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Brandt EJ, Tobb K, Cambron JC, Ferdinand K, Douglass P, Nguyen PK, Vijayaraghavan K, Islam S, Thamman R, Rahman S, Pendyal A, Sareen N, Yong C, Palaniappan L, Ibebuogu U, Tran A, Bacong AM, Lundberg G, Watson K. Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:1368-1385. [PMID: 37019584 DOI: 10.1016/j.jacc.2023.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.
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Affiliation(s)
- Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Kardie Tobb
- Cone Health Medical Group, Greensboro, North Carolina, USA
| | | | - Keith Ferdinand
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Douglass
- Wellstar Health System Center for Cardiovascular Care, Marietta, Georgia, USA
| | - Patricia K Nguyen
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Sabrina Islam
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ritu Thamman
- University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
| | - Shahid Rahman
- Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA
| | - Akshay Pendyal
- University of North Carolina School of Medicine, Novant Health Charlotte Campus, Charlotte, North Carolina, USA
| | - Nishtha Sareen
- Ascension Medical Group, Ascension St Mary's Hospital, Saginaw, Michigan, USA
| | - Celina Yong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Latha Palaniappan
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Uzoma Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Adrian M Bacong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Gina Lundberg
- Emory Women's Heart Center, Emory Heart and Vascular Center, Marietta, Georgia, USA
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, California, USA
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Qaqish O, Sharma S, Kumar A, Patel K, Mohammed K, Venigalla P, Ojha A, Sareen N, Goddla V, Dabaja A, Kondur A. Rotational atherectomy in acute coronary syndrome: A meta-analysis. Cardiovascular Revascularization Medicine 2022; 42:143-153. [DOI: 10.1016/j.carrev.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
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Baker KR, Nguyen TKV, Sareen N, Henderson BH. Meteorological and Air Quality Modeling for Hawaii, Puerto Rico, and Virgin Islands. Atmos Environ (1994) 2020; 234:117543-11753. [PMID: 32601520 PMCID: PMC7322826 DOI: 10.1016/j.atmosenv.2020.117543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A photochemical model platform for Hawaii, Puerto Rico, and Virgin Islands predicting O3, PM2.5, and regional haze would be useful to support assessments relevant for the National Ambient Air Quality Standards (NAAQS), Regional Haze Rule, and the Prevention of Significant Deterioration (PSD) program. These areas have not traditionally been modeled with photochemical transport models, but a reasonable representation of meteorology, emissions (natural and anthropogenic), chemistry, and deposition could support air quality management decisions in these areas. Here, a prognostic meteorological model (Weather Research and Forecasting) and photochemical transport (Community Multiscale Air Quality) model were applied for the entire year of 2016 at 27, 9, and 3 km grid resolution for areas covering the Hawaiian Islands and Puerto Rico/Virgin Islands. Model predictions were compared against surface and upper air meteorological and chemical measurements available in both areas. The vertical gradient of temperature, humidity, and winds in the troposphere was well represented. Surface layer meteorological model performance was spatially variable, but temperature tended to be underestimated in Hawaii. Chemically speciated daily average PM2.5 was generally well characterized by the modeling system at urban and rural monitors in Hawaii and Puerto Rico/Virgin Islands. Model performance was notably impacted by the wildfire emission methodology. Model performance was mixed for hourly SO2, NO2, PM2.5, and CO and was often related to how well local emissions sources were characterized. SO2 predictions were much lower than measurements at monitors near active volcanos on Hawaii, which was expected since volcanic emissions were not included in these model simulations. Further research is needed to assess emission inventory representation of these areas and how microscale meteorology influenced by the complex land-water and terrain interfaces impacts higher time resolution performance.
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Affiliation(s)
- K R Baker
- U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - T K V Nguyen
- U.S. Environmental Protection Agency, San Francisco, CA, USA
| | - N Sareen
- U.S. Environmental Protection Agency, New York, NY, USA
| | - B H Henderson
- U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
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Zoltowska DM, Agrawal Y, Patel N, Sareen N, Kalavakunta JK, Gupta V, Halabi A. Association Between Pulmonary Hypertension and Transcatheter Aortic Valve Replacement: Analysis of a Nationwide Inpatient Sample Database. Rev Recent Clin Trials 2019; 14:56-60. [PMID: 30457054 DOI: 10.2174/1574887113666181120113034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study was done to review the association of pulmonary hypertension (PH) with Transcatheter Aortic Valve Replacement (TAVR) procedures done in the US for years 2010 to 2012. METHODS We used Nationwide Inpatient Sample (NIS) data to extract data for patients who were hospitalized with a primary/secondary diagnosis of TAVR as specified by International Classification of Disease (ICD-9) codes 35.05 and 35.06. PH was identified with ICD-9 codes 416.0 and 416.8. Logistic regression models were used to analyze the association between PH and clinical outcomes of TAVR. RESULTS A total of 8,824 weighted discharges were identified with a primary/secondary diagnosis of TAVR, of which 1,976 (22.4%) also had PH. Mean age of patients undergoing TAVR with and without PH was 81.4 and 81.1 years, respectively. More females had a diagnosis of PH with TAVR when compared to males, (56.9% vs. 43.1). When controlling for demographics, diabetes and hypertension; the association between PH and TAVR was statistically significant (p<.0001). Estimated odds of TAVR with PH was 5.46 (95% CI: 4.63, 6.41) times greater than for TAVR without PH. Similarly, the estimated odds for a length of stay greater than 1 week for TAVR with PH was 1.43 (95% CI: 1.12, 1.82; p=.0034) times greater than odds for TAVR without PH. PH was not statistically significant for in-hospital mortality in patients receiving TAVR (p=0.7067). CONCLUSION This study suggests that underlying PH does not influence the immediate mortality of patients underlying TAVR. Further studies are needed to delve into the bearing of PH on TAVR.
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Affiliation(s)
- Dominika M Zoltowska
- Department of Internal Medicine, Western Michigan University Homer Stryker School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States
| | - Yashwant Agrawal
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Nilesh Patel
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Jagadeesh K Kalavakunta
- Department of Cardiology, Borgess Medical Center, 1521 Gull Rd, Kalamazoo, MI 49048, United States
| | - Vishal Gupta
- Department of Cardiology, Borgess Medical Center, 1521 Gull Rd, Kalamazoo, MI 49048, United States
| | - Abdul Halabi
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
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Saravanan S, Sareen N, Sequiera G, Moudgil M, Dhingra S. GRAPHENE OXIDE CONTAINING CHITOSAN BASED HYDROGEL IMPROVES THE SURVIVAL OF TRANSPLANTED ALLOGENEIC STEM CELLS IN INFARCTED HEART. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Culpepper O, Jerger M, Belen S, Carlson D, Badshah A, Sareen N, Abbey T, Hendrickson C, Leslie L. ALLERGIC ANGINA: A NEW ADDITION TO THE DIFFERENTIAL DIAGNOSIS AND PATHOPHYSIOLOGY OF CHEST PAIN. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32726-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zoltowska DM, Agrawal Y, Patria S, Aggarwal S, Reddy CS, Sareen N, Kalavakunta JK, Gupta V. Association Between Hypothyroidism and Takotsubo Cardiomyopathy: Analysis of Nationwide Inpatient Sample Database. Rev Recent Clin Trials 2018; 13:222-225. [PMID: 29607786 DOI: 10.2174/1574887113666180402144600] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Takotsubo Cardiomyopathy (TC), also called transient left ventricular (LV) ballooning syndrome, resembles myocardial infarction and is characterized by LV dysfunction in the absence of coronary artery disease. Hypothesis described for TC has been an intense social stressor, pheochromocytoma, thyrotoxicosis among others. We performed this study to analyze the association of hypothyroidism with TC. METHODS We queried the Nationwide Inpatient Sample which represents 20% of all the United States hospital data for our study. We identified TC and hypothyroidism through their respective ICD9. Codes for years 2006-2012. SAS 9.4 was used to perform a chi-square analysis to find any statistical significance and p < 0.05 used to determine statistical significance. Significant differences were identified using odds ratio (OR) estimates. RESULTS A total of 19,713 cases with TC were identified of which 17,340 (87.96%) were females and 2,373 (12.04%) were males. 3,272 patients with TC had diagnosis of hypothyroidism. There is statistically significant evidence of an association between TC and hypothyroidism (OR 2.21 (95% CI: 2.11- 2.31); p<0.0001). There is evidence of increased statistical significance of females having TC 5.24 (95% CI: 4.96-5.53; (p<0.0001)) compared to males, with an increased statistically significance of females with hypothyroidism having TC, OR 6.65 (95% CI: 5.57-7.93; p< 0.001) compared to males. CONCLUSION There is an increased association of hypothyroidism, especially hypothyroidism for females with TC.
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Affiliation(s)
- Dominika M. Zoltowska
- Department of Internal Medicine, Western Michigan University Homer Stryker School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States
| | - Yashwant Agrawal
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Sandeep Patria
- Department of Internal Medicine, Western Michigan University Homer Stryker School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, United States
| | - Sourabh Aggarwal
- Departmen of Cardiology, University of Nebraska Medical Center, S 42nd St & Emile St, Omaha, NE 68198, United States
| | - Chandra S Reddy
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, 44405 Woodward Ave, Pontiac, MI 48341, United States
| | - Jagadeesh Kumar Kalavakunta
- Department of Cardiology, Michigan State University/Borgess Medical Center, 1521 Gull Rd, Kalamazoo, MI 49048, United States
| | - Vishal Gupta
- Department of Cardiology, Michigan State University/ Borgess Medical Center, 1521 Gull Rd, Kalamazoo, MI 49048, United States
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Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S, Khandelwal A, Hanson I, George A, Ashbrook M, Blank N, Abdelsalam M, Sareen N, Timmis SB, O'Neill MD WW. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv 2017; 91:454-461. [DOI: 10.1002/ccd.27427] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Mir B. Basir
- Department of Cardiology; Henry Ford Hospital; Detroit Michigan
| | | | - Simon Dixon
- Department of Cardiology; Beaumont Hospital; Royal Oak Michigan
| | | | - Kirit Patel
- Department of Cardiology; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | - Steven Almany
- Department of Cardiology; Beaumont Hospital; Royal Oak Michigan
| | | | - Ivan Hanson
- Department of Cardiology; Beaumont Hospital; Royal Oak Michigan
| | - Augustine George
- Department of Cardiology; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | | | - Nimrod Blank
- Department of Cardiology; Detroit Medical Center; Detroit Michigan
| | - Murad Abdelsalam
- Department of Cardiology; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
| | - Nishtha Sareen
- Department of Cardiology; St. Joseph Mercy Oakland Hospital; Pontiac Michigan
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Sequiera G, Bailey K, Sareen N, Moudgil M, Abu-El Rub E, Sekaran S, Rockman-Greenberg C, Dhingra S. ESTABLISHMENT OF STABLE IN VITRO CARDIAC MODELS OF KEARNS-SAYRE SYNDROME USING INDUCED PLURIPOTENT STEM CELL TECHNOLOGY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abdelsalam M, George A, Milford B, Gjeka R, Sareen N, Halabi A, De Gregorio M, Patel K. TCT-647 Impella CP Use in Acute Myocardial Infarction Complicated by Cardiogenic Shock: A community Hospital Experience. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Basir M, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S, Khandelwal A, George A, Ashbrook M, Blank N, Sareen N, O'Neill W. TCT-100 Feasibility of Early Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The Detroit Cardiogenic Shock Initiative. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sareen N, Baber U, Aquino M, Sayseng S, Sweeny J, Barman N, Kapur V, Kini A, Sharma SK. Mid-term outcomes of consecutive 998 cases of coronary atherectomy in contemporary clinical practice. J Interv Cardiol 2017; 30:331-337. [DOI: 10.1111/joic.12398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- Nishtha Sareen
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Usman Baber
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Melissa Aquino
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Sonny Sayseng
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Joseph Sweeny
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Nitin Barman
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Vishal Kapur
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Annapoorna Kini
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Samin K. Sharma
- Department of Cardiology; Mount Sinai Medical Center; New York New York
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Sareen N, Baber U, Kezbor S, Sayseng S, Aquino M, Mehran R, Sweeny J, Barman N, Kini A, Sharma SK. Clinical and angiographic predictors of haemodynamically significant angiographic lesions: development and validation of a risk score to predict positive fractional flow reserve. EUROINTERVENTION 2017; 12:e2228-e2235. [PMID: 28191876 DOI: 10.4244/eij-d-16-00749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Coronary revascularisation based upon physiological evaluation of lesions improves clinical outcomes. Angiographic or visual stenosis assessment alone is insufficient in predicting haemodynamic stenosis severity by fractional flow reserve (FFR) and therefore cannot be used to guide revascularisation, particularly in the lesion subset <70%. Accordingly, we sought to identify independent determinants of angiographic intermediate lesions with haemodynamic significance. METHODS AND RESULTS We assessed consecutive intermediate lesions for patients from January 2014 to April 2015 at our institution. Independent predictors of FFR positivity (FFR ≤0.8) were identified and a scoring system formulated. Of 1,023 consecutive lesions (883 patients), 314 (31%) were haemodynamically significant. Characteristics associated with FFR ≤0.8 include male gender, higher SYNTAX score, lesions ≥20 mm, stenosis >50%, bifurcation, calcification, absence of tortuosity and smaller reference diameter. A user-friendly integer score was developed with the five variables demonstrating the strongest association. On prospective validation (in 279 distinct lesions), the increasing value of the score correlated well with increasing haemodynamic significance (C-statistic 0.85). CONCLUSIONS We identified several clinical and angiographic characteristics and formulated a scoring system to guide the approach to intermediate lesions. This may translate into cost savings. Larger studies with prospective validation are required to confirm our results.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, Mount Sinai Medical Center, New York, NY, USA
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Abdelsalam M, Gjeka R, Sareen N, Reddy C, Degregorio M, Halabi A, Patel K. EXTERNAL FEMORAL-FEMORAL BYPASS FOR ACUTE LIMB ISCHEMIA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35814-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sareen N, Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J Nucl Cardiol 2016; 23:1411-1429. [PMID: 26487011 DOI: 10.1007/s12350-015-0152-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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Sareen N, Mariychina A, Mahan M, Cajigas H, Ananthasubramaniam K. Do Right Ventricular Diastolic Tissue Doppler Parameters Add Diagnostic Value in Pulmonary Hypertension ? Chest 2015. [DOI: 10.1378/chest.2263988] [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: 11/01/2022] Open
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Kapil U, Sareen N. Management of children with severe acute malnutrition. Indian Pediatr 2014; 51:587-588. [PMID: 25031149] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Umesh Kapil
- Department of Human Nutrition, AIIMS, New Delhi, India.
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Kapil U, Jain V, Kabra M, Pandey RM, Sareen N, Khenduja P. Prevalence of neonatal hypothyroidism in Kangra Valley, Himachal Pradesh. Eur J Clin Nutr 2014; 68:748-9. [PMID: 24755928 DOI: 10.1038/ejcn.2014.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 11/09/2022]
Abstract
Iodine deficiency (ID) is an endemic health problem in Kangra District, Himachal Pradesh (HP). ID in pregnant mothers leads to neonatal hypothyroidism (NH), mental retardation, deaf mutism, squint, dwarfism, spastic dysplasia, neurological defects and congenital anomalies. NH can be assessed by estimating the thyroid stimulating hormone (TSH) in cord blood samples. The present study was conducted with an objective to assess the prevalence of NH in district Kangra, HP. In district Kangra, all the hospitals providing obstetric services were enlisted. Three hospitals conducting more than 100 deliveries per year were selected randomly. A total of 613 umbilical cord blood samples of neonates were collected on filter papers and analyzed for TSH. TSH was estimated by enzyme-linked immunosorbent assay method. Neonates with TSH levels ⩾20 mIU/l were recalled for reassessment of TSH for confirmation of NH. Prevalence of NH was found to be 4.4%. This finding suggests the need for the implementation of a neonatal screening program for early detection of children with ID.
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Affiliation(s)
- U Kapil
- Department of Human Nutrition, Public Health Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - V Jain
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - N Sareen
- Department of Human Nutrition, Public Health Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - P Khenduja
- Department of Human Nutrition, Public Health Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Kapil U, Pandey RM, Kabra M, Jain V, Sareen N, Bhadoria AS, Vijay J, Nigam S, Khenduja P. Status of iodine deficiency in district Kangra, Himachal Pradesh after 60 years of salt iodization. Eur J Clin Nutr 2013; 67:827-8. [PMID: 23820337 DOI: 10.1038/ejcn.2013.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/08/2013] [Accepted: 05/29/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES District Kangra, Himachal Pradesh(HP), India is a known endemic area for iodine deficiency disorders (IDD) since 1956. The present study was conducted in district Kangra, Himachal Pradesh with the objective to assess the prevalence of iodine deficiency in school-age children. SUBJECTS/METHODS A total of 1864 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. 'On the spot' urine samples were collected from 463 children. The salt samples were collected from 327 children. RESULTS The total goiter prevalence of 15.8% was found. The proportion of children with urinary iodine excretion (UIE) levels <50.0, 50.0-99.9 and ≥ 100 μg/l was 2.2, 14.3 and 83.5%, respectively. The median UIE level was 200 μg/l. About 82.3% of the families were consuming salt with iodine content ≥ 15 ppm. CONCLUSION The population in district Kangra is possibly in a transition phase from iodine deficient (as revealed by total goiter rate of 15.8%) to iodine sufficiency (as revealed by median UIE levels of 200 μg/l).
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Affiliation(s)
- U Kapil
- Department of Human Nutrition, AIIMS, New Delhi, India.
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Kapil U, Sachdev HPS, Dwivedi SN, Pandey RM, Upadhyay AD, Sareen N. Relative efficacy of weekly and two differing doses of daily iron-folate supplementation in improving hemoglobin in mild and moderately anemic children between 3 and 5 years of age: a cluster randomized trial. Eur J Clin Nutr 2013; 67:343-7. [PMID: 23403883 DOI: 10.1038/ejcn.2013.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES In India, 75% of children <5 years of age have anemia. The National Nutritional Anemia Control Program (NNACP) recommends 20 mg iron and 100 μg folic acid (IFA) supplementation for 100 days/year, but still anemia prevalence has remained high. To accelerate the progress, suggestions include increase in IFA to therapeutic dose or supervised weekly supplementation to improve compliance. The objectives of this study was to compare the hemoglobin response with two dosages of daily (20 mg iron and 100 μg folic acid, or 40 mg iron and 200 μg folic acid) and weekly (40 mg iron and 200 μg folic acid) IFA supplementation in children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl). SUBJECTS/METHODS Community-based cluster randomized control trial in nine adjoining Anganwadi Centers. Four hundred twenty six enrolled participants received directly supervised IFA tablet supplementation as per the above three groups. After 100 days, the number of available subjects in the NNACP daily dose (A), daily dose doubled (B) and weekly dose (C) groups were 112, 114 and 110, respectively. Hemoglobin was estimated at baseline, 50 and 100 days by the Cynmeth hemoglobin method. RESULTS At 50 days, there were no differences between the three groups, but at 100 days, adjusted hemoglobin was lowered with weekly supplementation. The mean (95% confidence interval) hemoglobin (g/dl) differences were: (i) A-B: -0.05 (-0.17, 0.05), (ii) A-C: -0.38 (-0.50, -0.27) and (iii) B-C: -0.33, (-0.45, -0.21). Anemia reduction was 18.8%, 18.4% and 10.9%, respectively, in the three groups. CONCLUSION Directly supervised IFA supplementation at the NNACP or double dose is equally efficacious but superior to weekly regimen.
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Affiliation(s)
- U Kapil
- Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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Kapil U, Sareen N, Singh P, Bhadoria AS. Reproductive factors and breast cancer: A case-control study in tertiary care hospital of North India. Indian J Cancer 2013; 50:316-21. [DOI: 10.4103/0019-509x.123606] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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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Wever-Pinzon O, Suma V, Ahuja A, Romero J, Sareen N, Henry SA, De Benedetti Zunino M, Chaudhry FF, Suryadevara RS, Sherrid MV, Chaudhry FA. Safety of echocardiographic contrast in hospitalized patients with pulmonary hypertension: a multi-center study. Eur Heart J Cardiovasc Imaging 2012; 13:857-62. [PMID: 22427401 DOI: 10.1093/ehjci/jes057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. In October 2007, the Food and Drug Administration (FDA) placed a black box warning on the label of the perflutren-based agents Definity and Optison, contraindicating their use in patients with pulmonary hypertension (PHT) and unstable cardiopulmonary status, after serious cardiopulmonary reactions occurred in temporal relation to EC administration. In 2008 and 2011, the FDA revised the black box warning allowing their use in this same population. However, limited data exist regarding the safety profile of these agents in patients with PHT. METHODS AND RESULTS Consecutive hospitalized patients with PHT who were referred for echocardiographic evaluation, but required the use of EC, were included. All our patients received the EC agent Definity. We evaluated these patients for serious adverse events (respiratory decompensation, hypotension, syncope, convulsions, arrhythmias, anaphylactic reactions, or death) occurring within 24 h of EC administration. The study group included 1513 patients (age 69 ± 14 years, 55% males, BMI 33 ± 9 kg/m(2)), of which 911 (60%) had mild PHT, 515 (34%) had moderate PHT, and 87 (6%) had severe PHT. The mean pulmonary artery systolic pressures (PASP) in the groups with mild, moderate, and severe PHT were 41 ± 4 (range 35-49) mmHg, 55 ± 5 (range 50-69) mmHg, and 78 ± 9 (range 70-122) mmHg, respectively. The incidence of adverse events in all subgroups was rare (0.002%) and they were not attributed to EC because of temporal and clinical considerations. CONCLUSION The use of the EC agent Definity is safe in hospitalized patients with PHT.
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Affiliation(s)
- Omar Wever-Pinzon
- Division of Cardiology, St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA.
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Schwier AN, Sareen N, Lathem TL, Nenes A, McNeill VF. Ozone oxidation of oleic acid surface films decreases aerosol cloud condensation nuclei activity. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2010jd015520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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