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Dutta S, Goel N, Kumar R. Assessment of frailty and its predictors in chronic obstructive pulmonary disease. Lung India 2024; 41:17-24. [PMID: 38160454 PMCID: PMC10883449 DOI: 10.4103/lungindia.lungindia_119_23] [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] [Received: 03/18/2023] [Accepted: 08/19/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Frailty represents a state of risk in which a relatively small stressor results in a disproportionate decline in health status. This study aims to determine the prevalence of frailty among patients with COPD in the Indian population and its associated risk factors. METHODS A descriptive cross-sectional study was conducted in 150 COPD patients. Frailty was assessed using the frailty phenotype method. RESULTS The mean age (SD) of the study population was 60.59 (5.9) years with 88.67% males and 53.33% ex-smokers. The prevalence of frailty was 51.33% (n = 77). Most of the frail patients belonged to GOLD group D (66.23%) (P < 0.0001). Post-bronchodilator FEV1(%) was lowest in the frail group (40 [36-47]%) (P < 0.0001). Risk of frailty significantly correlated with smoking pack years (1.036; 1.001-1.074), history of 1 exacerbation in last year (6.810; 2.036-22.779), post-bronchodilator FVC(%) (0.955; 0.926-0.985), post-bronchodilator FEV1(%) (0.940; 0.913-0.968), distance covered in 6-minute walk test [0.975; 0.965-0.986] and dyspnoea severity [1.044; 1.024-1.063]. In multivariate regression, 6-minute walk distance and GOLD group B were the independent predictors of frailty in COPD. CONCLUSION The prevalence of frailty in Indian patients with COPD was 51.33%. Six-minute walk distance is an important predictor of frailty. Early identification of frailty will lead to prompt intervention and rehabilitation.
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Affiliation(s)
- Sharmistha Dutta
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Landy R, Killcoyne S, Tang C, Juniat S, O’Donovan M, Goel N, Gehrung M, Fitzgerald RC. Real-world implementation of non-endoscopic triage testing for Barrett's oesophagus during COVID-19. QJM 2023; 116:659-666. [PMID: 37220898 PMCID: PMC10497181 DOI: 10.1093/qjmed/hcad093] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The Coronavirus pandemic (COVID-19) curtailed endoscopy services, adding to diagnostic backlogs. Building on trial evidence for a non-endoscopic oesophageal cell collection device coupled with biomarkers (Cytosponge), an implementation pilot was launched for patients on waiting lists for reflux and Barrett's oesophagus surveillance. AIMS (i) To review reflux referral patterns and Barrett's surveillance practices. (ii) To evaluate the range of Cytosponge findings and impact on endoscopy services. DESIGN AND METHODS Cytosponge data from centralized laboratory processing (trefoil factor 3 (TFF3) for intestinal metaplasia (IM), haematoxylin & eosin for cellular atypia and p53 for dysplasia) over a 2-year period were included. RESULTS A total of 10 577 procedures were performed in 61 hospitals in England and Scotland, of which 92.5% (N = 9784/10 577) were sufficient for analysis. In the reflux cohort (N = 4074 with gastro-oesophageal junction sampling), 14.7% had one or more positive biomarkers (TFF3: 13.6% (N = 550/4056), p53: 0.5% (21/3974), atypia: 1.5% (N = 63/4071)), requiring endoscopy. Among samples from individuals undergoing Barrett's surveillance (N = 5710 with sufficient gland groups), TFF3-positivity increased with segment length (odds ratio = 1.37 per cm (95% confidence interval: 1.33-1.41, P < 0.001)). Some surveillance referrals (21.5%, N = 1175/5471) had ≤1 cm segment length, of which 65.9% (707/1073) were TFF3 negative. Of all surveillance procedures, 8.3% had dysplastic biomarkers (4.0% (N = 225/5630) for p53 and 7.6% (N = 430/5694) for atypia), increasing to 11.8% (N = 420/3552) in TFF3+ cases with confirmed IM and 19.7% (N = 58/294) in ultra-long segments. CONCLUSIONS Cytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett's oesophagus status and surveillance requirements. Long-term follow-up will be important in these cohorts.
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Affiliation(s)
- R Landy
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Killcoyne
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - C Tang
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - S Juniat
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - M O’Donovan
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Goel
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - M Gehrung
- Cyted Ltd, 22 Station Road, Cambridge CB1 2JD, UK
| | - R C Fitzgerald
- Department of Oncology, Early Cancer Institute, University of Cambridge, Cambridge CB2 0XZ, UK
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Mrigpuri P, Goel N, Spalgais S, Nagaraja R, Sonal S, Yadav SR, Menon B, Kumar R. Uncontrolled Diabetes Mellitus Predicts Post-COVID-19 Fibrosis. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449692 DOI: 10.59556/japi.71.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Post-coronavirus 2019 (COVID-19) complications are now well-recognized and may involve multiple organs. Post-COVID-19 pulmonary fibrosis is one of the serious long-term consequences of COVID-19 infection, and the risk factors for its development largely remain unidentified. AIMS AND OBJECTIVES The study aimed to evaluate the clinical and radiological profile of post COVID-19 patients with diagnosed diabetes mellitus (DM). MATERIALS AND METHODS All the patients attending the post-COVID-19 respiratory care center over a period of 1 year who were diagnosed with cases of DM were evaluated for residual clinical symptoms and radiological changes and glycosylated hemoglobin (HbA1c) levels were measured from their blood samples. RESULTS A total of 50 patients were enrolled in this observational cross-sectional study. Most patients were males in the age group of 45-60 years. Approximately 74% of patients had uncontrolled DM. Patients with uncontrolled DM had a higher probability of having a severe disease with an odds ratio (OR) of 7.30 (0.85, 62.42, and confidence interval (CI) 95%) and were more likely to have fibrotic abnormalities on computed tomography (CT) chest with OR of 3.38 (0.87, 16.86, and CI 95%). CONCLUSION Uncontrolled diabetes predisposes to the development of post-COVID-19 fibrosis, so physicians should be more vigilant while managing these patients.
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Affiliation(s)
- Parul Mrigpuri
- Assistant Professor, Department of Pulmonary Medicine; Corresponding Author
| | - Nitin Goel
- Assistant Professor, Department of Pulmonary Medicine
| | | | | | | | | | | | - Raj Kumar
- Director, Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute (VPCI), Delhi, India
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Kulshrestha R, Saxena H, Kumar R, Spalgais S, Mrigpuri P, Goel N, Menon B, Rani M, Mahor P, Bhutani I. Subtyping of advanced lung cancer based on PD-L1 expression, tumor histopathology and mutation burden (EGFR and KRAS): a study from North India. Monaldi Arch Chest Dis 2023; 93. [PMID: 36723380 DOI: 10.4081/monaldi.2023.2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 02/02/2023] Open
Abstract
Immune checkpoint inhibitor (PD-L1) therapy of advanced non-small-cell lung cancer (NSCLC) has variable outcomes. Tumor subtypes based on PD-L1 expression, histopathology, mutation burden is required for patient stratification and formulation of treatment guidelines. Lung cancers (n=57) diagnosed at Pathology department, VPCI (2018-2021) were retrospectively analyzed. PD-L1(SP263) expressed by tumor cells [low (<1%), medium (1-49%), high (≥50%)] was correlated with histopathology, microenvironment, EGFR, KRAS expression. Patients were categorized into high and low risk based on their: i) gender: males (n=47, 30-89 years), females (n=10, 45-80 years); ii) smoking history: males 26/47 (45.61%), females 1/10 (10%); iii) tumor subtyping: squamous cell carcinoma 15/57 (26.32%), adenocarcinoma 6/57 (17.54%), NSCLC-undifferentiated 24/57 (42.10%), adenosquamous carcinoma 5/57 (8.77 %), carcinosarcoma 4/57 (7.02%), small cell carcinoma 1/57 (1.75%); iv) inflammatory tumor microenvironment/TILs 44/57 (77.1%); iv) PD-L1 positivity-31/57 (54.3%); v) concomitant EGFR/KRAS positivity. PD-L1positive cases showed squamous/undifferentiated histopathology, concomitant EGFR+ (9/20, 45%) and KRAS+ (8/15, 53.3%), smoking+ (21/31,67.74%).PD-L1 negative cases (26/57, 45.6%), were EGFR+ (2/14, 14.28%) and KRAS+ (6/19, 31.5%). The high-risk lung cancer subtypes show squamous/undifferentiated histopathology, inflammatory microenvironment, male preponderance, smoking history, higher concomitant PD-L1, KRAS and EGFR positivity. Lung cancer subtyping can predict clinical response/resistance of patients prior to initiation of PD-L1 inhibitor therapies and can be used to guide therapy.
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Affiliation(s)
- Ritu Kulshrestha
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Himanshi Saxena
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Balakrishnan Menon
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Meenu Rani
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Pawan Mahor
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Ishita Bhutani
- Department of Pathology, Vallabhbhai Patel Chest Institute, University of Delhi.
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Goel N, Goyal N, Spalgais S, Mrigpuri P, Varma-Basil M, Khanna M, Nagaraja R, Menon B, Kumar R. Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis. Thorac Res Pract 2023; 24:22-28. [PMID: 37503595 PMCID: PMC10765190 DOI: 10.5152/thoracrespract.2023.21307] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/02/2022] [Indexed: 07/29/2023]
Abstract
OBJECTIVE New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed "long-COVID." Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULTS Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue (P = .001), breathlessness (P = .001), tachycardia (P = .002), tachypnea (P < .001), raised blood pressure (P < .001), crepitations (P = .04), hypoxia at rest (P < .001), significant desaturation in 6-minute walk test (P = .27), type 1 respiratory failure (P = .001), and type 2 respiratory failure (P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Nitesh Goyal
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Mandira Varma-Basil
- Department of Microbiology, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Madhu Khanna
- Department of Virology, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Ravishankar Nagaraja
- Department of Biostatistics, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Balakrishnan Menon
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. Indian J Allergy Asthma Immunol 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Paul SP, Khattak H, Kini PK, Heaton PA, Goel N. NICE guideline review: neonatal infection: antibiotics for prevention and treatment (NG195). Arch Dis Child Educ Pract Ed 2022; 107:292-297. [PMID: 34772670 DOI: 10.1136/archdischild-2021-322349] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | - Nitin Goel
- Neonatal Medicine, University Hospital of Wales, Cardiff, UK
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Goel N, Needham M, Soler-Ferran D, Cotreau MM, Escobar J, Greenberg S. POS1342 DEPLETION OF KLRG1+ T CELLS IN A FIRST-IN-HUMAN CLINICAL TRIAL OF ABC008 IN INCLUSION BODY MYOSITIS (IBM). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2141] [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: 11/03/2022]
Abstract
BackgroundInclusion body myositis (IBM), a relentlessly progressive autoimmune skeletal muscle disease, has no effective available pharmacological therapy. A prominent feature of IBM on microscopy is highly differentiated effector CD8+ cytotoxic T (Tc) cells invading non-necrotic myofibers [1]. These Tc cells, known to be relatively resistant to apoptosis, express markers including killer cell lectin-like receptor G1 (KLRG1) [2]. ABC008, a first-in-class humanized, afucosylated monoclonal antibody (mAb) specific for KLRG1, selectively depletes these highly differentiated Tc cells while sparing other blood cell populations, e.g., naïve, central memory, and regulatory T cells and B cells. ABC008 has been designed to treat diseases mediated by these Tc cells, including IBM and T-cell large granular lymphocytic leukemia (T-LGLL). IBM and rheumatoid arthritis overlap clinically with T-LGLL and share similar expansions of large granular lymphocytes (LGLs), which also express KLRG1. We report here our preliminary data from our ongoing trial of ABC008 in IBM (NCT04659031).ObjectivesEvaluate the safety, pharmacodynamics (PD), and pharmacokinetics (PK) of ABC008 administered subcutaneously (SC) in adults with IBM.MethodsIn this first-in-human, open-label, single ascending dose trial with 3 + 3 design evaluating ABC008 SC, eligible participants must have clinicopathologically defined, clinically defined, or probable IBM according to the European Neuromuscular Centre 2011 research diagnostic criteria [3] and an IBM Functional Rating Scale (IBMFRS) score ≤38. Four dose cohorts are planned: ABC008 0.1, 0.5, 2.0, and 5.0 mg/kg. PD, PK, safety, and disease severity assessments are performed pre-dose (Day 0) and during the 6-month follow-up period.ResultsFive of the 6 (83.3%) participants were male with baseline mean age = 65.7 years, mean IBM disease duration = 6.8 years, and mean IBMFRS score = 27.5 (Table 1). Each received a single dose of ABC008 SC: Cohorts 1 (C1) and 2 (C2) received 0.1 and 0.5 mg/kg and have completed 168 and 56 days of follow-up, respectively.Table 1.Baseline DemographicsBaseline CharacteristicsABC008 SC Treatment GroupsCohort 10.1 mg/kg SC (n=3)Cohort 20.5 mg/kg SC (n=3)ABC008 Overall (N=6)Age (years), mean ± SD64.0 ± 11.3667.3 ± 6.6665.7 ± 8.52Male sex, n (%)3 (100)2 (66.7)5 (83.3)Caucasian3 (100)3 (100)6 (100)Body Mass Index (kg/m2)28.5 ± 3.5828.3 ± 4.2528.4 ± 3.52Disease Duration (years), mean ± SD9.7 ± 5.973.9 ± 4.486.8 ± 5.70IBMFRS score, mean ± SD30.0 ± 4.0825.0 ± 6.1627.5 ± 5.80Abbreviations: IBMFRS, Inclusion Body Myositis Functional Rating Scale; n or N, number; SC, subcutaneous; SD, standard deviation.Maximum depletion of CD8+KLRG1+ cells for C1 and C2 ranged from 46-96% and 98-99%, respectively (Figure 1A), with depletion evident by the next assessment on Day 1. Recovery in C1 began at Day 84 with Day 168 depletion at 29-71%. Other hematologic parameters generally were stable (e.g., T regulatory and B cells). CD8+CD57+ LGLs, mostly KLRG1+, were also depleted (Figure 1B). Preliminary PK showed that ABC008 SC displays a long absorption phase and slow clearance properties typical of mAb therapies. No severe adverse events (AEs) or discontinuations due to AEs have been reported. One unrelated serious AE of fall with muscle tear in a C1 participant with a prior history of falls occurred.Figure 1.Key pharmacodynamic parameters in Study ABC008-IBM-101. Baseline and change (A) of KLRG1+CD8+ T cells and (B) CD8+CD57+ large granular lymphocytes (LGLs). C1 and C2 are Cohorts 1 and 2; P1, P2, and P3 are Participants 1, 2, and 3.ConclusionIn study participants with IBM, single SC doses of 0.1 and 0.5 mg/kg of ABC008 resulted in the depletion of CD8+KLRG1+ cells and CD8+CD57+ LGLs with clear evidence of a dose response for KLRG1+ T cell depletion and no apparent safety signals. Based on these results, a study evaluating ABC008 for the treatment of T-LGLL is planned.References[1]Engel AG, et al. Ann Neurol. 1984;16:209-15.[2]Greenberg SA, et al. Brain. 2016;139:1348-60.[3]Rose MR, et al. Neuromuscul Disord. 2013;23:1044-55.Disclosure of InterestsNiti Goel Shareholder of: UCB, Abcuro, Inc, Employee of: Abcuro, Inc, Merrilee Needham Consultant of: Abcuro, Inc, Grant/research support from: Abcuro, Inc, Dulce Soler-Ferran Shareholder of: Abcuro, Inc, Employee of: Abcuro, Inc, Monette M. Cotreau Consultant of: Abcuro, Inc, Jorge Escobar Shareholder of: Abcuro, Employee of: Abcuro, Steven Greenberg Shareholder of: Abcuro, Inc, Consultant of: Abcuro, Inc
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Goel N. AB0953 Lack of Racial Diversity in Clinical Trials of Psoriatic Arthritis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4524] [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: 11/04/2022]
Abstract
BackgroundParticipant diversity in clinical trials of therapeutics in rheumatology is important to understand how persons of different races and ethnicities might respond differently to therapeutics. Specifically, for psoriatic arthritis (PsA), although people of color (POC) have lower disease prevalence, prevalence still ranges from 0.04-0.19% in Blacks, 0.13-0.19% in Asians, and 0.09-0.30% in Hispanics versus 0.19-0.34% in Whites in the insured population of the US1. Literature on the diversity of PsA clinical trials remains limited, though data suggest that minorities are underrepresented in clinical trials2. This analysis aims to evaluate the diversity of participants in randomized clinical trials (RCTs) of US Food and Drug Administration approved targeted therapies for PsA.ObjectivesTo evaluate the reporting of race and ethnicity in published RCTs of targeted therapeutics approved for the treatment of PsA in the US.MethodsTargeted therapies approved for use in the treatment of PsA in the US were identified. Package inserts and ClinicalTrials.gov (CT.gov) were used to identify the pivotal double blind, RCTs in PsA which supported the approval of the identified therapeutics in the US. The articles reporting the primary endpoint data were obtained. Race and ethnicity data were extracted from the published data. Countries in which the studies were conducted were identified from the publications or CT.gov. Descriptive analyses were performed.ResultsTwenty-nine pivotal RCTs in PsA evaluating targeted therapeutics, published from 2002 – 2022, were identified; 24 reported race; non-White race was reported in only 13 (45%) (Table 1 and Figure 1). In the latter, people of Black race comprised <1% of the overall population in 12 RCTs and 2.7% in the remaining RCT. People of Asian race comprised 6.1% of the overall population reflecting <10% of the population in 11 studies and 11.3% and 19.0% in the remaining 2 studies. Overall, 19 (65.6%) trials recruited participants from Asia Pacific countries. Hispanic/Latinx ethnicity was not reported in any study. Studies published from 2017-2022 reported non-White race (n=7 of 15 [47%]) no more frequently than studies published from 2004-2016 (n=6 of 14 [43%]). Although the 13 RCTs reporting non-White race may not reflect unique individuals, the total number of people included across these RCTs was 7261, of which 48 (0.7%), 441 (6.1%), and 6598 (90.9%) were Black, Asian, and White, respectively.Table 1.Race Reporting in Psoriatic Arthritis Pivotal Clinical Trials of Targeted TherapeuticsRace Reporting StatusTotal Trials (N)Trials which recruited in AP countries(n [% of N])Total Participants (N)White (n [% of N])Black (n [% of N])Asian (n [% of N])Other* (n [% of N])Not reported51 (20.0)1572----Non-White race reported1313 (44.8)72616598 (90.9)48 (0.7)441 (6.1)172 (2.4)Non-White race not reported115 (45.5)65885803 (88.1)---Total (N)2919 (65.5)15421----Abbreviations: AP, Asia Pacific; N and n, number.*Other also includes American Indian/Alaskan Native, mixed race, unknown raceNote: Numbers across rows may not add up to 0, and the total number of individuals reported in any one group may not be unique. Dashes reflect data not provided or able to be calculated.ConclusionOur data show under-reporting of race and ethnicity in publications of pivotal PsA RCTs, and no evidence of improved reporting over time. Whites were overrepresented in pivotal trials of PsA, especially when considering 72 and 62% of the US population was White in 2010 and 2020 (US Census data), respectively, and the reported prevalence of PsA by race in the insured population of the US1. Improved reporting of race/ethnicity and increased representation of racial/ethnic minorities in PsA RCTs are needed.References[1]Ogdie A, et al. Rheumatol Ther. 2021;8(4):1725-39.[2]https://trialfacts.com/diversity-inclusion/ accessed 22 Aug 2021Disclosure of InterestsNiti Goel Shareholder of: UCB, Abcuro, Employee of: Abcuro
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Goel N, Cannell S, Davies G, Natti MS, Kirupaalar V, Abelian A, Saeed S, Smith R, Manikonda R, Pitchaikani PK, Davies D, Morris RM, Edwards L, Govindaraju R, Creese K, Jones J, Choudhary J, Rowley S, Sethuraman C, Muxworthy H, Curtis F, Donnelly P, Joishy M, Barnard I, Kenny C, Pal R, Jones K, Banerjee S. Implementation of an adapted Sepsis Risk Calculator algorithm to reduce antibiotic usage in the management of early onset neonatal sepsis: a multicentre initiative in Wales, UK. Arch Dis Child Fetal Neonatal Ed 2022; 107:303-310. [PMID: 34551917 DOI: 10.1136/archdischild-2020-321489] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/06/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Assess the impact of introducing a consensus guideline incorporating an adapted Sepsis Risk Calculator (SRC) algorithm, in the management of early onset neonatal sepsis (EONS), on antibiotic usage and patient safety. DESIGN Multicentre prospective study SETTING: Ten perinatal hospitals in Wales, UK. PATIENTS All live births ≥34 weeks' gestation over a 12-month period (April 2019-March 2020) compared with infants in the preceding 15-month period (January 2018-March 2019) as a baseline. METHODS The consensus guideline was introduced in clinical practice on 1 April 2019. It incorporated a modified SRC algorithm, enhanced in-hospital surveillance, ongoing quality assurance, standardised staff training and parent education. The main outcome measure was antibiotic usage/1000 live births, balancing this with analysis of harm from delayed diagnosis and treatment, disease severity and readmissions from true sepsis. Outcome measures were analysed using statistical process control charts. MAIN OUTCOME MEASURES Proportion of antibiotic use in infants ≥34 weeks' gestation. RESULTS 4304 (14.3%) of the 30 105 live-born infants received antibiotics in the baseline period compared with 1917 (7.7%) of 24 749 infants in the intervention period (45.5% mean reduction). All 19 infants with culture-positive sepsis in the postimplementation phase were identified and treated appropriately. There were no increases in sepsis-related neonatal unit admissions, disease morbidity and late readmissions. CONCLUSIONS This multicentre study provides evidence that a judicious adaptation of the SRC incorporating enhanced surveillance can be safely introduced in the National Health Service and is effective in reducing antibiotic use for EONS without increasing morbidity and mortality.
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Affiliation(s)
- Nitin Goel
- Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Gemma Davies
- Department of Neonatal Medicine, Singleton Hospital, Swansea, UK
| | | | | | - Artur Abelian
- Department of Paediatrics, Wrexham Maelor Hospital, Wrexham, UK
| | - Shakir Saeed
- Department of Paediatrics, Ysbyty Gwynedd, Bangor, Gwynedd, UK
| | - Rhian Smith
- Department of Neonatal Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
| | - Ravi Manikonda
- Department of Paediatrics, Nevill Hall Hospital, Abergavenny, UK
| | | | - Dawn Davies
- Department of Paediatrics, Bronglais General Hospital, Aberystwyth, Ceredigion, UK
| | - Rachel May Morris
- Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | - Lynsey Edwards
- Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Kate Creese
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - Jane Jones
- Department of Paediatrics, Wrexham Maelor Hospital, Wrexham, UK
| | - Jalil Choudhary
- Department of Paediatrics, Ysbyty Gwynedd, Bangor, Gwynedd, UK
| | - Sarah Rowley
- Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Helen Muxworthy
- Department of Women's Health, Singleton Hospital, Swansea, UK
| | - Felicity Curtis
- Department of Women's Health, Singleton Hospital, Swansea, UK
| | | | - Manohar Joishy
- Department of Paediatrics, Ysbyty Gwynedd, Bangor, Gwynedd, UK
| | - Ian Barnard
- Department of Neonatal Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire, UK
| | - Celyn Kenny
- Department of Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | - Rajarshi Pal
- Department of Paediatrics, Glangwili General Hospital, Carmarthen, Carmarthenshire, UK
| | - Karen Jones
- Department of Paediatrics, Glangwili General Hospital, Carmarthen, Carmarthenshire, UK
| | - Sujoy Banerjee
- Department of Neonatal Medicine, Singleton Hospital, Swansea, UK
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Kalra P, Sharma V, Goel N. A study of factors affecting job satisfaction of management faculties with respect to gender based differences: The case of gender based differences in teaching sector. JIMS8M The Journal of Indian Management & Strategy 2022. [DOI: 10.5958/0973-9343.2022.00021.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mrigpuri P, Spalgais S, Goel N, Mehta RK, Sonal S, Kumar R. A low-cost pulmonary function test laboratory setup for infection control during COVID-19. Lung India 2022; 39:93-94. [PMID: 34975066 PMCID: PMC8926230 DOI: 10.4103/lungindia.lungindia_578_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Parul Mrigpuri
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Sonam Spalgais
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Nitin Goel
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Rajesh Kumar Mehta
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Sonal Sonal
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Raj Kumar
- Department Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
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13
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Chakraborty M, Rodrigues PRS, Watkins WJ, Hayward A, Sharma A, Hayward R, Smit E, Jones R, Goel N, Asokkumar A, Calvert J, Odd D, Morris I, Doherty C, Elliott S, Strang A, Andrews R, Zaher S, Sharma S, Bell S, Oruganti S, Smith C, Orme J, Edkins S, Craigon M, White D, Dantoft W, Davies LC, Moet L, McLaren JE, Clarkstone S, Watson GL, Hood K, Kotecha S, Morgan BP, O'Donnell VB, Ghazal P. nSeP: immune and metabolic biomarkers for early detection of neonatal sepsis-protocol for a prospective multicohort study. BMJ Open 2021; 11:e050100. [PMID: 37010923 PMCID: PMC8718461 DOI: 10.1136/bmjopen-2021-050100] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Diagnosing neonatal sepsis is heavily dependent on clinical phenotyping as culture-positive body fluid has poor sensitivity, and existing blood biomarkers have poor specificity.A combination of machine learning, statistical and deep pathway biology analyses led to the identification of a tripartite panel of biologically connected immune and metabolic markers that showed greater than 99% accuracy for detecting bacterial infection with 100% sensitivity. The cohort study described here is designed as a large-scale clinical validation of this previous work. METHODS AND ANALYSIS This multicentre observational study will prospectively recruit a total of 1445 newborn infants (all gestations)-1084 with suspected early-or late-onset sepsis, and 361 controls-over 4 years. A small volume of whole blood will be collected from infants with suspected sepsis at the time of presentation. This sample will be used for integrated transcriptomic, lipidomic and targeted proteomics profiling. In addition, a subset of samples will be subjected to cellular phenotype and proteomic analyses. A second sample from the same patient will be collected at 24 hours, with an opportunistic sampling for stool culture. For control infants, only one set of blood and stool sample will be collected to coincide with clinical blood sampling. Along with detailed clinical information, blood and stool samples will be analysed and the information will be used to identify and validate the efficacy of immune-metabolic networks in the diagnosis of bacterial neonatal sepsis and to identify new host biomarkers for viral sepsis. ETHICS AND DISSEMINATION The study has received research ethics committee approval from the Wales Research Ethics Committee 2 (reference 19/WA/0008) and operational approval from Health and Care Research Wales. Submission of study results for publication will involve making available all anonymised primary and processed data on public repository sites. TRIAL REGISTRATION NUMBER NCT03777670.
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Affiliation(s)
- Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | - W John Watkins
- Department of Statistics, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Angela Hayward
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Alok Sharma
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Rachel Hayward
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Elisa Smit
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Rebekka Jones
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Nitin Goel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Amar Asokkumar
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Jennifer Calvert
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - David Odd
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Ian Morris
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Cora Doherty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Sian Elliott
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Angela Strang
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Robert Andrews
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Summia Zaher
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Simran Sharma
- Infection and Immunity, Cardiff University, Cardiff, UK
- Women's unit, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Sarah Bell
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - Siva Oruganti
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Claire Smith
- Simpsons Special Cary Baby Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Judith Orme
- Simpsons Special Cary Baby Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sarah Edkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Marie Craigon
- Infection Medicine, Deanery of Biomedical Sciences, Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Daniel White
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Widad Dantoft
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Luke C Davies
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Linda Moet
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - James E McLaren
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Samantha Clarkstone
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Gareth L Watson
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, Institute of Molecular & Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - B Paul Morgan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Valerie B O'Donnell
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Ghazal
- Department of Systems Medicine, Medical School, Cardiff University, Cardiff, UK
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Goel N, Goyal N, Nagaraja R, Kumar R. Systemic corticosteroids for management of 'long-COVID': an evaluation after 3 months of treatment. Monaldi Arch Chest Dis 2021; 92. [PMID: 34730322 DOI: 10.4081/monaldi.2021.1981] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
Some patients even 4 weeks after Corona Virus Disease 2019 (COVID-19) remain to be symptomatic and are known as "long-COVID". In the present study we performed the follow up evaluation at 3 months of long-COVID patients, after treatment with systemic steroids. During the study duration, out of the 4,542 patients managed in the outpatient department of the particular unit, there were 49 patients of Long-COVID. The patients having abnormal computed tomography (CT) alongwith resting hypoxia or exertional desaturation were treated with systemic steroid (deflazacort) in tapering doses for 8-10 weeks. We retrospectively analysed the clinical and radiological findings of these patients at first presentation and at about 3 months of follow up visit. On follow up, all the 49 long-COVID patients showed improvement. The occurrence of breathlessness decreased from 91.83% to 44.89% (p<0.001) and cough from 77.55% to 8.16% (p<0.001). Twenty-four patients were prescribed systemic steroids. Out of these, nearly 58% patients had MMRC grade 4 breathlessness, which decreased to < 2 MMRC in about 86% of these patients. MMRC grade (median) decreased from 3 to 1 (p<0.001). Majority of patients who were tachypnoeic and hypoxic at rest (n=7) showed improvement (71%), post-treatment with corticosteroids. Occurrence of normal chest X-ray increased from 12% to 71% (p<0.001). All these patients had abnormal CT thorax initially, and post-treatment 25% had normal CT thorax. Hence, we conclude that systemic steroids are helpful in hastening recovery of select subset of long-COVID patients. Simultaneously, we should be cautious of immunosuppressive effects of steroids like tuberculosis reactivation, especially in tuberculosis endemic countries. These findings have therapeutic implications and may serve as guidance for future approach to the management of 'long-COVID' with pulmonary sequalae.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Nitesh Goyal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Ravishankar Nagaraja
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
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15
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McConnell D, Goel N, Eschbach E, Hickey S, Beattie B, Rozehnal J, Leibner E, Mathews K. 50 Emergency Department Management and Outcomes of COVID-19 Acute Hypoxemic Respiratory Failure During the New York City Surge. Ann Emerg Med 2021. [PMCID: PMC8335511 DOI: 10.1016/j.annemergmed.2021.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Coates LC, Soriano E, Corp N, Bertheussen H, Callis-Duffin K, Barbosa Campanholo C, Chau J, Eder L, Fernandez D, Fitzgerald O, Garg A, Gladman DD, Goel N, Grieb S, Helliwell P, Husni ME, Jadon D, Katz A, Laheru D, Latella J, Leung YY, Lindsay C, Lubrano E, Mazzuoccolo L, Mcdonald R, Mease PJ, O’sullivan D, Ogdie A, Olsder W, Schick L, Steinkoenig I, De Wit M, Van der Windt D, Kavanaugh A. OP0229 THE GROUP FOR RESEARCH AND ASSESSMENT OF PSORIASIS AND PSORIATIC ARTHRITIS (GRAPPA) TREATMENT RECOMMENDATIONS 2021. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4091] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Since the 2015 GRAPPA treatment recommendations were published, therapeutic options and management strategies for psoriatic arthritis (PsA) have advanced considerably.Objectives:The goal of the GRAPPA recommendations update is to develop high quality, evidence-based recommendations for the treatment of PsA, including related conditions and comorbidities.Methods:GRAPPA rheumatologists, dermatologists and patient research partners (PRPs) updated overarching principles for the management of adults with PsA by consensus. Principles considering use of biosimilars and tapering/discontinuing of therapy were added to this update. Systematic literature searches based on data publicly available from three databases (MEDLINE, EMBASE, and Cochrane CENTRAL) were conducted from the end of the previous recommendations’ searches through August 2020. Additional abstract searches were performed for conference presentations in 2017-2020. Searches covered PsA treatments (peripheral arthritis, axial arthritis, enthesitis, dactylitis, skin, and nail disease). Additional searches were performed for related conditions (uveitis and IBD) and comorbidities evaluating their impact on safety and treatment outcomes. Individual groups assessed the risk of bias and applied the GRADE system to generate strong or conditional recommendations for therapies within the domain groups and for the management of comorbidities and related conditions. These recommendations were then incorporated into an overall treatment schema.Results:Updated, evidence-based treatment recommendations are shown (Table 1). Since 2015, many new medications have been incorporated. Additional results for older medications, such as methotrexate, have been published across PsA domains. Based on the evidence, the treatment recommendations developed by individual groups were incorporated into the overall schema including principles for management of arthritis, spondylitis, enthesitis, dactylitis, skin, and nail disease in PsA, and associated conditions (Figure 1). Choice of therapy for an individual should ideally address all of the domains that impact on that patient, supporting shared decision making with the patient involved. Additional consideration in the recommendations was given to key associated conditions and comorbidities as these often impact on therapy choice.Conclusion:These GRAPPA treatment recommendations provide up to date, evidence-based guidance to providers who manage and treat adult patients with PsA. These recommendations are based on domain-based strategy for PsA and supplemented by overarching principles developed by consensus of GRAPPA members.IndicationStrongForConditional ForConditionalAgainstStrongAgainstInsufficient evidencePeripheral Arthritis DMARD NaïvecsDMARDs, TNFi, PDE4i, IL-12/23i, IL-17i, IL-23i, JAKiNSAIDs, oral CS, IA CS,IL-6i,Peripheral Arthritis DMARD IRTNFi, IL-12/23i, IL-17i, IL-23i, JAKiPDE4i, other csDMARD, NSAIDs, oral CS, IA CS,IL-6i,Peripheral ArthritisbDMARD IRTNFi, IL-17i, IL-23i, JAKi,NSAIDs, oral CS, IA CS, IL-12/23i, PDE4i, CTLA-4-IgIL-6i,Axial arthritis, Biologic NaïveNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKiCS SIJ injections, bisphosphonatescsDMARDs, IL-6i,IL-12/23i, IL-23iAxial PsA, Biologic IRNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKi csDMARDs, IL-6i,IL-12/23i, IL-23iEnthesitisTNFi, IL-12/23i, IL-17i, PDE4i, IL-23i, JAKiNSAIDs, physiotherapy, CS injections, MTXIL-6i,Other csDMARDsDactylitisTNFi IL-12/23i, IL-17i, IL-23i, JAKi, PDE4iNSAIDs, CS injections, MTXOther csDMARDsPsoriasisTopicals, phototherapy, csDMARDs, TNFi, IL-12/23i, IL-17i, IL-23i, PDE4i, JAKi AcitretinNail psoriasisTNFi, IL12/23i, IL17i, IL23i, PDE4iTopical CS, tacrolimus and calcipotriol combination or individual therapies, Pulsed dye laser, csDMARDs, acitretin, JAKiTopical Cyclosporine / Tazarotene, Fumarate, Fumaric Acid Esters, UVA and UVB Phototherapy, AlitretinoinIBDTNFi (not ETN), IL-12/23i, JAKiIL-17iUveitisTNFi (not ETN)Disclosure of Interests:Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, Janssen, Novartis Pharma, Pfizer, Roche, and UCB, Nadia Corp: None declared, Heidi Bertheussen Consultant of: Pfizer, Kristina Callis-Duffin Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Lilly, Janssen, Novartis, Pfizer, Sienna Biopharmaceuticals, Stiefel Laboratories, UCB, Ortho Dermatologics, Inc, Regeneron Pharmaceuticals, Inc., Anaptys Bio, Boehringer Ingelheim., Cristiano Barbosa Campanholo Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Jeffrey Chau: None declared, Lihi Eder Consultant of: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Grant/research support from: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Daniel Fernandez Consultant of: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Grant/research support from: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Oliver FitzGerald Speakers bureau: AbbVie, Janssen and Pfizer Inc, Consultant of: BMS, Celgene, Eli Lilly, Janssen and Pfizer Inc, Grant/research support from: AbbVie, BMS, Eli Lilly, Novartis and Pfizer Inc, Amit Garg Consultant of: Abbvie, Amgen, Asana Biosciences, Bristol Myers Squibb, Boehringer Ingelheim, Incyte, InflaRx, Janssen, Pfizer, UCB, Viela Biosciences, Grant/research support from: Abbvie, Dafna D Gladman Consultant of: Abbvie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Jansen, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Amgen, Eli Lilly, Jansen, Novartis, Pfizer and UCB, Niti Goel: None declared, Suzanne Grieb: None declared, Philip Helliwell Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Eli Lilly, M Elaine Husni Consultant of: Abbvie, Amgen, Janssen, Novartis, Lilly, UCB, Regeneron, and Pfizer, Deepak Jadon Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Arnon Katz: None declared, Dhruvkumar Laheru: None declared, John Latella: None declared, Ying Ying Leung Speakers bureau: Novartis, AbbVie, Eli Lilly, Janssen, Consultant of: Pfizer and Boehringer Ingelheim, Grant/research support from: Pfizer and conference support from AbbVie, Christine Lindsay Shareholder of: Amgen, Employee of: Aurinia pharmaceuticals, Ennio Lubrano Speakers bureau: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Consultant of: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Luis Mazzuoccolo Speakers bureau: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Consultant of: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Roland McDonald: None declared, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Janssen, Novartis, Pfizer, SUN and UCB, Denis O’Sullivan: None declared, Alexis Ogdie Consultant of: AbbVie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, and Pfizer, Grant/research support from: Novartis and Pfizer and Amgen, Wendy Olsder: None declared, Lori Schick: None declared, Ingrid Steinkoenig: None declared, Maarten de Wit Consultant of: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Danielle van der Windt: None declared, Arthur Kavanaugh Speakers bureau: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB
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Sharma P, Goel N, Dogar K, Bhalla M, Thami GP, Punia K. Adverse skin reactions related to PPE among healthcare workers managing COVID-19. J Eur Acad Dermatol Venereol 2021; 35:e481-e483. [PMID: 33866611 PMCID: PMC8251062 DOI: 10.1111/jdv.17290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- P Sharma
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - N Goel
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - K Dogar
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - M Bhalla
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - G P Thami
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
| | - K Punia
- Department of Dermatology, Government Medical College and Hospital, Chandigarh, India
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18
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Sharma MK, Mishra D, Goel N. Efficacy of ondansetron and palonosetron in prevention of shivering under spinal anesthesia: A prospective randomized double-blind study in patients undergoing elective LSCS. J Anaesthesiol Clin Pharmacol 2021; 37:63-66. [PMID: 34103825 PMCID: PMC8174421 DOI: 10.4103/joacp.joacp_215_18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 06/25/2019] [Accepted: 08/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Material and Methods: A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally. Results: No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group). Conclusion: Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.
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Affiliation(s)
- Manoj K Sharma
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
| | - Deepak Mishra
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
| | - Nitin Goel
- Department of Anaesthesiology and Critical Care, Military Hospital, Meerut, Uttar Pradesh, India
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19
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Goel N, Goyal N, Kumar R. Clinico-radiological evaluation of post COVID-19 at a tertiary pulmonary care centre in Delhi, India. Monaldi Arch Chest Dis 2021; 91. [PMID: 33691394 DOI: 10.4081/monaldi.2021.1682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
In the present COVID-19 pandemic situation, there is a gradual increase in number of patients with post-COVID-19 sequalae. The present study is a retrospective analysis of these post-COVID-19 patients presenting to one of the units of Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi in the period from 17 June 2020 to 22 October 2020. We analysed the demographic profile, history, functional assessment and all investigations of this study cohort. Out of the 2,165 patients provided consultation, there were 35 patients of post-COVID-19, which were included in the present study. These patients had a mean duration of 47 days from discharge to first visit to our hospital. Pre-existing respiratory comorbidity was present in 63%. History of hospitalisation was present in 52%. Fatigue (65%) was the most common symptom followed by breathlessness (60%), cough (45.71%) and chest pain (28.57%). Three patients had significant desaturation on 6-minute walk test and one patient had type 2 respiratory failure on presentation. Chest X-ray was abnormal in 34.28% (n=12). On CT thorax (n=17) the most common finding was diffuse reticulations (52.94%) followed by diffuse ground glass opacities (GGOs) (35.29%). One patient each were newly diagnosed as pulmonary tuberculosis and tubercular unilateral hilar lymphadenopathy. Conclusively, post-COVID-19 patients may have remnant symptoms like fatigue, breathlessness and cough. Also, patients with pre-existing respiratory diseases are more symptomatic and even may suffer from deterioration in the clinical course. Further we need to be alert of alternate diagnosis or infections like tuberculosis (TB) in these patients, especially in TB endemic countries like India. Simultaneously, the use of immunosuppressant drugs like steroids for COVID-19 management, predisposes to TB. A proper evaluation with holistic and standardised management plan is the need of the hour for post-COVID-19 patients, until its time course, evolution and manifestations are unravelled.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Nitesh Goyal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
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Goel N, Goyal N, Kumar R. Exertional dyspnea and hemoptysis in an adolescent: is it tuberculosis only? Monaldi Arch Chest Dis 2021; 91. [PMID: 33550793 DOI: 10.4081/monaldi.2021.1613] [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] [Received: 09/17/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
Unilateral pulmonary artery atresia (UPAA), commonly detected in childhood, can occasionally present in adulthood with typical symptoms of recurrent pulmonary infections, dyspnoea on exertion and hemoptysis. An 18-year-old girl presented with complaints of cough, dyspnea on exertion and hemoptysis. Chest radiograph revealed dilated pulmonary trunk, signs of left sided volume loss and cavitating lesion in left lower zone. Pulmonary CT angiography found left pulmonary artery atresia. Endobronchial lung biopsy revealed granulomatous inflammation. Diagnosis of left sided UPAA with pulmonary tuberculosis was established. She responded well to the anti-tubercular therapy. This case highlights the importance of awareness about UPAA as a possible differential for exertional dyspnea, recurrent chest infections, hemoptysis and pulmonary hypertension in adults.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Nitesh Goyal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
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Vaideeswar P, Bhuvan M, Goel N. Pulmonary ossifying carcinoid - MEN in a male? J Postgrad Med 2021; 68:44-47. [PMID: 33533747 PMCID: PMC8860124 DOI: 10.4103/jpgm.jpgm_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pulmonary carcinoid tumors are considered as low-grade neoplasms, seen as centrally located endobronchial masses or as peripheral circumscribed nodules. Calcification or ossification is a known phenomenon, but presentation as large bony mass is extremely uncommon. Herein, we report a case of ossifying bronchial carcinoid along with nodular Hashimoto's thyroiditis as incidental autopsy findings in a 32-year-old patient with a prior recent excision of pituitary macroadenoma. This association suggests the possibility of multiple endocrine neoplasia in this young male.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Bhuvan
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Mrigpuri P, Sonal S, Spalgais S, Goel N, Menon B, Kumar R. Uncontrolled diabetes mellitus: A risk factor for post COVID fibrosis. Monaldi Arch Chest Dis 2021; 91. [PMID: 33501821 DOI: 10.4081/monaldi.2021.1607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022] Open
Abstract
Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...
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Affiliation(s)
- Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Sonal Sonal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Balakrishnan Menon
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of New Delhi.
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Sharma P, Gupta S, Goel N, Gupta A, Saini V, Sharma N. A review: novel coronavirus (COVID-19): an evidence-based approach. Biomedical Engineering Tools for Management for Patients with COVID-19 2021. [PMCID: PMC8192331 DOI: 10.1016/b978-0-12-824473-9.00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The World Health Organization in China was informed about the cases of pneumonia of unknown antecedent ailments. Since then, there have been over 141 million cases globally of 2019 novel coronavirus (Covid-19), 3.01 million deaths, and over 80.4 million recovered. Clinical research of novel agents represent opportunities to inform real-time public health action. In 2018 there was a systematic review to identify priority research questions for Severe Acute Respiratory Syndrome-related coronavirus and Middle East Respiratory Syndrome-related coronavirus. Here, we review information available on COVID-19 and provide evidenced-based approaches in clinical research for the current COVID-19 outbreak.
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Goel N, Spalgais S, Mrigpuri P, Khanna M, Menon B, Kumar R. Characteristics of COVID-19 at a non-COVID tertiary pulmonary care centre in Delhi, India. Monaldi Arch Chest Dis 2020; 90. [PMID: 33169599 DOI: 10.4081/monaldi.2020.1568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022] Open
Abstract
The pandemic of COVID-19 has emerged as a serious health crisis globally and India too has been extensively affected with 604,641 active cases reported, till date. The present study focuses on the demographic, clinical and laboratory profile of such patients from a tertiary level non-COVID respiratory care hospital. This is a retrospective observational study. Seventy-seven sick patients fulfilling COVID suspect criteria were admitted to the isolation area. Their RT-PCR test was done from the designated laboratory and 35 of them were confirmed to be COVID-19 patients. The detailed demographic, clinical and laboratory profile of these COVID-19 patients was studied. The mean age was 46±17 years with male predominance (57%). Majority of the cases (83%) were symptomatic. The most common symptom was cough (66%) followed by breathlessness and fever. Nineteen (54.3%) patients had one or the other co-morbidity and 16 (45.7%) had chronic lung diseases as one of the comorbidities. Nearly half of the patients (51%) required supplementary oxygen on presentation. Two patients were put on invasive mechanical ventilation while 4 patients required non-invasive ventilation before being shifted to the COVID hospital. Hence, it can be concluded that COVID-19 in patients of chronic respiratory diseases manifests with higher prevalence of symptoms and also higher severity of disease. Further, the symptomatology of COVID-19 closely mimics the acute exacerbation of chronic lung diseases, so cautious screening and testing should be done, especially at the pulmonary department.
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Affiliation(s)
- Nitin Goel
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Madhu Khanna
- Virology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Balakrishnan Menon
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi.
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Boel L, Banerjee S, Clark M, Greenwood A, Sharma A, Goel N, Bagga G, Poon C, Odd D, Chakraborty M. Temporal trends of care practices, morbidity, and mortality of extremely preterm infants over 10-years in South Wales, UK. Sci Rep 2020; 10:18738. [PMID: 33127999 PMCID: PMC7603316 DOI: 10.1038/s41598-020-75749-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/15/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants < 28 weeks of gestation in tertiary neonatal units between 01/01/2007 and 31/12/2016. Patient characteristics, clinical practices, mortality, and morbidity were studied until death or discharge home. Temporal trends were examined by adjusted multivariable logistic regression models and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). A sensitivity analysis was conducted after excluding infants born at < 24 weeks of gestation. In this population, overall mortality for infants after live birth was 28.2% (267/948). The odds of mortality (aOR 0.93, 95% CI [0.88, 0.99]) and admission to the neonatal unit (0.93 [0.87, 0.98]) significantly decreased over time. Non-invasive ventilation support during stabilisation at birth increased significantly (1.26 [1.15, 1.38]) with corresponding decrease in mechanical ventilation at birth (0.89 [0.81, 0.97]) and following admission (0.80 [0.68–0.96]). Medical treatment for patent ductus arteriosus significantly decreased over the study period (0.90 [0.85, 0.96]). The incidence of major neonatal morbidities remained stable, except for a reduction in late-onset sepsis (0.94 [0.89, 0.99]). Gestation and centre of birth were significant independent factors for several outcomes. The results from our sensitivity analysis were compatible with our main results with the notable exception of death after admission to NICU (0.95 [0.89, 1.01]). There were significant improvements in survival and reduction of late-onset sepsis of extreme preterm infants in South Wales between 2007 and 2016. The sensitivity analysis suggests that some of the temporal changes observed were driven by improved outcomes in the most preterm of infants. Clinical practices related to respiratory support have changed but significant variations in clinical practices and outcomes between centres remain unexplained. The adoption of regional evidence-based clinical guidelines is likely to improve outcomes and reduce variation.
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Affiliation(s)
- Lieve Boel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Sujoy Banerjee
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, UK
| | - Megan Clark
- School of Medicine, Cardiff University, Cardiff, UK
| | - Annabel Greenwood
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Alok Sharma
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Nitin Goel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Gautam Bagga
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - Chuen Poon
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - David Odd
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK. .,Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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Roane B, Ostby S, Wall J, Londono A, Goel N, Leath C, Arend R. How do uterine cancer NGS results impact patient outcomes? Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Antony A, Holland R, Mokkink W, D’agostino MA, Maksymowych WP, Bertheussen H, Schick L, Goel N, Ogdie A, Orbai AM, Hoejgaard P, Coates LC, Strand V, Gladman DD, Christensen R, Leung YY, Mease PJ, Tillett W. AB0737 MEASUREMENT PROPERTIES OF RADIOGRAPHIC OUTCOME MEASURES IN PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW FROM THE GRAPPA-OMERACT INITIATIVE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Structural damage was identified as an important outcome domain in the Psoriatic Arthritis (PsA) Core Domain Set and should be assessed at least once in the development of a new therapeutic.Objectives:To conduct a systematic literature review (SLR) to identify studies addressing the measurement properties (MPs) for ROIs and appraise the evidence through the OMERACT Filter 2.1 Framework Instrument Selection Algorithm (OFISA). [1]Methods:An SLR was conducted in EMBASE and MEDLINE to identify full-text English studies developing or assessing MPs of ROIs in PsA. Determination of eligibility, data extraction and methodology asssessment were performed by 2 reviewers. MPs were rated according to the ‘Provisional Standards’ and assigned a Red/Amber/White/Green (RAWG) rating (Figure 1). [1, 2]Results:3621 references were screened, 531 full-text articles reviewed, and 12 were included (Figure 2). Nine instruments assessing peripheral radiographs and six assessing axial radiographs were identified (Table 1). Three of the nine peripheral radiographic instruments had adequate evidence for reliability and some evidence for construct validity: the modified Steinbrocker, Ratingen, and modified Sharp van der Heijde scores. There was scant evidence for reliability, construct validity and responsiveness for the axial ROIs, compounded by the lack of a standardized definition of axial PsA.Conclusion:This SLR summarizes the MPs of ROIs and identifies relevant knowledge gaps that need to be addressed prior to endorsement of an instrument for the PsA Core Domain Set.References:[1]Richards P and De Wit M, editors. The OMERACT Handbook (March 2019)[2]Mokkink LB and D’Agostino MA. Protocol for performing a systematic review on imaging techniques (unpublished)Figure 1.Criteria for the RAWG RatingFigure 2.PRISMA DiagramTable 1.Summary of Measurement PropertiesROIDomain MatchFeasibilityConstruct ValidityDiscriminationReliabilityResponsivenessInter-raterIntra-raterMeasurement ErrorLongitudinal Construct ValidityClinical Trial DiscriminationThresholds of MeaningOriginal Steinbrocker ScoreA[1]A[1]R[1]Modified Steinbrocker Score#G[2]G[2]A[1]A[2]Modified Larsen ScoreA[1]A[1]A[1]*Ratingen Score#A[1]G[3]G[3]A[3]A[1]mTSS-AA[1]A[1]A[1]mTSS-B#A[1]A[1]A[1]A[1]*mSvdHs#A[2]G[2]G[2]A[1]A[1]*ReXPsAR[0]SPARS#A[1]A[1]A[1]Axial PsA Definition 1MSASSS#A[2]R[0]BASRI - Total#A[2]R[0]PASRI#A[2]R[0]Axial PsA Definition 2MSASSS#A[1]R[1]A[1]A[1]BASRI - Spine#R[1]A[1]A[1]PASRI#A[1]A[1]A[1]Modified NYC#R[1]A[1]RASSS#R[1]A[1]A[1]A = Amber, R = Red, G = Green[Total available studies for synthesis following excluding studies with poor methodology]* RCT data available but no published effect sizes# Feasibility data availableDisclosure of Interests:Anna Antony: None declared, Richard Holland: None declared, Wieneke Mokkink: None declared, Maria-Antonietta d’Agostino: None declared, Walter P Maksymowych Grant/research support from: Received research and/or educational grants from Abbvie, Novartis, Pfizer, UCB, Consultant of: WPM is Chief Medical Officer of CARE Arthritis Limited, has received consultant/participated in advisory boards for Abbvie, Boehringer, Celgene, Eli-Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Received speaker fees from Abbvie, Janssen, Novartis, Pfizer, UCB., Heidi Bertheussen: None declared, Lori Schick: None declared, Niti Goel Shareholder of: UCB and Galapagos, Consultant of: VielaBio, Mallinckrodt, and IMMVention, Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service., Pil Hoejgaard: None declared, Laura C Coates: None declared, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Robin Christensen: None declared, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB
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Leung YY, Holland R, Mathew A, Lindsay C, Goel N, Ogdie A, Orbai AM, Hoejgaard P, Chau J, Coates LC, Strand V, Gladman DD, Christensen R, Tillett W, Mease PJ. AB0794 CLINICAL TRIAL DISCRIMINATION OF PHYSICAL FUNCTION INSTRUMENTS FOR PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.883] [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: 11/04/2022]
Abstract
Background:Physical function is a core domain to be measured in randomized controlled trials (RCTs) of psoriatic arthritis (PsA). The discriminative performance of patient reported outcome measures (PROMs) for physical function (PF) in RCTs has not been evaluated systematically.Objectives:In this systematic review, the GRAPPA-OMERACT working group aimed to evaluate the clinical trial discrimination of PF-PROMs in PsA RCTs.Methods:We searched PubMed and Scopus databases in English to identify all original RCTs conducted in PsA. We limited the review to RCTs of biologic and targeted synthetic DMARDs. Groups of two researchers extracted data independently for PF-PROMs. We assessed quality in each article using the OMERACT good method checklist. Effect sizes (ES) for the PF-PROMs were calculated and appraised usinga priorihypotheses. Evidence supporting clinical trial discrimination for each PF-PROM was summarized to derive recommendations.Results:32 articles were included (Figure 1). Four PF-PROMs had data for evaluation: HAQ-Disability Index (DI), HAQ-Spondyloarthritis (S), Short Form 36-item Health Survey Physical Component Summary (SF-36 PCS), and the Physical Functioning domain (SF-36 PF) (Table 1). The ES for intervention versus (vs.) control arms for HAQ-DI ranged from -0.55 to -1.81 vs. 0.24 to -0.52; and for SF-36 PCS ranged from 0.30 to 1.86 vs. -0.02 to 0.63.Table 1.Summary of Measurement Properties Table for clinical trial discriminationArticlesHAQ-DIHAQ-SSF-36 PCSSF-36 PFAntoni 2005 (IMPACT); Gottlieb 2009 (UST)+Antoni 2005 (IMPACT2)++Kavanaugh 2006 (IMPACT2)+Mease 2005 (ADEPT); Genovese 2007 (ADA); Mease 2010 (ETN); Kavanaugh 2009 (GO-REVEAL); Kavanaugh 2017 (GO-VIBRANT); Gladman 2014 (RAPID-PsA); Mease 2015 (FUTURE1); McInnes 2015 (FUTURE2); Kavanaugh, 2016 (FUTURE2)-subgroup; Nash 2018 (FUTURE3); Mease 2017 (SPIRIT-P1); Nash 2017 (SPIRIT-P2); Deodhar 2018 (GUS); Mease 2016 (CLZ)++Mease 2000 (ETN); McInne, 2013 (PSUMMIT 1); Ritchlin 2014 (PSUMMIT 2); Araugo 2019 (ECLIPSA)++Gniadecki 2012 (PRESTA)+Mease 2019 (SEAM-PsA)+/-+McInnes 2014 (SEC)++Mease 2014 (BRO)++Mease 2011 (ABT)+/-+Mease 2017 (ASTRAEA)++Mease 2006 (ALC)+/-Mease 2017 (OPAL Broaden); Gladman 2017 (OPAL Beyond)++Mease 2018 (EQUATOR)++Mease 2018 (ABT-122)+Total available articles311244Total articles for evidence synthesis291232Overall rating+++Color code in each box indicate study quality by OMERACT good methods. GREEN: “likely low risk of bias”; AMBER: “some cautions but can be used as evidence”; RED: “don’t use as evidence”. WHITE (empty boxes): absence of information from that study. (+): findings had adequate performance of the instrument; (+/-): equivocal performance; (-): poor performance (less than adequate).Conclusion:Clinical trial discrimination was supported for HAQ-DI and SF-36 PCS in PsA with low risk of bias; and for SF-36 PF with some caution. More studies are required for HAQ-S.Disclosure of Interests:Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly, Richard Holland: None declared, Ashish Mathew: None declared, Christine Lindsay Employee of: Previously employed (worked) for pharmaceutical company., Niti Goel Shareholder of: UCB and Galapagos, Consultant of: VielaBio, Mallinckrodt, and IMMVention, Alexis Ogdie Grant/research support from: Novartis, Pfizer – grant/research support, Consultant of: AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Takeda – consultant, Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service., Pil Hoejgaard: None declared, Jeffrey Chau: None declared, Laura C Coates: None declared, Vibeke Strand: None declared, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Robin Christensen: None declared, William Tillett: None declared, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau
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Yamazaki EM, Rosendahl-Garcia KM, MacMullen LE, Ecker AJ, Kirkpatrick JN, Goel N. 0042 Stroke Volume and Cardiac Index are Differentially Altered by Total Sleep Deprivation and Psychological Stress in Resilient vs. Vulnerable Individuals and Predict Cognitive Performance. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.041] [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] Open
Abstract
Abstract
Introduction
Individuals show robust resilience and vulnerability in neurobehavioral performance to sleep loss and stress. For the first time, we investigated the time course of two cardiovascular measurements, stroke volume (SV) and cardiac index (CI), both derived from echocardiography, across baseline, total sleep deprivation (TSD), the combination of TSD+psychological stress, and recovery. We also determined whether these variables differ in resilient vs. vulnerable individuals and whether they predict differential vulnerability in cognitive performance.
Methods
Thirty-one healthy adults (ages 27–53; mean±SD, 35.4±7.1y; 14 females) participated in a five-day experiment consisting of two 8h time-in-bed (TIB) baseline nights, 39h TSD, and two 8h-10h TIB recovery nights. A modified Trier Social Stress Test (TSST) was conducted on the TSD day to induce psychological stress. Echocardiographic measures of SV and CI were obtained at six time points (pre-study, baseline, during TSD, during TSD after the TSST, after recovery, and post-study). A median split of TSD performance [total lapses (>500 ms response time) and errors] on the 10-minute Psychomotor Vigilance Test (PVT), defined cognitively resilient (n=15) and vulnerable (n=16) groups. Repeated measures ANOVA and post-hoc comparisons corrected for multiple testing, examined SV and CI across time points between groups.
Results
There was a significant time*group interaction for SV: cognitively resilient individuals had greater SV during the five-day experiment. In addition, in both resilient and vulnerable individuals, SV increased with TSD and with TSD+psychological stress compared with baseline. Like SV, there was a significant time*group interaction for CI: resilient individuals had greater CI at all points of the experiment.
Conclusion
SV and CI differed between resilient and vulnerable individuals across TSD, psychological stress and recovery sleep. Greater SV and greater CI at baseline predicted resilience to TSD and TSD+psychological stress. CI and SV are novel physiological biomarkers of sleep loss, stress, and individual differences in cognitive performance.
Support
NASA NNX14AN49G.
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Affiliation(s)
- E M Yamazaki
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | - L E MacMullen
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A J Ecker
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J N Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA
| | - N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
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Galli O, Goel N, Basner M, Detre J, Thase M, Sheline Y, Rao H, Dinges D, Gehrman P. 1100 Self-Monitoring Of PVT Performance In Healthy Adults And Individuals With MDD. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1095] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Negativity bias in depression has been repeatedly demonstrated in the judgment and decision-making literature. Research investigating the impact of sleep deprivation on self-evaluation of performance in healthy or depressed populations is limited. We examined 1) whether individuals with Major Depressive Disorder (MDD) exhibit a negativity bias in subjective ratings of performance on the Psychomotor Vigilance Task (PVT) as compared with healthy adults, and 2) the impact of total sleep deprivation (TSD) on these ratings.
Methods
N=33 individuals with MDD and n=9 healthy adults completed a 5-day study protocol including two baseline nights (B1-B2, 9h TIB), 36 hours of TSD, and one night of recovery sleep opportunity (Rec). The PVT was administered every 2-4 hours. A brief questionnaire was administered immediately prior to (PRE) and following (POST) the PVT, asking participants to estimate their average reaction time (RT) using a 9-point Likert-type scale. Mixed-effects models examined the impact of group (MDD, Control), protocol day (B1, B2, SD, Rec), and their interaction on objective PVT performance (mean RT) and subjective performance estimates (PRE and POST ratings).
Results
Mean RT was significantly slower during TSD (p<0.001) for all participants. Individuals with MDD and healthy adults did not differ in objective PVT performance (p=0.25) across days. There was no significant interaction between group and protocol day (p=0.96). Both groups predicted slower RTs during TSD as compared with baseline or recovery days (PRE-PVT, p=0.006). Individuals with MDD anticipated slower RTs as compared with healthy adults (p=0.001). On POST-PVT estimates, all participants reported subjective poorer performance during TSD (p<0.008). Individuals with MDD reported slower RTs as compared with healthy adults (p=0.002). Interaction effects between group and protocol day on PRE- and POST- performance ratings were not significant.
Conclusion
This project is the first to investigate subjective estimates of PVT performance in healthy and depressed individuals. Individuals with MDD subjectively reported slower response times as compared with control participants, despite similar objective performance. Depressive symptoms may be a potential confounder of subjective, but not objective, PVT performance.
Support
5R01MH107571
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Affiliation(s)
- O Galli
- University of Pennsylvania, Philadelphia, PA
| | - N Goel
- Rush University Medical Center, Chicago, IL
| | - M Basner
- University of Pennsylvania, Philadelphia, PA
| | - J Detre
- University of Pennsylvania, Philadelphia, PA
| | - M Thase
- University of Pennsylvania, Philadelphia, PA
| | - Y Sheline
- University of Pennsylvania, Philadelphia, PA
| | - H Rao
- University of Pennsylvania, Philadelphia, PA
| | - D Dinges
- University of Pennsylvania, Philadelphia, PA
| | - P Gehrman
- University of Pennsylvania, Philadelphia, PA
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31
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Yamazaki EM, Rosendahl-Garcia KM, MacMullen LE, Ecker AJ, Kirkpatrick JN, Goel N. 0041 Heart Rate Variability Differs in Resilient vs. Vulnerable Adults from Total Sleep Deprivation and Psychological Stress and Predicts Cognitive Performance. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.040] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
There are substantial individual differences (resilience and vulnerability) in neurobehavioral performance from psychosocial stress and sleep loss. However, the time course of heart rate variability (HRV) across baseline, total sleep deprivation (TSD), the combination of TSD + psychological stress, and recovery has not been investigated; in addition, it remains unknown whether HRV and blood pressure (BP) differ in resilient vs. vulnerable individuals and predict individual differences in cognitive performance.
Methods
Thirty-one healthy adults (ages 27–53; mean±SD, 35.4±7.1y; 14 females) participated in a five-day experiment consisting of two 8h time-in-bed (TIB) baseline nights, 39h TSD, and two 8h-10h TIB recovery nights. A modified Trier Social Stress Test (TSST) induced psychological stress on the TSD day. Systolic and diastolic BP and HRV (derived from echocardiographic R-R interval) were obtained at six time points (pre-study, baseline, during TSD, during TSD after the TSST, after recovery, and post-study). Cognitively resilient (n=15) and vulnerable (n=16) groups were defined by a median split on 10-minute Psychomotor Vigilance Test (PVT) TSD performance [total lapses (>500ms response time) and errors]. Repeated measures ANOVA and post-hoc comparisons corrected for multiple testing, examined BP and HRV across time points between groups.
Results
HRV showed a significant time*group interaction: while resilient individuals had significantly lower HRV at pre-study compared to vulnerable individuals, their HRV increased above that of vulnerable individuals with TSD and with TSD + psychological stress. By contrast, systolic and diastolic BP did not show significant time*group interactions and did not predict cognitive vulnerability during TSD.
Conclusion
HRV differed between resilient and vulnerable individuals across TSD, psychological stress and recovery sleep and predicted individual differences in cognitive performance, whereby lower HRV during full-rested conditions predicted resilience to TSD and TSD + psychological stress. HRV, but not BP, is a reliable biomarker of sleep deprivation, psychological stress, and neurobehavioral vulnerability.
Support
NASA NNX14AN49G.
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Affiliation(s)
- E M Yamazaki
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | - L E MacMullen
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A J Ecker
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J N Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA
| | - N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
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32
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Titone MK, McArthur B, Ng TH, Burke TA, McLaughlin LE, MacMullen LE, Alloy LB, Goel N. 0364 Sex and Race Influence Objective and Self-Report Sleep and Circadian Measures in Emerging Adults at Risk for Bipolar Spectrum Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.361] [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] Open
Abstract
Abstract
Introduction
There is a critical need to understand key factors that impact sleep and circadian rhythm function for emerging adults at risk for bipolar spectrum disorder (BSD). Sex and race are common demographic factors contributing to differences in health outcomes; however, the influence of these variables on sleep and circadian rhythm patterns for emerging adults at risk for BSD has not been characterized.
Methods
Multiple objective and self-report facets of sleep and circadian function, including dim light melatonin onset (DLMO), and measures derived from actigraphy and sleep diaries, were assessed in a 20-day ecological momentary assessment (EMA) study of 150 emerging adults (mean ± SD, 21.8 ± 2.1y; 58.7% female; 57.9% White, 23.4% Black, 10.3% Asian or Pacific Islander, 8.0% Other ethnicity) at-risk for BSD. Bivariate Pearson correlations (two-tailed, p <.05) were conducted between the sleep and circadian measures. ANCOVAs, controlling for BSD status, were conducted to evaluate differences on sleep and circadian characteristics by sex and race.
Results
Males exhibited better actigraphic sleep efficiency and later DLMO phase than females, whereas females exhibited more actigraphic discrete sleep periods. White participants exhibited more actigraphy-measured total sleep time, better sleep efficiency, and fewer sleep periods, and self-reported more total sleep time and better sleep efficiency than Black participants.
Conclusion
We show for the first time that sex and race are significant predictors of objective and self-reported sleep and circadian rhythm measures in a large sample of emerging adults at risk for BSD participating in an EMA study. Our findings extend the existing literature to a novel clinical population and to a naturalistic setting and inform ongoing research on sex and racial health disparities in sleep and circadian rhythms.
Support
This work was supported by NIH R01 MH77908 and R01 MH102310; a Banting Postdoctoral Fellowship from the Social Sciences and Humanities Research Council; and a National Science Foundation Graduate Student Research Fellowship.
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Affiliation(s)
- M K Titone
- Department of Psychology, Temple University, Philadelphia, PA
| | - B McArthur
- Department of Psychology, University of Calgary, Calgary, AB, CANADA
| | - T H Ng
- Department of Psychology, Temple University, Philadelphia, PA
| | - T A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University, Providence, RI
| | - L E McLaughlin
- Department of Psychology, Temple University, Philadelphia, PA
| | - L E MacMullen
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - L B Alloy
- Department of Psychology, Temple University, Philadelphia, PA
| | - N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
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Goel N, Yamazaki EM, MacMullen LE, Ecker AJ. 0265 Cortisol and C-Reactive Protein Fail to Predict Individual Differences in Neurobehavioral Performance Responses to Total Sleep Deprivation and Psychological Stress. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.263] [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] Open
Abstract
Abstract
Introduction
Individuals show marked differential vulnerability in neurobehavioral deficits from psychosocial stress and sleep deprivation. Although changes in salivary cortisol and C-reactive protein (CRP) typically occur across total sleep deprivation (TSD) and recovery sleep, whether these biological markers during fully rested conditions predict individual differences in cognitive performance during TSD and stress remains unknown.
Methods
Thirty-one healthy adults (ages 27–53; mean ± SD, 35.4 ± 7.1y; 14 females) participated in a five-day experiment consisting of two 8h time-in-bed (TIB) baseline nights, followed by 39h TSD, and two 8h-10h TIB recovery nights. A modified Trier Social Stress Test (TSST) was conducted on the day of TSD to induce psychological stress. Salivary cortisol and CRP from blood were obtained at six time points during the study (pre-study, baseline, during TSD, during TSD after the TSST, after recovery, and post-study). A median split of TSD performance [total lapses (>500 ms response time) and errors] on the 10-minute Psychomotor Vigilance Test (PVT) defined cognitively resilient (n=15) and cognitively vulnerable (n=16) groups. Repeated measures ANOVA and post-hoc comparisons corrected for multiple testing, examined cortisol and CRP across time points between groups.
Results
In both cognitively resilient and vulnerable individuals, cortisol increased with TSD compared to baseline in the morning and decreased with TSD + psychological stress in the afternoon compared to TSD alone. By contrast, there were no significant changes in CRP levels throughout the experiment. In addition, there were no significant time*group interactions in cortisol or CRP levels.
Conclusion
Salivary cortisol increased with TSD compared to baseline and showed a time-of-day effect with stress during TSD. Notably, cortisol and CRP did not differ between cognitively resilient and vulnerable individuals across TSD, psychological stress or recovery sleep and thus are not reliable biomarkers for predicting performance under these conditions.
Support
NASA NNX14AN49G.
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Affiliation(s)
- N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - E M Yamazaki
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - L E MacMullen
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A J Ecker
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Malone SK, Peleckis AJ, Pack AI, Perez N, Yu G, Rickels MR, Goel N. 1020 Sleep and Glycemic Control in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1016] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Nocturnal hypoglycemia is life threatening for individuals with type 1 diabetes (T1D) due to loss of hypoglycemia symptom recognition (hypoglycemia unawareness) and impaired glucose counterregulation. These individuals also show disturbed sleep, which may result from glycemic dysregulation. Whether use of a hybrid closed loop (HCL) insulin delivery system with integrated continuous glucose monitoring (CGM) designed for improving glycemic control, relates to better sleep across time in this population remains unknown.
Methods
Six adults (median age=58y,T1D duration=41y) participated in an 18-month ongoing clinical trial assessing the effectiveness of an HCL system. Sleep and glycemic control were measured concurrently using wrist actigraphs and CGM at baseline (1 week) and months 3 and 6 (3 weeks) following HCL initiation. BMI and hemoglobin A1c (HbA1c) were collected at all timepoints. Spearman’s correlations modeled associations between sleep, BMI, and glycemic control at each time point. Repeated ANOVAs modeled sleep and glycemic control changes from baseline to 3 months and to 6 months.
Results
Sleep and glycemic control indices showed significant associations at baseline and 3 months. More time-in-bed and later sleep offset related to higher HbA1c levels at baseline. Later sleep onset, midpoint and offset, and greater sleep efficiency associated with greater %time with hyperglycemia (glucose >180 mg/dL) or hypoglycemia (glucose <70 mg/dL) at baseline and 3 months. Longer sleep duration and greater sleep efficiency related to greater %time with hyperglycemia at 3 months. At 3 months, more wake after sleep onset associated with lower HbA1c levels and longer nocturnal awakenings and more sleep fragmentation associated with less glycemic variability. While both sleep and glycemic control improved from baseline to 3 and 6 months, these were not statistically significant.
Conclusion
Various dimensions of actigraphic sleep related to concurrently estimated glycemic indices indicative of poorer glycemic control and HbA1c across time in adults with long-standing T1D and hypoglycemia unawareness.
Support
This work was supported by NIH R01DK117488 (NG), R01DK091331 (MRR), and K99NR017416 (SKM).
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Affiliation(s)
- S K Malone
- Rory Meyers College of Nursing, New York University, New York, NY
| | - A J Peleckis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - N Perez
- Rory Meyers College of Nursing, New York University, New York, NY
| | - G Yu
- Rory Meyers College of Nursing, New York University, New York, NY
| | - M R Rickels
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - N Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
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Abstract
Fibrosing mediastinitis (FM) is characterized by extensive and invasive fibro-inflammatory proliferation, triggered by a delayed hypersensitivity reaction to variety of infective or noninfective stimuli. The infective agents often have a geographic distribution such as Histoplasma capsulatum in North America and Mycobacterium tuberculosis in Asian regions. In few reports, the mediastinitis is caused by fungi, particularly Aspergillus species. We report the first case of possible aspergillous FM in a young pregnant woman.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - J Chaudhari
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Goel
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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36
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Gupta H, Batta NS, Kataria H, Batra V, Upadhyay AD, Jain V, Mishra P, Goel N. A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI. Malays Orthop J 2020; 14:34-41. [PMID: 32296480 PMCID: PMC7156171 DOI: 10.5704/moj.2003.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendon-trochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. Materials and Methods: This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. Results: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. Conclusions: The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.
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Affiliation(s)
- H Gupta
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - N S Batta
- Department of Radiodiagnosis, Mahajan Imaging, New Delhi, India
| | - H Kataria
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - V Batra
- Department of Radiodiagnosis, Mahajan Imaging, New Delhi, India
| | - A D Upadhyay
- Department of Biostatistics, All India Institute Of Medical Sciences, New Delhi, India
| | - V Jain
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - P Mishra
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - N Goel
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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37
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Goel N, Shrestha S, Smith R, Mehta A, Ketty M, Muxworthy H, Abelian A, Kirupaalar V, Saeed S, Jain S, Asokkumar A, Natti M, Barnard I, Pitchaikani PK, Banerjee S. Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch Dis Child Fetal Neonatal Ed 2020; 105:118-122. [PMID: 31296696 DOI: 10.1136/archdischild-2018-316777] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 01/02/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS). DESIGN Multicentre prospective observational projection study. SETTING Eight maternity hospitals in Wales, UK. PATIENTS All live births ≥34 weeks gestation over a 3-month period (February-April 2018). METHODS Demographics, maternal and infant risk factors, infant's clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC. MAIN OUTCOME MEASURE Proportion of infants recommended for antibiotics on either tool. RESULTS Of 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures-three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported. CONCLUSION The judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.
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Affiliation(s)
- Nitin Goel
- Neonatal Medicine, Singleton Hospital, Swansea, UK.,Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | | | - Rhian Smith
- Neonatal Medicine, Glan Clwyd Hospital, Rhyl, UK
| | - Akshay Mehta
- Neonatal Medicine, Singleton Hospital, Swansea, UK
| | - Malini Ketty
- Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | | | | | | | | | - Shikha Jain
- Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - Amar Asokkumar
- Neonatal Medicine, University Hospital of Wales, Cardiff, UK
| | - Murali Natti
- Neonatal Medicine, Royal Gwent Hospital, Newport, UK
| | - Ian Barnard
- Neonatal Medicine, Glan Clwyd Hospital, Rhyl, UK
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Rathi V, Ish P, Singh G, Tiwari M, Goel N, Gaur SN. Iron deficiency in non-anemic chronic obstructive pulmonary disease in a predominantly male population: an ignored entity. Monaldi Arch Chest Dis 2020; 90. [DOI: 10.4081/monaldi.2020.1126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022] Open
Abstract
Non-anemic iron deficiency has been studied in heart failure, but studies are lacking in chronic obstructive pulmonary disease (COPD). The potential clinical implications of association of iron deficiency with the severity of COPD warrant research in this direction. This was an observational, cross-sectional study on patients with COPD to compare disease severity, functional status and quality of life in non-anemic patients with COPD between two groups - iron deficient and non-iron deficient. Stable non-anemic COPD with no cause of bleeding were evaluated for serum iron levels, ferritin levels, TIBC, 6MWD, SGRQ, spirometry, and CAT questionnaire. The study patients were divided into iron replete (IR) and iron deficient (ID) groups. A total of 79 patients were studied, out of which 72 were men and seven were women. The mean age was 61.5±8.42 years. Of these, 36 (45.5%; 95% CI, 34.3-56.8%) had iron deficiency. Mean 6-minute-walk distance was significantly shorter in ID (354.28±82.4 meters vs 432.5±47.21 meters; p=0.001). A number of exacerbations in a year were more in ID group (p=0.003), and more patients in ID had at least two exacerbations of COPD within a year (p=0.001). However, the resting pO2, SaO2, and SpO2 levels did not differ significantly between the two groups (p=0.15 and p=0.52, respectively). Also, there was no significant difference in the distribution of patients of a different class of airflow limitations between the two groups. Non-anemic iron deficiency (NAID) is an ignored, yet easily correctable comorbidity in COPD. Patients with iron deficiency have a more severe grade of COPD, had lesser exercise capacity and more exacerbations in a year as compared to non-iron deficient patients. So, foraying into the avenue of iron supplementation, which has shown promising results in improving functional capacity in heart failure and pulmonary hypertension, may well lead to revolutionary changes in the treatment of COPD.
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39
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Gupta N, Shipley L, Goel N, Browning Carmo K, Leslie A, Sharkey D. Neurocritical care of high-risk infants during inter-hospital transport. Acta Paediatr 2019; 108:1965-1971. [PMID: 31321815 DOI: 10.1111/apa.14940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/23/2019] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022]
Abstract
The centralisation of neonatal intensive care in recent years has improved mortality, particularly of extremely preterm infants, but similar improvements in morbidity, such as neurodevelopmental impairment, have not been seen. Integral to the success of centralisation are specialised neonatal transport teams who provide intensive care prior to and during retrieval of high-risk neonates when in-utero transfer has not been possible. Neonatal retrieval aims to stabilise the clinical condition and then transfer the neonate during a high-risk period for patient. Transport introduces the hazards of noise and vibration; acceleration and deceleration forces; additional handling and temperature fluctuations. The transport team must stabilise the infant fully prior to transport as when on the move they are limited by space and movement to effectively attend to clinical deterioration. Inborn infants have better neurodevelopmental outcome compared with the outborn and aetiology of this seems to be multifactorial with the impact of transport itself during critical illness, remaining unclear. To improve the neurological outcomes for transported infants, it seems imperative to integrate the advancing intensive care neuromonitoring tools into the transport milieu. This review examines current inter-hospital transport neuromonitoring and how new modalities might be applied to the neurocritical care delivered by specialist transport teams.
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Affiliation(s)
- Neelam Gupta
- University of Southampton Southampton UK
- Wessex Southampton Oxford Neonatal Transport (SONeT) & Neonatal Intensive Care Services University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Lara Shipley
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
| | - Nitin Goel
- Neonatal Intensive Care Unit University Hospital of Wales Cardiff Wales UK
| | - Kathryn Browning Carmo
- Faculty of Medicine and Healthcare University of Sydney Sydney NSW Australia
- Grace Centre for Newborn Intensive Care Children's Hospital at WestmeadSCHN and NETS NSW Sydney NSW Australia
| | - Andrew Leslie
- CenTre Neonatal Transport Service University Hospitals of Leicester NHS Trust Leicester UK
| | - Don Sharkey
- Academic Child Health School of Medicine University of Nottingham Nottingham UK
- CenTre Neonatal Transport Service Nottingham University Hospitals NHS Trust Nottingham UK
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Affiliation(s)
- N. Goel
- Department of Chemistry and Centre for Advanced Studies in Chemistry, Panjab University, Chandigarh, India
| | - S. Gupta
- University Institute of Engineering & Technology, Panjab University, Chandigarh, India
| | - M. Sadhukhan
- Department of Chemistry, Indian Institute of Technology, Kanpur, India
| | - B. M. Deb
- Publishing Department, Visva-Bharati University, Kolkata, India
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Goel N, Morris JK, Tucker D, de Walle HEK, Bakker MK, Kancherla V, Marengo L, Canfield MA, Kallen K, Lelong N, Camelo JL, Stallings EB, Jones AM, Nance A, Huynh MP, Martínez-Fernández ML, Sipek A, Pierini A, Nembhard WN, Goetz D, Rissmann A, Groisman B, Luna-Muñoz L, Szabova E, Lapchenko S, Zarante I, Hurtado-Villa P, Martinez LE, Tagliabue G, Landau D, Gatt M, Dastgiri S, Morgan M. Trisomy 13 and 18-Prevalence and mortality-A multi-registry population based analysis. Am J Med Genet A 2019; 179:2382-2392. [PMID: 31566869 DOI: 10.1002/ajmg.a.61365] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/26/2019] [Accepted: 08/23/2019] [Indexed: 11/11/2022]
Abstract
The aim of the study is to determine the prevalence, outcomes, and survival (among live births [LB]), in pregnancies diagnosed with trisomy 13 (T13) and 18 (T18), by congenital anomaly register and region. Twenty-four population- and hospital-based birth defects surveillance registers from 18 countries, contributed data on T13 and T18 between 1974 and 2014 using a common data-reporting protocol. The mean total birth prevalence (i.e., LB, stillbirths, and elective termination of pregnancy for fetal anomalies [ETOPFA]) in the registers with ETOPFA (n = 15) for T13 was 1.68 (95% CI 1.3-2.06), and for T18 was 4.08 (95% CI 3.01-5.15), per 10,000 births. The prevalence varied among the various registers. The mean prevalence among LB in all registers for T13 was 0.55 (95%CI 0.38-0.72), and for T18 was 1.07 (95% CI 0.77-1.38), per 10,000 births. The median mortality in the first week of life was 48% for T13 and 42% for T18, across all registers, half of which occurred on the first day of life. Across 16 registers with complete 1-year follow-up, mortality in first year of life was 87% for T13 and 88% for T18. This study provides an international perspective on prevalence and mortality of T13 and T18. Overall outcomes and survival among LB were poor with about half of live born infants not surviving first week of life; nevertheless about 10% survived the first year of life. Prevalence and outcomes varied by country and termination policies. The study highlights the variation in screening, data collection, and reporting practices for these conditions.
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Affiliation(s)
- Nitin Goel
- Neonatal Unit, University Hospital of Wales, Cardiff, UK.,CARIS (Congenital Anomaly Register & Information Services), Public Health Wales, Singleton Hospital, Swansea, UK
| | - Joan K Morris
- Medical Statistics, Population Health Research Institute, St George's, University of London, London, UK
| | - David Tucker
- CARIS (Congenital Anomaly Register & Information Services), Public Health Wales, Singleton Hospital, Swansea, UK
| | - Hermien E K de Walle
- Department of Genetics, Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian K Bakker
- Department of Genetics, Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lisa Marengo
- BDESB (Birth Defects Epidemiology and Surveillance Branch), Texas Department of State Health Services, Austin, Texas
| | - Mark A Canfield
- BDESB (Birth Defects Epidemiology and Surveillance Branch), Texas Department of State Health Services, Austin, Texas
| | - Karin Kallen
- National Board of Health and Welfare, Stockholm, Sweden
| | - Nathalie Lelong
- REMAPAR, PARis REgistry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy Paris, Paris Descartes University, France
| | - Jorge L Camelo
- ECLAMC, Latin American Collaborative Study of Congenital Malformations, Buenos Aires, Argentina
| | - Erin B Stallings
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.,Carter Consulting, Incorporated, Atlanta, Georgia
| | - Abbey M Jones
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Healthcare Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah
| | - My-Phuong Huynh
- Utah Birth Defect Network, Bureau of Children with Special Healthcare Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah
| | | | - Antonin Sipek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Anna Pierini
- Tuscany Registry of Congenital Defects (RTDC), Institute of Clinical Physiology, National Research Council/Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Wendy N Nembhard
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences and Arkansas Reproductive Health Monitoring System (ARHMS), Little Rock, Arkansas
| | - Dorit Goetz
- Medical Faculty Otto-von-Guericke University Magdeburg, Malformation Monitoring Centre Saxony-Anhalt, Magdeburg, Germany
| | - Anke Rissmann
- Medical Faculty Otto-von-Guericke University Magdeburg, Malformation Monitoring Centre Saxony-Anhalt, Magdeburg, Germany
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), ANLIS, National Ministry of Health, National Center of Medical Genetics, Ciudad de Buenos Aires, Argentina
| | - Leonora Luna-Muñoz
- RYVEMCE, Registry and Epidemiological Surveillance of External Congenital Malformations, Mexico City, Mexico
| | - Elena Szabova
- Slovak Teratology Information Center, Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
| | - Serhiy Lapchenko
- OMNI-Net UBDP (Ukraine Birth Defects Prevention Program), Rivne, Ukraine
| | - Ignacio Zarante
- Congenital Malformations Surveillance Programme of Bogotà, Pontificia Universidad Javeriana, Bogota D.C., Colombia
| | - Paula Hurtado-Villa
- Faculty of Health Sciences, Congenital Malformations Surveillance Programme of Cali, Pontificia Universidad Javeriana-Cali, Cali, Colombia
| | - Laura E Martinez
- Registro DAN (Registro de Defectos al Nacimiento), Departamento de Genética, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Danielle Landau
- IBDSP (Israel Birth Defect Surveillance and Research program), Tel Aviv, Israel
| | - Miriam Gatt
- Directorate for Health Information and Research, Malta Congenital Anomalies Registry (MCAR), Guardamangia, Malta
| | - Saeed Dastgiri
- School of Medicine, Tabriz University of Medical Sciences, TROCA (Tabriz Registry of Congenital Anomalies), Tabriz, Iran
| | - Margery Morgan
- CARIS (Congenital Anomaly Register & Information Services), Public Health Wales, Singleton Hospital, Swansea, UK
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Goel N, Mittal M, Arora R. Case 1: Bilious Vomiting in a Term Neonate. Neoreviews 2019; 20:e346-e349. [PMID: 31261098 DOI: 10.1542/neo.20-6-e346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nitin Goel
- Division of Pediatric Surgery, Department of Pediatrics, Artemis Hospital, Gurgaon, Haryana, India
| | - Manish Mittal
- Department of Pediatrics and Neonatology, Apollo Cradle Hospital, Gurgaon, Haryana, India
| | - Rohit Arora
- Department of Pediatrics and Neonatology, Apollo Cradle Hospital, Gurgaon, Haryana, India
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Lubos D, Park J, Faestermann T, Gernhäuser R, Krücken R, Lewitowicz M, Nishimura S, Sakurai H, Ahn DS, Baba H, Blank B, Blazhev A, Boutachkov P, Browne F, Čeliković I, de France G, Doornenbal P, Fang Y, Fukuda N, Giovinazzo J, Goel N, Górska M, Ilieva S, Inabe N, Isobe T, Jungclaus A, Kameda D, Kim YK, Kojouharov I, Kubo T, Kurz N, Kwon YK, Lorusso G, Moschner K, Murai D, Nishizuka I, Patel Z, Rajabali MM, Rice S, Schaffner H, Shimizu Y, Sinclair L, Söderström PA, Steiger K, Sumikama T, Suzuki H, Takeda H, Wang Z, Warr N, Watanabe H, Wu J, Xu Z. Improved Value for the Gamow-Teller Strength of the ^{100}Sn Beta Decay. Phys Rev Lett 2019; 122:222502. [PMID: 31283269 DOI: 10.1103/physrevlett.122.222502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/11/2019] [Indexed: 06/09/2023]
Abstract
A record number of ^{100}Sn nuclei was detected and new isotopic species toward the proton dripline were discovered at the RIKEN Nishina Center. Decay spectroscopy was performed with the high-efficiency detector arrays WAS3ABi and EURICA. Both the half-life and the β-decay end point energy of ^{100}Sn were measured more precisely than the literature values. The value and the uncertainty of the resulting strength for the pure 0^{+}→1^{+} Gamow-Teller decay was improved to B_{GT}=4.4_{-0.7}^{+0.9}. A discrimination between different model calculations was possible for the first time, and the level scheme of ^{100}In is investigated further.
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Affiliation(s)
- D Lubos
- Physik Department E12, Technische Universität München, D-85748 Garching, Germany
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - J Park
- TRIUMF, Vancouver British Columbia, V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - T Faestermann
- Physik Department E12, Technische Universität München, D-85748 Garching, Germany
- Excellence Cluster "Origin and Structure of the Universe", D-85748, Garching, Germany
| | - R Gernhäuser
- Physik Department E12, Technische Universität München, D-85748 Garching, Germany
| | - R Krücken
- Physik Department E12, Technische Universität München, D-85748 Garching, Germany
- TRIUMF, Vancouver British Columbia, V6T 2A3, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - M Lewitowicz
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DSM-CNRS/IN2P3, Boulevard H. Becquerel, 14076 Caen, France
| | - S Nishimura
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - H Sakurai
- University of Tokyo, 7-3-1 Hongo Bunkyo, Tokyo 113-0033, Japan
| | - D S Ahn
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - H Baba
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - B Blank
- CEN Bordeaux-Gradignan Le Haut-Vigneau, F-33175 Gradignan Cedex, France
| | - A Blazhev
- Institute of Nuclear Physics, University of Cologne, D-50937 Cologne, Germany
| | - P Boutachkov
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - F Browne
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
- School of Computing, Engineering and Mathematics, University of Brighton, Brighton, BN2 4GJ, United Kingdom
| | - I Čeliković
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DSM-CNRS/IN2P3, Boulevard H. Becquerel, 14076 Caen, France
- "Vinča" Institute of Nuclear Sciences, University of Belgrade, 11000 Belgrade, Serbia
| | - G de France
- Grand Accélérateur National d'Ions Lourds (GANIL), CEA/DSM-CNRS/IN2P3, Boulevard H. Becquerel, 14076 Caen, France
| | - P Doornenbal
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Y Fang
- Osaka University, 1-1 Machikaneyama, Toyonaka, Osaka 560-0043, Japan
| | - N Fukuda
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - J Giovinazzo
- CEN Bordeaux-Gradignan Le Haut-Vigneau, F-33175 Gradignan Cedex, France
| | - N Goel
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - M Górska
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - S Ilieva
- Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - N Inabe
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - T Isobe
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - A Jungclaus
- Instituto de Estructura de la Materia, IEM-CSIC, E-28006 Madrid, Spain
| | - D Kameda
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Y K Kim
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, Republic of Korea
- Department of Nuclear Engineering, Hanyang University, Seoul 133-791, Republic of Korea
| | - I Kojouharov
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - T Kubo
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - N Kurz
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - Y K Kwon
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, Republic of Korea
| | - G Lorusso
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - K Moschner
- Institute of Nuclear Physics, University of Cologne, D-50937 Cologne, Germany
| | - D Murai
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - I Nishizuka
- Department of Physics, Faculty of Science, Tohoku University, Sendai 980-0845, Japan
| | - Z Patel
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - M M Rajabali
- TRIUMF, Vancouver British Columbia, V6T 2A3, Canada
- Physics Department, Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - S Rice
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - H Schaffner
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, D-64291 Darmstadt, Germany
| | - Y Shimizu
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - L Sinclair
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
- University of York, York YO10 5DD, United Kingdom
| | - P-A Söderström
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - K Steiger
- Physik Department E12, Technische Universität München, D-85748 Garching, Germany
| | - T Sumikama
- Department of Physics, Faculty of Science, Tohoku University, Sendai 980-0845, Japan
| | - H Suzuki
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - H Takeda
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Z Wang
- TRIUMF, Vancouver British Columbia, V6T 2A3, Canada
| | - N Warr
- Institute of Nuclear Physics, University of Cologne, D-50937 Cologne, Germany
| | - H Watanabe
- Beihang University, Beijing 100191, China
| | - J Wu
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
- Department of Physics, Peking University, Beijing 100871, China
| | - Z Xu
- University of Tokyo, 7-3-1 Hongo Bunkyo, Tokyo 113-0033, Japan
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Roane B, Goel N, Londono A, Toboni M, Arend R. Analysis of the utilization of next generation sequencing in gynecologic malignancies. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.157] [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: 11/15/2022]
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Iyengar A, Han J, Helmers M, Patrick W, Chung J, Goel N, Atluri P. Orthotopic Heart Transplant Volume Can Be Aggressively Increased While Maintaining Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1002] [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: 11/30/2022] Open
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47
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Sandhu VK, Goel N, Duro T. Hydroxychloroquine: do we all see eye to eye? A single-site analysis of hydroxychloroquine dosing compared with the 2016 Revision of the American Academy of Ophthalmology guidelines. Lupus 2019; 28:438-439. [PMID: 30712492 DOI: 10.1177/0961203319826682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- V K Sandhu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | - N Goel
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | - T Duro
- Loma Linda University Medical Center, Loma Linda, CA, USA
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Alloy LB, Ng TH, Titone MK, Dennis LE, Goel N. 0053 Circadian and Reward Measures Show Robust Bidirectional Relationships in Bipolar Spectrum Disorder in a 20-Day Naturalistic Ecological Momentary Assessment Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L B Alloy
- Department of Psychology, Temple University, Philadelphia, PA
| | - T H Ng
- Department of Psychology, Temple University, Philadelphia, PA
| | - M K Titone
- Department of Psychology, Temple University, Philadelphia, PA
| | - L E Dennis
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - N Goel
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Zajko MJ, Taylor DM, Pearson-Leary J, Bhatnagar S, Goel N. 0012 Peripheral MicroRNAs Are Altered by Total Sleep Deprivation and Psychological Stress and Predict Cognitive Performance in Humans. Sleep 2018. [DOI: 10.1093/sleep/zsy061.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Zajko
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - D M Taylor
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J Pearson-Leary
- Department of Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - S Bhatnagar
- Department of Anesthesiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - N Goel
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Goel N, Titone MK, Ng TH, Dennis LE, Alloy LB. 0054 Circadian Measures Are Not Phase Delayed in Bipolar Spectrum Disorder in a 20-Day Naturalistic Ecological Momentary Assessment Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Goel
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - M K Titone
- Department of Psychology, Temple University, Philadelphia, PA
| | - T H Ng
- Department of Psychology, Temple University, Philadelphia, PA
| | - L E Dennis
- Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - L B Alloy
- Department of Psychology, Temple University, Philadelphia, PA
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