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Patil N, Ma N, Mair M, Nazareth J, Sim A, Reynolds C, Freeman N, Chauhan M, Howells L, Peel D, Ahmad S, Sridhar T, Walter HS. Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community. Clin Oncol (R Coll Radiol) 2024; 36:300-306. [PMID: 38388251 DOI: 10.1016/j.clon.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
AIMS Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. MATERIALS AND METHODS All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. RESULTS Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). CONCLUSION Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.
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Affiliation(s)
- N Patil
- University Hospitals of Leicester, Leicester, UK.
| | - N Ma
- University Hospitals of Leicester, Leicester, UK
| | - M Mair
- University Hospitals of Leicester, Leicester, UK
| | - J Nazareth
- University Hospitals of Leicester, Leicester, UK
| | - A Sim
- University Hospitals of Leicester, Leicester, UK
| | - C Reynolds
- University Hospitals of Leicester, Leicester, UK
| | - N Freeman
- University Hospitals of Leicester, Leicester, UK
| | - M Chauhan
- University Hospitals of Leicester, Leicester, UK
| | - L Howells
- Institute for Precision Health, University of Leicester, Leicester, UK
| | - D Peel
- Department of Radiation Oncology, Regional Cancer Treatment Services, Midcentral District Health Board, Palmerston North, New Zealand
| | - S Ahmad
- University Hospitals of Leicester, Leicester, UK
| | - T Sridhar
- University Hospitals of Leicester, Leicester, UK
| | - H S Walter
- University Hospitals of Leicester, Leicester, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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2
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Jordan A, James AE, Gold JAW, Wu K, Glowicz J, Wolfe F, Vyas K, Litvintseva A, Gade L, Liverett H, Alverson M, Burgess M, Wilson A, Li R, Benowitz I, Gulley T, Patil N, Chakravorty R, Chu W, Kothari A, Jackson BR, Garner K, Toda M. Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital-Arkansas, June 2019-May 2021. Open Forum Infect Dis 2022; 9:ofac510. [PMID: 36320193 PMCID: PMC9605704 DOI: 10.1093/ofid/ofac510] [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: 07/14/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Background Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak. Methods We collected data on patients at Hospital A who had invasive mucormycosis during January 2017-June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection. Results During the outbreak period (June 2019-June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility. Conclusions We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.
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Affiliation(s)
- Alexander Jordan
- Correspondence: Alexander Jordan, MPH, 1600 Clifton Road NE, Atlanta, GA 30329, USA ()
| | - Allison E James
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Wu
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Glowicz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Frankie Wolfe
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anastasia Litvintseva
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalitha Gade
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hazel Liverett
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Alverson
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary Burgess
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amy Wilson
- Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ruoran Li
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac Benowitz
- Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - Winston Chu
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
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Ipe TS, Ugwumba B, Spencer HJ, Le T, Ridenour T, Armitage J, Ryan S, Pearson S, Kothari A, Patil N, Dare R, Crescencio JCR, Venkata A, Laudadio J, Mohammad K, Jamal N, Thompson J, McNew H, Gibbs M, Hennigan S, Kellar S, Reitzel K, Walser BE, Novak A, Quinn B. Treatment of COVID-19 Patients with Two Units of Convalescent Plasma in a Resource-Constrained State. Lab Med 2022; 53:623-628. [PMID: 35771890 PMCID: PMC9278218 DOI: 10.1093/labmed/lmac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Many therapies are used to treat COVID-19, the disease caused by the virus SARS-CoV-2, including convalescent plasma. The clinical utility of using 2 units of convalescent plasma for COVID-19 hospitalized patients is not fully understood. OBJECTIVE Many therapies are used to treat COVID-19, the disease caused by the virus SARS-CoV-2, including convalescent plasma. The clinical utility of using 2 units of convalescent plasma for COVID-19 hospitalized patients is not fully understood. Our study aims to determine the safety and efficacy of treating hospitalized COVID-19 patients with 2 units of COVID-19 convalescent plasma (CCP). METHOD This was a retrospective study of Arkansas patients treated with CCP using the (US) Food and Drug Administration (FDA) emergency Investigational New Drug (eIND) mechanism from April 9, 2020, through August 9, 2020. It was a multicenter, statewide study in a low-resource setting, which are areas that lack funding for health care cost coverage on various levels including individual, family, or social. Adult patients (n = 165, volunteer sample) in Arkansas who were hospitalized with severe or life-threatening acute COVID-19 disease as defined by the FDA criteria were transfused with 2 units of CCP (250 mL/unit) using the FDA eIND mechanism. The primary outcome was 7- and 30-day mortality after the second unit of CCP. RESULTS Unadjusted mortality was 12.1% at 7 days and 23.0% at 30 days. The unadjusted mortality was reduced to 7.7% if the first CCP unit was transfused on the date of diagnosis, 8.7% if transfused within 3 days of diagnosis, and 32.0% if transfused at or after 4 or more days of diagnosis. The risk of death was higher in patients that received low, negative, or missing titer CCP units in comparison to those that received higher titer units. CONCLUSION The provision of 2 units of CCP was associated with a reduction in mortality in patients treated with high titer units within 3 days of COVID-19 diagnosis. Given the results, CCP is a viable, low-cost therapy in resource-constrained states and countries.
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Affiliation(s)
- Tina S Ipe
- To whom correspondence should be addressed.
| | - Blessing Ugwumba
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Horace J Spencer
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tuan Le
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, OK, USA
| | - Terry Ridenour
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, OK, USA
| | - John Armitage
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, OK, USA
| | | | | | - Atul Kothari
- Arkansas Department of Health, Little Rock, AR, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, AR, USA
| | - Ryan Dare
- Department of Internal Medicine, Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Juan C R Crescencio
- Department of Internal Medicine, Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anand Venkata
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer Laudadio
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Khalid Mohammad
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Jefferson Regional Medical Center, Pine Bluff, AR, USA
| | - Naznin Jamal
- Department of Internal Medicine, Jefferson Regional Medical Center, Pine Bluff, AR, USA
| | - John Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St Bernards Healthcare, Jonesboro, AR, USA
| | - Hailey McNew
- Research Center, St Bernards Healthcare, Jonesboro, AR, USA
| | - McKenzie Gibbs
- Department of Laboratory Medicine, Northwest Medical Center, Springdale, AR, USA
| | - Steve Hennigan
- Department of Internal Medicine, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Stan Kellar
- Department of Pulmonary Medicine, Baptist Health, Little Rock, AR, USA
| | | | - Brandon E Walser
- Department of Infectious Diseases, Baptist Health, Little Rock, AR, USA
| | - Amanda Novak
- Department of Infectious Diseases, Baptist Health, North Little Rock, AR, USA
| | - Brian Quinn
- Department of Pathology, Baptist Health, Little Rock, AR, USA
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Gokulanathan N, Pandjatcharam J, Patil N, Udayakumar P, Pothuboina L. 13P Dosimetric comparisons of brachytherapy applicators used in carcinoma cervix and their utility in toxicity prediction. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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5
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Dulski TM, DeLong M, Garner K, Patil N, Cima MJ, Rothfeldt L, Gulley T, Porter A, Vyas KS, Liverett HK, Toda M, Gold JA, Kothari A. Notes from the Field: COVID-19-Associated Mucormycosis - Arkansas, July-September 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1750-1751. [PMID: 34914674 PMCID: PMC8675658 DOI: 10.15585/mmwr.mm7050a3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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6
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Cho B, Rodriguez-Abreu D, Hussein M, Cobo M, Patel A, Secen N, Gerstner G, Kim DW, Lee YG, Su WC, Huang E, Patil N, Huang M, Zhang Z, Wen X, Mendus D, Hoang T, Meng R, Johnson M. LBA2 Updated analysis and patient-reported outcomes (PROs) from CITYSCAPE: A randomised, double-blind, phase II study of the anti-TIGIT antibody tiragolumab + atezolizumab (TA) versus placebo + atezolizumab (PA) as first-line treatment for PD-L1+ NSCLC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.217] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Dziadziuszko R, Ahn M, Kelly K, Popat S, Wakelee H, Baird A, Rooney I, Afshari M, Coleman S, Zhang Z, Kiruki H, Patil N, Wen X, Bradley J. SKYSCRAPER-03: A Phase III, Open-Label, Randomized Study of Atezolizumab Plus Tiragolumab Compared With Durvalumab in Patients With Locally Advanced, Unresectable, Stage III NSCLC Who Have Not Progressed After Platinum-Based Concurrent Chemoradiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Jain P, Gutierrez Bugarin J, Guha A, Jain C, Patil N, Shen T, Stanevich I, Nikore V, Margolin K, Ernstoff M, Velcheti V, Barnholtz-Sloan J, Dowlati A. Corrigendum to 'Cardiovascular adverse events are associated with usage of immune checkpoint inhibitors in real-world clinical data across the United States': [ESMO Open Volume 6, Issue 5, October 2021, 100252]. ESMO Open 2021; 6:100286. [PMID: 34678570 DOI: 10.1016/j.esmoop.2021.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- P Jain
- University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA.
| | | | - A Guha
- Harrington Heart and Vascular Institute, Cleveland, USA
| | - C Jain
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - N Patil
- Research and Education Institute, University Hospitals Health System, Cleveland, USA
| | - T Shen
- Layer 6 AI, Toronto, Canada
| | | | | | - K Margolin
- Department of Medical Oncology, City of Hope, Duarte, USA
| | - M Ernstoff
- ImmunoOncology Branch, Developmental Therapeutics Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, USA
| | - V Velcheti
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, USA
| | - J Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences and Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA; Research and Education, University Hospitals Health System, Cleveland, USA
| | - A Dowlati
- University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA
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9
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Jain P, Gutierrez Bugarin J, Guha A, Jain C, Patil N, Shen T, Stanevich I, Nikore V, Margolin K, Ernstoff M, Velcheti V, Barnholtz-Sloan J, Dowlati A. Cardiovascular adverse events are associated with usage of immune checkpoint inhibitors in real-world clinical data across the United States. ESMO Open 2021; 6:100252. [PMID: 34461483 PMCID: PMC8403739 DOI: 10.1016/j.esmoop.2021.100252] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/08/2021] [Revised: 06/23/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) can cause life-threatening cardiovascular adverse events (CVAEs) that may not be attributed to therapy. The outcomes of clinical trials may underestimate treatment-related adverse events due to restrictive eligibility, limited sample size, and failure to anticipate selected toxicities. We evaluated the incidence and clinical determinants of CVAEs in real-world population on ICI therapy. Patients and methods Among 2 687 301 patients diagnosed with cancer from 2011 to 2018, 16 574 received ICIs for any cancer. Patients in the ICI and non-ICI cohorts were matched in a 1 : 1 ratio according to age, sex, National Cancer Institute comorbidity score, and primary cancer. The non-ICI cohort was stratified into patients who received chemotherapy (N = 2875) or targeted agents (N = 4611). All CVAEs, non-cardiac immune-related adverse events occurring after treatment initiation, baseline comorbidities, and treatment details were identified and analyzed using diagnosis and billing codes. Results Median age was 61 and 65 years in the ICI and non-ICI cohorts, respectively (P < 0.001). ICI patients were predominantly male (P < 0.001). Lung cancer (43.1%), melanoma (30.4%), and renal cell carcinoma (9.9%) were the most common cancer types. CVAE diagnoses in our dataset by incidence proportion (ICI cohort) were stroke (4.6%), heart failure (3.5%), atrial fibrillation (2.1%), conduction disorders (1.5%), myocardial infarction (0.9%), myocarditis (0.05%), vasculitis (0.05%), and pericarditis (0.2%). Anti-cytotoxic T-lymphocyte-associated protein 4 increased the risk of heart failure [versus anti-programmed cell death protein 1; hazard ratio (HR), 1.9; 95% confidence interval (CI) 1.27-2.84] and stroke (HR, 1.7; 95% CI 1.3-2.22). Pneumonitis was associated with heart failure (HR, 2.61; 95% CI 1.23-5.52) and encephalitis with conduction disorders (HR, 4.35; 95% CI 1.6-11.87) in patients on ICIs. Advanced age, primary cancer, nephritis, and anti-cytotoxic T-lymphocyte-associated protein 4 therapy were commonly associated with CVAEs in the adjusted Cox proportional hazards model. Conclusions Our findings underscore the importance of risk stratification and cardiovascular monitoring for patients on ICI therapy. Patient claims data across the United States were used to study cardiovascular adverse events (CVAEs) after ICI treatment. Patients on ICI treatment for advanced cancer have a higher incidence of CVAEs than previously reported. Median time to CVAE onset was significantly shorter with ICIs (~3 months) than with non-ICI systemic therapy (~8 months). Anti-CTLA-4 monotherapy or combination had a higher risk of heart failure and stroke than anti-PD-1 therapy (1.5-2 folds). Age, male sex, cancer type, nephritis, pneumonitis, and anti-CTLA-4 therapy were associated with a higher risk of CVAEs.
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Affiliation(s)
- P Jain
- University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA.
| | | | - A Guha
- Harrington Heart and Vascular Institute, Cleveland, USA
| | - C Jain
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - N Patil
- Research and Education Institute, University Hospitals Health System, Cleveland, USA
| | - T Shen
- Layer 6 AI, Toronto, Canada
| | | | | | - K Margolin
- Department of Medical Oncology, City of Hope, Duarte, USA
| | - M Ernstoff
- ImmunoOncology Branch, Developmental Therapeutics Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, USA
| | - V Velcheti
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, USA
| | - J Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences and Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA; Research and Education, University Hospitals Health System, Cleveland, USA
| | - A Dowlati
- University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, USA
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Gable P, Huang JY, Gilbert SE, Bollinger S, Lyons AK, Sabour S, Surie D, Biedron C, Haney T, Beshearse E, Gregory CJ, Seely KA, Clemmons NS, Patil N, Kothari A, Gulley T, Garner K, Anderson K, Thornburg NJ, Halpin AL, McDonald LC, Kutty PK, Brown AC. A Comparison of Less Invasive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Diagnostic Specimens in Nursing Home Residents-Arkansas, June-August 2020. Clin Infect Dis 2021; 73:S58-S64. [PMID: 33909063 PMCID: PMC8135387 DOI: 10.1093/cid/ciab310] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background SARS-CoV-2 testing remains essential for early identification and clinical management of cases. We compared the diagnostic performance of three specimen types for characterizing SARS-CoV-2 in infected nursing home residents. Methods A convenience sample of 17 residents were enrolled within 15 days of first positive SARS-CoV-2 result by real-time reverse transcription polymerase chain reaction (RT-PCR) and prospectively followed for 42 days. Anterior nasal swabs (AN), oropharyngeal swabs (OP), and saliva specimens (SA) were collected on the day of enrollment, every 3 days for the first 21 days, then weekly for 21 days. Specimens were tested for presence of SARS-CoV-2 RNA using RT-PCR and replication-competent virus by viral culture. Results Comparing the three specimen types collected from each participant at each time point, the concordance of paired RT-PCR results ranged from 80–88%. After the first positive result, SA and OP were RT-PCR–positive for ≤48 days; AN were RT-PCR–positive for ≤33 days. AN had the highest percentage of RT-PCR–positive results (81%; 21/26) when collected ≤10 days of participants’ first positive result. Eleven specimens were positive by viral culture: nine AN collected ≤19 days following first positive result and two OP collected ≤5 days following first positive result. Conclusions AN, OP, and SA were effective methods for repeated testing in this population. More AN than OP were positive by viral culture. SA and OP remained RT-PCR–positive longer than AN, which could lead to unnecessary interventions if RT-PCR detection occurred after viral shedding has likely ceased.
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Affiliation(s)
- Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wainberg Z, Matos I, Delord J, Cassier P, Gil-Martin M, Kim T, LoRusso P, Bahleda R, Italiano A, Mendus D, Hoang T, Xue C, Wen X, Carvalho O, Pham T, Patil N, Meng R, Bendell J, Cervantes A, Cho B. LBA-5 Phase Ib study of the anti-TIGIT antibody tiragolumab in combination with atezolizumab in patients with metastatic esophageal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Mehta SN, Murrill M, Suryavanshi N, Bhosale R, Naik S, Patil N, Gupta A, Mathad J, Shivakoti R, Alexander M. TB-related knowledge and stigma among pregnant women in low-resource settings. Int J Tuberc Lung Dis 2021; 25:148-150. [PMID: 33656428 DOI: 10.5588/ijtld.20.0241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S N Mehta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Murrill
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Bhosale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Naik
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - N Patil
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - J Mathad
- Weill Cornell Medical College, New York, NY
| | - R Shivakoti
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - M Alexander
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune
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Crotty T, Corbett M, Hussain T, Diaconescu A, Patil N. 907 Reduction of Nasal Fractures During COVID-19: A Single-Centre Experience. Br J Surg 2021. [PMCID: PMC8135712 DOI: 10.1093/bjs/znab134.096] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
The utilization of local or regional anaesthesia for manipulation of nasal fractures (MNF) avoids the need for general anaesthetic (GA), and the risk associated with instrumentation of the airway during the COVID-19 pandemic. Furthermore, MNF under local anaesthetic (LA) provides similar results with regards to cosmesis and patient satisfaction. We present our experience of performing MNF under LA during the COVID-19 pandemic.
Method
A single-centre, prospective study of all patients undergoing MNF under LA was conducted (13th July/20–11thSeptember/20). Following reduction, pain scores and patient satisfaction surveys were administered.
Results
A total of 25 patients (M/F:16/9, median age, 25.6yr (14-52yr)) were enrolled. The majority of patients received either one or two instillations of LA (n = 19, 76%). Pain reported during the MNF procedure was 4.4/10, whilst pain during LA administration was reported as 3.2/10. 80% of patients felt instillation of LA was less painful than expected. 88% of respondents tolerated the LA well, and only 8% would have opted for general anaesthetic. 24 (96%) participants were happy with the cosmetic result.
Discussion
MNF under LA is a safe and effective alternative to MNF under GA. More literature is needed to define the best method of administering LA prior to performing MNF.
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Affiliation(s)
- T Crotty
- Sligo University Hospital, Sligo, Ireland
| | - M Corbett
- Sligo University Hospital, Sligo, Ireland
| | - T Hussain
- Sligo University Hospital, Sligo, Ireland
| | | | - N Patil
- Sligo University Hospital, Sligo, Ireland
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14
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Tompkins LK, Gunn JKL, Cherney B, Ham JE, Horth R, Rossetti R, Bower WA, Benson K, Hagan LM, Crist MB, Mettee Zarecki SL, Dixon MG, Dillaha JA, Patil N, Dusseau C, Ross T, Matthews HS, Garner K, Starks AM, Weiner Z, Bowen MD, Bankamp B, Newton AE, Logan N, Schuh AJ, Trimble S, Pfeiffer H, James AE, Tian N, Jacobs JR, Ruiz F, McDonald K, Thompson M, Cooley L, Honein MA, Rose DA. Mass SARS-CoV-2 Testing in a Dormitory-Style Correctional Facility in Arkansas. Am J Public Health 2021; 111:907-916. [PMID: 33734845 PMCID: PMC8033997 DOI: 10.2105/ajph.2020.306117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess SARS-CoV-2 transmission within a correctional facility and recommend mitigation strategies.Methods. From April 29 to May 15, 2020, we established the point prevalence of COVID-19 among incarcerated persons and staff within a correctional facility in Arkansas. Participants provided respiratory specimens for SARS-CoV-2 testing and completed questionnaires on symptoms and factors associated with transmission.Results. Of 1647 incarcerated persons and 128 staff tested, 30.5% of incarcerated persons (range by housing unit = 0.0%-58.2%) and 2.3% of staff tested positive for SARS-CoV-2. Among those who tested positive and responded to symptom questions (431 incarcerated persons, 3 staff), 81.2% and 33.3% were asymptomatic, respectively. Most incarcerated persons (58.0%) reported wearing cloth face coverings 8 hours or less per day, and 63.3% reported close contact with someone other than their bunkmate.Conclusions. If testing remained limited to symptomatic individuals, fewer cases would have been detected or detection would have been delayed, allowing transmission to continue. Rapid implementation of mass testing and strict enforcement of infection prevention and control measures may be needed to mitigate spread of SARS-CoV-2 in this setting.
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Affiliation(s)
- Lindsay K Tompkins
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Jayleen K L Gunn
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Blake Cherney
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Jason E Ham
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Roberta Horth
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Rebecca Rossetti
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - William A Bower
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Kelsey Benson
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Liesl M Hagan
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Matthew B Crist
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Shauna L Mettee Zarecki
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Meredith G Dixon
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Jennifer A Dillaha
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Naveen Patil
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Charles Dusseau
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Tara Ross
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - H Stewart Matthews
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Kelley Garner
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Angela M Starks
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Zachary Weiner
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Michael D Bowen
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Bettina Bankamp
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Anna E Newton
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Naeemah Logan
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Amy J Schuh
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Sean Trimble
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Heidi Pfeiffer
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Allison E James
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Niu Tian
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Jesica R Jacobs
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Francisco Ruiz
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Kellen McDonald
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Marlowe Thompson
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Laura Cooley
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Margaret A Honein
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | - Dale A Rose
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
| | -
- Lindsay K. Tompkins and Allison E. James are with the Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Jayleen K. L. Gunn, Blake Cherney, Jason E. Ham, Roberta Horth, Rebecca Rossetti, William A. Bower, Kelsey Benson, Liesl M. Hagan, Matthew B. Crist, Shauna L. Mettee Zarecki, Meredith G. Dixon, Angela M. Starks, Zachary Weiner, Michael D. Bowen, Bettina Bankamp, Anna E. Newton, Naeemah Logan, Amy J. Schuh, Sean Trimble, Heidi Pfeiffer, Niu Tian, Francisco Ruiz, Kellen McDonald, Marlowe Thompson, Laura Cooley, Margaret A. Honein, and Dale A. Rose are with the COVID-19 Investigation Team, CDC. Charles Dusseau and Tara Ross are with the US Public Health Service Commissioned Corps, Rockville, MD. Jennifer A. Dillaha, Naveen Patil, H. Stewart Matthews, and Kelley Garner are with the Arkansas Department of Health, Little Rock. Jesica R. Jacobs is with the Laboratory Leadership Service, CDC
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15
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Patil N, Cho B, Johnson M, Caro R, Spira A, Chiu C, Molden N, Pham T, Yang X, Choi Y, Zhang Z, Hoang T, Ballinger M, Meng R, Rodríguez-Abreu D. P77.02 Efficacy of Tiragolumab + Atezolizumab in PD-L1 IHC and TIGIT Subgroups in the Phase II CITYSCAPE Study in First-Line NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Surie D, Huang JY, Brown AC, Gable P, Biedron C, Gilbert SE, Garner K, Bollinger S, Gulley T, Haney T, Lyons AK, Beshearse E, Gregory CJ, Sabour S, Clemmons NS, James AE, Tamin A, Reese N, Perry-Dow KA, Brown R, Harcourt JL, Campbell D, Houston H, Chakravorty R, Paulick A, Whitaker B, Murdoch J, Spicer L, Stumpf MM, Mills L, Coughlin MM, Higdem P, Rasheed MAU, Lonsway D, Bhatnagar A, Kothari A, Anderson K, Thornburg NJ, Breaker E, Adamczyk M, McAllister GA, Halpin AL, Seely KA, Patil N, McDonald LC, Kutty PK. Infectious Period of Severe Acute Respiratory Syndrome Coronavirus 2 in 17 Nursing Home Residents-Arkansas, June-August 2020. Open Forum Infect Dis 2021; 8:ofab048. [PMID: 33723510 PMCID: PMC7928697 DOI: 10.1093/ofid/ofab048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/01/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background To estimate the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adults with underlying conditions, we assessed duration of coronavirus disease 2019 (COVID-19) symptoms, reverse-transcription polymerase chain reaction (RT-PCR) positivity, and culture positivity among nursing home residents. Methods We enrolled residents within 15 days of their first positive SARS-CoV-2 test (diagnosis) at an Arkansas facility from July 7 to 15, 2020 and instead them for 42 days. Every 3 days for 21 days and then weekly, we assessed COVID-19 symptoms, collected specimens (oropharyngeal, anterior nares, and saliva), and reviewed medical charts. Blood for serology was collected on days 0, 6, 12, 21, and 42. Infectivity was defined by positive culture. Duration of culture positivity was compared with duration of COVID-19 symptoms and RT-PCR positivity. Data were summarized using measures of central tendency, frequencies, and proportions. Results We enrolled 17 of 39 (44%) eligible residents. Median participant age was 82 years (range, 58–97 years). All had ≥3 underlying conditions. Median duration of RT-PCR positivity was 22 days (interquartile range [IQR], 8–31 days) from diagnosis; median duration of symptoms was 42 days (IQR, 28–49 days). Of 9 (53%) participants with any culture-positive specimens, 1 (11%) severely immunocompromised participant remained culture-positive 19 days from diagnosis; 8 of 9 (89%) were culture-positive ≤8 days from diagnosis. Seroconversion occurred in 12 of 12 (100%) surviving participants with ≥1 blood specimen; all participants were culture-negative before seroconversion. Conclusions Duration of infectivity was considerably shorter than duration of symptoms and RT-PCR positivity. Severe immunocompromise may prolong SARS-CoV-2 infectivity. Seroconversion indicated noninfectivity in this cohort.
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Affiliation(s)
- Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison E James
- Arkansas Department of Health, Little Rock, Arkansas, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Azaibi Tamin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natashia Reese
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K Allison Perry-Dow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin Brown
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jennifer L Harcourt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davina Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Paulick
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Murdoch
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Lori Spicer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan M Stumpf
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Mills
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa M Coughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pamela Higdem
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - David Lonsway
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Breaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Adamczyk
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian A McAllister
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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Palmer J, Ostrom Q, Cioffi G, Patil N, Kruchko C, Zaorsky N, Trifiletti D, Gondi V, Brown P, Chakravarti A, Barnholtz-Sloan J. Association Of Radon And High Particulate Pollution With Incidence Of Brain Tumors In The United States. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.165] [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: 11/24/2022]
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18
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Labuda SM, Garner K, Cima M, Moulton-Meissner H, Laufer Halpin A, Charles-Toney N, Yu P, Bolton E, Pierce R, Crist MB, Gomes D, Gable P, McAllister G, Lawsin A, Houston H, Patil N, Wheeler JG, Bradsher R, Vyas K, Haselow D. Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018. Clin Infect Dis 2020; 71:e178-e185. [PMID: 31872853 PMCID: PMC7938859 DOI: 10.1093/cid/ciz1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections. METHODS ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness. RESULTS By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March-12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended. CONCLUSIONS Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH's reportable disease list and providing more oversight to outpatient oncology clinics.
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Affiliation(s)
- Sarah M Labuda
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Michael Cima
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service, Rockville, Maryland, USA
| | - Nadege Charles-Toney
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter Yu
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Erin Bolton
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Reid Pierce
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Matthew B Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danica Gomes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - J Gary Wheeler
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Robert Bradsher
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, Arkansas, USA
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19
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Ipe TS, Le T, Quinn B, Kellar S, Clark M, Carlisle S, Rassmann A, Hennigan S, Ridenour T, Roberts A, Avery D, Ryan S, Pearson S, Kothari A, Patil N. Provision of COVID-19 Convalescent Plasma in a Resource-Constrained State. Transfusion 2020; 60:2828-2833. [PMID: 32989778 PMCID: PMC7536906 DOI: 10.1111/trf.16118] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Arkansas is a rural state of 3 million people. It is ranked fifth for poverty nationally. The first case of coronavirus disease 2019 (COVID-19) in Arkansas occurred on 11 March 2020. Since then, approximately 8% of all Arkansans have tested positive. Given the resource limitations of Arkansas, COVID-19 convalescent plasma (CCP) was explored as a potentially lifesaving, therapeutic option. Therefore, the Arkansas Initiative for Convalescent Plasma was developed to ensure that every Arkansan has access to this therapy. STUDY DESIGN AND METHOD This brief report describes the statewide collaborative response from hospitals, blood collectors, and the Arkansas Department of Health (ADH) to ensure that CCP was available in a resource-limited state. RESULTS Early contact tracing by ADH identified individuals who had come into contact with "patient zero" in early March. Within the first week, 32 patients tested positive for COVID-19. The first set of CCP collections occurred on 9 April 2020. Donors had to be triaged carefully in the initial period, as many had recently resolved their symptoms. From our first collections, with appropriate resource and inventory management, we collected sufficient CCP to provide the requested number of units for every patient treated with CCP in Arkansas. CONCLUSIONS The Arkansas Initiative, a statewide effort to ensure CCP for every patient in a resource-limited state, required careful coordination among key players. Collaboration and resource management was crucial to meet the demand of CCP products and potentially save lives.
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Affiliation(s)
- Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tuan Le
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, Oklahoma, USA
| | - Brian Quinn
- Department of Pathology, Baptist Health, Little Rock, Arkansas, USA
| | - Stan Kellar
- Department of Medicine, Baptist Health, Little Rock, Arkansas, USA
| | - Melisa Clark
- Office of Research Regulatory Affairs (ORRA), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Suzanna Carlisle
- Office of Research Regulatory Affairs (ORRA), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anja Rassmann
- Clinical Trials Innovation Unit (CTIU), Translational Research Institute (TRI), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Steve Hennigan
- Washington Regional Medical Center, Fayetteville, Arkansas, USA
| | - Terry Ridenour
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, Oklahoma, USA
| | - Anthony Roberts
- Community Blood Center of the Ozarks, Springfield, Missouri, USA
| | - David Avery
- Clinical Trials Innovation Unit (CTIU), Translational Research Institute (TRI), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stefanie Ryan
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Shanna Pearson
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
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Hatfield KM, Reddy SC, Forsberg K, Korhonen L, Garner K, Gulley T, James A, Patil N, Bezold C, Rehman N, Sievers M, Schram B, Miller TK, Howell M, Youngblood C, Ruegner H, Radcliffe R, Nakashima A, Torre M, Donohue K, Meddaugh P, Staskus M, Attell B, Biedron C, Boersma P, Epstein L, Hughes D, Lyman M, Preston LE, Sanchez GV, Tanwar S, Thompson ND, Vallabhaneni S, Vasquez A, Jernigan JA. Facility-Wide Testing for SARS-CoV-2 in Nursing Homes - Seven U.S. Jurisdictions, March-June 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1095-1099. [PMID: 32790655 PMCID: PMC7440119 DOI: 10.15585/mmwr.mm6932e5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Undetected infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) contributes to transmission in nursing homes, settings where large outbreaks with high resident mortality have occurred (1,2). Facility-wide testing of residents and health care personnel (HCP) can identify asymptomatic and presymptomatic infections and facilitate infection prevention and control interventions (3-5). Seven state or local health departments conducted initial facility-wide testing of residents and staff members in 288 nursing homes during March 24-June 14, 2020. Two of the seven health departments conducted testing in 195 nursing homes as part of facility-wide testing all nursing homes in their state, which were in low-incidence areas (i.e., the median preceding 14-day cumulative incidence in the surrounding county for each jurisdiction was 19 and 38 cases per 100,000 persons); 125 of the 195 nursing homes had not reported any COVID-19 cases before the testing. Ninety-five of 22,977 (0.4%) persons tested in 29 (23%) of these 125 facilities had positive SARS-CoV-2 test results. The other five health departments targeted facility-wide testing to 93 nursing homes, where 13,443 persons were tested, and 1,619 (12%) had positive SARS-CoV-2 test results. In regression analyses among 88 of these nursing homes with a documented case before facility-wide testing occurred, each additional day between identification of the first case and completion of facility-wide testing was associated with identification of 1.3 additional cases. Among 62 facilities that could differentiate results by resident and HCP status, an estimated 1.3 HCP cases were identified for every three resident cases. Performing facility-wide testing immediately after identification of a case commonly identifies additional unrecognized cases and, therefore, might maximize the benefits of infection prevention and control interventions. In contrast, facility-wide testing in low-incidence areas without a case has a lower proportion of test positivity; strategies are needed to further optimize testing in these settings.
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Wallace M, Hagan L, Curran KG, Williams SP, Handanagic S, Bjork A, Davidson SL, Lawrence RT, McLaughlin J, Butterfield M, James AE, Patil N, Lucas K, Hutchinson J, Sosa L, Jara A, Griffin P, Simonson S, Brown CM, Smoyer S, Weinberg M, Pattee B, Howell M, Donahue M, Hesham S, Shelley E, Philips G, Selvage D, Staley EM, Lee A, Mannell M, McCotter O, Villalobos R, Bell L, Diedhiou A, Ortbahn D, Clayton JL, Sanders K, Cranford H, Barbeau B, McCombs KG, Holsinger C, Kwit NA, Pringle JC, Kariko S, Strick L, Allord M, Tillman C, Morrison A, Rowe D, Marlow M. COVID-19 in Correctional and Detention Facilities - United States, February-April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:587-590. [PMID: 32407300 DOI: 10.15585/mmwr.mm6919e1] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
An estimated 2.1 million U.S. adults are housed within approximately 5,000 correctional and detention facilities† on any given day (1). Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons (2,3). During April 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons and 15 deaths among staff members. Prompt identification of COVID-19 cases and consistent application of prevention measures, such as symptom screening and quarantine, are critical to protecting incarcerated and detained persons and staff members.
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22
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Gandara D, Zou W, Jiang J, Yaung S, Fuhlbrück F, Wu J, Peterson M, Palma J, Ballinger M, Peters E, Shames D, Patil N. An exploratory analysis of on-treatment ctDNA measurement as a potential surrogate for overall survival for atezolizumab benefit in the OAK study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.081] [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: 11/14/2022] Open
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23
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Hyde AJ, Nassabein R, AlShareef A, Armstrong D, Babak S, Berry S, Bossé D, Chen E, Colwell B, Essery C, Goel R, Goodwin R, Gray S, Hammad N, Jeyakuymar A, Jonker D, Karanicolas P, Lamond N, Letourneau R, Michael J, Patil N, Powell E, Ramjeesingh R, Saliba W, Singh R, Snow S, Stuckless T, Tadros S, Tehfé M, Thana M, Thirlwell M, Vickers M, Virik K, Welch S, Asmis T. Eastern Canadian Gastrointestinal Cancer Consensus Conference 2018. Curr Oncol 2019; 26:e665-e681. [PMID: 31708660 PMCID: PMC6821113 DOI: 10.3747/co.26.5193] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference was held in Halifax, Nova Scotia, 20-22 September 2018. Experts in radiation oncology, medical oncology, surgical oncology, and pathology who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of pancreatic cancer, pancreatic neuroendocrine tumours, hepatocellular cancer, and rectal and colon cancer, including ■ surgical management of pancreatic adenocarcinoma,■ adjuvant and metastatic systemic therapy options in pancreatic adenocarcinoma,■ the role of radiotherapy in the management of pancreatic adenocarcinoma,■ systemic therapy in pancreatic neuroendocrine tumours,■ updates in systemic therapy for patients with advanced hepatocellular carcinoma,■ optimum duration of adjuvant systemic therapy for colorectal cancer, and■ sequence of therapy in oligometastatic colorectal cancer.
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Affiliation(s)
- A J Hyde
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - R Nassabein
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - A AlShareef
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - D Armstrong
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - S Babak
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Berry
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - D Bossé
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - E Chen
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - B Colwell
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - C Essery
- New Brunswick-Saint John Regional Hospital, Saint John (Gray, Michael)
| | - R Goel
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - R Goodwin
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Gray
- British Columbia-Penticton Regional Hospital, Penticton (Essery)
| | - N Hammad
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - A Jeyakuymar
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - D Jonker
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - P Karanicolas
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - N Lamond
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - R Letourneau
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - J Michael
- British Columbia-Penticton Regional Hospital, Penticton (Essery)
| | - N Patil
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - E Powell
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - R Ramjeesingh
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - W Saliba
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - R Singh
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - S Snow
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - T Stuckless
- Newfoundland and Labrador-Dr. H. Bliss Murphy Cancer Centre, St. John's (Armstrong, Powell, Stuckless)
| | - S Tadros
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - M Tehfé
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - M Thana
- Nova Scotia-Queen Elizabeth ii Health Sciences Centre, Dalhousie University, Halifax (Colwell, Jeyakumar, Lamond, Patil, Ramjeesingh, Singh, Saliba, Snow, Thana)
| | - M Thirlwell
- Quebec-McGill University Health Centre, Montreal (Thirlwell); Centre Hospitalier de l'Université de Montréal, Montreal (Letourneau, Nassabein, Tehfé)
| | - M Vickers
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - K Virik
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - S Welch
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
| | - T Asmis
- Ontario-The Ottawa Hospital Cancer Centre, Ottawa (AlShareef, Asmis, Bossé, Goel, Goodwin, Hyde, Jonker, Tadros, Vickers); Queen's University and Cancer Centre of Southeastern Ontario, Kingston (Hammad, Virik); Princess Margaret Cancer Centre, Toronto (Chen); Markham Stouffville Hospital, Markham (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry, Karanicolas); London Health Sciences Centre, London (Welch)
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24
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Yang ZH, Gorden T, Liu DP, Mukasa L, Patil N, Bates JH. Increasing likelihood of advanced pulmonary tuberculosis at initial diagnosis in a low-incidence US state. Int J Tuberc Lung Dis 2019; 22:628-636. [PMID: 29862946 DOI: 10.5588/ijtld.17.0413] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Arkansas, USA. OBJECTIVE To investigate the relationship between an increase in the proportion of cases with advanced disease at first diagnosis and the recently observed slowing of the decline in tuberculosis (TB) incidence in low-incidence US states. DESIGN We conducted descriptive statistical analyses of de-identified surveillance data of 1246 culture-confirmed TB patients reported in Arkansas during 1996-2013. We then fitted stepwise, multivariate logistic regression models to identify predictors for advanced disease at diagnosis, defined as having either smear-positive sputum or lung cavitation. RESULTS From 1996 to 2013, the proportion of new cases with positive sputum smear and cases with lung cavitation increased from 51.6% to 75% and from 37.7% to 50%, respectively. Patients diagnosed during 2006-2013 were more likely to have positive sputum smears (adjusted odds ratio [aOR] 2.55, 95%CI 1.95-3.35) or lung cavitation (aOR 1.49, 95%CI 1.14-1.95) than those diagnosed during 1996-2005. During 1996-2013, age 15-64 years and excessive alcohol use were predictive of positive sputum smear or lung cavitation. CONCLUSION Measures to reduce the proportion of cases with advanced disease at first diagnosis may be helpful to achieve further decline in TB incidence in low-incidence settings.
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Affiliation(s)
- Z-H Yang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - T Gorden
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - D-P Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institute of Health, Bethesda, Maryland, Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - L Mukasa
- Arkansas Department of Health, Little Rock, Arkansas, Department of Epidemiology, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - N Patil
- Arkansas Department of Health, Little Rock, Arkansas, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - J H Bates
- Arkansas Department of Health, Little Rock, Arkansas, Department of Epidemiology, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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25
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Sandul AL, Nwana N, Holcombe JM, Lobato MN, Marks S, Webb R, Wang SH, Stewart B, Griffin P, Hunt G, Shah N, Marco A, Patil N, Mukasa L, Moro RN, Jereb J, Mase S, Chorba T, Bamrah-Morris S, Ho CS. High Rate of Treatment Completion in Program Settings With 12-Dose Weekly Isoniazid and Rifapentine for Latent Mycobacterium tuberculosis Infection. Clin Infect Dis 2019; 65:1085-1093. [PMID: 28575208 DOI: 10.1093/cid/cix505] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background Randomized controlled trials have demonstrated that the newest latent tuberculosis (LTBI) regimen, 12 weekly doses of directly observed isoniazid and rifapentine (3HP), is as efficacious as 9 months of isoniazid, with a greater completion rate (82% vs 69%); however, 3HP has not been assessed in routine healthcare settings. Methods Observational cohort of LTBI patients receiving 3HP through 16 US programs was used to assess treatment completion, adverse drug reactions, and factors associated with treatment discontinuation. Results Of 3288 patients eligible to complete 3HP, 2867 (87.2%) completed treatment. Children aged 2-17 years had the highest completion rate (94.5% [155/164]). Patients reporting homelessness had a completion rate of 81.2% (147/181). In univariable analyses, discontinuation was lowest among children (relative risk [RR], 0.44 [95% confidence interval {CI}, .23-.85]; P = .014), and highest in persons aged ≥65 years (RR, 1.72 [95% CI, 1.25-2.35]; P < .001). In multivariable analyses, discontinuation was lowest among contacts of patients with tuberculosis (TB) disease (adjusted RR [ARR], 0.68 [95% CI, .52-.89]; P = .005) and students (ARR, 0.45 [95% CI, .21-.98]; P = .044), and highest with incarceration (ARR, 1.43 [95% CI, 1.08-1.89]; P = .013) and homelessness (ARR, 1.72 [95% CI, 1.25-2.39]; P = .001). Adverse drug reactions were reported by 1174 (35.7%) patients, of whom 891 (76.0%) completed treatment. Conclusions Completion of 3HP in routine healthcare settings was greater overall than rates reported from clinical trials, and greater than historically observed using other regimens among reportedly nonadherent populations. Widespread use of 3HP for LTBI treatment could accelerate elimination of TB disease in the United States.
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Affiliation(s)
- Amy L Sandul
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nwabunie Nwana
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mark N Lobato
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Connecticut Department of Public Health, Hartford
| | - Suzanne Marks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Risa Webb
- Mississippi State Department of Health, Jackson.,University of Mississippi Medical Center, Jackson
| | | | - Brock Stewart
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phil Griffin
- Kansas Department of Health and Environment, Topeka
| | | | - Neha Shah
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,California Department of Public Health, San Francisco ; and
| | | | | | | | - Ruth N Moro
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Jereb
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sundari Mase
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Terence Chorba
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sapna Bamrah-Morris
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine S Ho
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Affiliation(s)
- Nirvik Sen
- Chemical Engineering Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
| | | | - Parag Thakur
- UICT, North Maharashtra University, Jalgaon, India
| | - K.K. Singh
- Chemical Engineering Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
| | - S. Mukhopadhyay
- Chemical Engineering Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
| | - R. Sirsam
- UICT, North Maharashtra University, Jalgaon, India
| | - N. Patil
- UICT, North Maharashtra University, Jalgaon, India
| | - K.T. Shenoy
- Chemical Engineering Division, Bhabha Atomic Research Centre, Trombay, Mumbai, India
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27
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Weldon E, Patil N, Voyles J, Chai S, Majors M, Mukasa L. 770. Multi-Drug-Resistant Tuberculosis Cases in Arkansas in 2017: A Tale of Two Threats. Open Forum Infect Dis 2018. [PMCID: PMC6255607 DOI: 10.1093/ofid/ofy210.777] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Multi-drug-resistant tuberculosis (MDR-TB) is a threat to TB elimination strategies worldwide. From 1998 to 2016, six cases of MDR-TB were reported in Arkansas. In 2017 alone, three cases were detected. We sought to describe the characteristics of these cases to inform our MDR-TB prevention strategy in AR. Methods The surveillance database identified three MDR-TB cases in 2017. A detailed review was done to define the demographics, clinical presentation, and laboratory reports relating to drug susceptibility testing (DST), including molecular detection of drug resistance (MDDR). A search was done in the Genotyping database for genotype patterns of the patient isolates. Results All three cases were born outside the United States and developed active disease after arrival in AR. Case 1, age 52, was born in the Marshall Islands, arrived in 2016, and had a history of Type 2 diabetes. He developed MDR-TB in February 2017. Case 2, age 42, was born in Mexico, arrived over 20 years ago, and was HIV positive. He developed TB in July 2016 with a pan-sensitive organism and completed an intermittent treatment regimen. A second TB episode with matching genotype but different drug sensitivities occurred in April 2017, less than 4 months after treatment completion, and was considered treatment failure. Case 3, age 56, was born in the Philippines, arrived in 1990, and was reportedly treated for latent TB infection in 1993 with 6 months of isoniazid. She visited the Philippines April–May 2017 and developed MDR-TB in October 2017. Her isolate was in cluster with a case in Oklahoma who came from Mexico in 2006 and was admitted in an AR hospital with a pan-sensitive organism. There are no epidemiological links between the two cases; only one isolate in each case. Because both isolates were identified in AR State TB laboratory, a complex contamination has been considered with no definite resolution at this time. Conclusion MDR-TB, due to both primary and secondary drug resistance, remains a threat in AR. Cooperation and communication between all levels of healthcare are crucial to avoid delayed diagnosis of MDR-TB. Timely DST via technologies like GeneXpert and MDDR service at CDC is critical. Consultation from Centers of Excellence is vital in the treatment of MDR-TB complicated by diabetes and HIV. Whole-genome sequencing could provide clarity in the cluster with discordant DST patterns. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Emily Weldon
- Arkansas Department of Health, Little Rock, Arkansas
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas
| | - Jan Voyles
- Arkansas Department of Health, Little Rock, Arkansas
| | - Sandra Chai
- Arkansas Department of Health, Little Rock, Arkansas
| | - Marsha Majors
- Arkansas Department of Health, Little Rock, Arkansas
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Gu M, Patil N, Fischbach L, Vance T, Bedell C, Mukasa L. 776. Tuberculosis Screening Among People Living With HIV in Arkansas: A Ryan White Program Evaluation. Open Forum Infect Dis 2018. [PMCID: PMC6255502 DOI: 10.1093/ofid/ofy210.783] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The current TB screening practice among people living with HIV in the United States is understudied. In our preliminary study, we found that only 6 (12%) US states recommended TB screening in their HIV guidelines; and only half of the Ryan White Programs capture client TB status. In this ongoing project, we aim to determine the prevalence of TB screening among people living with HIV in Arkansas, inform policy revisions, and ultimately reduce the burden of TB-HIV comorbidity. Methods We generated a sample of patients who received Ryan White service during the last grant year (April 1, 2016 to March 31, 2017) from CAREWare (Ryan White client database). We reviewed these patient files in multiple site visits and collected data on TB screening practice. We then performed descriptive analysis and multivariate logistic regression to analyze TB screening patterns in Arkansas. Results To date, we reviewed 728 patient records from 22 clinics across Arkansas during a 6-month study period. Three hundred sixty-seven (50%) patients have baseline (HIV diagnosis) TB status. On the basis of the multivariate logistic regression model (adjusting for age, gender, race, and patient residence), TB screening among Ryan White patients vary significantly by clinical regions in Arkansas (P < 0.0001). As compared with the central region, HIV patients in the North Central clinical region are more likely to be screened for TB (OR, 23.28; 95% CI, 5.29, 102.49); and HIV patients in the Northeast clinical region are less likely to be screened (OR, 0.05; 95% CI, 0.01, 0.30). Conclusion We observed in Arkansas (1) low adherence to recommendations for TB screening among people living with HIV and (2) insufficient HIV surveillance infrastructure to capture TB status, and (3) geographic variations in TB screening practice among people with HIV, indicating the need for (1) clearer guidelines, (2) stronger TB education among providers, and (3) program collaboration and service integration between TB and HIV. In our next steps, we want to explore further into the regional variations in TB screening among people with HIV, in order to tailor interventions to different geographic regions. We also want to examine changes in TB screening practice after implementation of the new contract, and to determine the optimal frequency of TB screening among people living with HIV. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Mofan Gu
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas
| | - Lori Fischbach
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tiffany Vance
- Arkansas Department of Health, Little Rock, Arkansas
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Gu M, Fischbach L, Patil N, Bates J, Mukasa L. 756. Targeting the Birth-Cohort of the Pre-antibiotic Era: A Proposal to Screen for Tuberculosis in Seniors in Arkansas. Open Forum Infect Dis 2018. [PMCID: PMC6255552 DOI: 10.1093/ofid/ofy210.763] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Approximately 13 million (4.7%) people in the United States have latent TB infection (LTBI). Persons born prior to 1951 have disproportionately higher LTBI prevalence, and frequently experience delays in TB diagnosis and TB deaths. Nevertheless, this birth-cohort was overlooked in the 2016 US Preventive Service Task Force (USPSTF) recommendation for LTBI screening. The aims of this project are to (1) determine the LTBI prevalence in this birth-cohort, (2) assess TB complications prevented by LTBI screening in this birth-cohort, and (3) raise TB awareness among providers and the community. Methods We propose to: (1) Develop educational pamphlets for the physicians and community. (2) Screen 10,000 members of the target birth-cohort during their routine clinical visits for 1 year, using T-SPOT.TB. County health officers, the partners of Arkansas Department of Health, will enroll physicians in their jurisdictions to participate in TB screening. LTBI prevalence in the birth cohort will be determined, and TB complications will be compared among cohort TB cases that were screened to those not previously screened. (3) Incorporate LTBI and birth-cohort status in patient medical forms. Results In our preliminary study, for the period 2009–2014, 142 of 326 TB cases (43.6% of all US-born TB cases) were reported from the target birth-cohort; 72.6% of the cases had unique genotype strains. Conclusion If the LTBI prevalence in this birth cohort exceeds 8–10%, we recommend a nation-wide screening program for this birth-cohort. Even without treatment, we believe that screening and noting diagnosis of LTBI in the patient record will impact delayed diagnosis and mortality. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Mofan Gu
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Lori Fischbach
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas
| | - Joseph Bates
- Arkansas Department of Health, Little Rock, Arkansas
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McGee S, AlGhareeb W, Ahmad C, Armstrong D, Babak S, Berry S, Biagi J, Booth C, Bossé D, Champion P, Colwell B, Finn N, Goel R, Gray S, Green J, Harb M, Hyde A, Jeyakumar A, Jonker D, Kanagaratnam S, Kavan P, MacMillan A, Muinuddin A, Patil N, Porter G, Powell E, Ramjeesingh R, Raza M, Rorke S, Seal M, Servidio-Italiano F, Siddiqui J, Simms J, Smithson L, Snow S, St-Hilaire E, Stuckless T, Tate A, Tehfe M, Thirlwell M, Tsvetkova E, Valdes M, Vickers M, Virik K, Welch S, Marginean C, Asmis T. Eastern Canadian Colorectal Cancer Consensus Conference 2017. Curr Oncol 2018; 25:262-274. [PMID: 30111967 PMCID: PMC6092057 DOI: 10.3747/co.25.4083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2017 was held in St. John's, Newfoundland and Labrador, 28-30 September. Experts in radiation oncology, medical oncology, surgical oncology, and cancer genetics who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of gastric, rectal, and colon cancer, including ■ identification and management of hereditary gastric and colorectal cancer (crc);■ palliative systemic therapy for metastatic gastric cancer;■ optimum duration of preoperative radiation in rectal cancer-that is, short- compared with long-course radiation;■ management options for peritoneal carcinomatosis in crc;■ implications of tumour location for treatment and prognosis in crc; and■ new molecular markers in crc.
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Affiliation(s)
- S.F. McGee
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - W. AlGhareeb
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - C.H. Ahmad
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - D. Armstrong
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - S. Babak
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - S. Berry
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - J. Biagi
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - C. Booth
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - D. Bossé
- Dana–Farber Cancer Institute, Boston, MA, U.S.A
| | - P. Champion
- Prince Edward Island—Prince Edward Island Cancer Treatment Centre, Charlottetown
| | - B. Colwell
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - N. Finn
- New Brunswick—Saint John Regional Hospital, Saint John (Gray); Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton (Finn, St-Hilaire); Dr. Everett Chalmers Hospital, Fredericton (Raza); Moncton City Hospital (Harb)
| | - R. Goel
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - S. Gray
- New Brunswick—Saint John Regional Hospital, Saint John (Gray); Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton (Finn, St-Hilaire); Dr. Everett Chalmers Hospital, Fredericton (Raza); Moncton City Hospital (Harb)
| | - J. Green
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - M. Harb
- New Brunswick—Saint John Regional Hospital, Saint John (Gray); Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton (Finn, St-Hilaire); Dr. Everett Chalmers Hospital, Fredericton (Raza); Moncton City Hospital (Harb)
| | - A. Hyde
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - A. Jeyakumar
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - D. Jonker
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - S. Kanagaratnam
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - P. Kavan
- Quebec—McGill University Health Centre, Montreal (Kavan, Thirlwell); Centre hospitalier de l’Université de Montréal, Montreal (Tehfé)
| | - A. MacMillan
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - A. Muinuddin
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - N. Patil
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - G. Porter
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - E. Powell
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - R. Ramjeesingh
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - M. Raza
- New Brunswick—Saint John Regional Hospital, Saint John (Gray); Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton (Finn, St-Hilaire); Dr. Everett Chalmers Hospital, Fredericton (Raza); Moncton City Hospital (Harb)
| | - S. Rorke
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - M. Seal
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - F. Servidio-Italiano
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - J. Siddiqui
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - J. Simms
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - L. Smithson
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - S. Snow
- Nova Scotia—qeii Health Sciences Centre, Dalhousie University, Halifax
| | - E. St-Hilaire
- New Brunswick—Saint John Regional Hospital, Saint John (Gray); Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton (Finn, St-Hilaire); Dr. Everett Chalmers Hospital, Fredericton (Raza); Moncton City Hospital (Harb)
| | - T. Stuckless
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - A. Tate
- Newfoundland and Labrador— Dr. H. Bliss Murphy Cancer Centre, St. John’s (Ahmad, Armstrong, Powell, Rorke, Seal, Siddiqui, Stuckless); Faculty of Medicine, Memorial University of Newfoundland, St. John’s (Green, Seal, Siddiqui, Tate); Faculty of Surgery, Memorial University of Newfoundland, St. John’s (Kanagaratnam); Eastern Health Authority, St. John’s (MacMillan); Labrador–Grenfell Regional Health Authority, Happy Valley–Goose Bay (Simms, Smithson)
| | - M. Tehfe
- Quebec—McGill University Health Centre, Montreal (Kavan, Thirlwell); Centre hospitalier de l’Université de Montréal, Montreal (Tehfé)
| | - M. Thirlwell
- Quebec—McGill University Health Centre, Montreal (Kavan, Thirlwell); Centre hospitalier de l’Université de Montréal, Montreal (Tehfé)
| | - E. Tsvetkova
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - M. Valdes
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - M. Vickers
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - K. Virik
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - S. Welch
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - C. Marginean
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
| | - T. Asmis
- Ontario—The Ottawa Hospital Cancer Centre, Ottawa (AlGhareeb, Asmis, Goel, Hyde, Jonker, Marginean, McGee, Vickers); Queen’s University and Cancer Centre of Southeastern Ontario, Kingston (Biagi, Booth, Virik); Princess Margaret Cancer Centre, Toronto (Dawson); St. Michael’s Hospital, Toronto (Babak); Sunnybrook Odette Cancer Centre, University of Toronto, Toronto (Berry); Cancer Centre of Southeastern Ontario, Kingston (Mahmud); Queensway Health Centre, Toronto (Muinuddin); Colorectal Cancer Canada, North York (Servidio-Italiano); Grand River Regional Cancer Centre, Kitchener (Tsvetkova, Valdes); London Health Sciences Centre, London (Welch)
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V S, Chate S, Patil N, Tekalaki B, Patil S. Prevalence of undiagnosed and untreated attention deficit hyperactivity disorder in men with alcohol dependence – A case-control study. Arch Psych Psych 2018. [DOI: 10.12740/app/80833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fogla S, Pansare VM, Camero LG, Syeda U, Patil N, Chaudhury A. Cavitary lung lesion suspicious for malignancy reveals Mycobacterium xenopi. Respir Med Case Rep 2018; 23:83-85. [PMID: 29326867 PMCID: PMC5760466 DOI: 10.1016/j.rmcr.2017.12.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/24/2017] [Accepted: 12/31/2017] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 68-year-old gentleman who presented with musculoskeletal chest pain which appeared suddenly when he bent over with his dog. The chest pain was localized to the left lower chest and increased with movement and deep breathing. The patient did not complain weight loss, night sweat, fever or chill. He complained of mild cough, with expectoration of whitish mucus. Imaging revealed cavitary chest lesion in the right upper lobe, which was initially suspected to be lung cancer. The patient had a 50-year-old history of smoking 2 packs per day. PET CT imaging did not reveal any specific activity. Needle biopsy and bronchoalveolar lavage, however, did not reveal any malignant cells. Rather, necrotic tissues were observed. A wedge resection of the lung mass was performed. No common organisms or fungi could be grown. However, acid fast bacilli were observed in clumps. The morphology hinted towards non-tuberculous mycobacterial organism(s). Molecular studies revealed infection with Mycobacterium xenopi. The patient was started on an anti-tuberculous regimen of INH, rifampicin, ethambutol and PZA, with pyridoxine. The patient is a Vietnam veteran and complained of exposure to dust from a bird's nest and asbestos exposure in childhood, but no specific exposure to tuberculosis. The patient had an uneventful recovery post-surgery. He complained of some nausea after initiation of the antituberculous medications, but his pain subsided with time. The patient had diabetes, though specific reasons of compromise of immune status could not be pinpointed as causative of his nontuberculous mycobacterial lung infection.
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Affiliation(s)
| | | | | | - Uzma Syeda
- Beaumont Hospital, Grosse Pointe, MI, USA
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Uchida M, Anderson EL, Squillace DL, Patil N, Maniak PJ, Iijima K, Kita H, O'Grady SM. Oxidative stress serves as a key checkpoint for IL-33 release by airway epithelium. Allergy 2017; 72:1521-1531. [PMID: 28273344 DOI: 10.1111/all.13158] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Interleukin (IL)-33 is implicated in the pathophysiology of asthma and allergic diseases. However, our knowledge is limited regarding how IL-33 release is controlled. The transcription factor nuclear factor-erythroid-2-related factor 2 (Nrf2) plays a key role in antioxidant response regulation. OBJECTIVE The goal of this project was to investigate the role of cellular oxidative stress in controlling IL-33 release in airway epithelium. METHODS Complementary approaches were used that included human bronchial epithelial cells and mouse models of airway type-2 immunity that were exposed to fungus Alternaria extract. The clinically available Nrf2 activator 2-cyano-3,12-dioxooleana-1,9-dien-28-oic acid methyl ester (CDDO-Me) was used to evaluate the role of Nrf2-induced antioxidant molecules. RESULTS Human bronchial epithelial cells produced reactive oxygen species (ROS) when they were exposed to Alternaria extract. ROS scavengers, such as glutathione (GSH) and N-acetyl cysteine, prevented extracellular secretion of ATP and increases in intracellular calcium concentrations that precede IL-33 release. Administration of CDDO-Me to mice enhanced expression of a number of antioxidant molecules in the lungs and elevated lung levels of endogenous GSH. Importantly, CDDO-Me treatment reduced allergen-induced ATP secretion and IL-33 release by airway epithelial cells in vitro and protected mice from IL-33 release and asthma-like pathological changes in the lungs. CONCLUSIONS The balance between oxidative stress and antioxidant responses plays a key role in controlling IL-33 release in airway epithelium. The therapeutic potential of Nrf2 activators needs to be considered for asthma and allergic airway diseases.
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Affiliation(s)
- M. Uchida
- Division of Allergic Diseases; Department of Internal Medicine; Mayo Clinic; Rochester MN USA
- Division of Hematology; Respiratory Medicine and Oncology; Department of Internal Medicine; Faculty of Medicine; Saga University; Saga Japan
| | | | - D. L. Squillace
- Division of Allergic Diseases; Department of Internal Medicine; Mayo Clinic; Rochester MN USA
| | - N. Patil
- Departments of Integrated Biology and Physiology and Animal Science; University of Minnesota; St. Paul MN USA
| | - P. J. Maniak
- Departments of Integrated Biology and Physiology and Animal Science; University of Minnesota; St. Paul MN USA
| | - K. Iijima
- Division of Allergic Diseases; Department of Internal Medicine; Mayo Clinic; Rochester MN USA
| | - H. Kita
- Division of Allergic Diseases; Department of Internal Medicine; Mayo Clinic; Rochester MN USA
- Department of Immunology; Mayo Clinic; Rochester MN USA
| | - S. M. O'Grady
- Departments of Integrated Biology and Physiology and Animal Science; University of Minnesota; St. Paul MN USA
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Patil N. American Association of Physicians of Indian Origin (AAPI), Arkansas Chapter. J Ark Med Soc 2017; 113:232. [PMID: 30204308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, Ravilla R, Marco A, Shekhawat NS, Montales MT, Kuriakose K, Sasapu A, Beebe A, Patil N, Musham CK, Lohani GP, Mirza W. Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management. Front Endocrinol (Lausanne) 2017; 8:6. [PMID: 28167928 PMCID: PMC5256065 DOI: 10.3389/fendo.2017.00006] [Citation(s) in RCA: 601] [Impact Index Per Article: 85.9] [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: 09/14/2016] [Accepted: 01/09/2017] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a global pandemic, as evident from the global cartographic picture of diabetes by the International Diabetes Federation (http://www.diabetesatlas.org/). Diabetes mellitus is a chronic, progressive, incompletely understood metabolic condition chiefly characterized by hyperglycemia. Impaired insulin secretion, resistance to tissue actions of insulin, or a combination of both are thought to be the commonest reasons contributing to the pathophysiology of T2DM, a spectrum of disease originally arising from tissue insulin resistance and gradually progressing to a state characterized by complete loss of secretory activity of the beta cells of the pancreas. T2DM is a major contributor to the very large rise in the rate of non-communicable diseases affecting developed as well as developing nations. In this mini review, we endeavor to outline the current management principles, including the spectrum of medications that are currently used for pharmacologic management, for lowering the elevated blood glucose in T2DM.
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Affiliation(s)
- Arun Chaudhury
- GIM Foundation, Little Rock, AR, USA
- *Correspondence: Arun Chaudhury, ; Wasique Mirza,
| | - Chitharanjan Duvoor
- GIM Foundation, Little Rock, AR, USA
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Shashank Kraleti
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Aditya Chada
- GIM Foundation, Little Rock, AR, USA
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Rahul Ravilla
- GIM Foundation, Little Rock, AR, USA
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Asween Marco
- GIM Foundation, Little Rock, AR, USA
- University of Arkansas for Little Rock (UALR), Little Rock, AR, USA
| | | | | | | | - Appalanaidu Sasapu
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | | | - Naveen Patil
- Arkansas Department of Health, Little Rock, AR, USA
| | | | | | - Wasique Mirza
- The Wright Center for Graduate Medical Education, Scranton, PA, USA
- *Correspondence: Arun Chaudhury, ; Wasique Mirza,
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Saadeh A, Patil N, Selig J, Bates J, Mukasa L. Is Bronchoscopy Being Overutilized in Tuberculosis Diagnosis? Arkansas Experience 2009–2015. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.89] [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)
- Abeer Saadeh
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naveen Patil
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Department of Health, Little Rock, Arkansas
| | - James Selig
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Joseph Bates
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Department of Health, Little Rock, Arkansas
| | - Leonard Mukasa
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Arkansas Department of Health, Little Rock, Arkansas
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Gu M, Patil N, Fischbach L, Vance T, Bedell C, Mukasa L. Tuberculosis Screening Among HIV-Infected Population in the United States: Preliminary Findings. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1718] [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: 11/13/2022] Open
Affiliation(s)
- Mofan Gu
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas
| | - Lori Fischbach
- Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tiffany Vance
- Arkansas Department of Health, Little Rock, Arkansas
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Rothfeldt LL, Patil N, Haselow DT, Williams SH, Wheeler JG, Mukasa LN. Notes from the Field: Cluster of Tuberculosis Cases Among Marshallese Persons Residing in Arkansas — 2014–2015. MMWR Morb Mortal Wkly Rep 2016; 65:882-3. [DOI: 10.15585/mmwr.mm6533a7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Keane E, Subramaniam T, Khan AH, Patil N. Management of Epistaxis - A Single Centre Experience and Economic Considerations. Ir Med J 2016; 109:427. [PMID: 27814444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.
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Affiliation(s)
- E Keane
- Departent of ENT Surgery, Sligo Regional Hospital, The Mall, Sligo
| | - T Subramaniam
- Departent of ENT Surgery, Sligo Regional Hospital, The Mall, Sligo
| | - A H Khan
- Departent of ENT Surgery, Sligo Regional Hospital, The Mall, Sligo
| | - N Patil
- Departent of ENT Surgery, Sligo Regional Hospital, The Mall, Sligo
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Pandey A, Desai A, Ostwal V, Patil V, Kulkarni A, Kulkarni R, Patil N, Chaukar D, Prabhash K, Banavali SD. Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: A retrospective study from rural India. South Asian J Cancer 2016; 5:52-5. [PMID: 27275446 PMCID: PMC4873695 DOI: 10.4103/2278-330x.181625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Oral cavity cancer is the most common cancer among rural India. There is a paucity of data for outcomes of operable oral cavity cancer from rural India. Use of maintenance metronomic may delay or avoid relapse. AIM To evaluate outcomes of operable oral cavity carcinoma and evaluate impact of maintenance metronomic chemotherapy. OBJECTIVES To evaluate disease-free survival (DFS), overall survival (OS), and factors affecting the outcome in operable oral cavity cancer. MATERIALS AND METHODS Data of patients diagnosed with oral cavity cancer registered between May 2008 and May 2014 were retrieved. Only those patients with operable oral cavity cancer and upfront definitive surgery were included in the study. Demographic profile, stage, tobacco consumption, adjuvant therapy, and pattern of failure were collected. Kaplan-Meir survival analysis was used to determine DFS and OS. Log-rank test was used to evaluate factors affecting outcome. RESULTS Median follow-up is 24 months. Out of 335 patients, 225 (67%) had advanced operable cancer with 42/225 (18%) and 183/225 (82%) as Stages III and IVA, respectively. Buccal mucosa was the most common subsite (178/335, 53%) followed by tongue (63/335, 19%). Ninety-two percent patients were addicted to smokeless tobacco, whereas 27% were smokers. Median DFS is 13 months with 2 years relative DFS 32%. Median OS is 30 months, with 2 years OS of 54%. Metronomic adjuvant oral chemotherapy was given in 130/225 (58%); Stage III and IVA patients with median of 14 months (3-18 months). Use of metronomic chemotherapy improved DFS (8 vs. 14 months, P = 0.22) and OS (14 vs. 26 months, P = 0.04). CONCLUSION Oral cavity cancer is a major health care problem in rural India. Presentation at advanced stage leads to suboptimal outcomes. Benefit of metronomic maintenance chemotherapy in locally advanced oral cavity needs to be further evaluated prospectively.
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Affiliation(s)
- Avinash Pandey
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Department of Medical Oncology, BKLWH, Ratnagiri, Maharashtra, India; Department of Radiation Oncology, BKLWH, Ratnagiri, Maharashtra, India
| | - A Desai
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Kulkarni
- Department of Radiation Oncology, BKLWH, Ratnagiri, Maharashtra, India
| | - R Kulkarni
- Department of Pathology, BKLWH, Ratnagiri, Maharashtra, India
| | - N Patil
- Department of Radiodiagnosis, BKLWH, Ratnagiri, Maharashtra, India
| | - D Chaukar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Montales MT, Beebe A, Chaudhury A, Haselow D, Patil S, Weinstein S, Taffner R, Patil N. A Clinical Review of Tick-Borne Diseases in Arkansas. J Ark Med Soc 2016; 112:254-258. [PMID: 27263175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tick-borne diseases are illnesses transmitted by ticks harboring wide variety of pathogens. Arkansas is reported as one of the states with a high incidence of tick-borne diseases. In Arkansas the four most frequently occurring tick-borne diseases are Rocky Mountain Spotted Fever (RMSF, also known as Spotted Fever Rickettsiosis), Ehrlichiosis, Tularemia and Anaplasmosis. Lyme disease, on the other hand, is not acquired in Arkansas and is only acquired by traveling to states where Lyme disease is endemic. The majority of tick-borne diseases are diagnosed based on a history of tick bite or exposure and the individual's clinical presentation. The recognition of specific symptoms requires prompt treatment to prevent long-term sequelae. Hence, knowledge of tick-borne diseases and preventive measures can help reduce the risks associated with the infection.
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Patil N. Testing and Treating HCV in Arkansas. J Ark Med Soc 2016; 112:220. [PMID: 27180415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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43
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Cardenas VM, Orloff MS, Kaminaga J, Cardenas IC, Brown J, Hainline-Williams S, Duthie MS, Gonzalez-Puche AC, Mukasa L, Patil N, Mcelfish PA, Bates JH. Tuberculosis and leprosy infections in the Marshallese population of Arkansas, USA. LEPROSY REV 2016. [DOI: 10.47276/lr.87.1.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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44
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Cardenas VM, Orloff MS, Kaminaga J, Cardenas IC, Brown J, Hainline-Williams S, Duthie MS, Gonzalez-Puche AC, Mukasa L, Patil N, Mcelfish PA, Bates JH. Tuberculosis and leprosy infections in the Marshallese population of Arkansas, USA. LEPROSY REV 2016; 87:109-112. [PMID: 27255065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The cross-immunity between tuberculosis and leprosy is unknown. The aim of this pilot study was to evaluate the occurrence of Mycobacterium tuberculosis and M. leprae infection in Marshallese adult volunteers in Springdale, Arkansas, U.S.A., a population that experiences high rates of leprosy and tuberculosis. We used immunodiagnostic testing for tuberculosis and leprosy infection and found significant prevalence of latent tuberculosis infection (19.0%), and asymptomatic Mycobacterium leprae infection (22.2%). We found a negative association between presence of antibodies to Mycobacterium leprae and a positive interferon-γ release assay for Mycobacterium tuberculosis infection, prevalence odds ratio = 0.1 (95% CI = 0.0, 0.9). Although these findings require confirmation on a larger scale, they are supportive of the existence of cross-immunity.
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Montales MT, Chaudhury A, Beebe A, Patil S, Patil N. HIV-Associated TB Syndemic: A Growing Clinical Challenge Worldwide. Front Public Health 2015; 3:281. [PMID: 26779470 PMCID: PMC4688350 DOI: 10.3389/fpubh.2015.00281] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 07/23/2015] [Accepted: 12/10/2015] [Indexed: 12/11/2022] Open
Abstract
The association of tuberculosis (TB) with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome over the past several years has become an emerging syndemic. Approximately 10% of people living with HIV (PLHIV) with latent TB infection will develop active TB disease each year. In this review, we highlight that this phenomenon is not limited to high endemic regions, such as Afro-Asian nations, but globalization/migration is causing increased case detection even in developed nations, such as the United States. Active screening should be performed for TB in PLHIV. A high degree of clinical suspicion for TB is warranted in PLHIV presenting with fever, cough, and unintentional weight loss. HIV-Mycobacterium tuberculosis (MTB) coinfection is often paucibacillary, precluding diagnosis by conventional diagnostics and/or smear microscopy/culture. Improved detection of pulmonary and extrapulmonary TB is now possible by incorporation of the GeneXPERT MTB/RIF assay (Cepheid Inc., Sunnyvale, CA, USA). The World Health Organization recommends instituting immediate therapy for MTB, in conjunction with ongoing or newly introduced anti-retroviral therapy. Vigilance is required to detect drug-induced organ injuries, and early-treatment-induced immune reconstitution inflammatory syndrome. Collaborating MTB and HIV activities in concentrated HIV epidemic settings should become a high public health priority.
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Affiliation(s)
| | - Arun Chaudhury
- GIM Foundation, Little Rock, AR, USA
- Arkansas Department of Health, Little Rock, AR, USA
| | | | - Sowmya Patil
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Naveen Patil
- University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
- Arkansas Department of Health, Little Rock, AR, USA
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46
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Guzzetta G, Ajelli M, Yang Z, Mukasa LN, Patil N, Bates JH, Kirschner DE, Merler S. Effectiveness of contact investigations for tuberculosis control in Arkansas. J Theor Biol 2015; 380:238-46. [PMID: 26051196 PMCID: PMC4522372 DOI: 10.1016/j.jtbi.2015.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/26/2015] [Revised: 03/31/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
Comprehensive assessment of the effectiveness of contact investigations for tuberculosis (TB) control is still lacking. In this study, we use a computational model, calibrated against notification data from Arkansas during the period 2001-2011, that reproduces independent data on key features of TB transmission and epidemiology. The model estimates that the Arkansas contact investigations program has avoided 18.6% (12.1-25.9%) of TB cases and 23.7% (16.4-30.6%) of TB deaths that would have occurred during 2001-2014 if passive diagnosis alone were implemented. If contacts of sputum smear-negative cases had not been included in the program, the percentage reduction would have been remarkably lower. In addition, we predict that achieving national targets for performance indicators of contact investigation programs has strong potential to further reduce TB transmission and burden. However, contact investigations are expected to have limited effectiveness on avoiding reactivation cases of latent infections over the next 60 years.
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Affiliation(s)
- Giorgio Guzzetta
- Fondazione Bruno Kessler, via Sommarive 18, 38123 Povo (TN), Italy; Trento RISE, via Sommarive 18, 38123 Povo (TN), Italy.
| | - Marco Ajelli
- Fondazione Bruno Kessler, via Sommarive 18, 38123 Povo (TN), Italy
| | - Zhenhua Yang
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI40109-2029, USA
| | - Leonard N Mukasa
- Arkansas Department of Health, Slot 8, 4815 West Markham Street, Little Rock, AR 72205, USA; University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | - Naveen Patil
- Arkansas Department of Health, Slot 8, 4815 West Markham Street, Little Rock, AR 72205, USA; University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | - Joseph H Bates
- Arkansas Department of Health, Slot 8, 4815 West Markham Street, Little Rock, AR 72205, USA; University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | - Denise E Kirschner
- University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Stefano Merler
- Fondazione Bruno Kessler, via Sommarive 18, 38123 Povo (TN), Italy
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Abstract
Context: Mycobacterium tuberculosis (MTB) infection is rarely seen in cystic fibrosis (CF) patients. Case Report: We report a 24-year-old CF patient with fever, cough, hemoptysis, and weight loss of 1week duration prior to admission. Past sputum cultures grew methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. The patient was treated with broad spectrum antibiotics based on previous culture data, but failed to improve. Chest radiograph and computed tomography (CT) chest revealed chronic collapse of the anterior subsegment of right upper lobe and multiple bilateral cavitary lesions which were worse compared to prior films. MTB was suspected and was confirmed by positive acid-fast bacilli (AFB) smears and cultures. After receiving first-line antituberculous drugs, the patient's condition markedly improved. Conclusion: MTB is an infrequent finding, but considered a potential pathogen in CF patients, and may lead to serious pulmonary complications if there is a delay in diagnosis and treatment.
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Affiliation(s)
- Naveen Patil
- Department of Health, Arkansas, United States ; University of Arkansas for Medical Sciences, Arkansas, United States
| | | | | | - Nutan Bhaskar
- University of Arkansas for Medical Sciences, Arkansas, United States
| | | | - Leonard N Mukasa
- Department of Health, Arkansas, United States ; University of Arkansas for Medical Sciences, Arkansas, United States
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Beebe A, Quattlebaum T, Gicquelais RE, Zohoori N, Haselow DT, Smith NH, Patil N. Hepatitis C in Arkansas: updates on epidemiology, testing and treatment. J Ark Med Soc 2015; 111:248-251. [PMID: 25966598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hepatitis C infection is the most common blood-borne infection in the United States with an estimated 2.7 million individuals suffering from chronic infection. Of those who are infected with Hepatitis C virus, 75-85% develop chronic infection. Without treatment for chronic infection, individuals can develop liver diseases, such as cirrhosis and hepatocellular carcinoma, during many years of asymptomatic infection. To examine the burden of Hepatitis C virus infection in the state, the Arkansas Department of Health created an epidemiologic profile based on data collected in 2013 from several data sources, including the department's Hepatitis C surveillance program. In order to make more Arkansans aware of their infection, the local health units in all 75 counties of the state recently began screening individuals at risk for the disease, including persons born during the years 1945-1965. Despite recent advances in treatment efficacy, identifying infected individuals and connecting patients to affordable HCV treatment and care remain priorities.
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Zych B, Garcia-Saez D, Sabashnikov A, Mohite P, Patil N, Zeriouh M, Popov A, De Robertis F, Amrani M, Bahrami T, Reed A, Carby M, Simon A. Do We Really Need to Rush? Early and Mid Term Results of Lung Transplantation (Ltx) of Organs With Total Ischemic Time (TIT) Over 8 Hours - A Propensity Score Matched, Single-Center Analysis. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sabashnikov A, Weymann A, Zeriouh M, Popov AF, Patil N, Zych B, Mohite P, Simon A. Extracorporeal Life Support in Patients with Refractory Cardiogenic Shock: Keep Them Awake. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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