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Koppiker C, Kelkar D, Kulkarni M, Pai M, Dhar U, Deshmukh C, Varghese B, Jumle N, Zamre V, Kadu S, Joshi A, Unde R, Banale R, Namewar N, Vaid P, Thomas G, Nare S, Pereira J, Badve S. P225 Impact Of Oncoplasty in Increasing Breast Conservation Rates Post Neo-Adjuvant Chemotherapy. Breast 2023. [DOI: 10.1016/s0960-9776(23)00343-0] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Huddart S, Ingawale P, Edwin J, Jondhale V, Pai M, Benedetti A, Shah D, Vijayan S. TB case fatality and recurrence in a private sector cohort in Mumbai, India. Int J Tuberc Lung Dis 2021; 25:738-746. [PMID: 34802496 PMCID: PMC8412104 DOI: 10.5588/ijtld.21.0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Half of India´s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates.METHODS: We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting.RESULTS: The treatment CFR was 7.1% (95% CI 6.0-8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7-3.0) and the recurrence rate was 1.9% (95% CI 1.3-2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02-1.03), clinical diagnosis (HR 0.61, 95% CI 0.45-0.84), treatment duration (HR 0.09, 95% CI 0.06-0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79-0.91) and adherence.CONCLUSIONS: We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.
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Affiliation(s)
- S Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, McGill International TB Centre, Montreal, QC, Canada
| | | | | | | | - M Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, McGill International TB Centre, Montreal, QC, Canada, Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
| | - A Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC
| | - D Shah
- Mumbai Municipal Corporation, Mumbai, India
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Rathore SS, Murthy HS, Girisha SK, Nithin MS, Nasren S, Mamun MAA, Puneeth TG, Rakesh K, Kumar BTN, Pai M. Supplementation of nano-selenium in fish diet: Impact on selenium assimilation and immune-regulated selenoproteome expression in monosex Nile tilapia (Oreochromis niloticus). Comp Biochem Physiol C Toxicol Pharmacol 2021; 240:108907. [PMID: 33027705 DOI: 10.1016/j.cbpc.2020.108907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/11/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
Selenium (Se), a fundamental element of nutrigenomic science in fish nutrition, was used to investigate its impact on selenoproteome expression and Se regulation in tilapia. Different concentrations (T1 - 0, T2 - 0.5, T3 - 1.0 and T4 - 2.0 mg/kg of feed) of dietary nano-Se were incorporated in the diets of monosex Nile tilapia. A total of 180 tilapia fingerlings with initial weight (15.73 ± 0.05 g) were stocked in 150 L capacity FRP tanks categorized into four diet groups with triplicate each for a feeding trial of 90 days. At the end of first, second and third months of the feeding trial, gill, liver, kidney and muscle tissues were harvested to evaluate the effect on the kinetics of Se bioaccumulation and assimilation as well as immune-regulated selenoprotein transcripts (GPx2, SelJ, SelL, SelK, SelS, SelW and Sepp1a) and their synthesis factors (SPS1 and Scly). The findings depicted that significantly (p < 0.05) higher weight gain was found in the diet supplemented with 1.0 mg/kg of nano-Se. The theory of second-order polynomial regression supported the same. The liver showed significantly (p < 0.05) higher Se accumulation and concentration factor among the harvested tissues in a different timeline. All the selected immune-regulated selenoproteins and synthesis factors in different fish tissues showed significantly (p < 0.05) up-regulation in the diet supplemented with 1.0 mg/kg of nano-Se for the second month. Therefore, the present findings suggested that the supplementation of nano-Se could be more effective for improved growth, better selenium regulation and expression of immune-regulated selenoproteins in the fish model.
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Affiliation(s)
- S S Rathore
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India.
| | - H S Murthy
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - S K Girisha
- Department of Aquatic Animal Health Management, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - M S Nithin
- Department of Aquatic Animal Health Management, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - S Nasren
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - M A A Mamun
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - T G Puneeth
- Department of Aquatic Animal Health Management, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - K Rakesh
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
| | - B T N Kumar
- Department of Aquatic Environment, College of Fisheries, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India
| | - M Pai
- Department of Aquaculture, College of Fisheries, Karnataka Veterinary, Animal and Fisheries Sciences University, Mangalore 575002, Karnataka, India
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Abstract
The End TB Strategy diagnostic pillar calls for access to high-sensitivity diagnostic testing and universal rapid drug susceptibility testing (DST). The recommended diagnostic technologies available in low and middle-income, high-burden countries for multidrug-resistant tuberculosis (MDR-TB) are essentially limited to Xpert® MTB/RIF and MTB/RIF Ultra assays, culture DST and the line-probe assays. The primary reasons for slow scale-up are insufficient political will, and therefore, insufficient funding for qualified human resources, and safe laboratory and health system infrastructure. Innovative approaches to enable the private health sector to provide high-quality diagnosis are also needed. The Essential Diagnostics List provides impetus and a standard benchmark for the rational implementation of MDR-TB diagnostics, but the epidemic will ultimately only be favorably impacted by complete end-to-end solutions to patients that address the complete cascade of care, including patient-centered diagnosis and treatment of TB and MDR-TB, management of comorbidities and social protection. By scaling up access to the currently available diagnostics, we lay the groundwork for future innovations for rapid accurate diagnosis of MDR-TB, which in turn will bring us closer to meeting the targets in the End TB Strategy.
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Affiliation(s)
- E A Talbot
- Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Department of Medicine, Dartmouth College, Hanover, NH, USA
| | - M Pai
- McGill International TB Centre, MontrÉal, QC, McGill Global Health Programs and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, MontrÉal, QC, Canada, Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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Cox V, Cox H, Pai M, Stillo J, Citro B, Brigden G. Health care gaps in the global burden of drug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 23:125-135. [PMID: 30808447 DOI: 10.5588/ijtld.18.0866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The drug-resistant tuberculosis (DR-TB) cascade-from estimated or incident cases to numbers successfully treated or disease-free survival-has long been characterised by sharp declines at each step in the cascade. The losses along the cascade vary across different settings, and the reasons why some countries have a higher burden of DR-TB are complex and multifactorial; broadly, weak health systems, inadequate financing and poverty all impact differential access to DR-TB care. Within a human rights framework that mandates the right to health and the right to benefit from scientific progress, the aim of this review is to focus on describing inequities in access to DR-TB care at critical points in the cascade.
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Affiliation(s)
- V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town
| | - H Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - M Pai
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - J Stillo
- College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan
| | - B Citro
- Northwestern Pritzker School of Law, Chicago, Illinois, USA
| | - G Brigden
- International Union Against TB and Lung Disease, Paris, France
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Adam P, Pai M. Implementation of Xpert ® MTB/RIF in high-burden countries: voices from the field matter. Public Health Action 2019; 9:78-79. [PMID: 31803576 PMCID: PMC6827496 DOI: 10.5588/pha.19.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Adam
- McGill International Tuberculosis Centre, McGill University, Montreal, Canada
| | - M Pai
- McGill International Tuberculosis Centre, McGill University, Montreal, Canada
- Manipal McGill Program for Infectious Diseases, Manipal Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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Dias HMY, Stallworthy G, Pai M. A roadmap to engage all care providers in tuberculosis prevention and care. Int J Tuberc Lung Dis 2019; 23:641-642. [PMID: 31315694 DOI: 10.5588/ijtld.18.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- H M Y Dias
- Global TB Programme World Health Organization, Geneva, Consultant World Health Organization, Geneva, Switzerland
| | - G Stallworthy
- Consultant World Health Organization, Geneva, Switzerland
| | - M Pai
- Consultant World Health Organization, Geneva, Switzerland, McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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Kendall EA, Sahu S, Pai M, Fox GJ, Varaine F, Cox H, Cegielski JP, Mabote L, Vassall A, Dowdy DW. What will it take to eliminate drug-resistant tuberculosis? Int J Tuberc Lung Dis 2019; 23:535-546. [PMID: 31097060 PMCID: PMC6600801 DOI: 10.5588/ijtld.18.0217] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 01/28/2023] Open
Abstract
Drug-resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but this situation is slowly changing. If the world is to drastically reduce the incidence of DR-TB, we must stop creating new DR-TB as an essential first step. The DR-TB epidemic that is ongoing should also be directly addressed. First-line drug resistance must be rapidly detected using universal molecular testing for resistance to at least rifampin and, preferably, other key drugs at initial TB diagnosis. DR-TB treatment outcomes must also improve dramatically. Effective use of currently available, new, and repurposed drugs, combined with patient-centered treatment that aids adherence and reduces catastrophic costs, are essential. Innovations within sight, such as short, highly effective, broadly indicated regimens, paired with point-of-care drug susceptibility testing, could accelerate progress in treatment outcomes. Preventing or containing resistance to second-line and novel drugs is also critical and will require high-quality systems for diagnosis, regimen selection, and treatment monitoring. Finally, earlier detection and/or prevention of DR-TB is necessary, with particular attention to airborne infection control, case finding, and preventive therapy for contacts of patients with DR-TB. Implementing these strategies can overcome the barrier that DR-TB represents for global TB elimination efforts, and could ultimately make global elimination of DR-TB (fewer than one annual case per million population worldwide) attainable. There is a strong cost-effectiveness case to support pursuing DR-TB elimination; however, achieving this goal will require substantial global investment plus political and societal commitment at national and local levels.
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Affiliation(s)
- E A Kendall
- Johns Hopkins University, Baltimore, Maryland, USA
| | - S Sahu
- Stop TB Partnership, Geneva, Switzerland
| | - M Pai
- McGill International TB Center, McGill University, Montreal, Quebec, Canada
| | - G J Fox
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - F Varaine
- Médecins Sans Frontières, Paris, France
| | - H Cox
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; **Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - L Mabote
- AIDS and Rights Alliance for Southern Africa, Cape Town, South Africa
| | - A Vassall
- London School of Hygiene & Tropical Medicine, London, UK
| | - D W Dowdy
- Johns Hopkins University, Baltimore, Maryland, USA
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Andre E, Isaacs C, Affolabi D, Alagna R, Brockmann D, de Jong BC, Cambau E, Churchyard G, Cohen T, Delmee M, Delvenne JC, Farhat M, Habib A, Holme P, Keshavjee S, Khan A, Lightfoot P, Moore D, Moreno Y, Mundade Y, Pai M, Patel S, Nyaruhirira AU, Rocha LEC, Takle J, Trébucq A, Creswell J, Boehme C. Connectivity of diagnostic technologies: improving surveillance and accelerating tuberculosis elimination. Int J Tuberc Lung Dis 2018; 20:999-1003. [PMID: 27393530 DOI: 10.5588/ijtld.16.0015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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
In regard to tuberculosis (TB) and other major global epidemics, the use of new diagnostic tests is increasing dramatically, including in resource-limited countries. Although there has never been as much digital information generated, this data source has not been exploited to its full potential. In this opinion paper, we discuss lessons learned from the global scale-up of these laboratory devices and the pathway to tapping the potential of laboratory-generated information in the field of TB by using connectivity. Responding to the demand for connectivity, innovative third-party players have proposed solutions that have been widely adopted by field users of the Xpert(®) MTB/RIF assay. The experience associated with the utilisation of these systems, which facilitate the monitoring of wide laboratory networks, stressed the need for a more global and comprehensive approach to diagnostic connectivity. In addition to facilitating the reporting of test results, the mobility of digital information allows the sharing of information generated in programme settings. When they become easily accessible, these data can be used to improve patient care, disease surveillance and drug discovery. They should therefore be considered as a public health good. We list several examples of concrete initiatives that should allow data sources to be combined to improve the understanding of the epidemic, support the operational response and, finally, accelerate TB elimination. With the many opportunities that the pooling of data associated with the TB epidemic can provide, pooling of this information at an international level has become an absolute priority.
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Affiliation(s)
- E Andre
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium; European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland
| | - C Isaacs
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Affolabi
- Faculty of Health Sciences, Abomey-Calavi University, Cotonou, National Tuberculosis Programme, Cotonou, Benin
| | - R Alagna
- TB Supranational Reference Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - D Brockmann
- Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany; Epidemiological Modelling of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - B C de Jong
- Unit of Mycobacteriology, Department of Biomedical Sciences, Institute of Tropical Medicine, Belgium
| | - E Cambau
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland; Université Paris Diderot, Institut National de la Santé et de la Recherche Médicale, Unité mixte de recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, Bactériologie, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | | | - T Cohen
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - M Delmee
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J-C Delvenne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Centre for Operations Research and Econometrics, Université Catholique de Louvain, Belgium
| | - M Farhat
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Habib
- Interactive Health Solutions, Karachi, Pakistan
| | - P Holme
- Sungkyunkwan University, Seoul, South Korea
| | - S Keshavjee
- Harvard Medical School Center for Global Health Delivery, Dubai, United Arab Emirates
| | - A Khan
- Interactive Research and Development, Karachi, Pakistan
| | - P Lightfoot
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Moore
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Department of Theoretical Physics, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - M Pai
- McGill International TB Centre & McGill Global Health Programs, McGill University, Montreal, Quebec, Canada
| | - S Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - L E C Rocha
- Karolinska Institutet, Stockholm, Sweden, Université de Namur, Namur, Belgium
| | - J Takle
- Global Connectivity LLC, Somerville, Massachusetts, USA
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease, France
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - C Boehme
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Mizandari M, Kumar J, Pai M, Chikovani T, Azrumelashvili T, Reccia I, Habib N. Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction. J Cancer 2018; 9:629-637. [PMID: 29556320 PMCID: PMC5858484 DOI: 10.7150/jca.23280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Malignant biliary and/or pancreatic obstruction has often encountered in the advanced stages of periampullary and cholangicarcinomas. HabibTM Radiofrequency (RF) ablation has been successfully used in the management of various cancers of liver and pancreas. Percutaneous HPB probe (EMcision Ltd, London, UK) is a new addition to this class of tools. It is an endoluminal Radiofrequency (RF) catheter which works on the principle of ablation and induces coagulative necrosis to recanalize the obstructed duct. The aim of this study is to address the technical details of canalization, feasibilities and outcomes of percutaneous endo-luminal Radiofrequency (RF) catheter in patients with unresectable malignancy with obstructed bile and pancreatic duct (PD). Material and Method: A total of 134 patients with inoperable malignant obstruction of biliary and PD underwent RF based percutaneous endoluminal RF ablation in a tertiary referral centre between December 15th, 2010 to August 7th, 2015. This device was used in a sequential manner with an intent to recanalize the obstructed. Following the initial catheter drainage of the duct, subsequent percutaneous endobiliary RF ablation, the metallic stent was placed to recanalize the obstructed bile and PD secondary to unresectable malignancy under real-time fluoroscopic guidance. Results: The percutaneous RF based ablation of obstructed bile duct and PD with metallic stent placement was successfully achieved in 130 (97.01%) cases. The three failures were noted in cases of biliary obstruction whilst, one with PD obstruction. The patency restored in 124 and patients, where the procedure was successfully completed and revealed clinical improvement reported. Conclusion: The percutaneous endoluminal RF based ablation of obstructed duct with metallic stent placement appeared to be a safe, effective procedure and may improve survival in patients with advanced stage cancer presenting with biliary and PD obstruction. Considering the above mentioned evidence, this modality may stand ahead of stenting alone. This could be considered as viable modality in management of such patients where very limited treatment options are available.
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Affiliation(s)
- M Mizandari
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - J Kumar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Pai
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Chikovani
- Department of Immunology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - T Azrumelashvili
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - I Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N Habib
- Department of Surgery and Cancer, Imperial College London, London, UK
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Walker I, Teitel J, Poon MC, Ritchie B, Akabutu J, Sinclair GD, Pai M, Wu JWY, Reddy S, Carter C, Growe G, Lillicrap D, Lam M, Blajchman MA, Lee D. Effect of the Factor V Leiden Mutation on the Clinical Expression of Severe Hemophilia A. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613824] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryTo determine whether the factor V Leiden mutation is associated with decreased bleeding in individuals with severe hemophilia A, factor concentrate utilization, maximum annual number of bleeding episodes, and the prevalence of hemophilic arthropathy between carriers and non-carriers of the factor V Leiden mutation were compared. Heterozygosity for the factor V Leiden mutation was found in 6 of 137 subjects (4.4%). Carriers of the factor V Leiden mutation utilized less factor concentrate (geometric mean: 310 vs. 1185 units/kg/year) and had fewer bleeding episodes than non-carriers (proportion with 10 or fewer bleeding episodes in their worst year: 50 vs. 11%). However, the factor V Leiden mutation was not associated with the absence of arthropathy. The intron 22 inversion mutation of the factor VIII gene was tested for in a subgroup of 80 subjects, but it was not found to be a significant variable for any of the bleeding endpoints. The results of this small study are consistent with the hypothesis that the factor V Leiden mutation imparts a protective effect; however, a larger confirmatory study in which the factor VIII molecular defects can be controlled for is needed. Furthermore, most severe hemophiliacs who used fewer than 200 units/kg/year of factor concentrate or who had experienced 10 or fewer bleeding episodes per year did not carry the factor V Leiden mutation, suggesting that the proportion of severe hemophiliacs whose mild clinical course can be attributed to the factor V Leiden mutation is small.
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Barty RL, Pai M, Liu Y, Arnold DM, Cook RJ, Zeller MP, Heddle NM. Group O RBCs: where is universal donor blood being used. Vox Sang 2017; 112:336-342. [DOI: 10.1111/vox.12492] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/22/2016] [Accepted: 12/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R. L. Barty
- Department of Medicine and McMaster Centre for Transfusion Research; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - M. Pai
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
| | - Y. Liu
- Department of Medicine and McMaster Centre for Transfusion Research; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - D. M. Arnold
- Department of Medicine and McMaster Centre for Transfusion Research; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
| | - R. J. Cook
- Department of Statistics and Actuarial Science; University of Waterloo; Waterloo ON Canada
| | - M. P. Zeller
- Department of Medicine and McMaster Centre for Transfusion Research; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
| | - N. M. Heddle
- Department of Medicine and McMaster Centre for Transfusion Research; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
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Lane SJ, Sholapur NS, Yeung CHT, Iorio A, Heddle NM, Sholzberg M, Pai M. Understanding stakeholder important outcomes and perceptions of equity, acceptability and feasibility of a care model for haemophilia management in the US: a qualitative study. Haemophilia 2017; 22 Suppl 3:23-30. [PMID: 27348398 DOI: 10.1111/hae.13009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Care for persons with haemophilia (PWH) is most commonly delivered through the integrated care model used by Hemophilia Treatment Centers (HTCs). Although this model is widely accepted as the gold standard for the management of haemophilia; there is little evidence comparing different care models. AIM We performed a qualitative study to gain insight into issues related to outcomes, acceptability, equity and feasibility of different care models operating in the US. METHODS We used a qualitative descriptive approach with semi-structured interviews. Purposive sampling was used to recruit individuals with experience providing or receiving care for haemophilia in the US through either an integrated care centre, a specialty pharmacy or homecare company, or by a specialist in a non-specialized centre. Persons with haemophilia, parents of PWH aged ≤18, healthcare providers, insurance company representatives and policy developers were invited to participate. RESULTS AND CONCLUSIONS Twenty-nine interviews were conducted with participants representing 18 US states. Participants in the study sample had experience receiving or providing care predominantly within an HTC setting. Integrated care at HTCs was highly acceptable to participants, who appreciated the value of specialized, expert care in a multidisciplinary team setting. Equity and feasibility issues were primarily related to health insurance and funding limitations. Additional research is required to document the impact of care on health and psychosocial outcomes and identify effective ways to facilitate equitable access to haemophilia treatment and care.
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Affiliation(s)
- S J Lane
- McMaster Centre for Transfusion Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - N S Sholapur
- McMaster Centre for Transfusion Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C H T Yeung
- Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, ON, Canada
| | - A Iorio
- Department of Clinical Epidemiology & Biostatics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - N M Heddle
- McMaster Centre for Transfusion Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Canadian Blood Services, Research and Development, Hamilton, ON, Canada
| | - M Sholzberg
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - M Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine McMaster University, Hamilton, ON, Canada
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15
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Yeung CHT, Santesso N, Pai M, Kessler C, Key NS, Makris M, Navarro-Ruan T, Soucie JM, Schünemann HJ, Iorio A. Care models in the management of haemophilia: a systematic review. Haemophilia 2017; 22 Suppl 3:31-40. [PMID: 27348399 DOI: 10.1111/hae.13000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient-important outcomes. OBJECTIVE To conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH). SEARCH METHODS We searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the field, and reviewed reference lists. SELECTION CRITERIA Randomized and non-randomized studies of PWH or carriers, focusing mainly on the assessment of care models on delivery. DATA COLLECTION AND ANALYSIS Two investigators independently screened title, abstract, and full text of retrieved articles for inclusion. Risk of bias and overall quality of evidence was assessed using Cochrane's ACROBAT-NRSI tool and GRADE respectively. Relative risks, mean differences, proportions, and means and their variability were calculated as appropriate. RESULTS 27 non-randomized studies were included: eight comparative and 19 non-comparative studies. We found low- to very low-quality evidence that in comparison to other models of care, integrated care may reduce mortality, hospitalizations and emergency room visits, may lead to fewer missed days of school and work, and may increase knowledge seeking. CONCLUSION Our comprehensive review found low- to very low-quality evidence from a limited number of non-randomized studies assessing the impact of haemophilia care models on some patient-important outcomes. While the available evidence suggests that adoption of the integrated care model may provide benefit to PWH, further high-quality research in the field is needed.
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Affiliation(s)
- C H T Yeung
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - N Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - M Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - C Kessler
- Georgetown University, Washington, DC, USA
| | - N S Key
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - T Navarro-Ruan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J M Soucie
- Centers for Disease Control and Prevention, Division of Blood Disorders, National Center for Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - H J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Iorio
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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16
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Yeung CHT, Santesso N, Zeraatkar D, Wang A, Pai M, Sholzberg M, Schünemann HJ, Iorio A. Integrated multidisciplinary care for the management of chronic conditions in adults: an overview of reviews and an example of using indirect evidence to inform clinical practice recommendations in the field of rare diseases. Haemophilia 2017; 22 Suppl 3:41-50. [PMID: 27348400 DOI: 10.1111/hae.13010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Integrated care models have been adopted for individuals with chronic conditions and for persons with rare diseases, such as haemophilia. OBJECTIVE To summarize the evidence from reviews for the effects of integrated multidisciplinary care for chronic conditions in adults and to provide an example of using this evidence to make recommendations for haemophilia care. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL and Cochrane Database of Systematic Reviews up to January 2016, and reviewed reference lists of retrieved papers. SELECTION CRITERIA Systematic reviews of at least one randomized study, on adults with non-communicable chronic conditions. DATA COLLECTION AND ANALYSIS Two investigators independently assessed eligibility and extracted data. Quality of reviews was assessed using ROBIS, and the evidence assessed using GRADE. RESULTS We included seven reviews reporting on three chronic conditions. We found low to high quality evidence. Integrated care results in a reduction in mortality; likely a reduction in emergency visits and an improvement in function; little to no difference in quality of life, but shorter hospital stays; and may result in little to no difference in missed days of school or work. No studies reported educational attainment, or patient adherence and knowledge. When used for haemophilia, judgment about the indirectness of the evidence was driven by disease, intervention or outcome characteristics. CONCLUSION This overview provides the most up to date evidence on integrated multidisciplinary care for chronic conditions in adults, and an example of how it can be used for guidelines in rare diseases.
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Affiliation(s)
- C H T Yeung
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - N Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - D Zeraatkar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - A Wang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - M Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - M Sholzberg
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
| | - H J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Iorio
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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17
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Maheshwari P, Chauhan K, Kadam R, Pujani A, Kaur M, Chitalia M, Dabas H, Perkins MD, Boehme CC, Denkinger CM, Raizada N, Ginnard J, Jefferson C, Pantoja A, Rupert S, Kik SV, Cohen C, Chedore P, Satyanarayana S, Pai M. Market assessment of tuberculosis diagnostics in India in 2013. Int J Tuberc Lung Dis 2017; 20:304-13. [PMID: 27046709 DOI: 10.5588/ijtld.15.0571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
BACKGROUND India represents a significant potential market for new tests. We assessed India's market for tuberculosis (TB) diagnostics in 2013. METHODS Test volumes and unit costs were assessed for tuberculin tests, interferon-gamma release assays, sputum smear microscopy, serology, culture, speciation testing, nucleic-acid amplification tests (i.e., in-house polymerase chain reaction, Xpert(®) MTB/RIF, line-probe assays) and drug susceptibility testing. Data from the public sector were collected from the Revised National TB Control Programme reports. Private sector data were collected through a survey of private laboratories and practitioners. Data were also collected from manufacturers. RESULTS In 2013, India's public sector performed 19.2 million tests, with a market value of US$22.9 million. The private sector performed 13.6 million tests, with a market value of US$60.4 million when prices charged to the patient were applied. The overall market was US$70.8 million when unit costs from the ingredient approach were used for the 32.8 million TB tests performed in the entire country. Smear microscopy was the most common test performed, accounting for 25% of the overall market value. CONCLUSION India's estimated market value for TB diagnostics in 2013 was US$70.8 million. These data should be of relevance to test developers, donors and implementers.
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Affiliation(s)
- P Maheshwari
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - K Chauhan
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - R Kadam
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - A Pujani
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - M Kaur
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - M Chitalia
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - H Dabas
- Clinton Health Access Initiative [CHAI], New Delhi, India
| | - M D Perkins
- Foundation for Innovative New Diagnostics [FIND], Geneva, Switzerland
| | - C C Boehme
- Foundation for Innovative New Diagnostics [FIND], Geneva, Switzerland
| | - C M Denkinger
- Foundation for Innovative New Diagnostics [FIND], Geneva, Switzerland
| | - N Raizada
- Foundation for Innovative New Diagnostics [FIND], Geneva, Switzerland
| | | | - C Jefferson
- Independent consultant, currently consulting for FIND and UNITAID, Philadelphia, Pennsylvania, USA
| | - A Pantoja
- Independent consultant, Zurich, Switzerland
| | - S Rupert
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - S V Kik
- McGill International TB Centre, Montreal, Quebec, Canada
| | - C Cohen
- McGill International TB Centre, Montreal, Quebec, Canada
| | - P Chedore
- McGill International TB Centre, Montreal, Quebec, Canada
| | | | - M Pai
- McGill Global Health Programs, Department of Epidemiology & Biostatistics, McGill International TB Centre, 1020 Pine Ave West, Montreal, QC, Canada H3A 1A2.
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18
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Zhao YL, Pang Y, Xia H, Du X, Chin D, Huan ST, Dong HY, Zhang ZY, Ginnard J, Perkins MD, Boehme CC, Jefferson C, Pantoja A, Qin ZZ, Chedore P, Denkinger CM, Pai M, Kik SV. Market assessment of tuberculosis diagnostics in China in 2012. Int J Tuberc Lung Dis 2017; 20:295-303. [PMID: 27046708 DOI: 10.5588/ijtld.15.0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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
OBJECTIVE To assess the 2012 served available market for tuberculosis (TB) diagnostics in China in the sector served by the China Centre for Disease Control and Prevention (CDC) and the hospital sector in China, including both designated TB hospitals and general hospitals. DESIGN Test volumes and unit costs were assessed for tuberculin skin tests, interferon-gamma release assays (IGRAs), smear microscopy, serology, cultures, speciation tests, nucleic-acid amplification tests (NAATs), drug susceptibility tests and adenosine-deaminase tests (ADA). Data were obtained from electronic databases (CDC sector) and through surveys (hospital sector), and were estimated for the two sectors and for the country as a whole. Test costs were estimated by staff at China CDC, and using published literature. RESULTS In 2012, the China CDC and hospital sectors performed a total of 44 million TB diagnostic tests at an overall value of US$294 million. Tests used by the CDC sector were smear microscopy, solid and liquid culture and DST, while the hospital sector also used IGRAs, NAATs, ADA and serology. The hospital sector accounted for 76% of the overall test volume and 94% of the market value. CONCLUSION China has a very large TB diagnostic market that encompasses a wide range of diagnostic tests, with the majority being performed in Chinese hospitals.
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Affiliation(s)
- Y-L Zhao
- National Tuberculosis Reference Laboratory of Chinese Center for Disease Control and Prevention, National Center for TB Control and Prevention, Chinese Center for Disease Control and Prevention, No 155, Chang Bai Road, Changping District, Beijing 102206, P R China.
| | - Y Pang
- National Tuberculosis Reference Laboratory, China Center for Disease Control and Prevention, Beijing, China
| | - H Xia
- National Tuberculosis Reference Laboratory, China Center for Disease Control and Prevention, Beijing, China
| | - X Du
- Tuberculosis surveillance and statistics department, China Center for tuberculosis control and prevention, China Center for Disease Control and Prevention, Beijing, China
| | - D Chin
- Bill and Melinda Gates Foundation China, Beijing, China
| | - S-T Huan
- Bill and Melinda Gates Foundation China, Beijing, China
| | - H-Y Dong
- PATH, Beijing Office, Beijing, China
| | - Z-Y Zhang
- PATH, Beijing Office, Beijing, China
| | | | | | | | - C Jefferson
- Independent consultant, currently consulting for FIND and UNITAID, Philadelphia, Pennsylvania, USA
| | | | - Z Z Qin
- McGill International TB Centre, Montreal, Canada
| | - P Chedore
- McGill International TB Centre, Montreal, Canada
| | - C M Denkinger
- FIND, Geneva, Switzerland; McGill International TB Centre, Montreal, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - M Pai
- McGill International TB Centre, Montreal, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - S V Kik
- KNCV Tuberculosis Foundation, PO Box 146, 2501 CC The Hague, The Netherlands.
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19
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Bronner Murrison L, Ananthakrishnan R, Swaminathan A, Auguesteen S, Krishnan N, Pai M, Dowdy DW. How do patients access the private sector in Chennai, India? An evaluation of delays in tuberculosis diagnosis. Int J Tuberc Lung Dis 2017; 20:544-51. [PMID: 26970166 DOI: 10.5588/ijtld.15.0423] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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 The diagnosis and treatment of tuberculosis (TB) in India are characterized by heavy private-sector involvement. Delays in treatment remain poorly characterized among patients seeking care in the Indian private sector. OBJECTIVE To assess delays in TB diagnosis and treatment initiation among patients diagnosed in the private sector, and pathways to care in an urban setting. DESIGN Cross-sectional survey of 289 consecutive patients diagnosed with TB in the private sector and referred for anti-tuberculosis treatment through a public-private mix program in Chennai from January 2014 to February 2015. RESULTS Among 212 patients with pulmonary TB, 90% first contacted a formal private provider, and 78% were diagnosed by the first or second provider seen after a median of three visits per provider. Median total delay was 51 days (mean 68). Consulting an informal (rather than formally trained) provider first was associated with significant increases in total delay (absolute increase 22.8 days, 95%CI 6.2-39.5) and in the risk of prolonged delay >90 days (aRR 2.4, 95%CI 1.3-4.4). CONCLUSION Even among patients seeking care in the formal (vs. informal) private sector in Chennai, diagnostic delays are substantial. Novel strategies are required to engage private providers, who often serve as the first point of contact.
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Affiliation(s)
- L Bronner Murrison
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | - M Pai
- McGill International TB Centre & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA
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20
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Warkentin TE, Pai M. Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis: reply. J Thromb Haemost 2016; 14:2317-2319. [PMID: 27608440 DOI: 10.1111/jth.13498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- T E Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - M Pai
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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21
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Pande T, Cohen C, Pai M, Ahmad Khan F. Computer-aided detection of pulmonary tuberculosis on digital chest radiographs: a systematic review. Int J Tuberc Lung Dis 2016; 20:1226-30. [DOI: 10.5588/ijtld.15.0926] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Pai M, Key NS, Skinner M, Curtis R, Feinstein M, Kessler C, Lane SJ, Makris M, Riker E, Santesso N, Soucie JM, Yeung CHT, Iorio A, Schünemann HJ. NHF-McMaster Guideline on Care Models for Haemophilia Management. Haemophilia 2016; 22 Suppl 3:6-16. [DOI: 10.1111/hae.13008] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 02/05/2023]
Affiliation(s)
- M. Pai
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
- McMaster Centre for Transfusion Research McMaster University; Hamilton ON Canada
| | - N. S. Key
- Department of Medicine; University of North Carolina; Chapel Hill NC USA
| | - M. Skinner
- Institute for Policy Advancement Ltd.; Washington DC USA
| | - R. Curtis
- Factor VIII Computing; Berkeley CA USA
| | | | - C. Kessler
- Georgetown University; Washington DC USA
| | - S. J. Lane
- McMaster Centre for Transfusion Research McMaster University; Hamilton ON Canada
| | - M. Makris
- Department of Infection, Immunity and Cardiovascular Disease; University of Sheffield; Sheffield UK
| | - E. Riker
- National Hemophilia Foundation; New York NY USA
| | - N. Santesso
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - J. M. Soucie
- Centers for Disease Control and Prevention; National Center for Birth Defects and Developmental Disabilities; Division of Blood Disorders; Atlanta GA USA
| | - C. H. T. Yeung
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - A. Iorio
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - H. J. Schünemann
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
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23
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Pai M, Santesso N, Yeung CHT, Lane S, Schünemann HJ, Iorio A. Methodology for the development of the NHF-McMaster Guideline on Care Models for Haemophilia Management. Haemophilia 2016; 22 Suppl 3:17-22. [DOI: 10.1111/hae.13007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/27/2022]
Affiliation(s)
- M. Pai
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton ON Canada
- McMaster Centre for Transfusion Research; McMaster University; Hamilton ON Canada
| | - N. Santesso
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - C. H. T. Yeung
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - S.J. Lane
- McMaster Centre for Transfusion Research; McMaster University; Hamilton ON Canada
| | - H. J. Schünemann
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
| | - A. Iorio
- Department of Medicine; McMaster University; Hamilton ON Canada
- Department of Clinical Epidemiology and Biostatistics; McMaster University; Hamilton ON Canada
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Homenauth E, Ghiasi M, Feldman L, Arrouf N, Mallya S, Lacombe J, Pichika SC, Zhao K, Aibibula W, Krishnan R, Kajeguka D, Kaaya R, Protopopoff N, Mosha F, Desrochers R, Watts A, Kulkarni M, Saravu K, Nair S, Mukhopadhyay C, George LS, Pai M, Jiang H, Brown P, Blais L, Lefebvre G, Samoilenko M, Kulkarni M, Jolly A, Roy-Gagnon MH, Sander B, Gauvreau CL, Memon S, Popadiuk C, Flanagan WM, Nadeau C, Coldman AJ, Wolfson MC, Miller AB, Acar E, Cox J, Hamelin AM, McLinden T, Klein MB, Brassard P, Chong M, Martin J. The Canadian Society for Epidemiology and Biostatistics 2016 National Student Conference001INVESTIGATING ECOLOGICAL DETERMINANTS OF MALARIA VECTOR DISTRIBUTION IN RURAL TANZANIA “A MULTI-SCALAR INVESTIGATION”002PREVALENCE AND RISK FACTORS OF TUBERCULOSIS INFECTION AMONG HEALTHCARE TRAINEES IN SOUTH INDIA003SPATIAL MODELLING OF LUNG AND THYROID CANCERS IN UNITED STATES COUNTIES004A MEDIATION ANALYSIS TO ASSESS THE IMPACT OF INHALED CORTICOSTEROIDS (ICSS) DURING PREGNANCY ON BIRTHWEIGHT005MODELLING HUMAN RISK OF WEST NILE VIRUS IN ONTARIO, 2002-2013: INCORPORATING SURVEILLANCE AND ENVIRONMENTAL DATA006EXPLORING THE HEALTH OUTCOMES OF VARIOUS PAN-CANADIAN CERVICAL CANCER SCREENING PROGRAMS USING MICROSIMULATION MODELING007INTEGRATIVE ANALYSIS OF MICRORNA AND GENE EXPRESSION DATA USING SPARSE CANONICAL CORRELATION ANALYSIS008CONDITIONAL DEPENDENCE MODELS UNDER COVARIATE MEASUREMENT ERROR009ASSOCIATION BETWEEN FOOD INSECURITY AND HIV VIRAL SUPPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS010ANTIBIOTICS VERSUS APPENDECTOMY FOR UNCOMPLICATED APPENDICITIS: A GLOBAL HEALTH PERSPECTIVE. Am J Epidemiol 2016. [DOI: 10.1093/aje/kww058] [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: 11/13/2022] Open
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25
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Linkins LA, Warkentin TE, Pai M, Shivakumar S, Manji RA, Wells PS, Wu C, Nazi I, Crowther MA. Rivaroxaban for treatment of suspected or confirmed heparin-induced thrombocytopenia study. J Thromb Haemost 2016; 14:1206-10. [PMID: 27061271 DOI: 10.1111/jth.13330] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Essentials Heparin-induced thrombocytopenia (HIT) is a thrombogenic condition that is difficult to treat. We evaluated rivaroxaban as a treatment option in patients with suspected or confirmed HIT. One patient had recurrent thrombosis and 9/10 patients with thrombocytopenia had platelet recovery. Rivaroxaban may be an effective and safe treatment option for HIT. SUMMARY Background Rivaroxaban is a direct oral anti-Xa inhibitor that has the potential to greatly simplify treatment of heparin-induced thrombocytopenia (HIT). Objectives To evaluate the efficacy and safety of rivaroxaban in this patient population, we conducted a multicenter, single-arm, prospective cohort study of patients with suspected or confirmed HIT. Patients/Methods Twenty-two consecutive adults with suspected or confirmed HIT received rivaroxaban 15 mg bid until a local HIT assay result was available. Participants with a positive local assay result continued rivaroxaban 15 mg bid until platelet recovery (or until day 21 if they had acute thrombosis at study entry), then stepped down to rivaroxaban 20 mg daily until day 30. Results and Conclusions The primary outcome measure, incidence of new symptomatic, objectively-confirmed venous and arterial thromboembolism at 30 days, occurred in one HIT-positive participant (4.5%; 95% confidence interval [CI], 0-23.5%) and one HIT-positive participant required limb amputation despite platelet recovery. Platelet recovery was achieved in nine out of 10 HIT-positive patients with thrombocytopenia. Rivaroxaban appears to be effective for treating patients with confirmed HIT, although the small number of patients enrolled limits precision.
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Affiliation(s)
- L A Linkins
- Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada
| | - T E Warkentin
- Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - M Pai
- Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - S Shivakumar
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - R A Manji
- Department of Surgery and Cardiac Sciences Program, University of Manitoba, Winnipeg, MB, Canada
| | - P S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | - C Wu
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - I Nazi
- Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada
| | - M A Crowther
- Department of Medicine, McMaster University, TAARI, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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26
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Dowdy DW, Houben R, Cohen T, Pai M, Cobelens F, Vassall A, Menzies NA, Gomez GB, Langley I, Squire SB, White R. Impact and cost-effectiveness of current and future tuberculosis diagnostics: the contribution of modelling. Int J Tuberc Lung Dis 2016; 18:1012-8. [PMID: 25189546 PMCID: PMC4436823 DOI: 10.5588/ijtld.13.0851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The landscape of diagnostic testing for tuberculosis (TB) is changing rapidly, and stakeholders need urgent guidance on how to develop, deploy and optimize TB diagnostics in a way that maximizes impact and makes best use of available resources. When decisions must be made with only incomplete or preliminary data available, modelling is a useful tool for providing such guidance. Following a meeting of modelers and other key stakeholders organized by the TB Modelling and Analysis Consortium, we propose a conceptual framework for positioning models of TB diagnostics. We use that framework to describe modelling priorities in four key areas: Xpert® MTB/RIF scale-up, target product profiles for novel assays, drug susceptibility testing to support new drug regimens, and the improvement of future TB diagnostic models. If we are to maximize the impact and cost-effectiveness of TB diagnostics, these modelling priorities should figure prominently as targets for future research.
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Affiliation(s)
- D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R Houben
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
| | - T Cohen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - M Pai
- Department of Epidemiology and Biostatistics & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - F Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vassall
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - N A Menzies
- Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G B Gomez
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - I Langley
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S B Squire
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R White
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
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McDowell A, Pai M. Treatment as diagnosis and diagnosis as treatment: empirical management of presumptive tuberculosis in India. Int J Tuberc Lung Dis 2016; 20:536-43. [DOI: 10.5588/ijtld.15.0562] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. McDowell
- McGill International TB Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - M. Pai
- McGill International TB Centre & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Satyanarayana S, Subbaraman R, Shete P, Gore G, Das J, Cattamanchi A, Mayer K, Menzies D, Harries AD, Hopewell P, Pai M. Quality of tuberculosis care in India: a systematic review. Int J Tuberc Lung Dis 2016; 19:751-63. [PMID: 26056098 DOI: 10.5588/ijtld.15.0186] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [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
BACKGROUND While Indian studies have assessed care providers' knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS We searched multiple sources to identify studies (2000-2014) on providers' knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India.
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Affiliation(s)
- S Satyanarayana
- Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada; Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Subbaraman
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Partners for Urban Knowledge, Action and Research, Mumbai, India
| | - P Shete
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA
| | - G Gore
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA
| | - J Das
- Life Sciences Library, McGill University, Montreal, Canada
| | - A Cattamanchi
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA
| | - K Mayer
- Development Economics Research Group, World Bank, Washington DC, USA
| | - D Menzies
- The Fenway Institute and Beth Israel Deaconess Medical Center, Boston Massachusetts, USA
| | - A D Harries
- Center for Operations Research, International Union Against Tuberculosis and Lung Disease, Paris, France; Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada
| | - P Hopewell
- Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA; Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, California, USA
| | - M Pai
- Department of Epidemiology, Biostatistics and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
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Warkentin TE, Pai M. Shock, acute disseminated intravascular coagulation, and microvascular thrombosis: is 'shock liver' the unrecognized provocateur of ischemic limb necrosis? J Thromb Haemost 2016; 14:231-5. [PMID: 26662371 DOI: 10.1111/jth.13219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 07/24/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
For unknown reasons, a small minority of critically ill patients with septic or cardiogenic shock, multiorgan failure, and disseminated intravascular coagulation develop symmetrical acral (distal extremity) limb loss due to microvascular thrombosis ('limb gangrene with pulses'). Case reports have described preceding 'shock liver' in some critically ill patients who developed such a picture of ischemic limb necrosis. This suggests that profoundly disturbed procoagulant-anticoagulant balance featuring uncontrolled generation of thrombin-resulting from failure of the protein C and antithrombin natural anticoagulant systems due to insufficient hepatic synthesis of these crucial proteins-could explain the microvascular thrombosis and associated limb loss. We hypothesize that shock liver is the key predisposing risk factor underlying ischemic limb necrosis in the majority of patients who develop this complication in the setting of acute disseminated intravascular coagulation complicating septic or cardiogenic shock. As shock liver precedes onset of limb ischemia by several days, therapeutic intervention may be possible.
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Affiliation(s)
- T E Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - M Pai
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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Giglio MC, Spalding DRC, Giakoustidis A, Zarzavadjian Le Bian A, Jiao LR, Habib NA, Pai M. Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection. Br J Surg 2016; 103:328-36. [DOI: 10.1002/bjs.10090] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 01/06/2023]
Abstract
Abstract
Background
Drain amylase content in the days immediately after major pancreatic resection has been investigated previously as a predictor of postoperative pancreatic fistula (POPF). Its accuracy, however, has not been determined conclusively. The purpose of this study was to evaluate the accuracy of drain amylase content on the first day after major pancreatic resection in predicting the occurrence of POPF.
Methods
A literature search of the MEDLINE, Embase and Scopus® databases to 13 May 2015 was performed to identify studies evaluating the accuracy of drain amylase values on day 1 after surgery in predicting the occurrence of POPF. The area under the hierarchical summary receiver operating characteristic (ROC) curve (AUChSROC) was calculated as an index of accuracy, and pooled estimates of accuracy indices (sensitivity and specificity) were calculated at different cut-off levels. Subgroup and meta-regression analyses were performed to test the robustness of the results.
Results
Thirteen studies involving 4416 patients were included. The AUChSROC was 0·89 (95 per cent c.i. 0·86 to 0·92) for clinically significant POPF and 0·88 (0·85 to 0·90) for POPF of any grade. Pooled estimates of sensitivity and specificity were calculated for the different cut-offs: 90–100 units/l (0·96 and 0·54 respectively), 350 units/l (0·91 and 0·84) and 5000 units/l (0·59 and 0·91). Accuracy was independent of the type of operation, type of anastomosis performed and octreotide administration.
Conclusion
Evaluation of drain amylase content on the first day after surgery is highly accurate in predicting POPF following major pancreatic resection. It may allow early drain removal and institution of an enhanced recovery pathway.
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Affiliation(s)
- M C Giglio
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - D R C Spalding
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - A Giakoustidis
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - A Zarzavadjian Le Bian
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - L R Jiao
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - N A Habib
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
| | - M Pai
- Hepatopancreaticobiliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, UK
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Satyanarayana S, Sagili K, Chadha SS, Pai M. Use of rapid point-of-care tests by primary health care providers in India: findings from a community-based survey. Public Health Action 2015; 4:249-51. [PMID: 26400704 DOI: 10.5588/pha.14.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/26/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022] Open
Abstract
In a cross-sectional survey conducted in 45 districts of India, we assessed 1) use of any rapid point-of-care (POC) tests by primary health care providers, and 2) their willingness to use POC tests for tuberculosis (TB) in future. A total of 767 primary health care providers, including private and public sector practitioners, health workers and chemists, were interviewed. A quarter of the primary health care providers reported using POC tests, with pregnancy tests being the most common. Nearly half of the respondents expressed willingness to use POC tests for TB, provided the test was available free or at low cost (<US$ 2.00).
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Affiliation(s)
- S Satyanarayana
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and McGill International TB Centre, Montreal, Quebec, Canada ; Centre for Operations Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - K Sagili
- The Union, South-East Asia Regional Office, New Delhi, India
| | - S S Chadha
- The Union, South-East Asia Regional Office, New Delhi, India
| | - M Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and McGill International TB Centre, Montreal, Quebec, Canada
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Schumacher SG, Thangakunam B, Denkinger CM, Oliver AA, Shakti KB, Qin ZZ, Michael JS, Luo R, Pai M, Christopher DJ. Impact of point-of-care implementation of Xpert ® MTB/RIF: product vs. process innovation. Int J Tuberc Lung Dis 2015; 19:1084-90. [DOI: 10.5588/ijtld.15.0120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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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Thakkar VP, Rao A, Rajesh G, Shenoy R, Pai M. Fluoride content and labelling of toothpastes marketed in India. Community Dent Health 2015; 32:170-173. [PMID: 26513853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To enumerate the fluoride content and labelling practices of toothpastes marketed in India and to determine if the content is in accordance with the information provided on the packaging. METHOD In vitro analysis of total and free available fluoride in 5 adult and 5 children's fluoride toothpastes in India using fluoride ion electrode. Information on the tube and carton was checked to assess the labelling. RESULTS The mean Total Fluoride concentrations (TF) in the toothpastes labelled 1,000 ppm, 500ppm and 458 ppm were 1,000, 500 and 449mg/L (sd values 3, 5 and 4mg/L) respectively. The toothpastes' Total Soluble Fluoride (TSF) concentration was generally slightly less than the TF concentration. Overall mean percentage of TSF concentration was 94% sd 9%. The mean percentage of TSF concentration in SMFP (sodium monofluorophosphate)/CaCO3 (calcium carbonate) containing toothpastes was 86% sd 16% while that in NaF (sodium fluoride)/Si (silica) based toothpastes was 98% sd 1% and 95% sd 1% in the remaining toothpastes with unknown abrasive. NaF/Si based toothpastes had more TSF concentration than the others (p<0.05). All the information required by the Indian regulations was shown on all 10 toothpastes. CONCLUSION The available fluoride content of one of the ten toothpastes was substantially less than the total fluoride content. Although the toothpastes were labelled following the guidelines of the regulatory body of India, 3 of the 10 failed to mention the abrasive present.
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Schulman S, Hwang HG, Eikelboom JW, Kearon C, Pai M, Delaney J. Loading dose vs. maintenance dose of warfarin for reinitiation after invasive procedures: a randomized trial. J Thromb Haemost 2014; 12:1254-9. [PMID: 24837794 DOI: 10.1111/jth.12613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is uncertainty regarding the optimal dosing regimen for the resumption of warfarin after interruption for invasive procedures. AIM To determine the efficacy and safety of warfarin resumption with loading doses or with the most recent maintenance dose. METHODS Patients receiving warfarin treatment and planned for invasive procedures with an expected hospital stay of ≤ 1 day were randomized to resume warfarin on the day of the procedure, defined as day 1, with most recent maintenance dose or with 2 initial days of double maintenance dose. Efficacy outcomes were proportion of international normalized ratio (INR) levels ≥ 2.0 on day 5 (primary outcome) and day 10. Safety outcomes were bleeding and thromboembolic events. In addition, D-dimer levels were analyzed on days 5 and 10 in a subset of the population. RESULTS There were 49 patients analyzed in each group. INR of ≥ 2.0 had been achieved by day 5 for 13% in the maintenance-dose group and for 50% in the loading-dose group (relative risk [RR] 0.27, 95% confidence interval [CI] 0.10-0.60) and by day 10 for 68% and 87%, respectively (RR 0.78, 95% CI 0.65-1.00). There were no thromboembolic events, and there was one major bleed before resumption of warfarin and one minor bleed, both in the maintenance-dose group. There was no difference between the groups in the proportion of patients with excessive INRs or elevated D-dimer levels or in the median D-dimer level. CONCLUSION Resumption of warfarin after minor-moderately invasive procedures with two loading doses achieves therapeutic INR faster than does only maintenance dose.
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Affiliation(s)
- S Schulman
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada; Department of Medicine, Thrombosis Service, Hamilton, ON, Canada; Karolinska Institutet, Stockholm, Sweden
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Pai R, Ghartimagar D, Khadilkar U, Pai M, Kini A. Lymph node infarction and lymphoma. J Pathol Nep 2014. [DOI: 10.3126/jpn.v4i7.10319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Non Hodgkin lymphoma with infarction at initial presentation is rare and can be confused with an acute inflammatory process. A 47 year-old-man presented with complaint of swelling in the left parotid region for 2 weeks which increased in size with severe, continuous and throbbing pain in the last 2-3 days. A clinical diagnosis of parotid abscess was made. Incision and drainage did not yield any pus. Fine needle aspiration cytology showed a highly cellular tumor comprising of somewhat uniform round cells with granular nuclear chromatin. Ghost outline of cytoplasm was noted. A diagnosis of infarcted neoplasm of the parotid gland, probably acinic cell carcinoma was suggested. Histopathologically, it was reported as non-Hodgkin lymphoma with infarction which was confirmed by immunohistochemistry. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10319 Journal of Pathology of Nepal (2014) Vol. 4, 591-593
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Zwerling A, Pai M, Michael JS, Christopher DJ. Serial testing using interferon- release assays in nursing students in India. Eur Respir J 2014; 44:257-60. [DOI: 10.1183/09031936.00011914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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37
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Kik SV, Denkinger CM, Chedore P, Pai M. Replacing smear microscopy for the diagnosis of tuberculosis: what is the market potential? Eur Respir J 2014; 43:1793-6. [DOI: 10.1183/09031936.00217313] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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38
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Reebye V, Sætrom P, Mintz P, Huang K, Swiderski P, Peng L, Liu C, Liu X, Jensen S, Zacharoulis D, Kostomitsopoulos N, Kasahara N, Nicholls J, Jiao L, Pai M, Mizandari M, Chikovani T, Emara M, Haoudi A, Tomalia D, Rossi J, Habib N, Spalding D. Novel RNA oligonucleotide improves liver function and inhibits liver carcinogenesis in vivo. Hepatology 2014; 59:216-27. [PMID: 23929703 PMCID: PMC4655108 DOI: 10.1002/hep.26669] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/31/2013] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) occurs predominantly in patients with liver cirrhosis. Here we show an innovative RNA-based targeted approach to enhance endogenous albumin production while reducing liver tumor burden. We designed short-activating RNAs (saRNA) to enhance expression of C/EBPα (CCAAT/enhancer-binding protein-α), a transcriptional regulator and activator of albumin gene expression. Increased levels of both C/EBPα and albumin mRNA in addition to a 3-fold increase in albumin secretion and 50% decrease in cell proliferation was observed in C/EBPα-saRNA transfected HepG2 cells. Intravenous injection of C/EBPα-saRNA in a cirrhotic rat model with multifocal liver tumors increased circulating serum albumin by over 30%, showing evidence of improved liver function. Tumor burden decreased by 80% (P = 0.003) with a 40% reduction in a marker of preneoplastic transformation. Since C/EBPα has known antiproliferative activities by way of retinoblastoma, p21, and cyclins, we used messenger RNA (mRNA) expression liver cancer-specific microarray in C/EBPα-saRNA-transfected HepG2 cells to confirm down-regulation of genes strongly enriched for negative regulation of apoptosis, angiogenesis, and metastasis. Up-regulated genes were enriched for tumor suppressors and positive regulators of cell differentiation. A quantitative polymerase chain reaction (PCR) and western blot analysis of C/EBPα-saRNA-transfected cells suggested that in addition to the known antiproliferative targets of C/EBPα, we also observed suppression of interleukin (IL)6R, c-Myc, and reduced STAT3 phosphorylation. CONCLUSION A novel injectable saRNA-oligonucleotide that enhances C/EBPα expression successfully reduces tumor burden and simultaneously improves liver function in a clinically relevant liver cirrhosis/HCC model.
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MESH Headings
- Albumins/metabolism
- Animals
- CCAAT-Enhancer-Binding Protein-alpha/metabolism
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/pathology
- Drug Evaluation, Preclinical
- Gene Expression Regulation
- Genetic Therapy
- Hep G2 Cells
- Humans
- Injections, Intravenous
- Liver/pathology
- Liver Cirrhosis/complications
- Liver Function Tests
- Liver Neoplasms, Experimental/complications
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/pathology
- Male
- Oligonucleotide Array Sequence Analysis
- Proto-Oncogene Proteins c-myc/metabolism
- RNA/therapeutic use
- Rats
- Rats, Wistar
- Receptors, Interleukin-6/metabolism
- STAT3 Transcription Factor/metabolism
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Affiliation(s)
- V. Reebye
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - P. Sætrom
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NO-7489 Trondheim, Norway
- Department of Computer and Information Science, Norwegian University of Science and Technology, NO-7489 Trondheim, Norway
| | - P.J. Mintz
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - K.W. Huang
- Department of Surgery & Hepatitis Research Center. National Taiwan University Hospital, Taipei City, 10002, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University. Taipei City, 10002, Taiwan
| | - P. Swiderski
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope, CA 91010. USA
| | - L. Peng
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - C. Liu
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - X.X. Liu
- Centre Interdisciplinaire de Nanoscience de Marseille, 13288 Marseille, France
| | - S. Jensen
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - D. Zacharoulis
- Department of Surgery, University Hospital of Larissa Mezourlo, Larisa, Greece
| | - N. Kostomitsopoulos
- Centre for Experimental Surgery, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - N. Kasahara
- Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90095-7019, USA
| | - J.P. Nicholls
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - L.R. Jiao
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - M. Pai
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - M. Mizandari
- Department of Radiology. Tbilisi 1 Hospital University Clinic. High Technology Medical Center. Tbilisi, Georgia
| | - T. Chikovani
- Department of Microbiology and Immunology. Faculty of Medicine. Tbilisi State Medical University. Tbilisi, Georgia
| | - M.M. Emara
- Qatar Biomedical Research Institute, Education City, P.O BOX 5825, Doha, Qatar
| | - A. Haoudi
- Qatar Biomedical Research Institute, Education City, P.O BOX 5825, Doha, Qatar
| | - D.A. Tomalia
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, USA
| | - J.J. Rossi
- Division of Molecular Biology, Beckman Research Institute of City of Hope, Duarte, CA 91010, USA
| | - N.A. Habib
- Department of Surgery and Cancer; Faculty of Medicine, Imperial College London, London, W12 0NN, UK
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Mathew J, Yusuf A, Vincent J, Eikelboom J, Shestakovska O, Fremes S, Noora J, Guo L, Peterson M, Spyropoulos A, Patel A, Schulman S, Pai M, Whitlock R. Efficacy and Safety of Different Bridging Regimens of Parenteral Anticoagulation After Mechanical Valve Replacement. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.595] [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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Hunter D, Shrestha AK, Pai M, Spalding D. Determining complete clinical response of radiologically disappearing colorectal liver metastases after chemotherapy and how they should be managed. Ann R Coll Surg Engl 2013. [DOI: 10.1308/rcsann.2013.95.6.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The 2013 Alpine Liver and Pancreatic Surgery meeting was held in Madonna di Campiglio, Italy. The meeting was organised by the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland. The following abstracts were selected for presentation at the meeting.
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Affiliation(s)
- D Hunter
- Imperial College Healthcare NHS Trust, UK
| | | | - M Pai
- Imperial College Healthcare NHS Trust, UK
| | - D Spalding
- Imperial College Healthcare NHS Trust, UK
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Mathew J, Yusuf A, Vincent J, Eikelboom J, Shestakovska O, Spyropolous A, Patel A, Schulman S, Pai M, Whitlock R. Efficacy and safety of different bridging regimens of parenteral anticoagulation after mechanical valve replacement. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nicolau I, Ling D, Tian L, Lienhardt C, Pai M. Methodological and reporting quality of systematic reviews on tuberculosis. Int J Tuberc Lung Dis 2013; 17:1160-9. [PMID: 23809432 DOI: 10.5588/ijtld.13.0050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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
BACKGROUND Systematic reviews are used to inform tuberculosis (TB) guidelines. However, there are no data on whether TB systematic reviews are conducted well and reported transparently. METHODS We searched four databases for reviews published between 2005 and 2010. Methodological quality was evaluated using AMSTAR and quality of reporting was assessed using PRISMA. RESULTS Of 152 articles, 137 (90%) met the inclusion criteria. Only 3 of 11 AMSTAR quality items were met in most reviews: appropriate methods to combine findings (67%), comprehensive literature search (72%) and presentation of characteristics of included studies (90%). The other eight items were met in 4-53% of the reviews. Only 4% of the reviews disclosed conflicts of interest. The majority of the PRISMA items were reported in more than 60-76% of the reviews. Only nine items were reported in less than 55% of the reviews, the lowest being the full-search strategy (30%), risk of bias across studies in the Methods (27%) and Results (21%) sections, and indication of a review protocol (15%). CONCLUSIONS Systematic reviews in our survey were well reported but generally of moderate to low quality. Better training, use of reporting guidelines and registration of systematic reviews could improve the quality of TB reviews.
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Affiliation(s)
- I Nicolau
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Denkinger CM, Grenier J, Stratis AK, Akkihal A, Pant-Pai N, Pai M. Mobile health to improve tuberculosis care and control: a call worth making. Int J Tuberc Lung Dis 2013; 17:719-27. [PMID: 23541232 DOI: 10.5588/ijtld.12.0638] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The use of mobile phones has substantially increased throughout the world over the last decade. This has opened up opportunities for the integration of mobile phones as health intervention tools in many aspects of health care, including prevention, diagnosis, data collection, treatment and adherence monitoring and surveillance. Several applications have been explored in human immunodeficiency virus care. The field of tuberculosis (TB) has not exploited the potential of mobile health (m-health) to the same extent, although the opportunities have been recognized. A number of proof-of-concept and pilot studies have been published on m-health in TB care, and an even larger number of studies are available in the grey literature. This article summarizes publications and recent developments at the intersection of TB care and m-health. We show that more rigorous studies evaluating different applications and implementation strategies are needed to establish an evidence base that serves to inform policy and decision making. We outline further areas of research that should be addressed and potential challenges that lie ahead if m-health applications are to enhance the accessibility and quality of TB care.
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Affiliation(s)
- C M Denkinger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. cdenking@ bidmc.harvard.edu
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Kraft J, Blanchette V, Babyn P, Feldman B, Cloutier S, Israels S, Pai M, Rivard GE, Gomer S, McLimont M, Moineddin R, Doria AS. Magnetic resonance imaging and joint outcomes in boys with severe hemophilia A treated with tailored primary prophylaxis in Canada. J Thromb Haemost 2012; 10:2494-502. [PMID: 23067060 DOI: 10.1111/jth.12025] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Tailored primary prophylaxis (TPP) is a reduced-intensity treatment program for hemophiliacs with the goal of preventing arthropathy. Our primary aim was to evaluate the joint outcomes of treated subjects using magnetic resonance imaging (MRI) and physical examination as outcome measures. METHODS Ankles, elbows and knees (index joints) of 24 subjects (median [range] age at start of therapy, 1.6 [1-2.5] years) with severe hemophilia A enrolled in the Canadian Hemophilia Primary Prophylaxis Study (CHPS) were examined by MRI at a median age of 8.8 years (range 6.2-11.5 years). Subjects were treated with TPP using a recombinant factor VIII concentrate, starting once weekly and escalating in frequency and dose according to frequency of bleeding. RESULTS Osteochondral changes (cartilage loss/subchondral bone damage) were detected in 9% (13/140) of the index joints and 50% (12/24) of study subjects. Osteochondral changes were restricted to joints with a history of clinically reported joint bleeding. Soft tissue changes were detected in 31% (20/65) of index joints with no history of clinically reported bleeding (ankles 75% (12/16); elbows 19% (6/32); and knees 12% (2/17)). In these apparently 'bleed free' index joints hemosiderin deposition was detected by MRI in 26% (17/65) of joints (ankles 63% (10/16); elbows 16% (5/32), and knees 12% (2/17)). CONCLUSION TPP did not completely avoid the development of MRI-detected structural joint changes in hemophilic boys in this prospective study. A longer period of follow-up is required for assessment of the longitudinal course of these early changes in hemophilic arthropathy, detected using a sensitive imaging technique (MRI).
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Affiliation(s)
- J Kraft
- Clarendon Wing Radiology Department, Leeds General Infirmary, Leeds, UK
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Kamath MP, Hegde MC, Bhojwani KM, Sreedharan S, Dinesh M, Pai M, Padmanabhan K. Histiocytosis of the temporal bone. Indian J Otolaryngol Head Neck Surg 2012; 52:274-6. [PMID: 23119694 DOI: 10.1007/bf03006202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Histiocytosis is a rare disease of unknown aetiology which commonly affects the head and neck region. In the ear it can closely mimic acute and chronic ear disease leading to a confusion in diagnosis. It can be easily misdiagnosed unless a high index of clinical suspicion is maintained. We present a case of Letterer Siwe disease of the temporal bone which presented with bilateral mastoid abscesses.
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Affiliation(s)
- M P Kamath
- Dept. of ENT, Kasturba Medical College, Mangalore
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Barr R, Pai M, Weitzman S, Feeny D, Furlong W, Rosenbaum P, Torrance G. A multiattribute approach to health-status measurement and clinical management illustrated by an application to brain-tumors in childhood. Int J Oncol 2012; 4:639-48. [PMID: 21566971 DOI: 10.3892/ijo.4.3.639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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] Open
Abstract
A comprehensive multi-attribute system was devised to assess global morbidity burden. The system was used to obtain qualitative and quantitative measures of health-status for a case series of survivors of brain tumors in childhood. Health-related quality-of-life scores for each global health-state were calculated from a utility function derived from measures of preferences collected during surveys of a random sample of parents of school age children in the general public (n=194). Global multi-attribute health status (MAHS) utility scores revealed a wide range of severity in morbidity burden. We suggest that the assessment of health-related quality-of-life should become an integral part of clinical management.
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Affiliation(s)
- R Barr
- MCMASTER UNIV,DEPT ECON,HAMILTON L8N 3Z5,ONTARIO,CANADA. MCMASTER UNIV,DEPT CLIN EPIDEMIOL & BIOSTAT,HAMILTON L8N 3Z5,ONTARIO,CANADA. MCMASTER UNIV,CTR HLTH ECON & POLICY ANAL,HAMILTON L8N 3Z5,ONTARIO,CANADA. HOSP SICK CHILDREN,TORONTO M5G 1X8,ONTARIO,CANADA. CHILDRENS HOSP CHEDOKE MCMASTER,HAMILTON,ON,CANADA
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Pai M, Palamountain KM. New tuberculosis technologies: challenges for retooling and scale-up [State of the art series. New tools. Number 4 in the series]. Int J Tuberc Lung Dis 2012; 16:1281-90. [PMID: 23107630 DOI: 10.5588/ijtld.12.0391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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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Grenier J, Pinto L, Nair D, Steingart K, Dowdy D, Ramsay A, Pai M. Widespread use of serological tests for tuberculosis: data from 22 high-burden countries. Eur Respir J 2012; 39:502-5. [PMID: 22298618 DOI: 10.1183/09031936.00070611] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ramsay A, Steingart KR, Cunningham J, Pai M. Translating tuberculosis research into global policies: the example of an international collaboration on diagnostics. Int J Tuberc Lung Dis 2012; 15:1283-93. [PMID: 22283885 DOI: 10.5588/ijtld.11.0297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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
Using the example of an international collaboration on tuberculosis (TB) diagnostics, we mapped the key stages and stakeholders involved in translating research into global policies. In our experience, the process begins with advocacy for high-quality, policy-relevant research and appropriate funding. Following the assessment of current policy and the identification of key study areas, policy-relevant research questions need to be formulated and prioritised. It is important that a framework for translating evidence into policy at the target policymaking level, in this case global, is available to researchers. This ensures that research questions, study designs and research standards are appropriate to the type and quality of evidence required. The framework may evolve during the period of research and, as evidence requirements may change, vigilance is required. Formal and informal multi-stakeholder partnerships, as well as information sharing through extensive networking, facilitate efficient building of a broad evidence base. Coordination of activities by an international, neutral body with strong convening powers is important, as is regular interaction with policy makers. It is recognised that studies on diagnostic accuracy provide weak evidence that a new diagnostic will improve patient care when implemented to scale in routine settings. This may be one reason why there has been poor uptake of new tools by national TB control programmes despite global policy recommendations. Stronger engagement with national policy makers and donors during the research-intopolicy process may be needed to ensure that their evidence requirements are met and that global policies translate into national policies. National policies are central to translating global policies into practice.
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Affiliation(s)
- A Ramsay
- United Nations International Children's Emergency Fund/United Nations Development Programme/World Bank/ World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
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Joshi R, Narang U, Zwerling A, Jain D, Jain V, Kalantri S, Pai M. Predictive value of latent tuberculosis tests in Indian healthcare workers: a cohort study. Eur Respir J 2012; 38:1475-7. [PMID: 22130764 DOI: 10.1183/09031936.00014611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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