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Bind RH, Sawyer K, Hazelgrove K, Rebecchini L, Miller C, Ahmed S, Dazzan P, Sevdalis N, Bakolis I, Davis R, Lopez MB, Woods A, Crane N, Manoharan M, Burton A, Dye H, Osborn T, Greenwood L, Perkins R, Fancourt D, Pariante CM, Estevao C. Feasibility, clinical efficacy, and well-being outcomes of an online singing intervention for postnatal depression in the UK: SHAPER-PNDO, a single-arm clinical trial. Pilot Feasibility Stud 2023; 9:131. [PMID: 37501172 PMCID: PMC10373337 DOI: 10.1186/s40814-023-01360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Postnatal depression (PND) affects over 12% of mothers, with numbers rising during COVID-19. Singing groups can support mothers with PND; however, online delivery has never been evaluated. SHAPER-PNDO, a single-arm clinical trial, evaluated the feasibility, clinical efficacy, and well-being outcomes of a 6-week online version of Breathe Melodies for Mums (M4M) singing intervention developed for mothers with PND during COVID-19 lockdowns. METHODS The primary objective of this study was to assess the feasibility of a group online singing intervention for new mothers with postnatal depression. This was ascertained through recruitment rates, study retention rates, attendance rates to the singing sessions, and study completion rates. The secondary objective of the study was to assess the clinical efficacy and well-being outcomes of the singing intervention. Specifically, we measured change in Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and Office for National Statistics Wellbeing Scale (ONS) scores from baseline to end-of-intervention (week 6); follow-up assessments were completed at weeks 3, 16, and 32. Mothers were eligible if they scored ≥10 on the baseline EPDS. RESULTS Eighty-seven percent of the 37 recruited mothers completed the study, attending, on average, 5 of the 6 group singing sessions. With regard to secondary outcomes, at end-of-treatment, mothers experienced significant reductions in depression (EPDS, 16.6 ± 3.7 to 11.2 ± 5.3, 95% CI [0.79,1.65]), anxiety (STAI-S, 48.4 ± 27.1 to 41.7 ± 26.8, 95% CI [4.96, 17.65]) and stress (PSS, 29.0 ± 5.7 to 19.7 ± 5.3, 95% CI [1.33, 7.07]); and, furthermore, significant improvements in life satisfaction (ONS, 50.5 ± 23.0 to 72.8 ± 11.7, 95% CI [- 39.86, - 4.64]) and feelings of worthwhileness (ONS, 51.7 ± 30.4 to 78.6 ± 15.1, 95% CI [- 52.79, - 0.85]). Reduction on the EPDS correlated with a reduction on the BDI and the STAI-S and maternal childhood maltreatment was predictive of a smaller treatment response. CONCLUSIONS M4M online was feasible to mothers who partook in the programme. Furthermore, M4M online supports the mental health and well-being of new mothers experiencing PND, especially when barriers to in-person treatment are present. TRIAL REGISTRATION ClinicalTrials.gov NCT04857593 . Registered 22 April 2021, retrospectively registered.
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Affiliation(s)
- Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK.
| | - Kristi Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Celeste Miller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Subeyda Ahmed
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Nikki Crane
- Culture Team, King's College London, Somerset House East Wing, London, WC2R 2LS, Strand, UK
| | - Manonmani Manoharan
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Hannah Dye
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Tim Osborn
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Lorna Greenwood
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Rosie Perkins
- Centre for Performance Science, Royal College of Music, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
| | - Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, Brixton, London, SE5 9RT, UK
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Thiyagarajan G, Manoharan M, Veerabadhran MM, Murugesan G, Vinodh S, Kamatchi M. Biodentine as BioRoot Inlay: A Case Report. Int J Clin Pediatr Dent 2023; 16:400-404. [PMID: 37519983 PMCID: PMC10373764 DOI: 10.5005/jp-journals-10005-2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aims and background The success of endodontic treatment in open apex teeth depends on the establishment of an ideal apical barrier so that apical canal space between the periodontium and the root canal system is filled. Biodentine is a calcium silicate-based cement having several advantages over mineral trioxide aggregate (MTA), glass ionomer cement (GIC), and calcium hydroxide in the treatment of teeth with open apices. Orthograde delivery of biodentine is technique-sensitive and requires multiple radiographs for verification, as well as retrograde placement of biodentine requires surgical intervention. To use the advantages of biodentine and to overcome the disadvantages of placement techniques, an innovative technique was done to obturate the tooth with an open apex using a custom-fit prefabricated BioRoot inlay in this case report. Case description In the present case, biodentine has been used as a BioRoot inlay to overcome the disadvantages of various management options of open apex with parallel dentinal walls. BioRoot inlay is an intraradicular custom-made prefabricated restoration which provides the three-dimensional seal of the root canal space and promotes an apical barrier formation in a wide-open apex. This BioRoot inlay, placed passively in the canal, had a good seal laterally and apically along with the Biodentine as sealer forming a monoblock. This sealer helps in sealing milder discrepancies between the plug and the root, providing a three-dimensional seal which had resulted in good healing of periradicular bone. Conclusion Biodentine, when used as BioRoot inlay, has been shown to induce faster periapical healing. It provides promising results when used in open apices with parallel walls. It establishes three-dimensional obturation and proper apical seal, which promotes effective root-end induction. Clinical significance It can be considered as the effective and definitive alternative for nonsurgical and surgical approaches to treating open apex. How to cite this article Thiyagarajan G, Manoharan M, Veerabadhran MM, et al. Biodentine as BioRoot Inlay: A Case Report. Int J Clin Pediatr Dent 2023;16(2):400-404.
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Affiliation(s)
- Gayatrikumary Thiyagarajan
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - M Manoharan
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - Mahesh Mathian Veerabadhran
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - Gawthaman Murugesan
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - S Vinodh
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - Mohanraj Kamatchi
- Department of Pedodontics and Preventive Dentistry, Vivekananda Dental College for Women, Tiruchengode, Tamil Nadu, India
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Powell J, Taylor D, Manoharan M. The pharmacological management of acute behavioural disturbance in pregnancy. BJPsych advances 2023. [DOI: 10.1192/bja.2023.7] [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: 02/17/2023]
Abstract
SUMMARY
Acute behavioural disturbance is relatively common during the perinatal period. The management of agitation in pregnant women is similar to that in the general population, although with some additional considerations, such as modifications to restraint techniques, careful medication selection, monitoring of maternal and fetal well-being and the importance of a debrief. There are benefits of agreeing a pre-determined care plan for women who are at risk.
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Prabhakar P, Ganapathi H, Eldefrawy A, Caso J, Manoharan M. Surgeon administered laparoscopic guided transversus abdominis plane block following robot-assisted laparoscopic radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ganapathi H, Prabhakar P, Kulkarni N, Eldefrawy A, Caso J, Manoharan M. Propensity-score matched survival analysis of octogenarians with muscle-invasive bladder cancer: Chemoradiation compared to radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bind RH, Estevao C, Fancourt D, Hazelgrove K, Sawyer K, Rebecchini L, Miller C, Dazzan P, Sevdalis N, Woods A, Crane N, Manoharan M, Burton A, Dye H, Osborn T, Greenwood L, Bakolis I, Lopez MB, Davis R, Perkins R, Pariante CM. Online singing interventions for postnatal depression in times of social isolation: a feasibility study protocol for the SHAPER-PNDO single-arm trial. Pilot Feasibility Stud 2022; 8:148. [PMID: 35851430 PMCID: PMC9289358 DOI: 10.1186/s40814-022-01112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible. AIMS The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression. METHODS A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention. DISCUSSION The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.
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Affiliation(s)
- Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK.
| | - Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Celeste Miller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
| | - Nikki Crane
- Culture Team, King's College London, Somerset House East Wing, Strand, WC2R 2LS, UK
| | - Manonmani Manoharan
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Hannah Dye
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Tim Osborn
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Lorna Greenwood
- Breathe Arts Health Research, The Clarence Centre, 6 St George's Circus, London, SE1 6FE, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rachel Davis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AB, UK
| | - Rosie Perkins
- Centre for Performance Science, Royal College of Music, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, UK
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Soukup T, Davis RE, Baldellou Lopez M, Healey A, Estevao C, Fancourt D, Dazzan P, Pariante C, Dye H, Osborn T, Bind R, Sawyer K, Rebecchini L, Hazelgrove K, Burton A, Manoharan M, Perkins R, Podlewska A, Chaudhuri R, Derbyshire-Fox F, Hartley A, Woods A, Crane N, Bakolis I, Sevdalis N. Study protocol: randomised controlled hybrid type 2 trial evaluating the scale-up of two arts interventions for postnatal depression and Parkinson's disease. BMJ Open 2022; 12:e055691. [PMID: 35105591 PMCID: PMC8808453 DOI: 10.1136/bmjopen-2021-055691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Research on the benefits of 'arts' interventions to improve individuals' physical, social and psychological well-being is growing, but evidence on implementation and scale-up into health and social care systems is lacking. This protocol reports the SHAPER-Implement programme (Scale-up of Health-Arts Programmes Effectiveness-Implementation Research), aimed at studying the impact, implementation and scale-up of: Melodies for Mums (M4M), a singing intervention for postnatal depression; and Dance for Parkinson's (PD-Ballet) a dance intervention for Parkinson's disease. We examine how they could be embedded in clinical pathways to ensure their longer-term sustainability. METHODS AND ANALYSIS A randomised two-arm effectiveness-implementation hybrid type 2 trial design will be used across M4M/PD-Ballet. We will assess the implementation in both study arms (intervention vs control), and the cost-effectiveness of implementation. The design and measures, informed by literature and previous research by the study team, were refined through stakeholder engagement. Participants (400 in M4M; 160 in PD-Ballet) will be recruited to the intervention or control group (2:1 ratio). Further implementation data will be collected from stakeholders involved in referring to, delivering or supporting M4M/PD-Ballet (N=25-30 for each intervention).A mixed-methods approach (surveys and semi-structured interviews) will be employed. 'Acceptability' (measured by the 'Acceptability Intervention Measure') is the primary implementation endpoint for M4M/PD-Ballet. Relationships between clinical and implementation outcomes, implementation strategies (eg, training) and outcomes will be explored using generalised linear mixed models. Qualitative data will assess factors affecting the acceptability, feasibility and appropriateness of M4M/PD-Ballet, implementation strategies and longer-term sustainability. Costs associated with implementation and future scale-up will be estimated. ETHICS AND DISSEMINATION SHAPER-PND (the M4M trial) and SHAPER-PD (the PD trial) are approved by the West London and GTAC (20/PR/0813) and the HRA and Health and Care Research Wales (REC Reference: 20/WA/0261) Research Ethics Committees. Study findings will be disseminated through scientific peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBERS Both trials are registered with NIH US National Library of Medicine, ClinicalTrials.gov. The trial registration numbers, URLs of registry records, and dates of registration are: (1) PD-Ballet: URL: NCT04719468 (https://eur03.safelinks.protection. OUTLOOK com/?url=https%3A%2F%2Fwww.clinicaltrials.gov%2Fct2%2Fshow%2FNCT04719468%3Fterm%3DNCT04719468%26draw%3D2%26rank%3D1&data=04%7C01%7Crachel.davis%40kcl.ac.uk%7C11a7c5142782437919f808d903111449%7C8370cf1416f34c16b83c724071654356%7C0%7C0%7C6375441942616) (date of registration: 22 Jan 2021). (2) Melodies for Mums: NCT04834622 (https://clinicaltrials.gov/ct2/show/NCT04834622?term=shaper-pnd&draw=2&rank=1) (date of registration: 8 Apr 2021).
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Affiliation(s)
- Tayana Soukup
- Centre Implementation Science, King's College London, London, UK
| | - Rachel E Davis
- Centre Implementation Science, King's College London, London, UK
| | | | - Andy Healey
- Centre Implementation Science, King's College London, London, UK
| | - Carolina Estevao
- Department of Psychological Medicine, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, King's College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, King's College London, London, UK
| | - Hannah Dye
- Breathe Arts Health Research, London, UK
| | - Tim Osborn
- Breathe Arts Health Research, London, UK
| | - Rebecca Bind
- Department of Psychological Medicine, King's College London, London, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Katie Hazelgrove
- Department of Psychological Medicine, King's College London, London, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Rosie Perkins
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Performance Science, Royal College of Music, London, UK
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | | | | | - Anthony Woods
- Department of Psychological Medicine, King's College London, London, UK
| | - Nikki Crane
- Department of Psychological Medicine, King's College London, London, UK
| | - Ioannis Bakolis
- Centre Implementation Science, King's College London, London, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Nick Sevdalis
- Centre Implementation Science, King's College London, London, UK
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Estevao C, Bind R, Fancourt D, Sawyer K, Dazzan P, Sevdalis N, Woods A, Crane N, Rebecchini L, Hazelgrove K, Manoharan M, Burton A, Dye H, Osborn T, Davis RE, Soukup T, Arias de la Torre J, Bakolis I, Healey A, Perkins R, Pariante C. SHAPER-PND trial: clinical effectiveness protocol of a community singing intervention for postnatal depression. BMJ Open 2021; 11:e052133. [PMID: 34789494 PMCID: PMC8601068 DOI: 10.1136/bmjopen-2021-052133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Postnatal depression (PND) affects approximately 13% of new mothers. Community-based activities are sought after by many mothers, especially mothers that prefer not to access pharmacological or psychological interventions. Singing has shown positive effects in maternal mood and mother-child bonding. The Scaling-Up Health-Arts Programmes: Implementation and Effectiveness Research-Postnatal Depression study will analyse the clinical and implementation effectiveness of 10-week singing sessions for PND in new mothers. This protocol paper will focus on the clinical effectiveness of this trial. METHODS AND ANALYSIS A total of 400 mothers with PND (with a score of at least 10 on the Edinburgh Postnatal Depression Scale) and their babies will be recruited for this hybrid type II randomised controlled trial. The intervention group will attend 10 weekly singing sessions held at community venues or online, facilitated by the arts organisation, Breathe Arts Health Research (Breathe). A control group will be encouraged to attend non-singing sessions in the community or online for 10 weeks. A package of assessments will be collected from participants for clinical, mechanistic and implementation outcomes, at different stages of the trial. Clinical assessments will include questionnaires and interviews for demographics, mental health and social measures, together with biological samples for measurement of stress markers; the study visits are at baseline, week 6 (mid-trial) and week 10 (end of trial), with follow ups at weeks 20 and 36. Multiple imputation will be used to deal with possible missing data and multivariable models will be fitted to assess differences between groups in the outcomes of the study. ETHICS AND DISSEMINATION Ethical approval has been granted by the London-West London and GTAC Research Ethics Committee, REC reference: 20/PR/0813. TRIAL REGISTRATION NUMBER NCT04834622; Pre-results.
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Affiliation(s)
- Carolina Estevao
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rebecca Bind
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
| | - Anthony Woods
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Nikki Crane
- Culture team, King's College London, London, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Alexandra Burton
- Department of Behavioural Science and Health, University College London, London, UK
| | - Hannah Dye
- Breathe Arts Health Research, London, UK
| | - Tim Osborn
- Breathe Arts Health Research, London, UK
| | - Rachel E Davis
- Centre for Implementation Science, King's College London, London, UK
| | - Tayana Soukup
- Centre for Implementation Science, King's College London, London, UK
| | - Jorge Arias de la Torre
- Centre for Implementation Science, King's College London, London, UK
- CIBER, Madrid, Comunidad de Madrid, Spain
| | - Ioannis Bakolis
- Centre for Implementation Science, King's College London, London, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, King's College London, London, UK
| | - Rosie Perkins
- Centre for Performance Science, Royal College of Music, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Carmine Pariante
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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Affiliation(s)
- P. Kavya
- Department of Statistics, University of Calicut, Malappuram, Kerala, India
| | - M. Manoharan
- Department of Statistics, University of Calicut, Malappuram, Kerala, India
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Rose E, Manoharan M, Powell J. Impact of the COVID-19 pandemic on maternal mental heath. Eur Psychiatry 2021. [PMCID: PMC9528193 DOI: 10.1192/j.eurpsy.2021.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction As countries adopt strict quarantines and lockdowns, increasing attention has been given to the impact on mental wellbeing. The influence of this on perinatal mental health and service provision is important to consider, as these women may be particularly vulnerable to the negative effects already seen in general and psychiatric populations. Objectives The impact on global mental health of Covid-19, and the isolation measures used to combat it’s spread, is increasingly acknowledged. We were interested in the effect the pandemic has had specifically on the mental health of women in the peripartum period. By reflecting on our experiences, we hope to generate ideas to improve services. Methods We considered the effects of the pandemic in this high-risk population during each stage of contact with services. This included pre-conception, antenatal and postnatal periods, as well as the potential longitudinal and service effects. Recent case examples were identified and described from our busy and diverse South London perinatal psychiatry service. Results Recent referrals to our service suggest the current crisis has been a key trigger for the deterioration of many women’s mental health. This includes women who have been impacted by various factors related to the pandemic, at all stages of the perinatal period. Conclusions It is vital to maintain equality of access to perinatal services and to continue to consider how to deliver best care. This will involve adapting to the new working environment, and optimising care delivery using remote technologies where appropriate, in a way that is safe, accessible and acceptable to service users.
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Estevao C, Fancourt D, Dazzan P, Chaudhuri KR, Sevdalis N, Woods A, Crane N, Bind R, Sawyer K, Rebecchini L, Hazelgrove K, Manoharan M, Burton A, Dye H, Osborn T, Jarrett L, Ward N, Jones F, Podlewska A, Premoli I, Derbyshire-Fox F, Hartley A, Soukup T, Davis R, Bakolis I, Healey A, Pariante CM. Scaling-up Health-Arts Programmes: the largest study in the world bringing arts-based mental health interventions into a national health service. BJPsych Bull 2021; 45:32-39. [PMID: 33355526 PMCID: PMC8058867 DOI: 10.1192/bjb.2020.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/19/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022] Open
Abstract
The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies - Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys - which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions.
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Affiliation(s)
- Carolina Estevao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - K. Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson Foundation International Centre of Excellence, King’s College Hospital and Kings College London, UK
| | - Nick Sevdalis
- Centre of Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Anthony Woods
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nikki Crane
- King's Cultural Community, King's College London, UK
| | - Rebecca Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Kristi Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Alexandra Burton
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Hannah Dye
- Breathe Arts Health Research, The Clarence Centre, London, UK
| | - Tim Osborn
- Breathe Arts Health Research, The Clarence Centre, London, UK
| | | | - Nick Ward
- Department of Clinical and Motor Neuroscience, UCL Queen Square Institute of Neurology, London, UK
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Centre for Health and Social Care Research, Kingston University and St George's, University of London, UK
| | - Aleksandra Podlewska
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Parkinson Foundation International Centre of Excellence, King’s College Hospital and Kings College London, UK
| | - Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Tayana Soukup
- Centre of Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Rachel Davis
- Centre of Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Ioannis Bakolis
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Andy Healey
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Abstract
SUMMARYThe ongoing impact on global mental health of the COVID-19 pandemic and the isolation measures used to combat its spread is increasingly acknowledged. This reflection focuses on the effect the pandemic has had specifically on the mental health of women in the peripartum period, using recent case examples from a busy and diverse south London community perinatal psychiatry service.
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Powell J, Manoharan M, Reed J. How should we manage bipolar II disorder in the perinatal period? BJPsych advances 2020. [DOI: 10.1192/bja.2019.27] [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: 11/23/2022]
Abstract
SUMMARYThis reflection summarises the evidence regarding the management of bipolar II disorder in the perinatal period, compares this to the authors’ clinical experience using case studies and considers the treatment of patients in current clinical practice.
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Martinez D, Sandman Y, Puig R, Gomez C, Gomez C, Caso J, Manoharan M. 317 Follow-up Assessment on the Treatment of Erectile Dysfunction With Bimix Gel. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.138] [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: 11/16/2022]
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Martinez D, Sandman Y, Puig R, Gomez C, Gomez C, Caso J, Manoharan M. 368 Beyond the Pill: Preliminary Data Looking at a Combination of Phosphodiesterase Inhibitors With Low Dose Bimix Intra-urethral Gel for the Management of Erectile Dysfunction. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ponnusamy A, Vasan S, Manoharan M. 411 Surgical sperm retrieval in Non-Obstructive Azoospermia(NOA) - How do we predict success? J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Disha P, Poornima P, Pai SM, Nagaveni NB, Roshan NM, Manoharan M. Malocclusion and dental caries experience among 8-9-year-old children in a city of South Indian region: A cross-sectional survey. J Educ Health Promot 2017; 6:98. [PMID: 29296599 PMCID: PMC5747238 DOI: 10.4103/jehp.jehp_24_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Although numerous studies have documented malocclusion in various age groups in India, the literature on the prevalence of malocclusion in mixed dentition is scanty. Dental caries is another most common condition affecting the general health. However, its association with malocclusion in mixed dentition is not well known. AIM The purpose of this study was to establish the prevalence of malocclusion and its association with caries experience in 8-9-year-old children of Davangere city, South Indian region. SETTING AND DESIGN The study design was a cross-sectional survey. MATERIALS AND METHODS A total of 800 children from 350 schools (both males and females) were randomly selected for the study. t-test and Chi-square test were used for statistical analysis. RESULTS The overall prevalence of malocclusion among 8-9-year-old children was 40.9%. The most prevalent malocclusion was crowding (11.5%), followed by excessive overjet (9.4%), deep bite (6.8%), spacing (6.5%), crossbite (4.5%), and open bite (3.2%). Class I molar relationship prevailed in 95.5% of children. CONCLUSION The prevalence of malocclusion in our study was in accordance with the other studies reported in India, which ranged from 19.6% to 90%. Furthermore, correlation of malocclusion and dental caries in the primary dentition, although nonsignificant, presented children with malocclusion to have a higher caries experience than children without malocclusion.
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Affiliation(s)
- Patil Disha
- Department of Pedodontics and Preventive Dentistry, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
| | - P. Poornima
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - Suryakanth M. Pai
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - N. B. Nagaveni
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - N. M. Roshan
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - M. Manoharan
- Department of Pedodontics and Preventive Dentistry, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
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Manoharan M, Shashibhushan KK, Poornima P, Naik SN, Patil D, Shruthi AS. Effect of newer antioxidants on the bond strength of composite on bleached enamel. J Indian Soc Pedod Prev Dent 2016; 34:391-6. [PMID: 27681405 DOI: 10.4103/0970-4388.191430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The study aims to evaluate the effect of the application of two antioxidants on the bond strength of composite resin to bleached enamel. MATERIALS AND METHODS Eighty enamel surfaces were obtained from forty human extracted premolars. Specimens were randomly divided into four groups (n = 20). Group 1: No bleaching (control); Group 2a: Bleaching with 15% carbamide peroxide gel; Group 2b: Bleaching, followed by application of 10% sodium ascorbate gel; Group 2c: Bleaching, followed by application of 5% proanthocyanidin agent. Surfaces were etched followed by application of total etch bonding system, and composite resin cylinders were bonded. Specimens were tested for shear bond strength. STATISTICAL ANALYSIS USED One-way analysis of variance was used for multiple group comparison and post hoc Tukey's test for individual group-wise comparison. RESULTS Significantly higher shear bond strength values were observed in Group 2c and 2b as compared with Group 1 and 2a (P < 0.05). Among the antioxidants, Group 2c showed significantly higher shear bond strength values than Group 2b (P < 0.05). CONCLUSION It can be concluded that the use of antioxidant before bonding procedures on bleached enamel completely neutralizes the deleterious effects of bleaching and increases the bond strength significantly.
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Affiliation(s)
- M Manoharan
- Department of Pedodontics and Preventive Dentistry, Vivekanandha Dental College, Namakkal, Tamil Nadu, India
| | - K K Shashibhushan
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - P Poornima
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - Sathyajith N Naik
- Department of Pedodontics and Preventive Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Disha Patil
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - A S Shruthi
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
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Iremashvili V, Manoharan M, Parekh DJ, Punnen S. Can nomograms improve our ability to select candidates for active surveillance for prostate cancer? Prostate Cancer Prostatic Dis 2016; 19:385-389. [DOI: 10.1038/pcan.2016.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/27/2016] [Accepted: 04/21/2016] [Indexed: 11/09/2022]
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Abstract
In this paper, we consider the life distribution H(t) of a device subject to shocks governed by a finite mixture of homogeneous Poisson processes. It will be shown that if (pk), the probabilities that the device fails on the kth shock, has a discrete phase-type (DPH) distribution, then H(t) is continuous phase-type (CPH). The relationship between the mean values of (pk) and H(t) is established.
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Diaz Pardo D, Abramowitz M, Mahmoud O, Ishkanian A, Fernandez G, Shields J, Manoharan M, Pollack A. Neoadjuvant Radiation Therapy Improves Survival in Patients With T2b/T3 Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Transurethral resection is an effective therapy for non-muscle-invasive bladder cancer. However, the high rates of recurrence and significant risk of progression in higher grade tumors mandates additional therapy with intravesical agents. In this review we discuss the role of various intravesical agents currently in use including the immunomodualtory agent BCG and chemotherapeutic agents. We discuss the current guidelines and the role of these therapeutic agents in the context of higher grade Ta and T1 tumors.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami, Miami, FL, USA
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Schwille PO, Schmiedl A, Manoharan M, Wipplinger J. Idiopathic Recurrent Calcium Urolithiasis (IRCU): pathophysiology evaluated in light of oxidative metabolism, without and with variation of several biomarkers in fasting urine and plasma--a comparison of stone-free and -bearing male patients, emphasizing mineral, acid-base, blood pressure and protein status. Eur J Med Res 2011; 16:349-66. [PMID: 21813378 PMCID: PMC3351987 DOI: 10.1186/2047-783x-16-8-349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND IRCU is traditionally considered as life?style disease (associations with, among others, overweight, obesity, hypertension, type-2 diabetes), arising from excess, in 24 h urine, of calcium (Ca) salts (calcium oxalate (CaOx), calcium phosphate (CaPi)), supersaturation of, and crystallization in, tubular fluid and urine, causing crystal-induced epithelial cell damage, proteinuria, crystal aggregation and uroliths. METHODS Another picture emerges from the present uncontrolled study of 154 male adult IRCU patients (75 stone-bearing (SB) and 79 age-matched stone-free (SF)), in whom stone-forming and other parameters in fasting urine and plasma were contrasted with five biomarkers (see footnote) of oxidative metabolism (OM), without and with variation of markers. RESULTS 1) In SB vs. SF unstratified OM biomarkers were statistically unchanged, but the majority of patients was overweight; despite, in SB vs. SF urine pH, total and non-albumin protein concentration were elevated, fractional urinary uric acid excretion and blood bicarbonate decreased, whereas urine volume, sodium, supersaturation with CaOx and CaPi (as hydroxyapatite) were unchanged; 2) upon variation of OM markers (strata below and above median) numerous stone parameters differed significantly, among others urine volume, total protein, Ca/Pi ratio, pH, sodium, potassium, plasma Ca/Pi ratio and parathyroid hormone, blood pressure, renal excretion of non-albumin protein and other substances; 3) a significant shift from SF to SB patients occurred with increase of urine pH, decrease of blood bicarbonate, and increase of diastolic blood pressure, whereas increase of plasma uric acid impacted only marginally; 4) in both SF and SB patients a strong curvilinear relationship links a rise of urine Ca/Pi to urine Ca/Pi divided by plasma Ca/Pi, but in SB urine Ca/Pi failed to correlate significantly with urine hydroxyapatite supersaturation; 5) also in SB, plasma Ca/Pi and urinary nitrate were negatively correlated, whereas in SF plasma Ca/Pi ratio, PTH and body mass index correlated positively; 6) multivariate regression analysis revealed that PTH, body mass index and nitrate together could explain 22 (p = 0.002) and only 7 (p = 0.06) per cent of variation of plasma Ca/Pi in SF and SB, respectively. CONCLUSIONS In IRCU a) numerous constituents of fasting urine, plasma, blood and blood pressure change in response to variation of OM biomarkers, suggesting involvement of OM imbalance as factor in functional deterioration of tissue; b) in the majority of patients a positive exponential relationship links urine Ca/Pi to urine Ca/Pi divided by plasma Ca/Pi, presumably to accumulate Ca outside tubular lumen, thereby minimizing intratubular and urinary Ca salt crystallization; c) alteration of interactions of low urine nitrate, PTH and Ca/Pi in plasma may be of importance in formation of new Ca stone and co-regulation of dynamics of blood vasculature; d) overweight, combined with OM-modified renal interstitial environment appears to facilitate these processes, carrying the risk that CaPi mineral develops within or/and close to blood vessel tissue, and spreads towards urothelium. - For future research focussing on IRCU pathogenesis studies are recommended on the role of affluent lifestyle mediated renal ischemia, mild hypertensive nephropathy, rise of uric acid precursor oxypurines and uricemia, clarifying also why loss of significance of interrelationships of OM biomarkers with traditional Ca stone risk factors is characteristic for SB patients.
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Soloway M, Manoharan M, Jorda M, Rosenberg D, Pelaez L, Kava B, Iremashvili V. POD-07.03 Pathology Results of Radical Prostatectomy in Patients Initially Managed by Active Surveillance. Urology 2011. [DOI: 10.1016/j.urology.2011.07.453] [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: 11/17/2022]
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Soloway M, Manoharan M, Jorda M, Rosenberg D, Iremashvili V. MP-13.07 Surgical Margin Status is not Associated with Overall Survival After Radical Prostatectomy. Urology 2011. [DOI: 10.1016/j.urology.2011.07.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muralidharan G, Narayanan B, Wong CC, Manoharan M. On The Influence Of Titanium Alloy Composition And Layer Thickness On The Mechanical Properties Of A Polyimide Substrate. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-515-203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTMetal-polymer bilayers and multilayers are being increasingly used in the microelectronics industry. In many cases, the reliability of the device or the package is determined by the mechanical behavior of these composite layers. Finite element analyses are being widely used to model these systems. An accurate experimental understanding of the mechanical behavior of these systems would further enhance the usefulness of such analyses. The present study focuses on the mechanical behavior of composite bilayers consisting of polyimide and sputtered Ti and Ti alloy thin films. Tensile tests and stretch-deformation tests have been performed on bilayers consisting of a polyimide substrate sputter-coated individually with a 50 nm and a 500 nm Ti layer, a 500 nm Ti-Cu layer, and a 500 nm Ti-Ni layer. Tensile moduli, stresses for 0.2%, 2% and 15% offset strains, and strains to failure have been obtained and compared. These values are discussed with reference to the known mechanical properties of the individual layers in the composite material.
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Manoharan M, Eldefrawy A, Katkoori D, Antebi E, Soloway MS. Comparison of urologist reimbursement for managing patients with low-risk prostate cancer by active surveillance versus total prostatectomy. Prostate Cancer Prostatic Dis 2010; 13:307-10. [DOI: 10.1038/pcan.2010.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gordian E, Ramachandran K, Reis IM, Manoharan M, Soloway MS, Singal R. Serum-free circulating DNA as a biomarker of prostate cancer diagnosis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4640] [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: 11/20/2022] Open
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Talebi T, Manoharan M, Soloway MS, Singal R. High-dose ketoconazole in castration-resistant, metastatic prostate cancer patients previously treated with docetaxel chemotherapy: Single institution retrospective review. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Orzechowska BU, Manoharan M, Sprague J, Estep RD, Axthelm MK, Wong SW. Viral interleukin-6 encoded by rhesus macaque rhadinovirus is associated with lymphoproliferative disorder (LPD). J Med Primatol 2010; 38 Suppl 1:2-7. [PMID: 19863672 DOI: 10.1111/j.1600-0684.2009.00369.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rhesus macaques (RM) co-infected with simian immunodeficiency virus (SIV) and rhesus macaque rhadinovirus (RRV) develop abnormal cellular proliferations characterized as extra-nodal lymphoma and retroperitoneal fibromatosis (RF). RRV encodes a viral interleukin-6 (vIL-6), much like Kaposi's sarcoma-associated herpesvirus, and involvement of the viral cytokine was examined in proliferative lesions. METHODS Formalin fixed tissue from RM co-infected with SIV and RRV were analyzed for RRV genomes by in situ hybridization and RRV vIL-6 expression by immunofluorescence analysis. RESULTS In situ hybridization analysis indicated that RRV is present in both types of lesions. Immunofluorescence analysis of different lymphomas and RF revealed positive staining for vIL-6. Similarly to KS, RF lesion is positive for vimentin, CD117 (c-kit), and smooth muscle actin (SMA) and contains T cell, B cell and monocytes/macrophage infiltrates. CONCLUSIONS Our data support the idea that vIL-6 may be critical to the development and progression of lymphoproliferative disorder in RRV/SIV-infected RM.
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Affiliation(s)
- B U Orzechowska
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, West Campus, Beaverton, OR 97006, USA
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Manoharan M, Ayyathurai R, de Los Santos R, Nieder AM, Soloway MS. Presentation and outcome following radical cystectomy in Hispanics with bladder cancer. Int Braz J Urol 2009; 34:691-8; discussion 698. [PMID: 19111073 DOI: 10.1590/s1677-55382008000600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2008] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Significant racial and ethnic differences in the epidemiology of bladder cancer (BC) exist. Studies have shown African Americans to have lower incidence of bladder cancer than Caucasians, but higher incidence of invasive BC. Hispanics are the largest minority group in the United States. However, no reported studies on bladder cancer among Hispanics are available to date. As our center is in a unique position to study BC in Hispanic patients we were prompted to assess presentation and outcome of patients undergoing radical cystectomy (RC) for BC. MATERIALS AND METHODS Between January 1992 and May 2006, 448 RC were performed. All relevant data were collected and entered into a database. Patients were categorized by ethnicity as Hispanic and non-Hispanic White. African-American and other minority groups were excluded because of the small number. Comparative analysis of Hispanic and non-Hispanic White patients was performed. RESULTS 67 (17%) patients were Hispanic. Mean follow-up period was 41 (SD +/- 40) months. Clinical and pathological data between these two groups were compared. Pre-cystectomy T stage was not significantly different between both groups. However, after RC incidence of < or = T1 disease in Hispanics was lower (22%) than Caucasians (37%). This difference, statistically significant (P = 0.024) indicates that Hispanics who undergo RC present with higher stage disease. Kaplan-Meier log rank test indicated a difference in disease free survival and disease specific survival between the two groups but however it did not reach statistical significance (Log Rank P = 0.082, P = 0.063). No significant difference in overall survival was observed (P = 0.465). CONCLUSIONS Hispanic patients managed with RC for bladder carcinoma present with higher stage disease.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida 33101, USA.
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Singal R, Navarro L, Gordian E, Ramachandran K, Reis I, Manoharan M, Soloway M. Aberrant promoter methylation in serum of prostate cancer patients and controls. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16046] [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: 11/20/2022] Open
Abstract
e16046 Background: The current screening method for prostate cancer (PC), which is based on prostate specific antigen (PSA) level lacks specificity and sensitivity. Previous studies have reported that increased levels of free circulating DNA (fcDNA) and hypermethylation of genes are associated with several cancers. In this study we evaluated the use of fcDNA level and aberrant promoter methylation of 4 genes in serum as biomarkers for PC. Methods: 89 PC patients, 59 with prostatitis (PT) and 104 with benign prostatic hyperplasia (BPH) were enrolled. Serum DNA was analyzed for methylation of GSTPi, RARB, RASSF1A and ECAD by methylation-specific PCR. FcDNA level was analyzed by quantitative PCR. We examined the effect of methylation and fcDNA on PC risk by fitting two logistic regression models, one comparing PC vs BPH and PT vs BPH and the other comparing PC vs PT+BPH. Models were adjusted for age, race, and log2PSA, and tested for variation in effect of methylation by race. Similar analyses assessed the effect of fcDNA as continuous variable, after log2 transformation, and as dichotomous variable with cutpoint near the upper quartile for BPH controls. Results: When adjusted for age and log2PSA, positive GSTPi methylation was associated with increased risk of PC in whites (OR = 6.11, p < 0.001, PC vs BPH; OR = 3.93, p = 0.001, PC vs BPH + PT). Methylation of RARB was associated with PT independent of race (OR = 2.85, p = 0.032, PT vs BPH). Patients with fcDNA ≥180ng/ml were at twice the risk of PC compared to those with levels <180ng/ml, and this result did not vary by race. Models including both GSTPi and fcDNA confirmed the independent effect of these two factors in whites (high fcDNA OR = 3.77, p = 0.002, positive GSTPi methylation OR = 5.41, p < 0.001, PC v. BPH + PT). Although high fcDNA also increased risk of PC in blacks, the effect was not statistically significant (OR = 1.91, p = 0.189, PC vs BPH + PT). Conclusions: Our results suggest that aberrant promoter methylation of GSTPi in serum is a potential biomarker for prostate cancer in whites. Level of fcDNA in serum also appears to be an independent diagnostic marker in whites. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - I. Reis
- University of Miami, Miami, FL
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Tunuguntla HSR, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. MINERVA UROL NEFROL 2009; 61:41-54. [PMID: 19417725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A survey on neobladder reconstruction after radical cystectomy due to invasive bladder cancer is presented. Stress is laid on the selection patients, factors affecting the choice of urinary diversion, contraindications for neobladder, oncological factors influencing selection of neobladder, continence, complications and other factors which may affect a favourable outcome.
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Affiliation(s)
- H S R Tunuguntla
- Department of Urology, University of Miami School of Medicine, Miami, FL 33101, USA
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Manoharan M, Tsuchiya Y, Oda S, Mizuta H. Silicon-on-insulator-based radio frequency single-electron transistors operating at temperatures above 4.2 K. Nano Lett 2008; 8:4648-4652. [PMID: 19367857 DOI: 10.1021/nl801992j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A radio frequency single-electron transistor (RF-SET) based on a silicon-on-insulator (SOI) substrate is demonstrated to operate successfully at temperatures above 4.2 K. The SOI SET was fabricated by inducing lateral constrictions in doped SOI nanowires. The device structure was optimized to overcome the inherent drawback of high resistance with the SOI SETs. We performed temperature variation measurements after five thermal cyclings of the same sample to 4.2 K and found that the single-dot device transport characteristics are highly stable. The charge sensitivity was measured to be 36 microe(rms) Hz(-1/2) at 4.2 K, and the RF-SET operation was demonstrated up to 12.5 K for the first time. This work is an important prerequisite to realizing operation of RF-SETs at noncryogenic temperatures.
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Affiliation(s)
- M Manoharan
- Quantum Nanoelectronics Research Center and Department of Physical Electronics, Tokyo Institute of Technology, 2-12-1 O-okayama, Meguro-ku, Tokyo, Japan.
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Manoharan M, Campbell L, Erskine KJ. Missing IUD: Recovery of an unusual coil. J OBSTET GYNAECOL 2008; 28:655-6. [PMID: 19003676 DOI: 10.1080/01443610802421528] [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: 10/21/2022]
Affiliation(s)
- M Manoharan
- Homerton University Hospital, NHS Foundation Trust, London, UK.
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Abstract
Radical cystectomy and urinary diversion is an effective curative treatment for muscle invasive bladder cancer. The orthotopic ileal neobladder has become a favorable choice of urinary diversion as it offers superior quality of life, cosmetic outcome and the potential for normal voiding. We treated two patients with bladder cancer who previously underwent renal transplant for end-stage renal disease. Radical cystectomy and orthotopic ileal neobladder reconstruction was performed in both patients. One patient had two renal transplants and underwent transplant nephrectomy at the time of cystectomy. In the other patient, the native kidneys were still present and the ureters were anastomosed to the neobladder. There is excellent function of the neobladder. There were no increased complications seen in these patients. Our cases demonstrate that an orthotopic ileal neobladder is safe and feasible after renal transplant and should be offered to these patients.
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Affiliation(s)
- T Cooke
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Ayyathurai R, Vyas S, Manoharan M, Luongo T, Soloway M. MP-18.08: Incidental prostatic neoplasia in patients undergoing radical cystoprostatectomy: does it affect the overall prognosis? Urology 2007. [DOI: 10.1016/j.urology.2007.06.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Manoharan M, Luongo T, Vyas S, Ayyathurai R, Soloway M. POS-03.59: Prospective randomized trial comparing transverse (pfannenstiel) and vertical incisions for patients undergoing radical retropubic prostatectomy. Urology 2007. [DOI: 10.1016/j.urology.2007.06.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Manoharan M, Ayyathurai R, De Los Santos R, Soloway M, Ciancio G. POD-03.03: Surgical management and outcome of renal cell carcinoma with level III IVC thrombus: a single center experience. Urology 2007. [DOI: 10.1016/j.urology.2007.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Kava B, Soloway C, Manoharan M, Soloway M. MP-18.16: Modified transverse Pfannenstiel and vertical minilaparotomy incisions provide excellent exposure, minimal perioperative pain, and excellent cosmesis in patients undergoing radical retropubic prostatectomy. Urology 2007. [DOI: 10.1016/j.urology.2007.06.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Singal R, Ramachandran K, Gopisetty G, Navarro L, Gordian E, Manoharan M. Role of GADD45α as a potential therapeutic target for prostate cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10566] [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: 11/20/2022] Open
Abstract
10566 Background: Defects in the apoptotic pathway contribute to uncontrolled cell proliferation of cancer cells and confer resistance to chemotherapeutic drugs. Understanding the mechanisms of deregulation of apoptosis related genes would enable targeted treatment methods to improve the efficacy of chemotherapy. Growth Arrest and DNA Damage inducible, alpha (GADD45a) mediates cytotoxicity of docetaxel chemotherapy. We examined the mechanism of regulation of GADD45a in prostate cancer cells and the effect of its upregulation on sensitivity to docetaxel chemotherapy. Methods: Levels of GADD45a in Du145, LNCaP and PC3 were analyzed by real time reverse transcriptase PCR and western blotting. DNA methylation was studied by bisulfite sequencing. Chromatin immunoprecipitation was used to study interaction of methyl binding proteins to GADD45 5’ sequence. Cytotoxicity after drug treatment was measured by MTT cell proliferation assay. Apoptosis assays were done by Annexin V/propidium iodide staining followed by flow cytometry. Results: Levels of expression of GADD45a in Du145 and LNCaP cells were lower than that in PC3. A 4 CpG region upstream of the proximal promoter region was methylated in Du145 and LNCaP cells. Methylation was reversed by treatment of Du145 and LNCaP cells with DNA methyl transferase (DNMT) inhibitors such as 5- Azacytidine or 5- Aza deoxycytidine leading to reactivation of GADD45a expression in these cells. This region was also frequently methylated in prostate cancer tissues. Methyl binding protein, MeCP2 was associated with the methylated 4 CpGs in Du145 and knock down of MeCP2 by transfection of MeCP2 siRNA vector in Du145 cells (Du145-MeCP2-ve) led to increased expression of GADD45a, without affecting the methylation status of the gene. Enhanced sensitivity to docetaxel was observed by upregulation of GADD45a in Du145 cells by (a) recombinant expression of GADD45a (b) downregulation of MeCP2 and (c) pretreatment with 5-Azacytidine. Conclusions: GADD45a is frequently deregulated in prostate cancer by methylation of 5’ 4 CpG region and is a potential therapeutic target for treatment of prostate cancer. [Table: see text]
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Affiliation(s)
- R. Singal
- Univ of Miami, Miami, FL; VA Medical Center, Miami, FL
| | | | - G. Gopisetty
- Univ of Miami, Miami, FL; VA Medical Center, Miami, FL
| | - L. Navarro
- Univ of Miami, Miami, FL; VA Medical Center, Miami, FL
| | - E. Gordian
- Univ of Miami, Miami, FL; VA Medical Center, Miami, FL
| | - M. Manoharan
- Univ of Miami, Miami, FL; VA Medical Center, Miami, FL
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Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Modified Pfannenstiel approach for radical retropubic prostatectomy: a 3-year experience. Prostate Cancer Prostatic Dis 2007; 11:74-8. [PMID: 17440438 DOI: 10.1038/sj.pcan.4500969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A modified Pfannenstiel approach for radical retropubic prostatectomy (RRP) has been described previously. We present our experience with this approach for performing a RRP over the past 3 years. Between January 2003 and July 2006, 544 consecutive RRPs by modified Pfannenstiel approach between January 2003 and July 2006 were performed. We analyzed blood loss, transfusions, use of drain, pain score, analgesia and hospital stay. Patients were followed up at 6 weeks, three monthly for a year and six monthly thereafter. All clinical and operative variables were entered into a database and analyzed. A total of 544 men underwent RRP with median follow-up of 11 (s.d.+/-10.5) months. The mean age was 60 (s.d.+/-7) years. About 83, 91 and 95% of patients had nerve sparing, bladder neck preservation and a lymph node dissection, respectively. Fifty-three patients had a concurrent inguinal hernia repair through the same incision. Mean estimated blood loss was 431 (s.d.+/-267) ml. The pathological staging distribution was T2, 82%; T3a, 9%; and T3b, 9%. The mean pain score at days 1 and 7 were 3.7 (s.d.+/-2.5) and 3.3 (s.d.+/-3), respectively. The median hospital stay was 36 h (s.d.+/-24). About 5.5% have had biochemical recurrence. At 12 months 97% were continent and 46% potent. RRP using a modified Pfannenstiel approach offers safety and efficacy. It facilitates repair of associated inguinal hernia through the same incision.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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45
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McNeill R, Sare GM, Manoharan M, Testa HJ, Mann DMA, Neary D, Snowden JS, Varma AR. Accuracy of single-photon emission computed tomography in differentiating frontotemporal dementia from Alzheimer's disease. J Neurol Neurosurg Psychiatry 2007; 78:350-5. [PMID: 17158559 PMCID: PMC2077783 DOI: 10.1136/jnnp.2006.106054] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 11/06/2006] [Accepted: 11/22/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the commonest causes of presenile dementia. In the absence of a biological marker, diagnosis is reliant on clinical evaluation. Confirmation is often sought from neuroimaging, including single-photon emission computed tomography (SPECT). Most previous SPECT studies lack pathological validation. AIM To examine the accuracy of SPECT in differentiating FTD from AD in patients with subsequent pathological confirmation. METHODS Technetium-99-labelled hexamethyl propylene amine oxime SPECT images obtained at initial evaluation in 25 pathologically confirmed cases of FTD were examined. These images were visually rated by an experienced blinded nuclear medicine consultant and compared with those of 31 patients with AD, also with pathological validation. RESULTS A reduction in frontal cerebral blood flow (CBF) was more common in FTD and was of diagnostic value (sensitivity 0.8, specificity 0.65 and likelihood ratio (LR) 2.25; 95% CI 1.35 to 3.77). A pattern of bilateral frontal CBF reduction without the presence of associated bilateral parietal CBF change is diagnostically more accurate (sensitivity 0.80, specificity 0.81 and +LR 4.13, 95% CI 1.96 to 8.71). Diagnostic categorisation (FTD or AD) on the basis of SPECT alone was less accurate than clinical diagnosis (based on neurology and detailed neuropsychological evaluation). One patient with FTD was initially clinically misdiagnosed as AD, owing to the lack of availability of full neuropsychological assessment. However, SPECT correctly diagnosed this patient, providing a diagnostic gain of 4%. CONCLUSION Technetium-99-labelled hexamethyl propylene amine oxime SPECT CBF patterns provide valuable information in the diagnosis of FTD and AD. These data can be better used as an adjunct to clinical diagnosis if pathology is to be correctly predicted in life.
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Affiliation(s)
- R McNeill
- Department of Neurology, Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford, Manchester, UK
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46
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Manoharan M, Azmi MAN, Soosay G, Mould T, Weekes AR. Mullerian adenosarcoma of uterine cervix: Report of three cases and review of literature. Gynecol Oncol 2007; 105:256-60. [PMID: 17292949 DOI: 10.1016/j.ygyno.2006.12.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/11/2006] [Accepted: 12/11/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mullerian adenosarcoma of the uterine cervix is a rare tumor seen in young women of reproductive age group. It presents as cervical polyps and is a low-grade malignancy with a tendency for local recurrence. Diagnosis can be difficult since it can easily be mistaken for benign polyps, both clinically and pathologically. CASE We present three cases of adenosarcoma of the cervix presenting as cervical polyps and review the clinical and pathological features of these tumors. CONCLUSION Adenosarcoma of the cervix should be ruled out especially in women presenting with recurrent cervical polyps. A careful histological examination is mandatory, important prognostic factors being myometrial invasion and sarcomatous overgrowth. Distant metastasis is very rare and therapy can be tailored to suit patient's needs but long term follow-up is essential.
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Manoharan M, Ayyathurai R. Radical cystectomy for urothelial cancer of the bladder: contemporary advances. MINERVA UROL NEFROL 2007; 59:99-107. [PMID: 17431374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Radical cystectomy (RC) is an effective curative treatment for high grade and muscle invasive bladder cancer. Other treatments such as chemoradiation and transurethral resection of bladder tumor as monotherapy are generally not considered as effective as RC. RC is a major surgical procedure associated with significant morbidity and mortality. However, over the last decade significant advances have been made in different aspects of RC, including perioperative care, instrumentation and surgical techniques which has dramatically improved the outcome following RC. Different approaches including open, laparoscopic and robotic approaches are used to perform a RC. Devices such as vascular staplers and ligasure have decreased the blood loss and the need for transfusion. In this article, we review relevant literature and discuss various advances made in an attempt to improve outcome following RC.
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Affiliation(s)
- M Manoharan
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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48
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Manoharan M, Ayyathurai R, Nieder AM, Soloway MS. Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study. Prostate Cancer Prostatic Dis 2007; 10:283-7. [PMID: 17310259 DOI: 10.1038/sj.pcan.4500955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/08/2022]
Abstract
Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (+/-1.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (+/-6.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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Manoharan M, Gomez P, Reyes MA, Soloway MS. Metastatic adenoid cystic carcinoma to the kidney in a young woman. Urology 2006; 68:1343.e11-2. [PMID: 17141832 DOI: 10.1016/j.urology.2006.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 06/29/2006] [Accepted: 09/08/2006] [Indexed: 10/23/2022]
Abstract
The incidence of an adenoid cystic carcinoma on major salivary glands is low, constituting only about 10% to 15% of all parotid malignancies. Cases of delayed metastasis have been reported, but reports of specific renal involvement have not been extensively found. We present the case of a 21-year-old woman with a left renal metastasis from an adenoid cystic carcinoma of the parotid gland that had been surgically treated 7 years previously. The patient underwent successful left radical nephrectomy. During follow-up, the patient developed pulmonary nodules that were metastatic adenoid cystic carcinoma and were surgically excised. At last follow-up, the patient was doing well with no evidence of disease.
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Affiliation(s)
- M Manoharan
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
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50
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Haider H, Tzakis A, Manoharan M, Selvaggi G, Nishida S, Levi D, Ciancio G. Ureteral reconstruction and bladder augmentation using intestinal allograft in a modified multivisceral transplant patient. Am J Transplant 2006; 6:1968-71. [PMID: 16889551 DOI: 10.1111/j.1600-6143.2006.01388.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Segments of ileum are used as conduits following ureteral resection and for bladder augmentation to achieve adequate bladder capacity. We herein report the use of a segment of transplanted ileum for this purpose in a patient with Gardner's syndrome who underwent multivisceral transplantation. To our knowledge this is the first such case report.
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Affiliation(s)
- H Haider
- Department of Surgery, University of Miami, Florida, USA.
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