better survival compared to those with the homozygous Thr(11) Th variant of aa11. No significant association was noted for SP-D variants of aa160. Lung allografts with the SP-D polymorphic variant Thr(11) Th of aa11 are associated with development of CLAD and reduced survival. The observed genetic differences of the donor lung, potentially with their effects on innate immunity, may influence the clinical outcomes after lung transplantation.
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Affiliation(s)
- B. Aramini
- Lung Transplant Program, Columbia University, New York, NY
| | - C. Kim
- Lung Transplant Program, Columbia University, New York, NY
| | - S. DiAngelo
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA
| | - E. Petersen
- Lung Transplant Program, Columbia University, New York, NY
| | - D.J. Lederer
- Lung Transplant Program, Columbia University, New York, NY
| | - L. Shah
- Lung Transplant Program, Columbia University, New York, NY
| | - H. Robbins
- Lung Transplant Program, Columbia University, New York, NY
| | - J. Floros
- Department of Obstetrics and Gynecology, Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research, The Pennsylvania State University College of Medicine, Hershey, PA
| | - S. M. Arcasoy
- Lung Transplant Program, Columbia University, New York, NY
| | - J. R. Sonett
- Lung Transplant Program, Columbia University, New York, NY
| | - F. D’Ovidio
- Lung Transplant Program, Columbia University, New York, NY,Corresponding author: Frank D’Ovidio,
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Lederer D, Sonett J, Philip N, Larkin M, Peterson E, Desai A, Sanyal S, Shah L, Robbins H, Raza K, Reilly G, D’Ovidio F, Bacchetta M, Arcasoy S. Frailty and Early Mortality after Lung Transplantation: Preliminary Results. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rank C, Njihia JG, Remis RS, Shah L, Swantee C, Brooks JI, Jayaraman GC, Archibald CP. Characterizing viral subtypes to assess patterns of HIV transmission. Int J STD AIDS 2012; 23:e6-9. [PMID: 23104760 DOI: 10.1258/ijsa.2009.009303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We characterized HIV-1 subtypes among 204 persons newly diagnosed with HIV in Ontario from 2003 to 2005 using samples from the Canadian HIV Strain and Drug Resistance Surveillance Program. We examined HIV-1 subtype by demographic characteristics and exposure category, and determined independent predictors of infection with a non-B HIV subtype using multivariate logistic regression. The distribution of HIV subtypes was: B 77.0%, C 10.3%, AG 4.9%, A 2.5%, AE 2.5% and others 3.0%. Overall, 23.0% were non-B, greater in women than in men (62.8% versus 12.4%, P < 0.0001) and persons under 35 years (31.1% versus 18.5% in those ≥35, P = 0.04). Non-B subtype was predominant (78.9%) among persons from HIV-endemic regions and considerable (28.6%) among other persons infected heterosexually. In multivariate modelling adjusted for gender, non-B subtype was significantly associated with birth in an HIV-endemic region (adjusted odds ratio [aOR] 59.2, P < 0.0001) and heterosexual exposure (aOR 6.3, P = 0.02). Additionally, compared with men who had sex with men, non-B subtype was greater among heterosexual women (aOR 17.8, P < 0.001) and women who injected drugs (injection drug use, aOR 13.4, P = 0.01). We found a non-negligible proportion of non-B subtypes among women infected heterosexually not from HIV-endemic countries, providing interesting insights into HIV transmission patterns.
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Affiliation(s)
- C Rank
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Canada
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Aramini B, Geraghty P, Lederer D, Wilt J, Shah L, Mattioli S, Floros J, Arcasoy S, Sonett J, D'Ovidio F. 412 Lung Transplant Immunosuppressive Drugs Influence Pulmonary Surfactant Protein A (SP-A) Expression. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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41
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Aramini B, Diangelo S, Lederer D, Wilt J, Shah L, Mattioli S, Keshavjee S, Floros J, Arcasoy S, Sonett J, D'Ovidio F. 148 Donor Lung Surfactant Protein D Gene Polymorphisms Are Associated with Bronchiolitis Obliterans Syndrome and Mortality after Lung Transplantation. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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42
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Cook VJ, Shah L, Gardy J, Bourgeois AC. Recommendations on modern contact investigation methods for enhancing tuberculosis control [Review article]. Int J Tuberc Lung Dis 2011; 16:297-305. [DOI: 10.5588/ijtld.11.0350] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shah L, Choi H, Krapp F, Zamudio C, Seas C, Ciampi A, Brewer T, Gotuzzo E. Predictors of primary multiple drug resistant tuberculosis (MDR-TB) transmission in Lima, Peru. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa. OBJECTIVES This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications. SELECTION CRITERIA Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease. DATA COLLECTION AND ANALYSIS Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality. MAIN RESULTS Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse. AUTHORS' CONCLUSIONS This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.
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Affiliation(s)
- R L Stowe
- University of Birmingham Clinical Trials Unit, Division of Medical Sciences, Robert Aitken Institute, Edgbaston, Birmingham, UK, B15 2TT
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Stowe RL, Ives NJ, Clarke C, van Hilten J, Ferreira J, Hawker RJ, Shah L, Wheatley K, Gray R. Dopamine agonist therapy in early Parkinson's disease. Cochrane Database Syst Rev 2008. [PMID: 18425954 DOI: 10.1002/14651858.cd006564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dopamine agonists are being used increasingly as first line treatment for Parkinson's disease, but there remains uncertainty about their clinical and cost-effectiveness relative to levodopa. OBJECTIVES This meta-analysis aims to quantify more reliably the benefits and risks of dopamine agonists compared to placebo or levodopa in early Parkinson's disease. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PubMed, LILACS and Web of Science, plus major journals in the field, abstract books, conference proceedings and reference lists of retrieved publications. SELECTION CRITERIA Randomised trials comparing an orally administered dopamine agonist (with or without levodopa) versus placebo or levodopa or both placebo and levodopa in participants with early Parkinson's disease. DATA COLLECTION AND ANALYSIS Two authors independently extracted data on clinician-rated disability, motor complications, other side-effects, treatment concordance, levodopa dose and mortality. MAIN RESULTS Twenty-nine eligible trials, involving 5247 participants, were identified. Participants randomised to a dopamine agonist were less likely to develop dyskinesia (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.43 to 0.59; P < 0.00001), dystonia (OR 0.64, 95% CI 0.51 to 0.81; P = 0.0002) and motor fluctuations (OR 0.75, 95% CI 0.63 to 0.90; P = 0.002) than levodopa-treated participants. However, various 'non-motor' side-effects, including oedema (OR 3.68, 95% CI 2.62 to 5.18; P < 0.00001), somnolence (OR 1.49, 95% CI 1.12 to 2.00; P = 0.007), constipation (OR 1.59, 95% CI 1.11 to 2.28; P = 0.01), dizziness (OR 1.45, 95% CI 1.09 to 1.92; P = 0.01), hallucinations (OR 1.69, 95% CI 1.13 to 2.52; P = 0.01) and nausea (OR 1.32, 95% CI 1.05 to 1.66; P = 0.02) were all increased in agonist-treated participants (compared with levodopa-treated participants). Agonist-treated participants were also significantly more likely to discontinue treatment due to adverse events (OR 2.49, 95% CI 2.08 to 2.98; P < 0.00001). Finally symptomatic control of Parkinson's disease was better with levodopa than with agonists, but data were reported too inconsistently and incompletely to meta-analyse. AUTHORS' CONCLUSIONS This meta-analysis confirms that motor complications are reduced with dopamine agonists compared to levodopa, but also establishes that other important side-effects are increased and symptom control is poorer with agonists. Larger, long-term comparative trials assessing patient-rated quality of life are needed to assess more reliably the balance of benefits and risks of dopamine agonists compared to levodopa.
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Affiliation(s)
- R L Stowe
- University of Birmingham Clinical Trials Unit, Division of Medical Sciences, Robert Aitken Institute, Edgbaston, Birmingham, UK, B15 2TT
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Zehtabchi S, Soghoian S, Liu Y, Carmody K, Shah L, Whittaker B, Sinert R. The Association of Coagulopathy and Traumatic Brain Injury. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shah L, Friedrich J. Calcium channel blockers for pulmonary hypertension. Hippokratia 2004. [DOI: 10.1002/14651858.cd004675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVES To evaluate the safety, efficacy and acceptability of QS in Karachi, Pakistan. METHODS 1000 women who had chosen sterilization during the 4-year period 1994 to 1997 inclusive were offered QS at both stationary clinics and in a mobile van at 23 sites in the outskirts of Karachi. The protocol involved transcervical insertion to the uterine fundus of 252 mg quinacrine in 7 pellets and 55 mg of ibuprofen in 3 pellets through an IUD inserter, during the proliferative phase of the menstrual cycle. Two doses were administered one month apart. A temporary method of contraception was provided for 3 cycles, usually DMPA. Follow-up was scheduled: monthly for 3 months, quarterly for 1 year and then every 6 months for 4 years. RESULTS The crude pregnancy rate after 4 years was 2.0%. Minor complications and complaints were reported by 59% of the patients. There was one ectopic pregnancy and no major complications. CONCLUSIONS QS was found to be safe and effective and has become the most popular method of sterilization in our area of Pakistan.
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Abstract
BACKGROUND Theophylline and long acting beta-2 agonists are bronchodilators used for the management of persistent asthma symptoms, especially nocturnal asthma. They represent different classes of drug with differing side-effect profiles. OBJECTIVES To assess the comparative efficacy, safety and side-effects of long-acting beta-2 agonists and theophylline in the maintenance treatment of asthma. SEARCH STRATEGY Randomised, controlled trials (RCTs) were identified using the Cochrane Airways Group register. The register was searched using the following terms: asthma and theophylline and long acting beta-agonist or formoterol or foradile or eformoterol or salmeterol or bambuterol or bitolterol. Date of last search was April 2003. Titles and abstracts were then screened to identify potentially relevant studies. The bibliography of each RCT was searched for additional RCTs. Authors of identified RCTs were contacted for other relevant published and unpublished studies. SELECTION CRITERIA All included studies were RCTs involving adults and children with clinical evidence of asthma. These studies must have compared oral sustained release and/or dose adjusted theophylline with an inhaled long-acting beta-2 agonist. DATA COLLECTION AND ANALYSIS Potentially relevant trials, identified by screening titles and/or abstracts, were obtained. Two reviewers independently assessed full text versions of these trials to decide whether the trial should be included in the review, and assessed its methodological quality. Where there was disagreement between reviewers, this was resolved by consensus, or reference to a third party. Data were extracted by two independent reviewers. Inter-rater reliability was assessed by simple agreement. Study authors were contacted to clarify randomisation methods, provide missing data, verify the data extracted and identify unpublished studies. Relevant pharmaceutical manufacturers were also contacted. MAIN RESULTS Six trials originally met the inclusion criteria. Five used salmeterol and one, bitolterol. In an updated version of the review, six more trials were included. Four trials used salmeterol and two used formoterol. They were of varying quality. Salmeterol improved FEV1 significantly more than theophylline in five studies and salmeterol use was associated with significantly more symptom free nights in all the studies comparing these agents. Formoterol, used in two studies was reported to be as effective as theophylline. Bitolterol, used in only one study, was reported to be less effective than theophylline. Subjects taking salmeterol experienced fewer adverse events than those using theophylline (Parallel studies: Relative Risk 0.44; 95% CI: 0.30 to 0.63), Risk Difference -0.11 (95%CI: -0.16 to -0.07), NNT 9 (6, 14). Significant reductions were reported for central nervous system adverse events (Relative Risk 0.50; 95%Confidence Intervals 0.29, 0.86), Risk Difference -0.07(95% CI -0.12, -0.02), NNT 14(8, 50) and gastrointestinal adverse events (Relative Risk 0.30; 95%Confidence Intervals 0.17, 0.55), Risk Difference -0.11(-0.16, -0.06), NNT 9(6, 16). REVIEWER'S CONCLUSIONS Long-acting beta-2 agonists are at least as effective than theophylline in reducing asthma symptoms including night waking and improving lung function. Fewer adverse events occurred in subjects using long-acting beta-2 agonists(salmeterol and formoterol) as compared to theophylline.
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Affiliation(s)
- L Shah
- Critical Care Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8
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Stegemann JP, Raina S, Nicholson DT, Jimenez P, Shah L, Cain S, Chandler B, Pitkin Z, Mullon C, Custer L. Comparison of analytical methods for quantitation of isolated porcine hepatocyte yields. Tissue Eng 2000; 6:253-64. [PMID: 10941220 DOI: 10.1089/10763270050044434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As cell-based therapies receive approval for clinical evaluation and use, the development of reliable methods to quantify cell number and control the dose of therapy delivered is becoming increasingly important. An example is the determination of the number and volume of primary porcine hepatocytes used in an extracorporeal treatment for patients with liver disease. Conventional cell counting using optical microscopy was compared against two alternate methods to quantify isolated porcine hepatocytes: (1) automated cell counting using a commercially available particle characterization instrument, and (2) quantitation by cell mass. Methods were compared based on accuracy, precision, specificity, linear range, and ruggedness. The automated method delivered substantially improved accuracy, precision, and ruggedness when compared to the conventional optical method. It also provided valuable information about the size distribution of cell preparations, which often contained clumps of cells, and showed that processing steps such as cryopreservation can alter the size characteristics of a cell population. The automated method was also faster, and was well suited to use in a commercial manufacturing process. The mass-based method was simple and inexpensive, but suffered from nonlinearity at low cell concentrations. Automated cell quantitation using a commercially available particle characterization instrument proved to be the preferred method for obtaining accurate and consistent porcine hepatocyte counts in a timely manner.
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Affiliation(s)
- J P Stegemann
- Department of Biomedical Engineering, Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332-0535, USA
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