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Verma N, Duseja A, Mehta M, De A, Lin H, Wong VWS, Wong GLH, Rajaram RB, Chan WK, Mahadeva S, Zheng MH, Liu WY, Treeprasertsuk S, Prasoppokakorn T, Kakizaki S, Seki Y, Kasama K, Charatcharoenwitthaya P, Sathirawich P, Kulkarni A, Purnomo HD, Kamani L, Lee YY, Wong MS, Tan EXX, Young DY. Machine learning improves the prediction of significant fibrosis in Asian patients with metabolic dysfunction-associated steatotic liver disease - The Gut and Obesity in Asia (GO-ASIA) Study. Aliment Pharmacol Ther 2024; 59:774-788. [PMID: 38303507 DOI: 10.1111/apt.17891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/28/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The precise estimation of cases with significant fibrosis (SF) is an unmet goal in non-alcoholic fatty liver disease (NAFLD/MASLD). AIMS We evaluated the performance of machine learning (ML) and non-patented scores for ruling out SF among NAFLD/MASLD patients. METHODS Twenty-one ML models were trained (N = 1153), tested (N = 283), and validated (N = 220) on clinical and biochemical parameters of histologically-proven NAFLD/MASLD patients (N = 1656) collected across 14 centres in 8 Asian countries. Their performance for detecting histological-SF (≥F2fibrosis) were evaluated with APRI, FIB4, NFS, BARD, and SAFE (NPV/F1-score as model-selection criteria). RESULTS Patients aged 47 years (median), 54.6% males, 73.7% with metabolic syndrome, and 32.9% with histological-SF were included in the study. Patients with SFvs.no-SF had higher age, aminotransferases, fasting plasma glucose, metabolic syndrome, uncontrolled diabetes, and NAFLD activity score (p < 0.001, each). ML models showed 7%-12% better discrimination than FIB-4 to detect SF. Optimised random forest (RF) yielded best NPV/F1 in overall set (0.947/0.754), test set (0.798/0.588) and validation set (0.852/0.559), as compared to FIB4 in overall set (0.744/0.499), test set (0.722/0.456), and validation set (0.806/0.507). Compared to FIB-4, RF could pick 10 times more patients with SF, reduce unnecessary referrals by 28%, and prevent missed referrals by 78%. Age, AST, ALT fasting plasma glucose, and platelet count were top features determining the SF. Sequential use of SAFE < 140 and FIB4 < 1.2 (when SAFE > 140) was next best in ruling out SF (NPV of 0.757, 0.724 and 0.827 in overall, test and validation set). CONCLUSIONS ML with clinical, anthropometric data and simple blood investigations perform better than FIB-4 for ruling out SF in biopsy-proven Asian NAFLD/MASLD patients.
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Affiliation(s)
- Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Huapeng Lin
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruveena Bhavani Rajaram
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ming-Hua Zheng
- NAFLD Research Centre Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wen-Yue Liu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sombat Treeprasertsuk
- Division of Gastroenterology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Thaninee Prasoppokakorn
- Division of Gastroenterology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Satoru Kakizaki
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Centre, Takasaki, Japan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Centre, Yotsuya Medical Cube, Tokyo, Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Centre, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Phalath Sathirawich
- Division of Gastroenterology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anand Kulkarni
- Asian Institute of Gastroenterology Hospital, Hyderabad, India
| | - Hery Djagat Purnomo
- Faculty of Medicine, Diponegoro University, Kariadi Hospital, Semarang, Indonesia
| | | | - Yeong Yeh Lee
- School of Medical Sciences Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Mung Seong Wong
- School of Medical Sciences Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Eunice X X Tan
- Department of Medicine, National University Singapore, Singapore, Singapore
| | - Dan Yock Young
- Department of Medicine, National University Singapore, Singapore, Singapore
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De A, Bhagat N, Mehta M, Taneja S, Duseja A. Metabolic dysfunction-associated steatotic liver disease (MASLD) definition is better than MAFLD criteria for lean patients with NAFLD. J Hepatol 2024; 80:e61-e62. [PMID: 37558135 DOI: 10.1016/j.jhep.2023.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Bhagat
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Mehta M, Schug B, Blume HH, Beuerle G, Jiang W, Koenig J, Paixao P, Tampal N, Tsang YC, Walstab J, Wedemeyer R, Welink J. The Global Bioequivalence Harmonisation Initiative (GBHI): Report of the fifth international EUFEPS/AAPS conference. Eur J Pharm Sci 2023; 190:106566. [PMID: 37591469 DOI: 10.1016/j.ejps.2023.106566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
The series of conferences of the Global Bioequivalence Harmonisation Initiative (GBHI) was started in 2015 by the European Federation for Pharmaceutical Sciences (EUFEPS). All GBHI meetings so far were co-organised together with the American Association of Pharmaceutical Scientists (AAPS). Beginning with the 3rd workshop US-FDA joined as co-sponsor - to support global harmonisation of regulatory recommendations for bioequivalence (BE) assessment. At the 5th GBHI conference, the following BE topics were intensively discussed, and the following main conclusions were drawn: (1) Statistical considerations for BE assessment in specific situations covering scaling approaches for highly variable drug (HVD) products, two-stage adaptive design and opportunities of modelling and simulation to support BE: even though special BE study concepts like adaptive designs are not often used in practise so far, a majority of the workshop participants were in favour of a more frequent application of such approaches. The regulatory conditions relevant in this context need further concretisation and harmonisation between the regions. Moreover, modelling and simulation were considered as a promising and evolving approach, also for BE development programmes. (2) Fed versus fasting conditions in BE trials: Findings that BE between generic products could be confirmed only after fasted administration but failed under fed conditions seem more an exception than the rule. Obviously, BCS class IV compounds are most problematic in this context. Differences in critical excipients such as surfactants or pH-modifiers may be relevant reasons for different sensitivity for interactions in fasted versus fed conditions. Consequently, such deviations in composition of generic preparations should be avoided. Moreover, confirmation of BE may be generally difficult comparing different dosage forms, such like capsules versus tablets, especially in fed state. (3) BE assessment of locally acting drug products applied topically to the skin: Appropriateness and potential benefit of in-vitro tests as alternatives to clinical efficacy studies have been comprehensively discussed. In addition to the already well-established in-vitro release and permeation tests, other techniques were suggested, e.g., Raman spectroscopy or dermal open flow microperfusion. Validation of those methods is challenging and, despite significant progress already achieved during previous years, more research is needed before they may be fully accepted for regulatory purposes. (4) BE evaluation of narrow therapeutic index (NTI) drugs: The discrepancies amongst regulatory agencies in necessity of tighter BE acceptance ranges, the recommendations for inclusion of peak and total drug exposure into BE assessment with more restrictive criteria and the importance of comparison of the product-related within-subject variability for NTI drugs were debated. Arguments in favour and against the different approaches were presented and discussed but need further consideration before harmonisation can be achieved. The highly interactive meeting and extensive exchange between regulators and scientists from industry and academia resulted in useful progress in open BE issues and supported the goal of science-driven harmonisation.
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Affiliation(s)
- M Mehta
- U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - B Schug
- SocraTec R&D GmbH, Oberursel/Erfurt, Germany.
| | - H H Blume
- SocraTec C&S GmbH, Oberursel, Germany; Frankfurt Foundation Quality of Medicines, Frankfurt/Main, Germany
| | | | - W Jiang
- U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - J Koenig
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - P Paixao
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Portugal
| | - N Tampal
- U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | | | - J Walstab
- SocraTec R&D GmbH, Oberursel/Erfurt, Germany
| | - R Wedemeyer
- SocraTec R&D GmbH, Oberursel/Erfurt, Germany
| | - J Welink
- Medicines Evaluation Board, Utrecht, the Netherlands
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De A, Mehta M, Singh P, Bhagat N, Mitra S, Das A, Duseja A. Lean Indian patients with non-alcoholic fatty liver disease (NAFLD) have less metabolic risk factors but similar liver disease severity as non-lean patients with NAFLD. Int J Obes (Lond) 2023; 47:986-992. [PMID: 37474570 DOI: 10.1038/s41366-023-01346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/01/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Although most patients with NAFLD are obese or overweight, some are lean with normal BMI. Our aim was to assess differences in clinicopathological profile and liver disease severity among lean and non-lean NAFLD. METHODS Data of 1040 NAFLD patients over last 10 years was analysed. BMI < 23 kg/m2 categorised lean patients. Non-invasive assessment of steatosis was done by ultrasound and controlled attenuation parameter (CAP) while fibrosis was assessed with FIB-4 and liver stiffness measurement (LSM). FibroScan-AST (FAST) score was used for non-invasive prediction of NASH with significant fibrosis. Histology was reported using NASH-CRN system. RESULTS 149 (14.3%) patients were lean while 891 (85.7%) patients were non-lean. Diabetes mellitus [25 (16.7%) vs 152 (17.05%), p > 0.99], elevated triglycerides [81 (54.3%) vs 525 (58.9%), p = 0.33] and low HDL [71(47.6%) vs 479(53.7%), p = 0.18] were observed in a similar proportion. Lean patients were less likely to have central obesity [72 (48.3%) vs 788 (88.4%), p < 0.001], hypertension [16 (10.7%) vs 239(26.8%), p < 0.001] and metabolic syndrome [21 (14.09%) vs 290 (32.5%), p < 0.001]. No difference in steatosis assessment was noted using ultrasound (p = 0.55) or CAP (0.11). FAST [0.38 (0.18-0.66) vs 0.39 (0.27-0.73), p = 0.53], FIB-4 [1.08 (0.65-1.91) vs 1.09 (0.66-1.94), p = 0.94] and LSM [6.1 (4.8-7.9) vs 6.2 (4.7-8.6), p = 0.19) were similar. Liver biopsy was available in 149 patients [lean: 19 (12.7%), non-lean: 130 (87.3%)]. There was no difference in the number of patients with NASH [4 (21.05%) vs 20 (15.3%), p = 0.51], significant fibrosis [2 (10.5%) vs 32 (24.6%), p = 0.25] or advanced fibrosis [1 (5.26%) vs 18 (13.84%), p = 0.47]. CONCLUSION Although metabolic co-morbidities are less common, there is no difference in liver disease severity among both groups.
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Affiliation(s)
- Arka De
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Bhagat
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Yeh K, Sharma I, Falahkheirkhah K, Confer MP, Orr AC, Liu YT, Phal Y, Ho RJ, Mehta M, Bhargava A, Mei W, Cheng G, Cheville JC, Bhargava R. Infrared spectroscopic laser scanning confocal microscopy for whole-slide chemical imaging. Nat Commun 2023; 14:5215. [PMID: 37626026 PMCID: PMC10457288 DOI: 10.1038/s41467-023-40740-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Chemical imaging, especially mid-infrared spectroscopic microscopy, enables label-free biomedical analyses while achieving expansive molecular sensitivity. However, its slow speed and poor image quality impede widespread adoption. We present a microscope that provides high-throughput recording, low noise, and high spatial resolution where the bottom-up design of its optical train facilitates dual-axis galvo laser scanning of a diffraction-limited focal point over large areas using custom, compound, infinity-corrected refractive objectives. We demonstrate whole-slide, speckle-free imaging in ~3 min per discrete wavelength at 10× magnification (2 μm/pixel) and high-resolution capability with its 20× counterpart (1 μm/pixel), both offering spatial quality at theoretical limits while maintaining high signal-to-noise ratios (>100:1). The data quality enables applications of modern machine learning and capabilities not previously feasible - 3D reconstructions using serial sections, comprehensive assessments of whole model organisms, and histological assessments of disease in time comparable to clinical workflows. Distinct from conventional approaches that focus on morphological investigations or immunostaining techniques, this development makes label-free imaging of minimally processed tissue practical.
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Affiliation(s)
- Kevin Yeh
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Ishaan Sharma
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Kianoush Falahkheirkhah
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Matthew P Confer
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Andres C Orr
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yen-Ting Liu
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Yamuna Phal
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Ruo-Jing Ho
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Manu Mehta
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Ankita Bhargava
- University of Illinois Laboratory High School, Urbana, IL, 61801, USA
| | - Wenyan Mei
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, 61802, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Georgina Cheng
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
- Carle Health, Urbana, IL, 61801, USA
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, College of Medicine and Science, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rohit Bhargava
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
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Mehta M, Polli JE, Seo P, Bhoopathy S, Berginc K, Kristan K, Cook J, Dressman JB, Mandula H, Munshi U, Shanker R, Volpe DA, Gordon J, Veerasingham S, Welink J, Almeida S, Gonzalez P, Painter D, Tsang YC, Vaidyanathan J, Velagapudi R. Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS)-Based Biowaivers: A workshop Summary Report. J Pharm Sci 2023; 112:1749-1762. [PMID: 37142122 DOI: 10.1016/j.xphs.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
The workshop "Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS) Based Biowaivers" was held virtually on December 6, 2021, organized by the University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI), and the Food and Drug Administration (FDA). The workshop focused on the industrial, academic, and regulatory experiences in generating and evaluating permeability data, with the aim to further facilitate implementation of the BCS and efficient development of high-quality drug products globally. As the first international permeability workshop since the BCS based biowaivers was finalized as the ICH M9 guideline, the workshop included lectures, panel discussions, and breakout sessions. Lecture and panel discussion topics covered case studies at IND, NDA, and ANDA stages, typical deficiencies relating to permeability assessment supporting BCS biowaiver, types of evidence that are available to demonstrate high permeability, method suitability of a permeability assay, impact of excipients, importance of global acceptance of permeability methods, opportunities to expand the use of biowaivers (e.g. non-Caco-2 cell lines, totality-of-evidence approach to demonstrate high permeability) and future of permeability testing. Breakout sessions focused on 1) in vitro and in silico intestinal permeability methods; 2) potential excipient effects on permeability and; 3) use of label and literature data to designate permeability class.
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Affiliation(s)
- M Mehta
- US Food & Drug Administration, Silver Spring, MD, USA.
| | - J E Polli
- University of Maryland, Baltimore, MD, USA
| | - P Seo
- US Food & Drug Administration, Silver Spring, MD, USA
| | | | | | | | - J Cook
- Pfizer Inc, Groton, CT, USA
| | - J B Dressman
- Fraunhofer Institute of Translational Medicine and Pharmacology, Frankfurt, Germany
| | - H Mandula
- US Food & Drug Administration, Silver Spring, MD, USA
| | - U Munshi
- US Food & Drug Administration, Silver Spring, MD, USA
| | | | - D A Volpe
- US Food & Drug Administration, Silver Spring, MD, USA
| | - J Gordon
- World Health Organization, Geneva, Switzerland
| | | | - J Welink
- European Medicines Agency, Amsterdam, the Netherlands
| | - S Almeida
- Medicines for Europe, Brussels, Belgium
| | - P Gonzalez
- Biopharmaceutical Evaluation Center, Santiago, Chile
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Grewal J, Bortner B, Gregoski M, Cook D, Britt A, Hajj J, Rofael M, Sheidu M, Montovano M, Mehta M, Hajduczok A, Rajapreyar I, Brailovski Y, Genuardi M, Kanwar M, Atluri P, Lander M, Shah P, Hsu S, Kilic A, Houston B, Tedford R. Validation of the Heartmate 3 Risk Score in a Real World Patient Cohort. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Liao J, Mehta M, Hsu F. LIMITED CUTANEOUS SYSTEMIC SCLEROSIS MIMICKING HEREDITARY ANGIOEDEMA WITH NORMAL C1 INHIBITOR. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.830] [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: 11/11/2022]
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Bhatt N, Chitranshi J, Mehta M. Testing Herzberg’s two factor theory on millennials. CM 2022. [DOI: 10.18137/cardiometry.2022.22.231236] [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: 11/08/2022] Open
Abstract
This study tests Herzberg’s two-factor theory of motivation on working millennials. The purpose of the study is to evaluate what the assumptions and the findings of the original study hold for millennials. With the increasing trend of amalgamation of work life and personal life, job satisfaction and general job happiness have never been more on an individual’s personal life. This impact is far-reaching, with strong indications of affecting the employees’ physical, mental, and social health. In such a scenario, organizations need to keep their employees motivated and satisfied. For studying Herzberg’s two-factor theory of motivation on working millennials, we have selected respondents with work experience of at least one year. We have not restricted the study to any particular industry; hence our sample is across all industries. The type of sampling used was convenient sampling. From the analysis, we have found that for the concerned sample, hygiene factors tower above the motivating factors in terms of job satisfaction for millennials. From the data collection and analysis, we proved that both motivators and hygiene factors affect job satisfaction, unlike what has been said by Herzberg. This study will contribute to the exciting literature on motivation.
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Gopalan S, Mehta M. Study of trust of government handling of Covid-19 in India and USA and disinformation tactics used by the government. CM 2022. [DOI: 10.18137/cardiometry.2022.22.323334] [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: 11/08/2022] Open
Abstract
This research aims to find out the status of trust the people of the world’s two prominent democracies – The United States of America, known worldwide as the most powerful democracy, and the Republic of India, known as the World’s Largest Democracy in the handling of the COVID-19 epidemic, that has gripped the entire world by storm. Also, the second objective of this study is to find out if the population of the two nations believe that their governments have actively used disinformation tactics – once thought to be used only by a despot or autocratic governments, on its populace to control the COVID-19 panic and hysteria surrounding it. This study also aims to understand the relationship between trust and disinformation, if any. The study aims to fulfill its objective via individual responses. The survey was conducted via Google Forms and was floated via social media apps like Face book, Linked In, Whatsapp, Instagram, and popular chat sites such as Omegle and Reddit.
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Malukar S, Kunikullaya U, Parikh A, Mehta M, Patel Shah S, Shivhare V, Rath S, Kulshrestha A, T A, Singh J, Dash N, Patel D. PO-1346 Single Institute Retrospective Audit of protracted hypo-fractionated RT in Advanced Carcinoma Cervix. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bashir A, Duseja A, De A, Mehta M, Tiwari P. Non-alcoholic fatty liver disease development: A multifactorial pathogenic phenomena. Liver Research 2022. [DOI: 10.1016/j.livres.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Martins DA, Mazibuko N, Zelaya F, Vasilakopoulou S, Loveridge J, Oates A, Maltezos S, Mehta M, Wastling S, Howard M, McAlonan G, Murphy D, Williams SCR, Fotopoulou A, Schuschnig U, Paloyelis Y. Author Correction: Effects of route of administration on oxytocin-induced changes in regional cerebral blood flow in humans. Nat Commun 2022; 13:1876. [PMID: 35361784 PMCID: PMC8971402 DOI: 10.1038/s41467-022-29419-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- D A Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Mazibuko
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - F Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Vasilakopoulou
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Loveridge
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Oates
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Maltezos
- Adult Autism and ADHD Service, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Wastling
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G McAlonan
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Murphy
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Y Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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De A, Ahmad N, Mehta M, Singh P, Duseja A. NAFLD vs. MAFLD - It is not the name but the disease that decides the outcome in fatty liver. J Hepatol 2022; 76:475-477. [PMID: 34530064 DOI: 10.1016/j.jhep.2021.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nishat Ahmad
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Duseja A, Singh SP, Mehta M, Shalimar, Venkataraman J, Mehta V, Devadas K, Kar SK, Goyal O, Nagral A, Saigal S, Nijhawan S, Praharaj D, Shukla A, Sharma B, Narayanasamy K, Kumar P, Rao PN, Arora A, Mehta R, Asati P, Ranjan P, Koshy A, Alam S, Mukewar S, Mukewar S, Mohan Prasad VG, Rastogi M, Sanyal AJ. Clinicopathological Profile and Outcome of a Large Cohort of Patients with Nonalcoholic Fatty Liver Disease from South Asia: Interim Results of the Indian Consortium on Nonalcoholic Fatty Liver Disease. Metab Syndr Relat Disord 2022; 20:166-173. [PMID: 35085026 DOI: 10.1089/met.2021.0104] [Citation(s) in RCA: 2] [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] [Indexed: 12/20/2022] Open
Abstract
Background: Previous data from South Asia and India had shown that patients with nonalcoholic fatty liver disease (NAFLD) have mild liver disease severity. There are no data regarding long-term clinical outcomes in patients with NAFLD from South Asia. The aim of the study was to evaluate the clinicopathological profile, severity of NAFLD, and clinical outcomes in a large cohort of patients with NAFLD from South Asia. Methods: In an ongoing real-life study [Indian Consortium on nonalcoholic fatty liver disease (ICON-D)], interim data captured across 23 centers in India over 18 months was analyzed for clinicopathological profile, severity of NAFLD, and hepatic/extrahepatic events on follow-up. Results: Of 4313 patients (mean age 45 ± 12.2 years, males 52%), data on metabolic risk factors in 3553 (82.3%) patients revealed that 378 (10.6%) were lean, 575 (16.2%) overweight, 2584 (72.7%) obese; metabolic syndrome in 1518 (42.7%) and at least one metabolic risk factor in 3292 (92.6%) patients. Evidence of significant or advanced fibrosis assessed with [aspartate transaminase to platelet ratio index (APRI), n = 3196 (74%)], [fibrosis-4 (FIB-4), n = 3554 (82.4%)], [NAFLD fibrosis score (NFS), n = 1924 (44.6%)], [Fibroscan, n = 2475, (57.3%)], and histology [n = 267 (6.2%)] was present in 682 (21.3%), 676 (19%), 397 (20.6%), 715 (29%), and 41 (15.4%) patients, respectively; 246 (10%) patients on Fibroscan and 22 (8.2%) on histology had evidence of cirrhosis. On a mean follow-up 43.5 months, hepatic and extrahepatic events recorded in 1353 (31.3%) patients showed that patients with compensated cirrhosis [71 (5.2%)] had more hepatic [26 (36.7%)] and extrahepatic events [8 (11.3%)] in comparison with those without cirrhosis (P < 0.0001). Conclusion: Around one fifth of patients with NAFLD in South Asia have significant liver disease. Both hepatic and extrahepatic events on follow-up are observed more commonly in patients with nonalcoholic steatohepatitis-related compensated cirrhosis.
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaram P Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, India
| | - Manu Mehta
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Krishnadas Devadas
- Department of Gastroenterology, Government Medical College, Trivandrum, India
| | | | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | | | | | - Dibyalochan Praharaj
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - K Narayanasamy
- Department of Hepatology, Madras Medical College, Chennai, India
| | - Pramod Kumar
- Centre of Liver Sciences, AIG Hospitals, Hyderabad, India
| | | | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India
| | - Rajiv Mehta
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Pankaj Asati
- NSC Bose Medical College and Hospital, Jabalpur, India
| | - Piyush Ranjan
- Department of Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India
| | - Abraham Koshy
- Department of Hepatology, VPS Lakeshore, Kochi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | | | | | - Mukul Rastogi
- Department of Hepatology, Gastroenterology and Liver Transplant, Fortis Hospital, Noida, India
| | - Arun J Sanyal
- Division of Gastroenterology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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De A, Keisham A, Mishra S, Mehta M, Verma N, Premkumar M, Taneja S, Das A, Singh V, Duseja A. FibroScan-AST (FAST) Score for Nonalcoholic Steatohepatitis - Validation in an Indian Cohort. J Clin Exp Hepatol 2022; 12:440-447. [PMID: 35535068 PMCID: PMC9077185 DOI: 10.1016/j.jceh.2021.06.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background The FibroScan-AST (FAST) score was recently described to detect patients with nonalcoholic steatohepatitis (NASH) having elevated nonalcoholic fatty liver disease (NAFLD) activity score (NAS ≥ 4) and significant fibrosis (≥ F2) on liver biopsy (NASH+ NAS ≥ 4 + F ≥ 2). Aim The aim of this study was to validate the FAST score in Indian patients with NAFLD and to derive optimal cut-offs. Methods Sixty patients with biopsy-proven NAFLD [men: 38 (63.3%), age 40 (32-52) years] with all parameters for assessing the FAST score within 3 months of liver histology were retrospectively analysed. Results Histological NASH was present in 17 patients (28.3%), while 11 (18.3%) patients had NASH + NAS ≥ 4 + F ≥ 2. The area under the curve (AUROC) of the FAST score for discriminating NASH + NAS ≥ 4 + F ≥ 2 was 0.81. Using cut-offs by Newsome et al, the rule-out cut-off (FAST: ≤ 0.35) had a negative predictive value (NPV) of 0.88 [sensitivity: 0.91, specificity: 0.14, negative likelihood ratio (LR): 0.64], while the rule-in cut-off (FAST: ≥ 0.67) had a positive predictive value (PPV) of 0.33 (sensitivity: 0.73, specificity: 0.67, positive LR: 2.22). Fifteen (25%) patients were correctly classified as per histology, while 28 (46.67%) patients fell in the grey zone. On recalculating the optimal cut-offs for our patients, the rule-out cut-off (FAST: ≤ 0.55) had an NPV of 0.95 (sensitivity: 0.90, specificity: 0.45, negative LR: 0.21), while the optimal rule-in cut-off (FAST: ≥ 0.78) had a PPV of 0.70 (sensitivity: 0.64, specificity 0.94, positive LR: 10.39). With these cut-offs, 27 (45%) patients fell in the grey zone and 29 (48.3%) were correctly classified as per histology, performing better than the cut-offs by Newsome et al (P < 0.001). Conclusion The FAST score demonstrates good AUROC for detecting NASH with significant fibrosis and inflammation on histology. Cut-offs should be recalibrated based on prevalence of disease. Lay summary India has a high burden of NAFLD with an estimated 25 million patients at potential risk for significant liver disease. Liver biopsy remains the gold standard for diagnosing NASH, although its application in routine clinical practice is limited. Noninvasive tests for the simultaneous detection of steatosis, inflammation and fibrosis are thus the need of the hour. The FAST score has been recently suggested for the noninvasive detection of NASH with significant fibrosis (≥ F2) and inflammation (NAS ≥ 4) on liver biopsy. We validated the utility of the FAST score for detecting NASH with significant fibrosis and inflammation on liver biopsy in Indian patients with NAFLD. This noninvasive, easy-to-use and nonproprietary FAST score can correctly classify disease severity in more than 50% patients. However, our results suggest that cut-offs should be recalibrated based on the anticipated prevalence of NASH + NAS ≥ 4 + F ≥ 2 in the given population.
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Key Words
- ALT, Alanine Aminotransferase
- AMA, Antimitochondrial Antibody
- ANAs, Antinuclear Antibodies
- AST, Aspartate aminotransferase
- BMI, Body Mass Index
- CAP, Controlled Attenuation Parameter
- FAST, FibroScan-AST
- FLIP, Fatty Liver Inhibition of Progression
- FibroScan
- HTN, Hypertension
- LKM, Antiliver Kidney Microsomal Antibody
- LSM, Liver Stiffness Measurement
- NAFLD
- NAFLD, Nonalcoholic Fatty Liver Disease
- NAS, NAFLD Activity Score
- NASH, Nonalcoholic Steatohepatitis
- NASH-CRN, NASH Clinical Research Network
- SAF, Steatosis, Activity and Fibrosis Score
- T2DM, Type 2 Diabetes Mellitus
- nonalcoholic fatty liver disease
- steatosis
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ajay Duseja
- Address for correspondence: Dr. Ajay Duseja, MD, DM, FAASLD, FACG, FAMS, FSGEI, Professor, Department of Hepatology, Sector 12, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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17
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Mehta M, Shafi S, Leeds S. M028 SYSTEMIC REACTION AFTER TOPICAL CAPSAICIN. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.202] [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: 10/19/2022]
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18
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Spira A, Ramalingam S, Neal J, Piotrowska Z, Mekhail T, Tsao A, Gentzler R, Riely G, Bazhenova L, Gadgeel S, Nguyen D, Johnson M, Vincent S, Jin S, Griffin C, Bunn V, Lin J, Churchill E, Mehta M, Janne P. OA15.01 Mobocertinib in EGFR Exon 20 Insertion–Positive Metastatic NSCLC Patients With Disease Control on Prior EGFR TKI Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.082] [Citation(s) in RCA: 4] [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: 11/28/2022]
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19
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Nguyen D, Ramalingam S, Spira A, Riely G, Kim T, Yang JH, Piotrowska Z, Campelo MG, Felip E, Bazhenova L, Jin S, Griffin C, Diderichsen P, Gupta N, Bunn V, Lin J, Churchill E, Mehta M, Zhou C, Janne P. 1218P Characterization of GI toxicities and their impact on efficacy in patients (pts) with EGFR exon 20 insertion+ (ex20ins+) non-small cell lung cancer (NSCLC) treated with mobocertinib (TAK-788) who previously received platinum chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Christopoulos P, Ou SH, Lin J, Berg D, Hong JL, Yin Y, Lin J, Bunn V, Lin H, Mehta M, Thomas M. 1224P Systematic review and meta-analysis of immunotherapy effectiveness for pretreated patients with non-small cell lung cancer harboring EGFR exon 20 insertions. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Hida T, Nishino M, Yoh K, Asato T, Kitagawa T, Zhang S, Mehta M, Ohe Y. 1246P A phase I dose-escalation study of mobocertinib (TAK-788), an oral tyrosine kinase inhibitor (TKI), in Japanese NSCLC patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Ou SH, Lin H, Hong JL, Yin Y, Jin S, Lin J, Mehta M, Nguyen D, Neal J. 1211P Indirect comparison of mobocertinib and standard of care in platinum-pretreated patients with NSCLC with EGFR exon 20 insertion. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1816] [Citation(s) in RCA: 2] [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: 10/20/2022] Open
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23
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Yang JH, Ramalingam S, Kim T, Kim SW, Riely G, Mekhail T, Nguyen D, Campelo MG, Felip E, Bazhenova L, Jin S, Griffin C, Bunn V, Lin J, Churchill E, Mehta M, Janne P, Zhou C. 1231P Characterization and management of mobocertinib (TAK-788) induced skin toxicity in patients with EGFR exon 20 insertion+ (ex20ins+) non-small cell lung cancer (NSCLC) who previously received platinum chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ratanchandani K, Kunikullaya S, Parikh A, Mehta M, Patel S, Shivhare V, Rath S, Modi V, Jain H, Anand D, Bathija N. PO-1038 Radiotherapy with Temozolomide for Pediatric Glioblastoma:A single institute retrospective analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Bathija N, Rathod H, Kunikullaya S, Parikh A, Mehta M, Patel S, Shivhare V, Rath S, Modi V, Jain H, Anand D, Ratanchandani K. PO-1211 Intraluminal brachytherapy boost in esophageal cancer: A single institute retrospective analysis. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Mehta M, O'Toole A, Gooderham M. Real-world experience with risankizumab in patients with plaque psoriasis: a retrospective study. J Eur Acad Dermatol Venereol 2021; 35:e685-e688. [PMID: 34050980 DOI: 10.1111/jdv.17410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- M Mehta
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A O'Toole
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - M Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada.,Queen's University, Kingston, ON, Canada
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Abstract
BACKGROUND Correction of high regular and irregular astigmatism with rigid gas-permeable contact lenses can result in discomfort, compromised corneal physiology and fluctuations in visual acuity due to excessive lens movement. Using a non-probability sample, this study explored the optical, clinical and subjective performance of a modified countersunk piggyback lens (MCL) for the management of high regular and irregular corneal astigmatic refractive conditions, as the first phase for a larger randomised control study of the efficacy of the custom piggyback MCL system. METHOD The sample was a single group of 10 patients (n = 17 eyes) selected primarily on the basis of a history of failure with conventional management regimes. The objective clinical and optical performance of the MCL used in the management of high degrees of regular and irregular corneal astigmatic conditions was assessed, including measures of visual performance and ocular health. Subjective performance of the MCL was evaluated by patient feedback. RESULTS Objective and subjective measures were analysed using appropriate statistical analyses. There was a significant improvement in the uncorrected vision and visual acuity (VA) with the MCL, as well as a significant improvement in refractive status. There was no statistically significant increase in adverse ocular responses with the MCL. Statistical analysis of the subjective responses indicated a strong acceptance of the MCL by all subjects, thus supporting the objective analysis indicating the superior performance of the MCL over prior conventional treatment regimens. DISCUSSION The custom piggyback MCL performed successfully in the management of a range of high regular and irregular astigmatic conditions, which have been unsuccessfully managed with a range of conventional optical corrections. Despite the additional cost and handling implications of the two-lens system, the MCL was well accepted by all subjects due to its superior optical and clinical performance.
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Affiliation(s)
- M Mehta
- School of Physiotherapy, Sports Science and Optometry, University of KwaZulu-Natal, Durban, South Africa.
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28
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Taneja S, Duseja A, Mehta M, De A, Verma N, Premkumar M, Dhiman RK, Singh V, Singh MP, Ratho RK, Ramachandran R, Kumar V, Kohli HS. Sofosbuvir and Velpatasvir combination is safe and effective in treating chronic hepatitis C in end-stage renal disease on maintenance haemodialysis. Liver Int 2021; 41:705-709. [PMID: 33025685 DOI: 10.1111/liv.14685] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/05/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS There is emerging data on the use of Sofosbuvir-based directly acting antiviral (DAA) drug regimens in chronic hepatitis C (CHC) patients with end-stage renal disease (ESRD) on maintenance haemodialysis (MHD). We evaluated the safety and efficacy of Sofosbuvir plus Velpatasvir fixed-dose combination in CHC patients with ESRD on MHD. METHODS Fifty-one CHC patients with ESRD on MHD were included in a real-life prospective study. All patients irrespective of genotype; presence of cirrhosis; treatment naive or experienced status were treated with full-dose Sofosbuvir (400 mg) plus Velpatasvir (100 mg) fixed-dosed combination given daily for 12 weeks. The efficacy was assessed by the sustained virological response (SVR12) with negative HCV RNA 12 weeks after the end of treatment (ETR). Side effects if any were recorded in all patients. RESULTS The median HCV RNA level in 51 CHC patients [Males 41 (80.4%), mean age 42.8 ± 14.6 years] was 2.0 × 106 IU/mL. HCV genotype was available in 19 patients with predominant genotype 1 in 15 (79%) patients. Ten (19.6%) patients had evidence of cirrhosis (defined as LSM ≥ 12.5 kPa on Transient Elastography), and 8 (15.6%) patients were treatment experienced. Testing for ETR was done in 36 patients and all 36 (100%) patients achieved ETR, and 49 patients (96%) achieved SVR 12. All 51 patients tolerated the Sofosbuvir + Velpatasvir combination, with none of the patients reporting any serious adverse event. CONCLUSION Sofosbuvir plus Velpatasvir fixed-dose combination is safe and effective in treating CHC in patients with ESRD on MHD.
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Affiliation(s)
- Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha K Ratho
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harbir S Kohli
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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29
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Duseja A, Chahal GS, Jain A, Mehta M, Ranjan A, Grover V. Association between nonalcoholic fatty liver disease and inflammatory periodontal disease: A case‑control study. J Indian Soc Periodontol 2021; 25:47-54. [PMID: 33642741 PMCID: PMC7904021 DOI: 10.4103/jisp.jisp_45_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. Aim: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. Settings and Design: Tertiary health care center, cross-sectional case-control observational study. Materials and Methods: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. Statistical Data Analysis: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). Results: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. Conclusion: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, PGIMER, Panjab University, Chandigarh, India
| | - Gurparkash Singh Chahal
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Ashish Jain
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Manu Mehta
- Department of Hepatology, PGIMER, Panjab University, Chandigarh, India
| | - Aditya Ranjan
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
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30
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Martins DA, Mazibuko N, Zelaya F, Vasilakopoulou S, Loveridge J, Oates A, Maltezos S, Mehta M, Wastling S, Howard M, McAlonan G, Murphy D, Williams SCR, Fotopoulou A, Schuschnig U, Paloyelis Y. Effects of route of administration on oxytocin-induced changes in regional cerebral blood flow in humans. Nat Commun 2020; 11:1160. [PMID: 32127545 PMCID: PMC7054359 DOI: 10.1038/s41467-020-14845-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Could nose-to-brain pathways mediate the effects of peptides such as oxytocin (OT) on brain physiology when delivered intranasally? We address this question by contrasting two methods of intranasal administration (a standard nasal spray, and a nebulizer expected to improve OT deposition in nasal areas putatively involved in direct nose-to-brain transport) to intravenous administration in terms of effects on regional cerebral blood flow during two hours post-dosing. We demonstrate that OT-induced decreases in amygdala perfusion, a key hub of the OT central circuitry, are explained entirely by OT increases in systemic circulation following both intranasal and intravenous OT administration. Yet we also provide robust evidence confirming the validity of the intranasal route to target specific brain regions. Our work has important translational implications and demonstrates the need to carefully consider the method of administration in our efforts to engage specific central oxytocinergic targets for the treatment of neuropsychiatric disorders.
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Affiliation(s)
- D A Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Mazibuko
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - F Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Vasilakopoulou
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Loveridge
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Oates
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Maltezos
- Adult Autism and ADHD Service, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Wastling
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G McAlonan
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Murphy
- Department of Forensic and Neurodevelopmental Science (SM), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Y Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Mehta M, Wang L, Guo C, Warner N, Li Q, Pan J, Boztug K, Uhlig H, Muise A. A39 NOVEL GAIN OF FUNCTION NON-RECEPTOR TYROSINE KINASE MUTATIONS ARE LINKED TO THE PATHOGENESIS OF VEOIBD. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Very early-onset inflammatory bowel disease (VEOIBD) is an emerging global disease, that results in inflammation of the digestive tract. Severe forms of VEOIBD can be caused by mutations in a single gene (monogenic variants) and, can result in death. A candidate gene which codes for a non-receptor tyrosine kinase (nRTK) has recently been implicated as a monogenic cause of IBD (unpublished). Whole exome sequencing was performed in two unrelated children who presented with symptoms of IBD identifying two distinct de novo gain of function mutations (S550Y and P342T). Both mutations are located in the highly conserved region of the nRTK, and were predicted to have similar downstream effects. Furthermore, four other patients with a variety of adult-onset immune disorders have recently been identified with rare variants in the same gene (M450I, R42P, A353T, V433M, S550F) but, their potential gain of function status remains to be determined. Studies show that this nRTK is an essential mediator in inflammation. It is expressed in both intestinal epithelial and immune cells however, its role in infantile IBD is unclear. This protein is first activated by phosphorylation and is linked to activating downstream transcription factors such as ERK and JNK. All these target proteins play a meaningful role in intestinal inflammation in patients with IBD.
Aims
Since we identified P342T and S550Y to be gain of function, we wanted to determine if the new variants exhibit a similar downstream impact on target protein expression levels when compared with S550Y and P342T. We also wanted to identify if all variants can be rescued with a known nRTK inhibitor. It is hypothesized that the new variants are gain of function and that all variants can be rescued with the inhibitor.
Methods
Using western blot analysis, the activation of ERK, JNK and nRTK was compared between wildtype (WT) and mutants. This in vitro method helped identify the degree of activation. For the second part of the study, HEK293T cells were treated with inhibitor to test for a rescue of phenotypes via western blot analysis.
Results
Results show an increased activation of nRTK, ERK and JNK in all variants with S550Y and S550F having the highest activation. Furthermore, pharmacological inhibition using small molecular kinase inhibitors resulted in decreased activation of nRTK, ERK and JNK suggesting a rescue of phenotypes.
Conclusions
Characterizing the downstream functional impact of these nRTK variants is an important first step to determine if gain of function nRTK mutations drive IBD. With a rising prevalence of IBD worldwide, these findings may lead to the development of pharmacological nRTK inhibitors as a novel personalized therapeutic approach for these patients and possibly for the broader IBD population.
Funding Agencies
CIHR
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Affiliation(s)
- M Mehta
- Biochemistry, University of Toronto, Markham, ON, Canada
| | - L Wang
- Cell biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - C Guo
- Cell biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - N Warner
- Cell biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Q Li
- Cell biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Pan
- Cell biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - H Uhlig
- University of Oxford, Oxford, England, United Kingdom
| | - A Muise
- Hospital for Sick Children, Toronto, ON, Canada
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Adams DR, Tollinche LE, Yeoh CB, Artman J, Mehta M, Phillips D, Fischer GW, Quinlan JJ, Sakai T. Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study. Anaesthesia 2019; 75:348-352. [PMID: 31721151 DOI: 10.1111/anae.14914] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 10/15/2019] [Indexed: 12/17/2022]
Abstract
Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end-stage renal disease; however, reports exist of its use in this group of patients. This two-institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end-stage renal disease who required pre-operative renal replacement therapy. Adult surgical patients with end-stage renal disease requiring pre-operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re-intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty-eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non-renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre-existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re-intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end-stage renal disease receiving pre-operative renal replacement therapy.
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Affiliation(s)
- D R Adams
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L E Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C B Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Artman
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Mehta
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Phillips
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - G W Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J J Quinlan
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T Sakai
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Butler M, Robert C, Negrier S, In G, Walker J, Krajsova I, Atkinson V, Hansson J, Kapiteijn E, Loquai C, Shaw H, Cheng T, Mansard S, Grob J, Guidoboni M, Mehta M, Ascierto P, Diab A. ILLUMINATE 301: A randomized phase III study of tilsotolimod in combination with ipilimumab compared with ipilimumab alone in patients with advanced melanoma following progression on or after anti-PD-1 therapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.061] [Citation(s) in RCA: 2] [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: 11/12/2022] Open
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34
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Mehta M, Gondi V, Ahluwalia M, Brown P. Radiosurgery followed by tumour treating fields (TTFields) for brain metastases (1-10) from NSCLC in the phase III METIS trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Duseja A, Acharya SK, Mehta M, Chhabra S, Rana S, Das A, Dattagupta S, Dhiman RK, Chawla YK. High potency multistrain probiotic improves liver histology in non-alcoholic fatty liver disease (NAFLD): a randomised, double-blind, proof of concept study. BMJ Open Gastroenterol 2019; 6:e000315. [PMID: 31423319 PMCID: PMC6688701 DOI: 10.1136/bmjgast-2019-000315] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Pharmacological treatment of non-alcoholic fatty liver disease (NAFLD) is still evolving. Probiotics could be a promising treatment option, but their effectiveness needs to be established. The present study aimed to evaluate the efficacy of a high potency multistrain probiotic in adult patients with NAFLD. Methods Thirty-nine liver biopsy-proven patients with NAFLD were randomised in a double-blind fashion to either lifestyle modifications plus an oral multistrain probiotic (675 billion bacteria daily, n=19) or identical placebo (n=20) for 1 year. Lifestyle modifications included regular exercise for all and control of overweight/obesity (with additional dietary restrictions), hypertension and hyperlipidaemia in those with these risk factors. Primary objective of the study was the histological improvement in NAFLD activity score (NAS) and its components and secondary objectives were improvement in alanine transaminase (ALT) and cytokine profile. Results Thirty (76.9%) out of 39 patients with NAFLD completed the study with 1 year of follow-up. A repeat liver biopsy at 1 year could be done in 10 patients (52.6%) in probiotic group and five patients (25%) in placebo group. In comparison to baseline, hepatocyte ballooning (p=0.036), lobular inflammation (p=0.003) and NAS score (p=0.007) improved significantly at 1 year in the probiotic group. When compared with placebo, the NAS score improved significantly in the probiotic group (p=0.004), along with improvements in hepatocyte ballooning (p=0.05) and hepatic fibrosis (p=0.018). A significant improvement in levels of ALT (p=0.046), leptin (p=0.006), tumour necrosis factor-α (p=0.016) and endotoxins (p=0.017) was observed in probiotic group in comparison to placebo at 1 year. No significant adverse events were reported in the study. Conclusion Patients with NAFLD managed with lifestyle modifications and multistrain probiotic showed significant improvement in liver histology, ALT and cytokines. Trial registration number The clinical trial is registered with CLINICAL TRIAL REGISTRYINDIA (CTRI); http://ctri.nic.in, No. CTRI/2008/091/000074
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Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subrat K Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Manu Mehta
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shruti Chhabra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satyavati Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Radha K Dhiman
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh K Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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36
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Gupta T, Achari R, Chatterjee A, Chen ZP, Mehta M, Bouffet E, Jalali R. Comparison of Epidemiology and Outcomes in Neuro-Oncology Between the East and the West: Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:539-548. [PMID: 31182288 DOI: 10.1016/j.clon.2019.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/29/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
Although neoplasms of the brain and central nervous system (CNS) are relatively uncommon, comprising only 1-2% of the overall cancer burden, they represent a substantial source of morbidity and mortality worldwide. The age-adjusted annual incidence of CNS tumours is reportedly low; however, there is substantial global variability in its incidence, with nearly a five-fold difference between regions with the highest rates in developed countries in the West and those with the lowest rates in developing countries in South-East Asia, including India, possibly attributable to key differences in environmental factors, genetic susceptibilities and cultural practices, as well as resource constraints in low-middle income countries precluding precise ascertainment and accurate diagnosis. The burden of CNS tumours is further compounded by the fact that they require highly specialised and skilled multidisciplinary care, including access to modern neuroimaging, neurosurgery, neuropathology and molecular biology, radiotherapy, chemotherapy and rehabilitation services, which may not be widely available in an integrated manner in large parts of the world with a large variation in clinical pathways, non-uniformity of care and resultant heterogeneity in clinical outcomes. CNS tumours encompass a heterogeneous spectrum of histopathological entities with differences in presentation, distinct molecular/genetic alterations, diverse biological behaviour and varying clinical outcomes. Survival is highly dependent on histology, grade and molecular biology, but varies widely across continents, even for the same tumour type and grade. In general, survival is higher in children with primary brain tumours than in adults, largely due to the differences in histological distribution across age groups. However, there is widespread variability, with 5-year survival for paediatric brain tumours being <40% in some low-middle income countries compared with 70-80% in the developed world. This review compares the descriptive epidemiology and clinical outcomes of primary brain tumours between the East and the West that pose unique challenges but also provide new opportunities in contemporary neuro-oncological practice.
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Affiliation(s)
- T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
| | - R Achari
- Department of Radiation Oncology, Tata Medical Centre, Kolkata, India
| | - A Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Z-P Chen
- Department of Neurosurgery, SunYat-sen University Cancer Centre, Guangzhou, China
| | - M Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - E Bouffet
- Neuro-Oncology Section, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - R Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India
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37
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Fernandez Turienzo C, Bick D, Bollard M, Brigante L, Briley A, Coxon K, Cross P, Healey A, Mehta M, Melaugh A, Moulla J, Seed PT, Shennan AH, Singh C, Tribe RM, Sandall J. POPPIE: protocol for a randomised controlled pilot trial of continuity of midwifery care for women at increased risk of preterm birth. Trials 2019; 20:271. [PMID: 31088505 PMCID: PMC6518651 DOI: 10.1186/s13063-019-3352-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background High rates of preterm births remain a UK public health concern. Preterm birth is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, psychosocial effects on the family and health care costs. We aim to test whether a model of care combining continuity of midwife care with rapid referral to a specialist obstetric clinic throughout pregnancy, intrapartum and the postpartum period is feasible and improves experience and outcomes for women at increased risk of preterm birth. Methods This pilot, hybrid, type 2 randomised controlled implementation trial will recruit 350 pregnant women at increased risk of preterm birth to a midwifery continuity of care intervention or standard care. The intervention will be provided from recruitment (antenatal), labour, birth and the postnatal period, in hospital and community settings and in collaboration with specialist obstetric clinic care, when required. Standard care will be the current maternity care provision by NHS midwives and obstetricians at the study site. Participants will be followed up until 6–8 weeks postpartum. The composite primary outcome is the appropriate initiation of any specified interventions related to the prevention and/or management of preterm labour and birth. Secondary outcomes are related to: recruitment and attrition rates; implementation; acceptability to women, health care professionals and stakeholders; health in pregnancy and other complications; intrapartum outcomes; maternal and neonatal postnatal outcomes; psycho-social health; quality of care; women’s experiences and health economic analysis. The trial has 80% power to detect a 15% increase in the rate of appropriate interventions (40 to 55%). The analysis will be by ‘intention to treat’ analysis. Discussion Little is known about the underlying reasons why and how models of midwifery continuity of care are associated with fewer preterm births, better maternal and infant outcomes and more positive experiences; nor how these models of care can be implemented successfully in the health services. This will be the first study to provide direct evidence regarding the effectiveness, implementation and evaluation of a midwifery continuity of care model and rapid access to specialist obstetric services for women at increased risk of preterm birth. Trial registration ISRCTN37733900. Retrospectively registered on 21 August 2017.
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Affiliation(s)
- C Fernandez Turienzo
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - D Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7A, UK
| | - M Bollard
- Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6HL, UK
| | - L Brigante
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, London, SE1 8WA, UK
| | - A Briley
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - K Coxon
- Department of Midwifery, Kingston University and St. George's, University of London, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | - P Cross
- Department of Public Health, London Borough of Lewisham, Laurence House, London, SE6 4RU, UK
| | - A Healey
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - M Mehta
- Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6HL, UK
| | - A Melaugh
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - J Moulla
- Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6HL, UK
| | - P T Seed
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - A H Shennan
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - C Singh
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - R M Tribe
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK
| | - J Sandall
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
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Mehta M, Gondi V, Ahluwalia M, Brown P. Phase III METIS study: Tumor treating fields (150 kHz) and radiosurgery for supra- and/or infratentorial brain metastases (1-10) from non-small cell lung cancer (NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz068.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Mehta M, Wang L, Li Q, Warner N, Pan J, Muise A. A117 CHARACTERIZATION OF A NOVEL GAIN OF FUNCTION MUTATION IN A NON-RECEPTOR TYROSINE KINASE IN THE DEVELOPMENT OF VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Mehta
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
| | - L Wang
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
| | - Q Li
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
| | - N Warner
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
| | - J Pan
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
| | - A Muise
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Toronto, ON, Canada
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40
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Mason KP, Kelhoffer ER, Prescilla R, Mehta M, Root JC, Young VJ, Robinson F, Veselis RA. Feasibility of measuring memory response to increasing dexmedetomidine sedation in children. Br J Anaesth 2018; 118:254-263. [PMID: 28100530 DOI: 10.1093/bja/aew421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The memory effect of dexmedetomidine has not been prospectively evaluated in children. We evaluated the feasibility of measuring memory and sedation responses in children during dexmedetomidine sedation for non-painful radiological imaging studies. Secondarily, we quantified changes in memory in relation to the onset of sedation. METHODS A 10 min bolus of dexmedetomidine (2 mcg kg-1) was given to children as they named simple line drawings every five s. The absence of sedation was identified as any verbal response, regardless of correctness. After recovery, recognition memory was tested with correct Yes/No recognitions (50% novel pictures) and was matched to sedation responses during the bolus period (subsequent memory paradigm). RESULTS Of 64 accruals, 30 children (mean [SD]6.1 (1.2) yr, eight male) received dexmedetomidine and completed all study tasks. Individual responses were able to be modelled successfully in the 30 children completing all the study tasks, demonstrating feasibility of this approach. Children had 50% probability of verbal response at five min 40 s after infusion start, whereas 50% probability of subsequent recognition memory occurred sooner at four min five s. CONCLUSIONS Quantifying memory and sedation effects during dexmedetomidine infusion in verbal children was possible and demonstrated that memory function was present until shortly before verbal unresponsiveness occurred. This is the first study to investigate the effect of dexmedetomidine on memory in children. CLINICAL TRIAL REGISTRATION NCT 02354378.
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Affiliation(s)
- K P Mason
- Department of Anesthesia, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - E R Kelhoffer
- Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - R Prescilla
- Department of Anaesthesiology, Perioperative and Pain Medicine, Harvard Medical School, MA, USA
| | - M Mehta
- Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - J C Root
- Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.,Department of Psychology in Anesthesiology, Neurocognitve Research Lab, Memorial Sloan-Kettering Cancer Center, New York, NY,USA
| | - V J Young
- Department of Anesthesia, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | | | - R A Veselis
- Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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Cohen E, Harrington K, Hong D, Mesia R, Brana I, Perez Segura P, Wise-Draper T, Scott M, Mitchell P, Mugundu G, McCoon P, Cook C, Mehta M, Keilholz U. A phase Ib/II study (SCORES) of durvalumab (D) plus danvatirsen (DAN; AZD9150) or AZD5069 (CX2i) in advanced solid malignancies and recurrent/metastatic head and neck squamous cell carcinoma (RM-HNSCC): Updated results. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gupta V, Sreenivas V, Mehta M, Ramam M. What do Vitiligo Impact Scale‐22 scores mean? Studying the clinical interpretation of scores using an anchor‐based approach. Br J Dermatol 2018; 180:580-585. [DOI: 10.1111/bjd.17040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- V. Gupta
- Department of Dermatology and Venereology All India Institute of Medical Sciences New DelhiIndia
| | - V. Sreenivas
- Department of Biostatistics All India Institute of Medical Sciences New DelhiIndia
| | - M. Mehta
- Department of Psychiatry All India Institute of Medical Sciences New DelhiIndia
| | - M. Ramam
- Department of Dermatology and Venereology All India Institute of Medical Sciences New DelhiIndia
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Bähr O, Mehta M, Gondi V, Ahluwalia M, Brown P. P05.83 Tumor Treating Fields and radiosurgery for supra- and/or infratentorial brain metastases (1–10) from NSCLC in the phase 3 METIS study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.409] [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: 11/12/2022] Open
Affiliation(s)
- O Bähr
- University Hospital Frankfurt, Frankfurt, Germany
| | - M Mehta
- Miami Cancer Institute, Miami, FL, United States
| | - V Gondi
- Northwestern Medicine Cancer Center, Warrenville, IL, United States
| | - M Ahluwalia
- Cleveland Clinic, Cleveland, OH, United States
| | - P Brown
- Mayo Clinic, Rochester, MN, United States
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Soni BK, Makwana R, Mukherjee S, Parashari S, Suryanarayana SV, Nayak BK, Naik H, Mehta M. Neutron capture cross-sections for 159Tb isotope in the energy range of 5 to 17 MeV. Appl Radiat Isot 2018; 141:10-14. [PMID: 30144772 DOI: 10.1016/j.apradiso.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/16/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022]
Abstract
The neutron capture cross-sections have been measured for the 159Tb(n, γ)160Tb reaction at the spectrum average peak neutron energies of 5.08 ± 0.165, 12.47 ± 0.825, and 16.63 ± 0.95 MeV respectively. The experiment has been carried out using the standard neutron activation technique and off-line γ-ray spectrometry. The present measurement has been done for the energies where very few measured results are available in the data library. The results have been compared with ENDF/B-VII.1 and JENDL-4.0 data libraries. The present results have also been supported by theoretical predictions of nuclear model code TALYS 1.9. Detailed covariance analysis was carried out to find the uncertainty and the correlations among the measured cross-sections.
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Affiliation(s)
- B K Soni
- Department of Physics, Faculty of Science, The M. S. University of Baroda, Vadodara 390002, Gujarat, India
| | - Rajnikant Makwana
- Department of Physics, Faculty of Science, The M. S. University of Baroda, Vadodara 390002, Gujarat, India
| | - S Mukherjee
- Department of Physics, Faculty of Science, The M. S. University of Baroda, Vadodara 390002, Gujarat, India.
| | - Siddharth Parashari
- Department of Physics, Faculty of Science, The M. S. University of Baroda, Vadodara 390002, Gujarat, India
| | - S V Suryanarayana
- Nuclear Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - B K Nayak
- Nuclear Physics Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - H Naik
- Radiochemistry Division, Bhabha Atomic Research Centre, Mumbai 400085, India
| | - M Mehta
- Institute for Plasma Research, Gandhinagar, Gujarat 382428, India
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Das S, Kailash S, Mehta M, Bisoi A. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass. Journal of Neuroanaesthesiology and Critical Care 2018. [DOI: 10.4103/2348-0548.148389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Postoperative cognitive decline (POCD) after coronary artery bypass grafting (CABG) is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07), digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09) and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008), digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008) and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02). The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.
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Affiliation(s)
- Sambhunath Das
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Suparna Kailash
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Manu Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Akshya Bisoi
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND Childhood abuse is associated with abnormalities in brain structure and function. Few studies have investigated abuse-related brain abnormalities in medication-naïve, drug-free youth that also controlled for psychiatric comorbidities by inclusion of a psychiatric control group, which is crucial to disentangle the effects of abuse from those associated with the psychiatric conditions. METHODS Cortical volume (CV), cortical thickness (CT) and surface area (SA) were measured in 22 age- and gender-matched medication-naïve youth (aged 13-20) exposed to childhood abuse, 19 psychiatric controls matched for psychiatric diagnoses and 27 healthy controls. Both region-of-interest (ROI) and whole-brain analyses were conducted. RESULTS For the ROI analysis, the childhood abuse group compared with healthy controls only, had significantly reduced CV in bilateral cerebellum and reduced CT in left insula and right lateral orbitofrontal cortex (OFC). At the whole-brain level, relative to healthy controls, the childhood abuse group showed significantly reduced CV in left lingual, pericalcarine, precuneus and superior parietal gyri, and reduced CT in left pre-/postcentral and paracentral regions, which furthermore correlated with greater abuse severity. They also had increased CV in left inferior and middle temporal gyri relative to healthy controls. Abnormalities in the precuneus, temporal and precentral regions were abuse-specific relative to psychiatric controls, albeit at a more lenient level. Groups did not differ in SA. CONCLUSIONS Childhood abuse is associated with widespread structural abnormalities in OFC-insular, cerebellar, occipital, parietal and temporal regions, which likely underlie the abnormal affective, motivational and cognitive functions typically observed in this population.
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Affiliation(s)
- L Lim
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - H Hart
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - M Mehta
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - A Worker
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - A Simmons
- Department of Neuroimaging,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - K Mirza
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - K Rubia
- Department of Child & Adolescent Psychiatry,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
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Mehta M, Outram M, Wilkinson J, Kakodkar P. Frozen ultrasound image as a prompt for stop before you block. Anaesthesia 2018; 73:396-397. [PMID: 29437218 DOI: 10.1111/anae.14221] [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: 11/30/2022]
Affiliation(s)
- M Mehta
- Northampton General Hospital, Northampton, UK
| | - M Outram
- Northampton General Hospital, Northampton, UK
| | - J Wilkinson
- Northampton General Hospital, Northampton, UK
| | - P Kakodkar
- Northampton General Hospital, Northampton, UK
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Mehta M, Puntambekar S, Chitale M, Puntambekar S, Parikh H. Reconstruction of the Distal Ureter Following an Extensive Resection of Ureter for Stage IV Endometriosis. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Puntambekar S, Puntambekar S, Manchekar M, Parikh K, Mehta M. Laparoscopic Ureteroneocystostomy Following UV Fistula in Ectopic Kidney. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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50
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Sakpal M, Satsangi S, Mehta M, Duseja A, Bhadada S, Das A, Dhiman RK, Chawla YK. Vitamin D supplementation in patients with nonalcoholic fatty liver disease: A randomized controlled trial. JGH Open 2017; 1:62-67. [PMID: 30483536 PMCID: PMC6207029 DOI: 10.1002/jgh3.12010] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/12/2017] [Indexed: 01/10/2023]
Abstract
Background and Aim Deficiency of vitamin D may be related to the pathogenesis of nonalcoholic fatty liver disease (NAFLD). The aim of the present study was to evaluate the effect of vitamin D supplementation in patients with NAFLD. Methods A total of 81 patients with NAFLD with normal or raised (n = 47) serum alanine aminotransferase (ALT) having vitamin D deficiency were randomized prospectively. Group 1 (n = 51) received lifestyle modifications and a single injection of vitamin D (600 000 U) (standard medical treatment [SMT] + vitamin D) and group 2 (n = 30) received lifestyle modifications (SMT) for 6 months. The primary objective of this study was to assess the improvement in insulin resistance (IR) and serum ALT (in patients with raised ALT) and the secondary objective was to assess the change in cytokine profile in the SMT + vitamin D group. Results After 6 months, significant improvement in serum levels of ALT was observed in the SMT + vitamin D group when compared to the SMT group (ALT [87 ± 48 and 59 ± 32 IU/mL, P < 0.001] vs [64 ± 35 and 62 ± 24 IU/mL, P = 0.70]). Mean insulin levels and homeostasis model assessment‐IR remained unchanged at 6 months in the SMT + vitamin D group while there was a significant increase in mean insulin and homeostasis model assessment‐IR in the SMT group. SMT + vitamin D group had significant increase in mean serum levels of adiponectin (836 ± 309 and 908 ± 312 (pg/mL), P = 0.018) compared with the baseline; tumor necrosis factor‐α levels decreased from baseline but the change was not significant. Conclusion Patients with NAFLD given vitamin D in addition to lifestyle modifications have significant improvement in serum ALT and serum adiponectin levels.
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Affiliation(s)
- Mallikarjun Sakpal
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sandeep Satsangi
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Manu Mehta
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Ajay Duseja
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sanjay Bhadada
- Department of Endocrinology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Ashim Das
- Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Radha K Dhiman
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Yogesh K Chawla
- Department of Hepatology Postgraduate Institute of Medical Education and Research Chandigarh India
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