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Baboudjian M, Hashim H, Bhatt N, Creta M, De Nunzio C, Gacci M, Herrmann T, Karavitakis M, Malde S, Moris L, Netsch C, Rieken M, Sakalis V, Schouten N, Tutolo M, Cornu JN. Summary Paper on Underactive Bladder from the European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2024:S0302-2838(24)02273-5. [PMID: 38644139 DOI: 10.1016/j.eururo.2024.04.004] [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: 02/27/2024] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU) Guidelines Panel on non-neurogenic male lower urinary tract symptoms (LUTS) aimed to develop a new subchapter on underactive bladder (UAB) in non-neurogenic men to inform health care providers of current best evidence and practice. Here, we present a summary of the UAB subchapter that is incorporated into the 2024 version of the EAU guidelines on non-neurogenic male LUTS. METHODS A systematic literature search was conducted from 2002 to 2022, and articles with the highest certainty evidence were selected. A strength rating has been provided for each recommendation according to the EAU Guideline Office methodology. KEY FINDINGS AND LIMITATIONS Detrusor underactivity (DU) is a urodynamic diagnosis defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is a terminology that should be reserved for describing symptoms and clinical features related to DU. Invasive urodynamics is the only widely accepted method for diagnosing DU. In patients with persistently elevated postvoid residual (ie, >300 ml), intermittent catheterization is indicated and preferred to indwelling catheters. Alpha-adrenergic blockers are recommended before more invasive techniques, but the level of evidence is low. In men with DU and concomitant benign prostatic obstruction (BPO), benign prostatic surgery should be considered only after appropriate counseling. In men with DU and no BPO, a test phase of sacral neuromodulation may be considered. CONCLUSIONS AND CLINICAL IMPLICATIONS The current text represents a summary of the new subchapter on UAB. For more detailed information, refer to the full-text version available on the EAU website (https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts). PATIENT SUMMARY The European Association of Urology guidelines on underactive bladder in non-neurogenic adult men are presented here. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, La Croix, Quint Fonsegrives, France.
| | | | - Nikita Bhatt
- Department of Urology, East of England Deanery, Cambridge, UK
| | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University, Ospedale Sant'Andrea, Rome, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Vasileios Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Manuela Tutolo
- Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Sharma A, Nathan A, Rossiter M, Ng A, Asif A, Edison M, Bhatt N, Khadhouri S, Mani N, Sidhu PS, Freeman S, Burkert J, Huang D, McLeod A, Kelly D, Azam A, Kasivisvanathan V, Warren H, Zimmermann E. Scrotal point-of-care ultrasonography: a UK cross-speciality pilot training course evaluation. BJU Int 2023; 132:645-648. [PMID: 37539771 DOI: 10.1111/bju.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Akash Sharma
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- British Urology Researchers in Surgical Training (BURST), London, UK
| | - Arjun Nathan
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Marimo Rossiter
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Ng
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Aqua Asif
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Marie Edison
- British Urology Researchers in Surgical Training (BURST), London, UK
| | - Nikita Bhatt
- British Urology Researchers in Surgical Training (BURST), London, UK
| | - Sinan Khadhouri
- British Urology Researchers in Surgical Training (BURST), London, UK
| | - Nick Mani
- Emergency Department, Chesterfield Royal Hospital, Chesterfield, UK
| | - Paul S Sidhu
- Department of Radiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Simon Freeman
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Julia Burkert
- Emergency Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Dean Huang
- Department of Radiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ailey McLeod
- Department of Targeted Intervention, University College London, London, UK
| | - Daniel Kelly
- School of Health Care Sciences, University of Cardiff, Cardiff, UK
| | - Aishah Azam
- British Urology Researchers in Surgical Training (BURST), London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Hannah Warren
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Eleanor Zimmermann
- British Urology Researchers in Surgical Training (BURST), London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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Gallagher K, Bhatt N, Clement K, Zimmermann E, Khadhouri S, MacLennan S, Kulkarni M, Gaba F, Anbarasan T, Asif A, Light A, Ng A, Chan V, Nathan A, Cooper D, Aucott L, Marcq G, Teoh JYC, Hensley P, Duncan E, Goulao B, O'Brien T, Nielsen M, Mariappan P, Kasivisvanathan V. Audit, Feedback, and Education to Improve Quality and Outcomes in Transurethral Resection and Single-Instillation Intravesical Chemotherapy for Nonmuscle Invasive Bladder Cancer Treatment: Protocol for a Multicenter International Observational Study With an Embedded Cluster Randomized Trial. JMIR Res Protoc 2023; 12:e42254. [PMID: 37318875 DOI: 10.2196/42254] [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: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Nonmuscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance and repeat treatments. There is evidence that the quality of the initial surgical procedure (transurethral resection of bladder tumor [TURBT]) and administration of postoperative bladder chemotherapy significantly reduce cancer recurrence rates and improve outcomes (cancer progression and mortality). There is surgeon-reported evidence that TURBT practice varies significantly across surgeons and sites. There is limited evidence from clinical trials of intravesical chemotherapy that NMIBC recurrence rate varies significantly between sites and that this cannot be accounted for by differences in patient, tumor, or adjuvant treatment factors, suggesting that how the surgery is performed may be a reason for the variation. OBJECTIVE This study primarily aims to determine if feedback on and education about surgical quality indicators can improve performance and secondarily if this can reduce cancer recurrence rates. Planned secondary analyses aim to determine what surgeon, operative, perioperative, institutional, and patient factors are associated with better achievement of TURBT quality indicators and NMIBC recurrence rates. METHODS This is an observational, international, multicenter study with an embedded cluster randomized trial of audit, feedback, and education. Sites will be included if they perform TURBT for NMIBC. The study has four phases: (1) site registration and usual practice survey; (2) retrospective audit; (3) randomization to audit, feedback, and education intervention or to no intervention; and (4) prospective audit. Local and national ethical and institutional approvals or exemptions will be obtained at each participating site. RESULTS The study has 4 coprimary outcomes, which are 4 evidence-based TURBT quality indicators: a surgical performance factor (detrusor muscle resection); an adjuvant treatment factor (intravesical chemotherapy administration); and 2 documentation factors (resection completeness and tumor features). A key secondary outcome is the early cancer recurrence rate. The intervention is a web-based surgical performance feedback dashboard with educational and practical resources for TURBT quality improvement. It will include anonymous site and surgeon-level peer comparison, a performance summary, and targets. The coprimary outcomes will be analyzed at the site level while recurrence rate will be analyzed at the patient level. The study was funded in October 2020 and began data collection in April 2021. As of January 2023, there were 220 hospitals participating and over 15,000 patient records. Projected data collection end date is June 30, 2023. CONCLUSIONS This study aims to use a distributed collaborative model to deliver a site-level web-based performance feedback intervention to improve the quality of endoscopic bladder cancer surgery. The study is funded and projects to complete data collection in June 2023. TRIAL REGISTRATION ClinicalTrials.org NCT05154084; https://clinicaltrials.gov/ct2/show/NCT05154084. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42254.
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Affiliation(s)
- Kevin Gallagher
- Department of Urology, Western General Hospital Edinburgh, Edinburgh, United Kingdom
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Nikita Bhatt
- British Urology Researchers in Surgical Training, London, United Kingdom
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Keiran Clement
- British Urology Researchers in Surgical Training, London, United Kingdom
- Department of Urology, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Eleanor Zimmermann
- British Urology Researchers in Surgical Training, London, United Kingdom
- Department of Urology, University Hospitals Plymouth, Plymouth, United Kingdom
| | - Sinan Khadhouri
- British Urology Researchers in Surgical Training, London, United Kingdom
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Steven MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Meghana Kulkarni
- British Urology Researchers in Surgical Training, London, United Kingdom
- Department of Urology, St. George's University Hospital London, London, United Kingdom
| | - Fortis Gaba
- British Urology Researchers in Surgical Training, London, United Kingdom
- Harvard Business School, Harvard University, Boston, MA, United States
| | - Thineskrishna Anbarasan
- British Urology Researchers in Surgical Training, London, United Kingdom
- Oxford University Hospitals, Oxford, United Kingdom
| | - Aqua Asif
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Alexander Light
- British Urology Researchers in Surgical Training, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alexander Ng
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Vinson Chan
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Arjun Nathan
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, Centre Hospitalier Universitaire de Lille, Lille, France
- Cancer Heterogeneity Plasticity and Resistance to Therapies, Institute Pasteur de Lille, University of Lille, Lille, France
| | - Jeremy Yuen-Chun Teoh
- S H Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Hensley
- Department of Urology, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Tim O'Brien
- Department of Urology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Matthew Nielsen
- Department of Urology, University of North Carolina Medical School, Chapel Hill, NC, United States
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital Edinburgh, Edinburgh, United Kingdom
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Amira M, Bhatt N, Basford E, Chih H, Willsher P, Chan A. Contralateral Breast Cancer: Influence Of Molecular Subtype, Clinical Features And Treatment Given In A Single Institution Study. Breast 2023. [DOI: 10.1016/j.breast.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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Yadav KK, Chouhan N, Thubstan R, Norlha S, Hariharan J, Borwankar C, Chandra P, Dhar VK, Mankuzhyil N, Godambe S, Sharma M, Venugopal K, Singh KK, Bhatt N, Bhattacharyya S, Chanchalani K, Das MP, Ghosal B, Godiyal S, Khurana M, Kotwal SV, Koul MK, Kumar N, Kushwaha CP, Nand K, Pathania A, Sahayanathan S, Sarkar D, Tolamati A, Koul R, Rannot RC, Tickoo AK, Chitnis VR, Behere A, Padmini S, Manna A, Joy S, Nair PM, Jha KP, Moitra S, Neema S, Srivastava S, Punna M, Mohanan S, Sikder SS, Jain A, Banerjee S, . K, Deshpande J, Sanadhya V, Andrew G, Patil MB, Goyal VK, Gupta N, Balakrishna H, Agrawal A, Srivastava SP, Karn KN, Hadgali PI, Bhatt S, Mishra VK, Biswas PK, Gupta RK, Kumar A, Thul SG, Kalmady R, Sonvane DD, Kumar V, Gaur UK, Chattopadhyay J, Gupta SK, Kiran AR, Parulekar Y, Agrawal MK, Parmar RM, Reddy GR, Mayya YS, Pithawa CK. Commissioning of the MACE gamma-ray telescope at Hanle, Ladakh, India. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v123/i12/1428-1435] [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: 01/25/2023]
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Bhatt N, Chitranshi J, Mehta M. Testing Herzberg’s two factor theory on millennials. CM 2022. [DOI: 10.18137/cardiometry.2022.22.231236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study tests Herzberg’s two-factor theory of motivation on working millennials. The purpose of the study is to evaluate what the assumptions and the findings of the original study hold for millennials. With the increasing trend of amalgamation of work life and personal life, job satisfaction and general job happiness have never been more on an individual’s personal life. This impact is far-reaching, with strong indications of affecting the employees’ physical, mental, and social health. In such a scenario, organizations need to keep their employees motivated and satisfied. For studying Herzberg’s two-factor theory of motivation on working millennials, we have selected respondents with work experience of at least one year. We have not restricted the study to any particular industry; hence our sample is across all industries. The type of sampling used was convenient sampling. From the analysis, we have found that for the concerned sample, hygiene factors tower above the motivating factors in terms of job satisfaction for millennials. From the data collection and analysis, we proved that both motivators and hygiene factors affect job satisfaction, unlike what has been said by Herzberg. This study will contribute to the exciting literature on motivation.
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Gallagher K, Bhatt N, Clement K, Zimmermann E, Khadhouri S, Kulkarni M, Anbarasan T, Wai-Shun Chan V, Light A, Lam CM, Asif A, Gaba F, Rossi S, Gao C, Nathan A, O'Brien T, Maclennan S, Nielsen M, Mariappan P, Kasivisvanathan V. PD10-11 GLOBAL VARIATION IN QUALITY OF TRANSURETHRAL RESECTION OF BLADDER SURGERY, RESULTS FROM THE RESECT STUDY. J Urol 2022. [DOI: 10.1097/ju.0000000000002536.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gubichuk M, Bhatt N, Faircloth J, Cerminara D, Melicoff E. 186: Elexacaftor/tezacaftor/ivacaftor post-solid organ transplant: A transplant center experience. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Emmanuel A, Kanthabalan A, Alexander C, Bhatt N, Chan V, Kasivisvanathan V, Shabbir M. Expedited Radical Orchidectomy for Testicular Cancer: Compromising Fertility Outcomes Without Oncological Benefit? Eur Urol 2021; 80:766-767. [PMID: 34503880 DOI: 10.1016/j.eururo.2021.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Anthony Emmanuel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Abi Kanthabalan
- Department of Urology, Worcestershire Royal Hospital, Worcester, UK
| | | | - Nikita Bhatt
- Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Vinson Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
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Silay MS, 't Hoen L, Bhatt N, Quaedackers J, Bogaert G, Dogan HS, Nijman RJM, Rawashdeh Y, Stein R, Tekgul S, Radmayr C. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. J Pediatr Urol 2021; 17:303-315. [PMID: 33691984 DOI: 10.1016/j.jpurol.2021.02.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias. MATERIALS AND METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded. DISCUSSION A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study. CONCLUSIONS Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.
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Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Deparment of Urology, Biruni University, Istanbul, Turkey.
| | - Lisette 't Hoen
- Erasmus MC, Department of Urology, Rotterdam, the Netherlands
| | - Nikita Bhatt
- Urology Registrar, East of England Deanery, Cambridge, United Kingdom
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands
| | | | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Silay M, ‘t Hoen L, Bhatt N, Quaedackers J, Bogaert G, Dogan H, Nijman R, Rawashdeh Y, Stein R, Tekgul S, Radmayr C. Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Light A, Gallagher K, Bhatt N, Clement K, Kulkarni MA, Khadhouri S, Zimmermann E, Gao C, Lam C, Anbarasan T, Chan V, Rossi S, Jayaraajan K, Asif A, Shah T, Kasivisvanathan V. 377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.
Method
RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.
Results
As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusions
RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.
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Affiliation(s)
- A Light
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Gallagher
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Western General Hospital, Edinburgh, United Kingdom
| | - N Bhatt
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Queen Elizabeth Hospital, King's Lynn, United Kingdom
| | - K Clement
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Royal Alexandra Hospital, Paisley, United Kingdom
| | - M a Kulkarni
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Guy's Hospital, London, United Kingdom
| | - S Khadhouri
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - E Zimmermann
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Torbay Hospital, Torbay, United Kingdom
| | - C Gao
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- William Harvey Hospital, Ashford, United Kingdom
| | - C Lam
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Bronglais Hospital, Aberystwyth, United Kingdom
| | - T Anbarasan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- NHS Lothian, Edinburgh, United Kingdom
| | - V Chan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leeds School of Medicine, Leeds, United Kingdom
| | - S Rossi
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - K Jayaraajan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Imperial College School of Medicine, London, United Kingdom
| | - A Asif
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Leicester Medical School, Leicester, United Kingdom
| | - T Shah
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- Charing Cross Hospital, London, United Kingdom
| | - V Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) research collaborative, London, United Kingdom
- University College London, London, United Kingdom
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Bhatt N, Ganatra A. Improvement of deep cross-modal retrieval by generating real-valued representation. PeerJ Comput Sci 2021; 7:e491. [PMID: 33987458 PMCID: PMC8093956 DOI: 10.7717/peerj-cs.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
The cross-modal retrieval (CMR) has attracted much attention in the research community due to flexible and comprehensive retrieval. The core challenge in CMR is the heterogeneity gap, which is generated due to different statistical properties of multi-modal data. The most common solution to bridge the heterogeneity gap is representation learning, which generates a common sub-space. In this work, we propose a framework called "Improvement of Deep Cross-Modal Retrieval (IDCMR)", which generates real-valued representation. The IDCMR preserves both intra-modal and inter-modal similarity. The intra-modal similarity is preserved by selecting an appropriate training model for text and image modality. The inter-modal similarity is preserved by reducing modality-invariance loss. The mean average precision (mAP) is used as a performance measure in the CMR system. Extensive experiments are performed, and results show that IDCMR outperforms over state-of-the-art methods by a margin 4% and 2% relatively with mAP in the text to image and image to text retrieval tasks on MSCOCO and Xmedia dataset respectively.
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Affiliation(s)
- Nikita Bhatt
- U & P U. Patel Department of Computer Engineering, Chandubhai S. Patel Institute of Technology, Charotar University of Science and Technology (CHARUSAT), Changa, India
| | - Amit Ganatra
- Devang Patel Institute of Advance Technology and Research, Charotar University of Science and Technology (CHARUSAT), Changa, India
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Lam CM, Gallagher K, Bhatt N, Clement K, Zimmermann E, Shah T, Khadhouri S, Kulkarni M, Gao C, Light A, Jayaraajan K, Asif A, Anbarasan T, Chan V, Kasivisvanathan V. P57 Global recruitment for the RESECT study (transurethral REsection and Single-instillation intravesical chemotherapy Evaluation in bladder Cancer Treatment) - an international observational cohort study aiming to improve the quality of surgery for non-muscle invasive bladder cancer. BJS Open 2021. [PMCID: PMC8153804 DOI: 10.1093/bjsopen/zrab032.056] [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
Abstract
Introduction
Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.
Methods
RESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.
Results
As of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.
Conclusion
RESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.
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Affiliation(s)
- C M Lam
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Gallagher
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - N Bhatt
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Clement
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - E Zimmermann
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Shah
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - S Khadhouri
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - M Kulkarni
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - C Gao
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Light
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - K Jayaraajan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - A Asif
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - T Anbarasan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Chan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
| | - V Kasivisvanathan
- Bronglais Hospital, Aberystwyth; British Urology Researchers in Surgical Training (BURST)
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Quaedackers JSLT, Stein R, Bhatt N, Dogan HS, Hoen L, Nijman RJM, Radmayr C, Silay MS, Tekgul S, Bogaert G. Clinical and surgical consequences of the COVID-19 pandemic for patients with pediatric urological problems: Statement of the EAU guidelines panel for paediatric urology, March 30 2020. J Pediatr Urol 2020; 16:284-287. [PMID: 32291208 PMCID: PMC7144609 DOI: 10.1016/j.jpurol.2020.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
Abstract
The COVID-19-pandemic forces hospitals to reorganize into a dual patient flow system. Healthcare professionals are forced to make decisions in patient prioritization throughout specialties. Most pediatric urology pathologies do not require immediate or urgent care, however, delay may compromise future renal function or fertility. Contact with patients and parents, either physical in safe conditions or by (video)telephone must continue. The Paediatric-Urology-Guidelines-panel of the EAU proposes recommendations on prioritization of care. Pediatric-Urology program directors must ensure education, safety and attention for mental health of staff. Upon resumption of care, adequate prioritization must ensure minimal impact on outcome.
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Affiliation(s)
- Josine S L T Quaedackers
- University of Groningen, University Medical Center Groningen, Department of Urology, the Netherlands.
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikita Bhatt
- Urology Registrar, East of England Deanery, Cambridge, United Kingdom
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rien J M Nijman
- University of Groningen, University Medical Center Groningen, Department of Urology, the Netherlands
| | | | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
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Wells AU, Flaherty KR, Brown KK, Inoue Y, Devaraj A, Richeldi L, Moua T, Crestani B, Wuyts WA, Stowasser S, Quaresma M, Goeldner RG, Schlenker-Herceg R, Kolb M, Aburto M, Acosta O, Andrews C, Antin-Ozerkis D, Arce G, Arias M, Avdeev S, Barczyk A, Bascom R, Bazdyrev E, Beirne P, Belloli E, Bergna M, Bergot E, Bhatt N, Blaas S, Bondue B, Bonella F, Britt E, Buch K, Burk J, Cai H, Cantin A, Castillo Villegas D, Cazaux A, Cerri S, Chaaban S, Chaudhuri N, Cottin V, Crestani B, Criner G, Dahlqvist C, Danoff S, Dematte D'Amico J, Dilling D, Elias P, Ettinger N, Falk J, Fernández Pérez E, Gamez-Dubuis A, Giessel G, Gifford A, Glassberg M, Glazer C, Golden J, Gómez Carrera L, Guiot J, Hallowell R, Hayashi H, Hetzel J, Hirani N, Homik L, Hope-Gill B, Hotchkin D, Ichikado K, Ilkovich M, Inoue Y, Izumi S, Jassem E, Jones L, Jouneau S, Kaner R, Kang J, Kawamura T, Kessler R, Kim Y, Kishi K, Kitamura H, Kolb M, Kondoh Y, Kono C, Koschel D, Kreuter M, Kulkarni T, Kus J, Lebargy F, León Jiménez A, Luo Q, Mageto Y, Maher T, Makino S, Marchand-Adam S, Marquette C, Martinez R, Martínez M, Maturana Rozas R, Miyazaki Y, Moiseev S, Molina-Molina M, Morrison L, Morrow L, Moua T, Nambiar A, Nishioka Y, Nunes H, Okamoto M, Oldham J, Otaola M, Padilla M, Park J, Patel N, Pesci A, Piotrowski W, Pitts L, Poonyagariyagorn H, Prasse A, Quadrelli S, Randerath W, Refini R, Reynaud-Gaubert M, Riviere F, Rodríguez Portal J, Rosas I, Rossman M, Safdar Z, Saito T, Sakamoto N, Salinas Fénero M, Sauleda J, Schmidt S, Scholand M, Schwartz M, Shapera S, Shlobin O, Sigal B, Silva Orellana A, Skowasch D, Song J, Stieglitz S, Stone H, Strek M, Suda T, Sugiura H, Takahashi H, Takaya H, Takeuchi T, Thavarajah K, Tolle L, Tomassetti S, Tomii K, Valenzuela C, Vancheri C, Varone F, Veeraraghavan S, Villar A, Weigt S, Wemeau L, Wuyts W, Xu Z, Yakusevich V, Yamada Y, Yamauchi H, Ziora D. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 2020; 8:453-460. [PMID: 32145830 DOI: 10.1016/s2213-2600(20)30036-9] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis. METHODS The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178. FINDINGS Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population. INTERPRETATION The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Athol U Wells
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Bruno Crestani
- Université de Paris, Inserm U1152, APHP, Hôpital Bichat, Centre de reference constitutif pour les maladies pulmonaires rares, Paris, France
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Manuel Quaresma
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | | | | | - Martin Kolb
- McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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Neupane R, Bhatt N, Poudyal A, Sharma A. Methicillin-Resistant Staphylococcus Aureus Nasal Carriers among Laboratory Technical Staff of Tertiary Hospital in Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2020; 18:3-8. [PMID: 33582679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) has been the leading cause of nosocomial and community infections worldwide. In particular, healthcare workers are at constant risk to develop MRSA carriage. There is a paucity of data regarding the epidemiology of MRSA in laboratory workers who are constantly in contact with these pathogens in almost every hospital. Objective This study was undertaken to identify the burden of MRSA nasal carriers and the antibiotic susceptibility pattern of the isolates among laboratory technical staff. Method Sterile nasal swabs were taken from 50 laboratory technical staff working in the Central and Emergency laboratory of BP Koirala Institute of Health Sciences (BPKIHS). Standard procedures were followed for isolation, identification and antibiotic sensitivity testing. Antibiotic susceptibility tests were performed using disc diffusion and growth on Oxacillin screen agar based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Result Out of 50 isolates of Staphylococcus aureus, 44 (88%) were Methicillin-sensitive (MSSA) while six (12%) were Methicillin-resistant (MRSA). All 50 isolates of S. aureus were found resistant to Penicillin while all were found sensitive to Teicoplanin, Linezolid, and Levofloxacin. Only five (10%) were sensitive to Erythromycin while 49 (98%) were sensitive to both Amikacin and Gentamicin. However, none of the MRSA isolates were found sensitive to all tested antimicrobial agents. Conclusion This repertoire portrays the emergence of MRSA in laboratory workers which clearly indicates the necessity of complying with the sanitary and antibacterial guidelines and adhering to the rational use of antibiotics to prevent nosocomial infections.
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Affiliation(s)
- R Neupane
- Department of Microbiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - N Bhatt
- Department of Microbiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - A Poudyal
- Department of Microbiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - A Sharma
- Department of Microbiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Boland M, Ryan E, Dunne E, Bhatt N, Lowery AJ. 03. Impact of progesterone receptor status on oncological outcomes in oestrogen receptor positive breast cancer patients – a systematic review and meta-analysis. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.01.189] [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] Open
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Howard L, Davis R, Bhatt N, Khan U, Keith D. Eccrine porocarcinoma in a patient with Schöpf-Schulz-Passarge syndrome. Clin Exp Dermatol 2019; 44:938-939. [PMID: 30689236 DOI: 10.1111/ced.13932] [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] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- L Howard
- Department of Dermatology, Royal United Hospital, Bath, UK
| | - R Davis
- Department of Dermatology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - N Bhatt
- Department of Dermatology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - U Khan
- Department of Dermatology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - D Keith
- Department of Dermatology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Walker S, Adamali H, Bhatt N, Maskell N, Barratt S. Pleuroparenchymal sarcoidosis - A recognised but rare manifestation of disease. Respir Med Case Rep 2018; 23:110-114. [PMID: 29719794 PMCID: PMC5925957 DOI: 10.1016/j.rmcr.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/19/2017] [Revised: 01/09/2018] [Accepted: 01/21/2018] [Indexed: 11/30/2022] Open
Abstract
Pleural involvement is rare in sarcoidosis. The presence of a large symptomatic effusion in a patient with sarcoidosis should therefore prompt further investigation for an alternate aetiology. Here we present a case of confirmed pleuro-parenchymal sarcoidosis. We discuss the important differential diagnoses and review the current literature.
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Affiliation(s)
- S. Walker
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - H. Adamali
- North Bristol Interstitial Lung Disease Service, Southmead Hospital, Bristol, UK
| | - N. Bhatt
- North Bristol Interstitial Lung Disease Service, Southmead Hospital, Bristol, UK
| | - N. Maskell
- North Bristol Interstitial Lung Disease Service, Southmead Hospital, Bristol, UK
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - S.L. Barratt
- North Bristol Interstitial Lung Disease Service, Southmead Hospital, Bristol, UK
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
- Corresponding author. North Bristol Interstitial Lung Disease Service, Southmead Hospital, Bristol, UK.
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Sabiiti W, Mtafya B, Kuchaka D, Azam K, Viegas S, Mdolo A, Farmer ECW, Khonga M, Evangelopoulos D, Honeyborne I, Rachow A, Heinrich N, Ntinginya NE, Bhatt N, Davies GR, Jani IV, McHugh TD, Kibiki G, Hoelscher M, Gillespie SH. Optimising molecular diagnostic capacity for effective control of tuberculosis in high-burden settings. Int J Tuberc Lung Dis 2018; 20:1004-9. [PMID: 27393531 DOI: 10.5588/ijtld.15.0951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The World Health Organization's 2035 vision is to reduce tuberculosis (TB) associated mortality by 95%. While low-burden, well-equipped industrialised economies can expect to see this goal achieved, it is challenging in the low- and middle-income countries that bear the highest burden of TB. Inadequate diagnosis leads to inappropriate treatment and poor clinical outcomes. The roll-out of the Xpert(®) MTB/RIF assay has demonstrated that molecular diagnostics can produce rapid diagnosis and treatment initiation. Strong molecular services are still limited to regional or national centres. The delay in implementation is due partly to resources, and partly to the suggestion that such techniques are too challenging for widespread implementation. We have successfully implemented a molecular tool for rapid monitoring of patient treatment response to anti-tuberculosis treatment in three high TB burden countries in Africa. We discuss here the challenges facing TB diagnosis and treatment monitoring, and draw from our experience in establishing molecular treatment monitoring platforms to provide practical insights into successful optimisation of molecular diagnostic capacity in resource-constrained, high TB burden settings. We recommend a holistic health system-wide approach for molecular diagnostic capacity development, addressing human resource training, institutional capacity development, streamlined procurement systems, and engagement with the public, policy makers and implementers of TB control programmes.
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Affiliation(s)
- W Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - B Mtafya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania
| | - D Kuchaka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - K Azam
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - S Viegas
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - A Mdolo
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - E C W Farmer
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Khonga
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - D Evangelopoulos
- Centre for Clinical Microbiology, University College London, London, UK
| | - I Honeyborne
- Centre for Clinical Microbiology, University College London, London, UK
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - N Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - N E Ntinginya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania
| | - N Bhatt
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - G R Davies
- College of Medicine, University of Malawi, Blantyre, Malawi; Institutes of Global Health & Translational Medicine, University of Liverpool, Liverpool, UK
| | - I V Jani
- Instituto Nacional de Saude, Ministerio da Saude, Maputo, Mozambique
| | - T D McHugh
- Centre for Clinical Microbiology, University College London, London, UK
| | - G Kibiki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - M Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany; German Center for Infection Research, Munich, Germany
| | - S H Gillespie
- School of Medicine, University of St Andrews, St Andrews, UK
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Bhatt N, Haroon U, Akram M, Drumm J, Flood H, Giri S. Comparison of patient experience after transperineal template prostate biopsy with prior transrectal ultrasound guided prostate biopsy. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/s1569-9056(17)30683-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wlodek C, Ng Y, Bovill B, Johnson EM, Bhatt N, Shipley D. An unusual cause of cutaneous ulceration. Clin Exp Dermatol 2017; 42:226-229. [PMID: 28044361 DOI: 10.1111/ced.13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C Wlodek
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
| | - Y Ng
- Department of Infectious Diseases, Southmead Hospital, Bristol, UK
| | - B Bovill
- Department of Infectious Diseases, Southmead Hospital, Bristol, UK
| | - E M Johnson
- Public Health England Mycology Reference Laboratory, Bristol, UK
| | - N Bhatt
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
| | - D Shipley
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Fonia A, Bhatt N, Robson A, Kennedy CTC. Acral pseudolymphomatous angiokeratoma of children (APACHE)-like eruption in adult identical twins. Clin Exp Dermatol 2016; 41:751-3. [DOI: 10.1111/ced.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A. Fonia
- Department of Dermatology; Bristol Royal Infirmary; Bristol UK
| | - N. Bhatt
- Department of Dermatology; Bristol Royal Infirmary; Bristol UK
| | - A. Robson
- Department of Dermatopathology; St John's Institute of Dermatology; St Thomas's Hospital; London UK
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Abstract
We report a case of a mediastinal mass indenting the left lateral tracheal wall of a 35-year-old male who presented with weight loss, cough and breathlessness. Flow volume loop and thyroid function tests were normal and thyroid peroxidase antibodies were negative. Technetium scintigraphy and positron emission tomography both showed no uptake. Endobronchial ultrasound-guided fine needle aspiration confirmed ectopic mediastinal thyroid tissue. Mediastinal ectopic thyroid tissue is very rare. Most patients are asymptomatic and euthyroid with positive signals on scintigraphy. False negative technetium scintigraphy can occur in areas of necrosis, carcinoma and from substernal tissue. Ectopic thyroid tissue is a rare but important differential diagnosis when investigating mediastinal lesions and should be considered even if scintigraphy is negative in the right clinical context. Endobronchial ultrasound-guided fine needle aspiration can be used when scintigraphy is not diagnostic.
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Affiliation(s)
- J Hardy
- ARL Medford, North Bristol Lung Centre & University of Bristol Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK, E-mail
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Bhatt N, McGovern R, Boland M, Lal A, Tormey S, Lowrey A, Merrigan A. Upper Limb Lymphoedema after axillary surgery in Breast Cancer Patients: An analysis of referral trends over a three year period in a specialist breast unit. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Boland MR, O'Rahelly M, Bhatt N, Okninska J, Murphy M, Lal A, Tormey S, Lowery AJ, Merrigan BA. Axillary ultrasound guided core biopsy to assess for lymph node metastases in breast cancer patients – What is the burden of disease? Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Affiliation(s)
- J Temporal
- From the North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, England, UK
| | - L Armstrong
- Department of Radiology, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, England, UK
| | - N Bhatt
- Department of Pathology, Bristol Royal Infirmary, Bristol BS2 8HW, England, UK
| | - A R L Medford
- From the North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, England, UK
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Gillis A, Morris M, Bhatt N, Ridgway P. Pilot evaluation of a novel observational tool for collaboration and communication within multidisciplinary team meetings (MDTs). Commun Med 2016; 13:135-147. [PMID: 29958345 DOI: 10.1558/cam.26716] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite widespread use of multidisciplinary team meetings (MDTs) to facilitate patient care, little evidence exists that MDTs improve patient survival or impact care. Research into MDT function and outcome is limited. This pilot study looks to validate a novel tool developed to assess MDT functioning. METHODS A tool was developed with predefined Likert behaviour stems in the areas of structure, communication and collaboration. The tool was evaluated in nine MDTs by three independent observers and included participant evaluation. Inter-rater reliability was calculated with intraclass-correlation coefficients (ICC); Student's t-test was used to calculate significance in participant evaluation and matched observations. RESULTS The tool was used to evaluate 9 MDTs, discussing 133 cases. The overall ICC for the three coders was 0.935; for each MDT: 0.776-0.917. The inter-rater reliability for each MDT observation ranged from 0.245-0.923; the majority with an ICC >0.8. No significant difference was noted between participant evaluation and observer response. DISCUSSION MDTs provide a means of coordinating complex care for patients. This tool provides a means of evaluating group interaction within MDTs and is designed for use by different medical personnel. The pilot study has shown promising ICC; further evaluation is needed using a broader group of MDTs and including case complexity and outcome.
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Sharp C, Edwards A, Mayers L, Lamb H, Barrett S, Bhatt N, Chandratreya L, Darby M, Edey A, Millar AB, Adamali H. P29 Bristol interstitial lung disease (BILD) service experience: BILDing on the MDT: Abstract P29 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.166] [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: 11/04/2022]
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Bhatt N, Deady S, Gillis A, Bertuzzi A, Fabre A, Heffernan E, Gillham C, O'Toole G, Ridgway PF. Epidemiological study of soft-tissue sarcomas in Ireland. Cancer Med 2015; 5:129-35. [PMID: 26589778 PMCID: PMC4708898 DOI: 10.1002/cam4.547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
Soft‐tissue sarcomas (STS) account for 1% of adult and 7% of pediatric malignancies. Histopathology and classification of these rare tumors requires further refinements. The aim of this paper is to describe the current incidence and survival of STS from 1994 to 2012 in Ireland and compare these with comparably coded international published reports. This is a retrospective, population study based on the data from the National Cancer Registry of Ireland (NCRI). Incidence and relative survival rates for STS in Ireland were generated. Incidence of STS based on gender, age and anatomical location was examined. Annual mean incidence rate (European Age Standardized) in Ireland between 1994 and 2012 was 4.48 ± 0.15 per 100,000 person‐years. The overall relative 5‐year survival rate of STS for the period 1994–2011 in Ireland was 56%, which was similar to that reported in the U.K. but lower than in most of Europe and U.S.A. Survival rate fluctuated over the period examined, declining slightly in females but showing an increase in males. STS incidence trends in Ireland were comparable to international reports. Survival trends of STS were significantly different between Ireland and other European countries, requiring further study to understand causation.
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Affiliation(s)
- Nikita Bhatt
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | | | - Amy Gillis
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Alexia Bertuzzi
- Department of Medical Oncology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eric Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - Gary O'Toole
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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Bhatt N, Sheridan G, Connolly M, Kelly S, Gillis A, Conlon K, Lane S, Shanahan E, Ridgway PF. Postoperative exercise training is associated with early discharge: A case-control study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
How transfers from ward to ward can affect continuity of care.
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Affiliation(s)
- M Williamson
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - M Ghazaly
- Epsom and St Helier University Hospitals NHS Trust, UK
- Lecturer of Surgery, Tanta University, Egypt
| | - N Bhatt
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - D Nehra
- Epsom and St Helier University Hospitals NHS Trust, UK
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Merchant R, Bhatt N, Merchant M. Surgical Considerations for Massive Tarsal Coalitions in Multiple Synostosis Syndrome: A Case Report. J Foot Ankle Surg 2015; 54:1162-5. [PMID: 25799911 DOI: 10.1053/j.jfas.2014.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Indexed: 02/03/2023]
Abstract
Tarsal-carpal coalition syndrome is an autosomal dominant inherited condition characterized by fusion of the carpal and tarsal bones and foot deformity. Associated pain and/or gait disturbance are the main complaints. The deformity usually consists of varying degrees of hindfoot varus and forefoot supination. The treatment of these patients is mainly aimed at symptomatic relief. We performed a published data review of this condition and discuss our findings in the context of the case of a 10-year-old female with congenital varus deformity of both feet. The tarsal-carpal coalition syndrome has been included in the spectrum of heritable disorders related to mutations in the NOG gene. Deformity management should be customized to the patient's requirements, and satisfactory results are achievable with adequate rehabilitation. It is important to remember that surgery is only necessary for symptomatic relief and that patients with tarsal-carpal coalition syndrome should be followed up over time because the condition can evolve.
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Affiliation(s)
- Rajiv Merchant
- Registrar, Waterford Regional Hospital, Waterford, Ireland.
| | - Nikita Bhatt
- Medical Officer, Shubheccha Multispeciality Hospital, Baroda, India
| | - Mrugank Merchant
- Consultant Orthopedic Surgeon, Shubheccha Multispeciality Hospital, Baroda, India
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Bhatt N, Dutta N, Rios J, McCullough K, Silverman C, Woo S, El-Ghamry M, Kloecker G, Dunlap N. Evaluation of Prognostic Variables in Patients With Small Cell Lung Cancer: The Role of Volumetric Response to Initial Therapy in Determining the Benefit of Prophylactic Cranial Irradiation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1880] [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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Jeyabalan A, Bhatt N, Medford ARL. Isolated colorectal mediastinal metastasis. QJM 2014; 107:473-4. [PMID: 22661543 DOI: 10.1093/qjmed/hcs089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- A Jeyabalan
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - N Bhatt
- Department of Pathology, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, England, UK
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
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Jeyabalan A, Bhatt N, Edey AJ, West DG, Medford ARL. A node or not a node; that is the question? QJM 2014; 107:309-10. [PMID: 22661544 DOI: 10.1093/qjmed/hcs090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
AIM The aim of the study was to study the abnormalities in the cardiovascular profile in postmenopausal Indian women and to compare the same with the cardiovascular profile of pre menopausal Indian women belonging to the same age group; taken as controls. The goal was to throw some light on the cardiovascular risk in postmenopausal women of the Indian population as this population is thought to be at higher risk than their western counterparts and significant studies of the same kind in this population have been few. MATERIALS AND METHODS A cross-sectional comparative study on 100 women who were either postmenopausal or premenopausal and were between the age group of 40 to 55 years was carried out over a period of ten months at our hospital. The variations in the cardiovascular profile between both groups were studied. All the women were subjected to a detailed history, thorough examination, investigations and imaging studies. RESULTS The evaluation revealed that Coronary Artery Disease (CAD), hypertension, abnormal Body Mass Index (BMI) and abnormal Waist Hip Ratio (WHR) were significantly higher in the postmenopausal group as compared to the premenopausal group. The post menopausal women had significantly higher prevalence of abnormal lipid profiles as compared to their premenopausal counterparts. The postmenopausal women with a normal lipid profile also had increased prevalence of CAD and SAHT, which emphasizes the non-lipid cardiovascular benefits of estrogen. CONCLUSION Thus, we can conclude that cardiovascular disease was more common in postmenopausal women of age group 40-55 years as compared to those not yet achieved menopause in a population of western Indian women. And this risk was significantly associated with central obesity, an abnormal lipid profile and the postmenopausal state in itself.
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Affiliation(s)
- Rupal Dosi
- Professor, Department of Medicine, Medical College Baroda, Gujrat, India
| | - Nikita Bhatt
- Intern, Department of Medicine, Medical College Baroda, Gujrat, India
| | - Priyanki Shah
- Ex-Senior Resident, Department of Medicine, Medical College Baroda, Gujrat, India
| | - Rushad Patell
- Senior Resident, Department of Medicine, Medical College Baroda, Gujrat, India
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Medford ARL, Bhatt N, Edey AJ. Pulmonary carcinoid presenting with cavitating lung infection and oligometastatic mediastinal disease. Br J Hosp Med (Lond) 2013; 74:528-9. [PMID: 24022556 DOI: 10.12968/hmed.2013.74.9.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A R L Medford
- Consultant and Honorary Senior Clinical Lecturer in Interventional Pulmonology and Thoracic Medicine in the North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol
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Affiliation(s)
- S Walters
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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Pillai P, Pandya C, Bhatt N, Gupta SS. Biochemical and reproductive effects of gestational/lactational exposure to lead and cadmium with respect to testicular steroidogenesis, antioxidant system, endogenous sex steroid and cauda-epididymal functions. Andrologia 2011; 44:92-101. [DOI: 10.1111/j.1439-0272.2010.01109.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pandya C, Pillai P, Nampoothiri LP, Bhatt N, Gupta S, Gupta S. Effect of lead and cadmium co-exposure on testicular steroid metabolism and antioxidant system of adult male rats. Andrologia 2011; 44 Suppl 1:813-22. [PMID: 21933223 DOI: 10.1111/j.1439-0272.2010.01137.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The mechanism of testicular toxicity of lead (Pb) and cadmium (Cd) is poorly understood. Previous studies focused on single metal-related changes in testicular toxicity. This study points towards the possible involvement of Pb- and Cd-induced oxidative stress in the suppression of steroidogenesis. The oxidative status of testis of adult male rats exposed to Pb acetate and cadmium acetate either alone or in combination at a dose of 0.025 mg kg(-1) body weight of metal intraperitoneally for 15 days was studied. Pb and Cd caused an increase in reactive oxygen species (ROS) by elevating testicular malondialdehydes (MDA) and decrease in activities of testicular antioxidant enzymes superoxide dismutase (SOD), catalase, glucose 6 phosphate dehydrogenase (G6PDH) and glutathione-S-transferase (GST) in mitochondrial and/or post-mitochondrial fraction. Activities of steroidogenic enzymes 3β and 17β-hydroxysteroid dehydrogenase also decreased significantly leading to altered testosterone production. Metal-exposed groups showed significantly decreased testicular and epididymal sperm count. Epididymal sperm motility and viability was also decreased on Pb and Cd exposure. Cd exposure showed more toxic effect than lead exposure, while combined exposure demonstrated least toxicity. In vitro experiments showed that vitamin C restores steroidogenic enzyme activities, suggesting that Pb- and Cd-induced ROS inhibits the testicular steroidogenesis.
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Affiliation(s)
- C Pandya
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
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Prosser JD, Bhatt N, Coleman T, Jackson L. Case Report of Periocular Merkel Cell Carcinoma Treated with Primary Concomitant Chemotherapy and Radiation, and Review of the Literature Regarding Its Use. Laryngoscope 2011; 120 Suppl 4:S177. [DOI: 10.1002/lary.21641] [Citation(s) in RCA: 3] [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: 11/11/2022]
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Bhatt N, McDermott N, Young M. O-9 AUDIT ON BK VIRUS DETECTION IN RENAL TRANSPLANT RECIPIENTS. Cytopathology 2006. [DOI: 10.1111/j.1365-2303.2006.00392_11_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This report documents the occurrence of a minimal change nephrotic syndrome in a patient antedating the recognition of Hodgkin's lymphoma. An 18-year-old woman presented with the clinical symptoms of nephrotic syndrome and was started on prednisolone with partial response. 13 months after the diagnosis was made, she presented with weight loss and right upper abdominal pain for two months. Kidney biopsy revealed minimal change glomerulonephritis. She subsequently developed cervical lymphadenopathy, which on excision biopsy report, turned out to be Hodgkin's disease, nodular sclerosing type. Hodgkin's lymphoma clinical stage IIIB was diagnosed. A review of literature yielded altogether three cases in which the onset of nephrotic syndrome preceded the diagnosis of Hodgkin's lymphoma by more than 12 months.
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Affiliation(s)
- N Bhatt
- University Hospital of Wales, Cardiff, UK.
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Vasagar K, Golden D, Bhatt N, Viksman A, Parihar S, Parihar A, Fiorentino I, Saini S. Basophil activation marker expression in subjects undergoing sting challenges: Novel biomarkers of anaphylaxis? J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clemens KE, Churchill G, Bhatt N, Richardson K, Noonan FP. Genetic control of susceptibility to UV-induced immunosuppression by interacting quantitative trait loci. Genes Immun 2001; 1:251-9. [PMID: 11196701 DOI: 10.1038/sj.gene.6363667] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultraviolet B radiation (290-320 nm) initiates a dose and wavelength dependent down-regulation of cell-mediated immunity which is critical in experimental ultraviolet radiation (UV) carcinogenesis, preventing immune attack on highly antigenic UV-induced tumors. UV-induced immunosuppression has been demonstrated in humans and may be a risk factor for skin cancer. In this study, we have investigated genetic linkage of the autosomal loci controlling this trait. Previously, we had derived a model describing control of susceptibility to UV-induced immunosuppression in inbred mice by unlinked interacting autosomal and X-linked loci. A genome-wide scan using MIT microsatellite markers was carried out on 100 backcross (BALB/c x (BALB/c x C57BL/6) F1) mice derived from the inbred strains BALB/c (low susceptibility) and C57BL/6 (high susceptibility) and tested for systemic UV-induced immunosuppression of a contact hypersensitivity response. The values for % suppression for each animal and the genotype data were used to investigate genetic linkage by multiple regression analysis. Significance was assessed using the permutation test. Both main effects and interactive effects were investigated, first with each genotype marker singly, and secondly, in a novel approach using markers pairwise. A joint model was derived in which all loci and pairs of loci identified were included simultaneously in a multiple regression model. This model indicates four quantitative trait loci (QTLs) with significant main effects, one on chromosome 10 which decreased susceptibility to UV-induced immunosuppression and QTLs on chromosomes 6, 17 and 1 which increased susceptibility. Additionally, loci on chromosomes 14 and 19 showed significant interaction with the locus on chromosome 1. Further investigation indicated a potential three-way interaction involving the loci on chromosomes 1, 14 and 19.
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Affiliation(s)
- K E Clemens
- Laboratory of Photobiology and Photoimmunology, Department of Dermatology, George Washington University Medical Center, Washington DC 20037, USA
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