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Vega B, Desai R, Solk P, McKoy JM, Flores AM, Phillips SM, Barber EL. Increasing physical activity among older adults with gynecologic cancers: a qualitative study. Support Care Cancer 2024; 32:282. [PMID: 38600364 DOI: 10.1007/s00520-024-08483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The purpose of this study was to gain an understanding of older gynecologic cancer patients' preferences and opinions related to physical activity during chemotherapy, including interventions to promote physical activity. METHODS Gynecologic cancer patients 60 years or older receiving chemotherapy at a single institution within the last 12 months completed questionnaires and a semi-structured interview asking about their preferences for physical activity interventions aimed at promoting physical activity while receiving treatment. RESULTS Among the 30 gynecologic cancer patients surveyed and interviewed, a majority agreed with the potential usefulness of a physical activity intervention during chemotherapy (67%) and most reported they would be willing to use an activity tracker during chemotherapy (73%). They expressed a preference for an aerobic activity intervention such as walking, indicated a desire for education from their clinical team on the effects physical activity can have on treatment symptoms, and stated a need for an intervention that could be accessed from anywhere and anytime. Additionally, they emphasized a need for an intervention that considered their treatment symptoms as these were a significant barrier to physical activity while on chemotherapy. CONCLUSION In this study of older gynecologic cancer patients receiving chemotherapy, most were open to participating in a virtually accessible and symptom-tailored physical activity intervention to promote physical activity during chemotherapy.
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Affiliation(s)
- Brenda Vega
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E Superior Suite 05-138, Chicago, IL, 60611, USA
| | - Ria Desai
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Payton Solk
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E Superior Suite 05-138, Chicago, IL, 60611, USA.
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Seyedin SN, Fattah A, Desai R, Yeakel J, Harada GK, Dayyani F, Valerin J, Elquza E, Imagawa D, Jutric Z, Wolf R, Kuo JV. Effect of Interval between Neoadjuvant Chemotherapy and Radiation Therapy on Metastasis Risk for Inoperable Non-Metastatic Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e337. [PMID: 37785183 DOI: 10.1016/j.ijrobp.2023.06.2395] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In inoperable pancreatic cancer patients requiring radiotherapy (RT) after neoadjuvant chemotherapy (CT), there can be delays in starting radiation due to multiple complications. However, pancreatic cancer can progress rapidly during short intervals without treatment. We hypothesize that longer intervals between neoadjuvant chemotherapy and radiation could expediate the development of metastatic disease. MATERIALS/METHODS We identified patients with inoperable non-metastatic borderline resectable or locally advanced pancreatic cancer treated with neoadjuvant CT followed by RT from 2011 to 2021 at a single institution. Patients who completed palliative RT as defined by a biologic effective dose (BED) of less than 50 Gy, or those who were lost to follow-up within 3 months after completing RT without documented disease progression were excluded. The interval between RT and CT was defined as the time between last date of CT administration and initiation of RT. The primary endpoint was metastasis-free survival (MFS) after RT completion. Differences in MFS between patients who started RT within or after 4, 6, and 8 weeks of completing CT were examined utilizing log rank analysis of MFS generated via the Kaplan-Meier method. RESULTS At a median follow-up of 5.45 months, twenty-three patients were included. Most patients were male (61%) with cT4 (61%), cN0 (83%) pancreatic adenocarcinoma. Almost all patients completed combination neoadjuvant CT (91%) followed by either intensity modulated RT to 50.4 Gy in 28 fractions with capecitabine (n = 9) or stereotactic body RT to 33-40 Gy in 5 fractions (n = 14). Eleven (48%) patients received adjuvant CT after radiation therapy. The median time between last CT and RT initiation was 34 days (range 13-142). The MFS of patients who initiated RT within 4 weeks of CT compared to after was higher but not significant (16.8 vs 9.9 months, p = 0.144). Those who received RT within 6 or 8 weeks of completing CT exhibited significantly longer MFS compared to later than 6 (16.0 vs 6.9 mo, p = 0.016) or 8 weeks (15.1 vs 2.1 mo, p = 0.004). There was no statistical correlation between MFS and other variables (CA 19-9 before radiation, T-stage, receipt of adjuvant CT, BED). CONCLUSION These results suggest that a longer interval between CT and RT is associated with the risk of developing metastatic disease sooner but requires validation in a prospective cohort. Root causes of delays in starting radiation (e.g., insurance authorization) should be investigated as well.
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Affiliation(s)
- S N Seyedin
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - A Fattah
- University of California - Irvine, Irvine, CA
| | - R Desai
- Department of Internal Medicine, UT Southwestern, Dallas, TX
| | - J Yeakel
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - G K Harada
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
| | - F Dayyani
- Division of Hematology/Oncology, Department of Medicine, University of California - Irvine, Orange, CA
| | - J Valerin
- Division of Hematology/Oncology, Department of Medicine, University of California - Irvine, Orange, CA
| | - E Elquza
- Division of Hematology/Oncology, Department of Medicine, University of California - Irvine, Orange, CA
| | - D Imagawa
- Division of Hepatobiliary, Pancreas Surgery & Islet Cell Transplantation, Department of Surgery, University of California, Irvine, Orange, CA
| | - Z Jutric
- Division of Hepatobiliary, Pancreas Surgery & Islet Cell Transplantation, Department of Surgery, University of California, Irvine, Orange, CA
| | - R Wolf
- Division of Hepatobiliary, Pancreas Surgery & Islet Cell Transplantation, Department of Surgery, University of California, Irvine, Orange, CA
| | - J V Kuo
- Department of Radiation Oncology, University of California - Irvine, Orange, CA
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West HW, Siddique M, Williams MC, Volpe L, Desai R, Lyasheva M, Thomas S, Dangas K, Kotanidis CP, Tomlins P, Mahon C, Kardos A, Adlam D, Graby J, Rodrigues JCL, Shirodaria C, Deanfield J, Mehta NN, Neubauer S, Channon KM, Desai MY, Nicol ED, Newby DE, Antoniades C. Deep-Learning for Epicardial Adipose Tissue Assessment With Computed Tomography: Implications for Cardiovascular Risk Prediction. JACC Cardiovasc Imaging 2023; 16:800-816. [PMID: 36881425 PMCID: PMC10663979 DOI: 10.1016/j.jcmg.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) volume is a marker of visceral obesity that can be measured in coronary computed tomography angiograms (CCTA). The clinical value of integrating this measurement in routine CCTA interpretation has not been documented. OBJECTIVES This study sought to develop a deep-learning network for automated quantification of EAT volume from CCTA, test it in patients who are technically challenging, and validate its prognostic value in routine clinical care. METHODS The deep-learning network was trained and validated to autosegment EAT volume in 3,720 CCTA scans from the ORFAN (Oxford Risk Factors and Noninvasive Imaging Study) cohort. The model was tested in patients with challenging anatomy and scan artifacts and applied to a longitudinal cohort of 253 patients post-cardiac surgery and 1,558 patients from the SCOT-HEART (Scottish Computed Tomography of the Heart) Trial, to investigate its prognostic value. RESULTS External validation of the deep-learning network yielded a concordance correlation coefficient of 0.970 for machine vs human. EAT volume was associated with coronary artery disease (odds ratio [OR] per SD increase in EAT volume: 1.13 [95% CI: 1.04-1.30]; P = 0.01), and atrial fibrillation (OR: 1.25 [95% CI: 1.08-1.40]; P = 0.03), after correction for risk factors (including body mass index). EAT volume predicted all-cause mortality (HR per SD: 1.28 [95% CI: 1.10-1.37]; P = 0.02), myocardial infarction (HR: 1.26 [95% CI:1.09-1.38]; P = 0.001), and stroke (HR: 1.20 [95% CI: 1.09-1.38]; P = 0.02) independently of risk factors in SCOT-HEART (5-year follow-up). It also predicted in-hospital (HR: 2.67 [95% CI: 1.26-3.73]; P ≤ 0.01) and long-term post-cardiac surgery atrial fibrillation (7-year follow-up; HR: 2.14 [95% CI: 1.19-2.97]; P ≤ 0.01). CONCLUSIONS Automated assessment of EAT volume is possible in CCTA, including in patients who are technically challenging; it forms a powerful marker of metabolically unhealthy visceral obesity, which could be used for cardiovascular risk stratification.
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Affiliation(s)
- Henry W West
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Muhammad Siddique
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Caristo Diagnostics Pty Ltd, Oxford, United Kingdom
| | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Lucrezia Volpe
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ria Desai
- Northwestern University, Evanston, Illinois, USA
| | - Maria Lyasheva
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sheena Thomas
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Katerina Dangas
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christos P Kotanidis
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pete Tomlins
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Caristo Diagnostics Pty Ltd, Oxford, United Kingdom
| | - Ciara Mahon
- Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Attila Kardos
- Translational Cardiovascular Research Group, Department of Cardiology, Milton Keynes University Hospital, Milton Keynes, United Kingdom; Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham, United Kingdom
| | - David Adlam
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - John Graby
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Jonathan C L Rodrigues
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom; Department of Health, University of Bath, Bath, United Kingdom
| | - Cheerag Shirodaria
- Caristo Diagnostics Pty Ltd, Oxford, United Kingdom; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Keith M Channon
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Edward D Nicol
- Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
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Desai R, Jampol LM. RETINAL TOXICITY FOLLOWING PRESUMED INADVERTENT INTRAOCULAR INJECTION OF MITOMYCIN C DURING TRABECULECTOMY. Retin Cases Brief Rep 2023; 17:329-333. [PMID: 34293779 PMCID: PMC10121365 DOI: 10.1097/icb.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of postoperative retinal toxicity following the use of mitomycin C during a routine trabeculectomy. METHODS Case report of a single patient who underwent complete ophthalmic examination and multimodal imaging, including color fundus photos, optical coherence tomography, fundus autofluorescence, and fluorescein angiography. The study was declared exempt by the Institutional Review Board of Northwestern University. This research followed the tenets of the Declaration of Helsinki. RESULTS The patient developed profound vision loss and retinal damage during the postoperative course. Posterior segment findings include loss of vascular perfusion, diffuse loss of the outer, then inner, retinal layers, and subsequent total retinal detachment. CONCLUSION Although mitomycin C is commonly used in glaucoma filtering surgeries, reports of postoperative posterior segment toxicity are rare. The etiology of postoperative toxicity in this case is probable inadvertent intraocular injection of mitomycin C.
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Affiliation(s)
- Ria Desai
- Department of Ophthalmology, Northwestern Lake Forest Hospital, Lake Forest, Illinois; and
| | - Lee M. Jampol
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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West H, Siddique M, Volpe L, Desai R, Lyasheva M, Dangas K, Tomlins P, Mitchell A, Kardos A, Casadei B, Channon K, Antoniades C. Automated deep learning quantification of epicardial adiposity on cardiac CT predicts atrial fibrillation risk immediately following cardiac surgery and long-term. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Epicardial adipose tissue (EAT) is a visceral fat deposit within the pericardial sac which surrounds the heart myocardium and coronary arteries. The automated quantification of EAT volume is possible from routine CCTA scans via a deep-learning approach. The use of automated EAT quantification for the assessment of atrial fibrillation (AF) risk in the post-operative period, and longer-term, has not been previously investigated.
Purpose
To apply a deep-learning approach for automated segmentation of EAT from routine CCTA scans to assess the immediate post-operative and long-term risk of AF conveyed by EAT.
Methods
A deep-learning automated EAT segmentation tool using a 3D Residual-U-Net neural network architecture for 3D volumetric segmentation of CCTA data was created and trained on over 2800 consecutive CCTA performed as part of clinical care in patients with stable chest pain from 2015 onwards within the European arm of the Oxford Risk Factors And Non Invasive Imaging (ORFAN) Study. External validation in 817patients demonstrated excellent correlation between machine and human expert (CCC = 0.972). The prognostic value of deep-learning derived EAT volume was assessed in the AdipoRedOx Study (n=253; UK patients undergoing cardiac surgery) against both immediate in-hospital outcomes and longer-term outcomes from UK-wide NHS data, with adjustment for AF risk factors.
Results
There were 97 cases of new-onset AF in the immediate post-operative period (38.3%). EAT volume was found to be an independent predictor of post-operative AF regardless of body mass index. Utilising the median EAT volume as the cut point, the adjusted hazard ratio (HR [95% CI]) for risk of new-onset post-operative AF in-hospital was 1.56 [1.09–3.85], p<0.01 (Figure 1A). In receiver-operator characteristic analysis EAT volume added significant incremental prognostic power for the discrimination of in-hospital post-operative AF over a traditional risk factor model ΔAUC=0.101, p<0.01 (Figure 1B).
Over a median follow-up period of 89 months there were 48 unique cases (19%) of confirmed AF found in nation-wide NHS hospital episode statistics data for the AdipoRedOx cohort. EAT volume was found to be a significant independent predictor of long-term AF. Utilising the median EAT volume as the cut point, the adjusted HR for risk of new-onset long-term AF following cardiac surgery was 1.25 [1.08–3.17], p<0.01 (Figure 1C).
Conclusions
Automatically segmented EAT volume measured using a deep learning network predicts risk of both short-term new onset AF following cardiac surgery, and long-term risk of AF in the 7 years following the surgery independently of BMI and AF risk factors. This suggests that EAT is a potent mediator of AF risk in the post cardiac surgery setting.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation - TG/19/2/34831EU Commission - 965286
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Affiliation(s)
- H West
- University of Oxford , Oxford , United Kingdom
| | - M Siddique
- University of Oxford , Oxford , United Kingdom
| | - L Volpe
- University of Oxford , Oxford , United Kingdom
| | - R Desai
- Northwestern University , Chicago , United States of America
| | - M Lyasheva
- University of Oxford , Oxford , United Kingdom
| | - K Dangas
- University of Oxford , Oxford , United Kingdom
| | - P Tomlins
- Caristo Diagnostics , Oxford , United Kingdom
| | - A Mitchell
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A Kardos
- Milton Keynes University Hospital NHS Trust , Milton Keynes , United Kingdom
| | - B Casadei
- University of Oxford , Oxford , United Kingdom
| | - K Channon
- University of Oxford , Oxford , United Kingdom
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Desai R, Singh S, Dyutima DR, Verma J, Raina J, Itare V, Rizvi B, Gandhi Z, Vyas A, Jain A. Predictors of acute pulmonary embolism-related hospitalizations – an artificial neural network analysis using a nationwide cohort in the United States. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Considering a paucity of large-scale data on predictors of pulmonary embolism (PE) and its higher association with complications and worse outcomes, we aimed to determine the predictors of PE in this United States population-based analysis using Artificial Neural Network (ANN) Model in a nationally representative cohort.
Methods
We identified PE-related hospitalizations using 2018's National Inpatient Sample database. The relevant predictive factors for ANN were selected for this cohort. Of all admissions (unweighted n=7,105,498, weighted n=35,527,481), PE cohort (weighted n=387805) consisted of 1.1% of all admissions in 2018. The 2018 cohort was randomly split into training data (unweighted n=4716132, 70.0%) which were used to calibrate ANN and testing data (unweighted n=2019290, 30%) which were used to assess the accurateness of the algorithm. We equated the rate of incorrect prediction between training and testing data and measured the Area under Receiver Operator Curve (AUC) to determine ANN's efficacy in predicting PE hospitalizations.
Results
Patients hospitalized with PE often consisted of older (mean age 62.5±17.1 years), female (51.3%), white (70.5%) patients, and patients from lower-income quartile (0–25% income quartile: 28.8%%), often admitted non-electively (93.7%) with higher rates of cardiovascular disease risk factors. PE admissions revealed significantly higher (6.5% vs. 1.9%, p<0.001) in-hospital mortality, less frequent routine discharges (51.4% vs. 68.1%) and more frequent other facility transfers and requirement of home health care. Normalized Predictors of PE admissions are displayed in Fig. 1. Our ANN model had AUC 0.873 which correlates with an excellent prediction model. Our data demonstrated low levels (0.8%) error in both testing and training models.
Conclusion
Our ANN model showed high performance to predict risk factors for PE admissions in the US population. It will enable clinicians to screen patients at high-risk for PE admissions, curtail complication rate, improve survival and lower the healthcare cost.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Desai
- Independent Researcher , Atlanta , United States of America
| | - S Singh
- Royal Free Hospital, Neurology and Stroke , London , United Kingdom
| | - D R Dyutima
- James Cook University Hospital, Internal Medicine , Middlesbrough , United Kingdom
| | - J Verma
- District Hospital Sangrur, Pulmonology, Sangrur , Punjab , India
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine , Brooklyn , United States of America
| | - V Itare
- Bronxcare Health System, Internal Medicine , Bronx , United States of America
| | - B Rizvi
- Saint Agnes Medical Center, Internal Medicine , Fresno , United States of America
| | - Z Gandhi
- Geisinger Wyoming Valley Medical Center, Internal Medicine , Wilkes-Barre , United States of America
| | - A Vyas
- Baptist Hospitals of Southeast Texas, Internal Medicine , Beaumont , United States of America
| | - A Jain
- Mercy Catholic Medical Center, Internal Medicine , Darby , United States of America
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West H, Siddique M, Volpe L, Desai R, Lyasheva M, Dangas K, Tomlins P, Mitchell A, Kardos A, Casadei B, Channon K, Antoniades C. 410 Automated Deep Learning Quantification Of Epicardial Adiposity On Cardiac CT Predicts Atrial Fibrillation Risk Immediately Following Cardiac Surgery And Long-term. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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West H, Siddique M, Lyasheva M, Volpe L, Desai R, Dangas K, Tomlins P, Mitchell A, Kardos A, Casadei B, Channon KM, Antoniades C. 139 Automated deep learning quantification of epicardial adiposity on cardiac ct predicts atrial fibrillation risk immediately following cardiac surgery and long-term. IMAGING 2022. [DOI: 10.1136/heartjnl-2022-bcs.139] [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: 11/03/2022] Open
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Mishra V, Desai R, Chhina AK, Raina J, Itare V, Patel M, Doshi R, Gangani K, Sachdeva R, Kumar G. Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade.
Purpose
Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young.
Methods
We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities.
Results
AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p<0.001; CABG; aOR=0.66 (0.61-0.71), p<0.001) (Table 2).
Conclusion
Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.
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Affiliation(s)
- V Mishra
- Sir JJ Group of Hospitals, Mumbai, India
| | - R Desai
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - AK Chhina
- Washington D.C. Va Medical Center, Washington, DC, United States of America
| | - J Raina
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - V Itare
- Brookdale University Hospital & Medical Center, Internal Medicine, Brooklyn, United States of America
| | - M Patel
- Smt. BK Shah Medical Institute and Research Centre, Medicine, Vadodara, India
| | - R Doshi
- St Joseph’s Regional Medical Center, Paterson, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Internal Medicine, Arlington, Texas, USA
| | - R Sachdeva
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta VA Medical Healthcare System, Cardiology, Atlanta, United States of America
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Desai R, Mandal A, Peethala MM, Raju AR, Valdez-Aquino C, Fatima B, Raina J, Itare V, Mishra V, Jain A. Frequency, risk and predictors of type 2 myocardial infarction hospitalizations in young obese patients: A nationwide population-based analysis in the United States. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Obesity in the young population is emerging as a challenging health concern. Though there is a rising prevalence of obesity and its potential association with demand ischemia-related myocardial infarction, data remains non-existent to evaluate the association of obesity or higher body mass index (BMI) with type 2 myocardial infarction (T2MI). We aim to identify the frequency, risk and predictors of T2MI in young hospitalized obese patients compared to non-obese patients in this population-based study.
Methods
We used National Inpatient Sample (2018, ICD-10 codes) to identify T2MI in young (18-44 years) hospitalized patients. Obesity was identified from comorbidities or using diagnostic codes for BMI>30 kg/m2. We performed multivariable regression analysis for the primary outcome of odds of T2MI in young obese patients compared to non-obese patients. The frequency of T2MI was compared between obese vs non-obese patients in overall and subgroup populations. Sociodemographic characteristics and comorbidities in T2MI-obese vs. T2MI-non-obese cohorts were also compared. A p<0.05 was considered a threshold for statistical significance.
Results
Out of 1,268,255 young hospitalized patients with obesity, 555 had T2MI. T2MI was significantly higher in young obese than non-obese (44 T2MI/100000 hospitalizations in young obese patients vs. 17 T2MI/100000 hospitalizations in young non-obese patients, overall 0.04% in obese vs. 0.02% in non-obese, p<0.001). Multivariate analysis revealed higher odds of T2MI in obese than nonobese when adjusted for demographics (aOR 2.65, 95% CI:2.42-2.90, p<0.001) and social demographics with comorbidities (aOR 1.60, 95% CI:1.24-2.07, p<0.001). In young obese, higher risk was found with advancing age (OR 1.07, 95% CI 1.03-1.11, p=0.001), in males than females (aOR 2.70, p<0.001), and blacks (aOR 2.22, p=0.011) and Native Americans (OR 3.91, 95% CI: 1.13-13.49, p=0.011) vs whites. Comorbidities including chronic obstructive pulmonary disease (OR 1.86), chronic kidney disease (CKD, OR 2.36), rheumatoid arthritis/collagen vascular disease (RA/CVD, OR 3.04) Iin young obese patients independently increased the risk of T2MI hospitalizations [Table 1]. The T2MI-obese cohort had a significantly higher rate of hyperlipidemia, hypertension, diabetes, COPD, and prior history of MI and TIA/stroke compared to the T2MI-nonobese cohort [Table 2].
Conclusion
This nationwide analysis revealed a significantly higher risk of T2MI in young obese patients compared to nonobese after excluding patients with concomitant diagnoses of T1MI. Males, blacks compared to females and whites, and comorbidities including COPD, CKD and RA/CVD predicted a higher risk of T2MI in young obese patients. Future studies are warranted to evaluate the role of higher body mass index in myocardial oxygen demand-supply mismatch and short-term/long-term risk and outcomes of T2MI.
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Affiliation(s)
- R Desai
- Independent Researcher, Atlanta, United States of America
| | - A Mandal
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - MM Peethala
- Rajeev Gandhi Institute of Medical Sciences, Department of Medicine, Kadapa, India
| | - AR Raju
- Karuna Medical College, Department of Medicine, Palakkad, India
| | - C Valdez-Aquino
- Instituto Nacional de Diabetes (INDEN), Santo Domingo, Dominican Republic
| | - B Fatima
- Deccan College of Medical Sciences, Hyderabad, India
| | - J Raina
- Brookdale University Hospital & Medical Center, Brooklyn, United States of America
| | - V Itare
- Bronxcare Health System, Bronx, United States of America
| | - V Mishra
- Grant Govt. Medical College and Sir J. J. Group of Hospitals, Mumbai, India
| | - A Jain
- Mercy Catholic Medical Center, Internal Medicine, Darby, United States of America
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11
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Desai R, Mandal A, Peethala MM, Raju AR, Fatima B, Valdez-Aquino C, Raina J, Itare V, Mishra V, Jain A. Nationwide frequency, risk and outcomes of type-2 myocardial infarction in patients with versus without previously revascularized myocardial infarction (type 1). Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Type 2 myocardial infarction (T2MI), due to a mismatch between myocardial oxygen demand and supply, is being increasingly recognized with improved diagnostics. The upsetting concern of developing T2MI in patients with prior revascularized occlusive acute myocardial infarction (AMI) or type 1 MI (T1MI) makes it crucial to define the clinical profile and outcomes of T2MI in revascularized patients of ACS.
Purpose
To determine the risk and prognosis of T2MI in patients who had previously had coronary revascularization (PCI or CABG)
Methods
We used the National Inpatient Sample (2018) dataset from the United States to identify T2MI adult hospitalizations using ICD-10 codes and define our study arm as T2MI excluding secondary T1MI diagnoses but having prior revascularized (with percutaneous coronary intervention or coronary artery bypass grafting) AMI. We then compared demographics and comorbidities in T2MI cohort with vs without personal history of revascularized AMI. We used multivariate analysis to study the odds of T2MI hospitalizations with prior revascularized AMI and in-hospital outcomes (all-cause mortality, cardiogenic shock and resource utilization) adjusting for confounders.
Results
There were 33155 T2MI adult hospitalizations after excluding AMI (median age 71 years, 50.6% male, 67.3% white); 1435 (4.3%) had previously revascularized AMI. T2MI in the study arm had higher chances of hospitalization with prior revascularized AMI when adjusted for socio-demographics (aOR 6.92, 95% CI:6.50-7.36, p<0.001) and socio-demographics with comorbidities (aOR 5.70, 95%CI: 5.48-5.94, p<0.001) (Table 1). Study arm often had elderly (≥65 years old, 78.4% vs 65.8%), male (66.6% vs 49.9%), white (76.7% vs 66.9%), upper socio-economic class (20.2 vs 16.8%), patients who were often admitted to non-electively (99.3 vs 97.1%) and to rural (10.5 vs 9.3%) hospitalizations compared to control arm. The study arm had a significantly higher prevalence of diabetes mellitus, hyperlipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemias, prior TIA/stroke, depression and smoking. T2MI cohort with prior revascularized AMI did not show any significant association with in-hospital all-cause mortality (1.7 vs 3.0%, aOR 0.49, 95%CI 0.18-1.34, p=0.164) and cardiogenic shock (1.7% vs 2.1%, p=0.399) however, had lower hospital expenditure (median USD 31273 vs 36567) and fewer transfers to other facilities (19.5 vs 22.1%) than those without prior revascularized AMI (Table 2).
Conclusion
Population-based analysis of this nationally representative sample revealed up to six times higher risk of developing T2MI in patients with prior history of AMI (revascularized) but without any significant impact on all-cause in-hospital mortality or cardiogenic shock. Future studies are warranted to assess the short-term/long-term outcomes of T2MI in high risk patient population with previously revascularized AMI.
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Affiliation(s)
- R Desai
- Independent Researcher, Atlanta, United States of America
| | - A Mandal
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - MM Peethala
- Rajeev Gandhi Institute of Medical Sciences, Department of Medicine, Kadapa, India
| | - AR Raju
- Karuna Medical College, Department of Medicine, Palakkad, India
| | - B Fatima
- Deccan College of Medical Sciences, Hyderabad, India
| | - C Valdez-Aquino
- Instituto Nacional de Diabetes (INDEN), Santo Domingo, Dominican Republic
| | - J Raina
- Brookdale University Hospital & Medical Center, Brooklyn, United States of America
| | - V Itare
- Bronxcare Health System, Bronx, United States of America
| | - V Mishra
- Grant Govt. Medical College and Sir J. J. Group of Hospitals, Mumbai, India
| | - A Jain
- Mercy Catholic Medical Center, Department of Internal Medicine, Darby, United States of America
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12
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Mitchell EJ, Goodman K, Wakefield N, Cochran C, Cockayne S, Connolly S, Desai R, Hartley S, Lawton SA, Oatey K, Rhodes S, Savage JS, Taylor J, Youssouf NFJ. Clinical trial management: a profession in crisis? Trials 2022; 23:357. [PMID: 35477835 PMCID: PMC9044377 DOI: 10.1186/s13063-022-06315-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Clinical trial managers play a vital role in the design and conduct of clinical trials in the UK. There is a current recruitment and retention crisis for this specialist role due to a complex set of factors, most likely to have come to a head due to the COVID-19 pandemic. Academic clinical trial units and departments are struggling to recruit trial managers to vacant positions, and multiple influences are affecting the retention of this highly skilled workforce. Without tackling this issue, we face major challenges in the delivery on the Department of Health and Social Care's Future of UK Clinical Research Delivery implementation plan. This article, led by a leading network of and for UK Trial Managers, presents some of the issues and ways in which national stakeholders may be able to address this.
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Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - K Goodman
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0NA, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Cochran
- Centre for Healthcare and Randomised Controlled Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, AB23 2ZD, UK
| | - S Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Connolly
- Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R Desai
- King's Ophthalmology Research Unit, King's College Hospital, London, SE5 9RS, UK
| | - S Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - S A Lawton
- Keele Clinical Trials Unit, School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - K Oatey
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, EH16 4UX, UK
| | - S Rhodes
- Exeter Clinical Trials Unit, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J S Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - J Taylor
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - N F J Youssouf
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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13
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Reisel D, Burnell M, Side L, Loggenberg K, Gessler S, Desai R, Sanderson S, Brady AF, Dorkins H, Wallis Y, Jacobs C, Legood R, Beller U, Tomlinson I, Wardle J, Menon U, Jacobs I, Manchanda R. Jewish cultural and religious factors and uptake of population-based BRCA testing across denominations: a cohort study. BJOG 2021; 129:959-968. [PMID: 34758513 DOI: 10.1111/1471-0528.16994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association of Jewish cultural and religious identity and denominational affiliation with interest in, intention to undertake and uptake of population-based BRCA (Breast Cancer Gene)-testing. DESIGN Cohort-study set within recruitment to GCaPPS-trial (ISRCTN73338115). SETTING London Ashkenazi-Jewish (AJ) population. POPULATION OR SAMPLE AJ men and women, >18 years. METHODS Participants were self-referred, and attended recruitment clinics (clusters) for pre-test counselling. Subsequently consenting individuals underwent BRCA testing. Participants self-identified to one Jewish denomination: Conservative/Liberal/Reform/Traditional/Orthodox/Unaffiliated. Validated scales measured Jewish Cultural-Identity (JI) and Jewish Religious-identity (JR). Four-item Likert-scales analysed initial 'interest' and 'intention to test' pre-counselling. Item-Response-Theory and graded-response models, modelled responses to JI and JR scales. Ordered/multinomial logistic regression modelling evaluated association of JI-scale, JR-scale and Jewish Denominational affiliation on interest, intention and uptake of BRCA testing. MAIN OUTCOME MEASURES Interest, intention, uptake of BRCA testing. RESULTS In all, 935 AJ women/men of mean age = 53.8 (S.D = 15.02) years, received pre-test education and counselling through 256 recruitment clinic clusters (median cluster size = 3). Denominational affiliations included Conservative/Masorti = 91 (10.2%); Liberal = 82 (9.2%), Reform = 135 (15.1%), Traditional = 212 (23.7%), Orthodox = 239 (26.7%); and Unaffiliated/Non-practising = 135 (15.1%). Overall BRCA testing uptake was 88%. Pre-counselling, 96% expressed interest and 60% intention to test. JI and JR scores were highest for Orthodox, followed by Conservative/Masorti, Traditional, Reform, Liberal and Unaffiliated Jewish denominations. Regression modelling showed no significant association between overall Jewish Cultural or Religious Identity with either interest, intention or uptake of BRCA testing. Interest, intention and uptake of BRCA testing was not significantly associated with denominational affiliation. CONCLUSIONS Jewish religious/cultural identity and denominational affiliation do not appear to influence interest, intention or uptake of population-based BRCA testing. BRCA testing was robust across all Jewish denominations. TWEETABLE ABSTRACT Jewish cultural/religious factors do not affect BRCA testing, with robust uptake seen across all denominational affiliations.
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Affiliation(s)
- D Reisel
- Institute for Women's Health, University College, London, UK
| | - M Burnell
- Institute for Women's Health, University College, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Loggenberg
- Institute for Women's Health, University College, London, UK
| | - S Gessler
- Institute for Women's Health, University College, London, UK
| | - R Desai
- Institute for Women's Health, University College, London, UK
| | - S Sanderson
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - A F Brady
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Dept Clinical Genetics, Guy's Hospital, London, UK.,University of Technology Sydney, Ultimo, NSW, Australia
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - U Beller
- Department of Gynaecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - J Wardle
- Behavioral Sciences Unit, Dept Epidemiology and Public Health, University College London, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- Institute for Women's Health, University College, London, UK.,University of New South Wales, Sydney, NSW, Australia
| | - R Manchanda
- MRC Clinical Trials Unit, University College London, London, UK.,Wolfson Institute of Population Health, CRUK Barts Centre, Queen Mary University of London, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
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14
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West HW, Siddique M, Volpe L, Desai R, Lyasheva M, Dangas K, Shirodaria C, Neubauer S, Channon K, Desai MY, Newby DE, Rodrigues JCL, Adlam D, Nicol ED, Antoniades C. Automated quantification of epicardial adipose tissue on CCTA via deep-learning detection of the pericardium: clinical implications. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Epicardial adipose tissue (EAT) is a visceral fat deposit within the pericardial sac which surrounds the heart myocardium and coronary arteries. EAT volume has been demonstrated to be strongly associated with the development and prognosis of cardiovascular diseases, but its measurement is subjective and challenging in practice.
Purpose
To develop a deep-learning approach for automated segmentation of EAT from routine CCTA scans, that could assist clinical interpretation of CCTA.
Methods
A deep-learning method using a 3D Residual-U-Net neural network architecture for 3D volumetric segmentation of CCTA data was created. The network was trained on a diverse sample of 1900 CCTAs, each manually segmented by a single expert, drawn from the UK sites of the Oxford Risk Factors And Non-invasive imaging (ORFAN) Study. Three iterations of feedback learning were used to fine tune the algorithm for the segmentation of the whole heart within the bounds of the pericardium. In each iteration, the machine analysed sets of 100–250 unannotated CCTAs unseen by the machine which were then corrected by experts. EAT volumes were calculated by automated thresholding of adipose tissue (−190HU through −30HU) from within the bound of the pericardial segment (Figure 1). The network was then applied to 817 unseen CCTAs from US sites of the ORFAN Study. These scans were also segmented for ground truth by two experts blind to all other data. Comparisons between machine vs expert total pericardial volume and EAT volume were made using Lin's concordance correlation coefficient (CCC). The algorithm was then applied externally in 1588 CCTAs from the SCOTHEART trial (UK), and the EAT volume was automatically calculated for each case. Cross-sectional associations between standardised EAT volumes and prevalent AF and CAD were performed.
Results
Within both the internal (UK ORFAN sites) and external (USA ORFAN sites) validation cohorts correlation between human and machine segmented total pericardium and EAT was excellent, with CCC of 0.97 for both volumes (external validation cohort shown in Figure 2A). Utilising SCOTHEART CCTAs with automatically segmented EAT volumes, a multivariable-adjusted logistic regression model accounting for risk factors of age, sex, BMI, hypertension, diabetes mellitus, valvular disease, and previous heart surgery found that EAT volumes were significantly associated with prevalent AF, with odds ratio (OR) per 1 SD increase of EAT volume of 1.20 (95% CI, 1.06 to 1.44; P=0.03). A similar model for prevalent CAD, adjusted for age, sex, BMI, hypertension, non-HDL cholesterol, diabetes mellitus, and coronary artery calcium score resulted in an OR per 1 SD increase of EAT volume of 1.26 (95% CI, 1.10 to 1.45; P=0.001) (Figure 2B).
Conclusion
Highly accurate, reproducible, and instantaneous EAT volume quantification is possible utilising deep-learning detection of the whole human heart within the pericardial sac.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart FoundationNational Institute for Health Research - Oxford University Hospitals Biomedical Research Centre Figure 1Figure 2
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Affiliation(s)
- H W West
- University of Oxford, Oxford, United Kingdom
| | - M Siddique
- University of Oxford, Oxford, United Kingdom
| | - L Volpe
- University of Oxford, Oxford, United Kingdom
| | - R Desai
- Northwestern University, Chicago, United States of America
| | - M Lyasheva
- University of Oxford, Oxford, United Kingdom
| | - K Dangas
- University of Oxford, Oxford, United Kingdom
| | - C Shirodaria
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Oxford, United Kingdom
| | - K Channon
- University of Oxford, Oxford, United Kingdom
| | - M Y Desai
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, United States of America
| | - D E Newby
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J C L Rodrigues
- Royal United Hospital Bath NHS Trust, Department of Radiology, Bath, United Kingdom
| | - D Adlam
- University of Leicester, Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - E D Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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15
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Hanna B, Desai R, Sachdeva S, Singh S, Gangani K, Taha Y, Echols M, Paul T, Berman A, Bloom H, Kumar G, Sachdeva R. Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.
Methods
PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).
Results
We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred >2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.
Conclusion
PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (>24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Hanna
- Morehouse School of Medicine, Atlanta, United States of America
| | - R Desai
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical College and Hospitals, Department of Medicine, New Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - Y Taha
- Morehouse School of Medicine, Atlanta, United States of America
| | - M Echols
- Morehouse School of Medicine, Atlanta, United States of America
| | - T.K Paul
- East Tennessee State University, Division of Cardiology, Johnson city, Tennessee, United States of America
| | - A Berman
- Augusta University, Augusta, United States of America
| | - H Bloom
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - G Kumar
- Atlanta Veterans Affairs Medical Center, Cardiology, Atlanta, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta, United States of America
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16
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Desai R, Sachdeva S, Singh S, Rajan S, Shaik A, Haider M, Fong H, Gangani K, Sachdeva R, Kumar G. Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.
Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.
Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).
Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Desai
- Atlanta Veterans Affairs Medical Centre, Division of Cardiology, Atlanta, United States of America
| | - S Sachdeva
- Lady Hardinge Medical college and hospitals, Delhi, India
| | - S Singh
- Amsterdam University Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, Netherlands (The)
| | - S.K Rajan
- Medical City Plano, Department of Medicine, plano, Texas, United States of America
| | - A.S Shaik
- Silver Lane Medical Centre, Department of Medicine, East Hartford, Connecticut, United States of America
| | - M Haider
- New York-Presbyterian Hospital, Department of Internal Medicine, New York, United States of America
| | - H.K Fong
- UC Davis Medical Centre, Division of Cardiovascular Medicine, Sacramento, United States of America
| | - K Gangani
- Texas Health Arlington Memorial Hospital, Department of Internal Medicine, Arlington, Texas, United States of America
| | - R Sachdeva
- Morehouse School of Medicine, Atlanta VA Medical centre & Medical College of Georgia, Division of Cardiology, Augusta,Georgia, United States of America
| | - G Kumar
- Emory University & Atlanta VA Medical Centre, Division of Cardiology, Atlanta, Georgia, United States of America
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17
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Desai S, Desai R. The Experiences of a Low Vision Center in India. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9408800315] [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: 11/16/2022]
Affiliation(s)
- S. Desai
- Rupal Gajjar Low Vision Centre, Tarabai Desai Eye Hospital, E-22, Shastri Nagar, Jodhpur 342 003, India
| | - R. Desai
- Rupal Gajjar Low Vision Centre, Tarabai Desai Eye Hospital, E-22, Shastri Nagar, Jodhpur 342 003, India
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18
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Khumalo G, Desai R, Xaba X, Moshabela M, Essack S, Lutge E. Prioritising health research in KwaZulu-Natal: has the research conducted met the research needs? Health Res Policy Syst 2020; 18:32. [PMID: 32183821 PMCID: PMC7079502 DOI: 10.1186/s12961-020-0538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background The KwaZulu-Natal (KZN) Health Act of 2009 mandates the Provincial Health Research and Ethics Committee to develop health research priorities for the province. During 2013, the KZN Department of Health embarked on a research prioritisation process for the province. Priority research questions were generated by an inclusive process, in which a variety of stakeholders in health research in the province were engaged. The aim of this study was to determine whether research conducted at public health facilities in KZN between 01 January 2014 and 31 March 2017 met the research priorities of the province developed through the provincial research prioritisation process of 2013. Methods This was a mixed methods study. Qualitative thematic analysis was used to categorise priority research questions generated in the priority-setting process and the titles of research projects conducted after that process into themes. Quantitative analysis was used to determine the correlation between themes of the priority questions, and those of the research projects conducted after the prioritisation exercise. Statistical Package for Social Science version 25 was used to analyse the data. Results In 72% of thematic areas, there were disproportionately more priority questions than there were research projects conducted. There is thus a large disjuncture between the priorities developed through the provincial research prioritisation process of 2013 and the research projects conducted after that process in terms of major research areas. Conclusions Ensuring that research conducted responds to priority questions raised is important because it ensures that research responds to locally important issues and to the concerns of local actors. Local health managers, communities and researchers should work together to ensure that the research conducted in their areas respond to the research priorities of those areas. Health Research Committees and local ethics committees can play important roles in facilitating the responsiveness to research priorities.
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Affiliation(s)
- G Khumalo
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa.
| | - R Desai
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa
| | - X Xaba
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa
| | - M Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
| | - S Essack
- School of Health Sciences, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
| | - E Lutge
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
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19
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Handelsman DJ, Desai R, Seibel MJ, Le Couteur DG, Cumming RG. Circulating Sex Steroid Measurements of Men by Mass Spectrometry Are Highly Reproducible after Prolonged Frozen Storage. J Steroid Biochem Mol Biol 2020; 197:105528. [PMID: 31712118 DOI: 10.1016/j.jsbmb.2019.105528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 01/10/2023]
Abstract
Long-term studies investigating hormone-dependent cancers and reproductive health often require prolonged frozen storage of serum which assumes that the steroid molecules and measurements are stable over that time. Previous studies of reproducibility of circulating steroids have relied upon flawed historical rather than contemporaneous controls. We measured serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2) and estrone (E1) in 150 randomly selected serum samples by liquid chromatography-mass spectrometry (LC-MS) from men 70 years or older (mean age 77 years) in the CHAMP study. The original measurements in 2009 were repeated 10 years later using the identical serum aliquot (having undergone 2-4 freeze-thaw cycles in the interim) in 2019 together with another never-thawed aliquot of the same serum sample. The results of all three sets of measurements were evaluated by Passing-Bablok regression and Bland-Altman difference analysis. Serum androgens (T, DHT) and estrogens (E2, E1) measured by LC-MS display excellent reproducibility when stored for 10 years at -80 C without thawing. Serum T and DHT displayed high level of reproducibility across all three sets of measurements. Multiple freeze-thaw cycles over those storage conditions do not significantly affect serum T, DHT and E1 concentrations but produce a modest increase (21%) in serum E2 measurements.
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Affiliation(s)
- D J Handelsman
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Australia.
| | - R Desai
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Australia
| | - M J Seibel
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Australia
| | - D G Le Couteur
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Australia
| | - R G Cumming
- Andrology Laboratory, ANZAC Research Institute, University of Sydney, Australia
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20
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Desai R, Ruiter RAC, Schepers J, Reddy SP, Mercken LAG. Tackling smoking among out of school youth in South Africa: An analysis of friendship ties. Addict Behav Rep 2019; 10:100214. [PMID: 31517020 PMCID: PMC6728272 DOI: 10.1016/j.abrep.2019.100214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background Friendships during adolescence play a significant role in the initiation and maintenance of tobacco use. Smoking behaviour among adolescent friends has not been explored among out of school youth (OSY) in South Africa. Out of school youth (OSY), described as those between 13 and 20 years old, have not completed their schooling and are not currently enrolled in school, are at greater risk for tobacco use. Aim The main aim of this study is to examine whether the smoking behaviour of OSY is associated with that of their OSY friends. Methods Respondent driven sampling was used to recruit OSY and their OSY friends. A mixed effects logistic regression with a random intercept across school-province combinations was used to analyse survey data. Race and gender were also incorporated into the analyses as effect moderators (n = 391). Results Results of this study confirm that cigarette smoking was common among OSY and their OSY friends, with 53.5% of the respondents smoking in the past month (SD = 0.44). When OSY friends were either all non-smokers or half their friends were non-smokers, Coloured (mixed race) OSY were less likely to smoke compared to Black African and Other (mostly Asian descent) OSY. Conclusion Cultural norms and values associated with the different race groups may play a role in the smoking behaviour of out of school youth friends. Understanding this relationship is useful for identifying those OSY that are vulnerable to the behaviours that place them at risk of tobacco related morbidity and mortality. Smoking was common among out of school youth and their out of school youth friends. Racial differences were found in out of school youth smoking and their friends. Cultural norms and values influence smoking behaviour of out of school youth friends.
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Affiliation(s)
- R Desai
- Department of Work & Social Psychology, Maastricht University, P.O. Box 6200, MD, Maastricht, the Netherlands
| | - R A C Ruiter
- Department of Work & Social Psychology, Maastricht University, P.O. Box 6200, MD, Maastricht, the Netherlands
| | - J Schepers
- Department of Methodology and Statistics, Maastricht University, P.O. Box 6200, MD, Maastricht, the Netherlands
| | - S P Reddy
- Human Sciences Research Council, Social Aspects of Health, Private Bag X9182, Cape Town 8000, South Africa
| | - L A G Mercken
- Department of Health Promotion, Maastricht University and Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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21
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Manchanda R, Burnell M, Gaba F, Desai R, Wardle J, Gessler S, Side L, Sanderson S, Loggenberg K, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Legood R, Beller U, Tomlinson I, Menon U, Jacobs I. Randomised trial of population‐based
BRCA
testing in Ashkenazi Jews: long‐term outcomes. BJOG 2019; 127:364-375. [PMID: 31507061 DOI: 10.1111/1471-0528.15905] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- R Manchanda
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
- Department of Gynaecological Oncology St Bartholomew's Hospital London UK
- MRC Clinical Trials Unit University College London London UK
| | - M Burnell
- MRC Clinical Trials Unit University College London London UK
| | - F Gaba
- Wolfson Institute of Preventive Medicine Barts Cancer Institute Queen Mary University of London London UK
| | - R Desai
- MRC Clinical Trials Unit University College London London UK
| | - J Wardle
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - S Gessler
- MRC Clinical Trials Unit University College London London UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust Southampton UK
| | - S Sanderson
- Behavioural Sciences Unit Department of Epidemiology and Public Health University College London London UK
| | - K Loggenberg
- North East Thames Regional Genetics Unit Department of Clinical Genetics Great Ormond Street Hospital London UK
| | - AF Brady
- North West Thames Regional Genetics Service Northwick Park Hospital Harrow UK
| | - H Dorkins
- St Peter's College University of Oxford Oxford UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Chapman
- West Midlands Regional Genetics Service Department of Clinical Genetics Birmingham Women's NHS Foundation Trust Birmingham UK
| | - C Jacobs
- Department of Clinical Genetics Guy's Hospital London UK
- University of Technology Sydney Sydney NSW Australia
| | - R Legood
- Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London UK
| | - U Beller
- Department of Gynaecology Shaare Zedek Medical Centre Jerusalem Israel
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - U Menon
- MRC Clinical Trials Unit University College London London UK
| | - I Jacobs
- University of New South Wales UNSW Sydney Sydney NSW Australia
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22
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Manchanda R, Burnell M, Gaba F, Sanderson S, Loggenberg K, Gessler S, Wardle J, Side L, Desai R, Brady AF, Dorkins H, Wallis Y, Chapman C, Jacobs C, Tomlinson I, Beller U, Menon U, Jacobs I. Attitude towards and factors affecting uptake of population-based BRCA testing in the Ashkenazi Jewish population: a cohort study. BJOG 2019; 126:784-794. [PMID: 30767407 DOI: 10.1111/1471-0528.15654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate factors affecting unselected population-based BRCA testing in Ashkenazi Jews (AJ). DESIGN Cohort-study set within recruitment to the GCaPPS trial (ISRCTN73338115). SETTING North London AJ population. POPULATION OR SAMPLE Ashkenazi Jews women/men >18 years, recruited through self-referral. METHODS Ashkenazi Jews women/men underwent pre-test counselling for BRCA testing through recruitment clinics (clusters). Consenting individuals provided blood samples for BRCA testing. Data were collected on socio-demographic/family history/knowledge/psychological well-being along with benefits/risks/cultural influences (18-item questionnaire measuring 'attitude'). Four-item Likert-scales analysed initial 'interest' and 'intention-to-test' pre-counselling. Uni- and multivariable logistic regression models evaluated factors affecting uptake/interest/intention to undergo BRCA testing. Statistical inference was based on cluster robust standard errors and joint Wald tests for significance. Item-Response Theory and graded-response models modelled responses to 18-item questionnaire. MAIN OUTCOME MEASURES Interest, intention, uptake, attitude towards BRCA testing. RESULTS A total of 935 individuals (women = 67%/men = 33%; mean age = 53.8 (SD = 15.02) years) underwent pre-test genetic-counselling. During the pre-counselling, 96% expressed interest in and 60% indicated a clear intention to undergo BRCA testing. Subsequently, 88% opted for BRCA testing. BRCA-related knowledge (P = 0.013) and degree-level education (P = 0.01) were positively and negatively (respectively) associated with intention-to-test. Being married/cohabiting had four-fold higher odds for BRCA testing uptake (P = 0.009). Perceived benefits were associated with higher pre-counselling odds for interest in and intention to undergo BRCA testing. Reduced uncertainty/reassurance were the most important factors contributing to decision-making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional impact/inability to prevent cancer/marriage ability/ethnic focus/stigmatisation) were significantly associated with lower odds of uptake of BRCA testing, and discriminated between acceptors and decliners. Male gender/degree-level education (P = 0.001) had weaker correlations, whereas having children showed stronger (P = 0.005) associations with attitudes towards BRCA testing. CONCLUSIONS BRCA testing in the AJ population has high acceptability. Pre-test counselling increases awareness of disadvantages/limitations of BRCA testing, influencing final cost-benefit perception and decision-making on undergoing testing. TWEETABLE ABSTRACT BRCA testing in Ashkenazi Jews has high acceptability and uptake. Pre-test counselling facilitates informed decision-making.
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Affiliation(s)
- R Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - M Burnell
- MRC Clinical Trials Unit, University College London, London, UK
| | - F Gaba
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - S Sanderson
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - K Loggenberg
- Department of Clinical Genetics, North East Thames Regional Genetics Unit, Great Ormond Street Hospital, London, UK
| | - S Gessler
- MRC Clinical Trials Unit, University College London, London, UK
| | - J Wardle
- Behavioural Sciences Unit, Department of Epidemiology and Public Health, University College London, London, UK
| | - L Side
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Desai
- MRC Clinical Trials Unit, University College London, London, UK
| | - A F Brady
- Department of Clinical Genetics, North West Thames Regional Genetics Unit, Northwick Park Hospital, London, UK
| | - H Dorkins
- St Peter's College, University of Oxford, Oxford, UK
| | - Y Wallis
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Chapman
- Department of Clinical Genetics, West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - C Jacobs
- Department of Clinical Genetics, Guy's Hospital, London, UK
- University of Technology Sydney, Sydney, NSW, Australia
| | - I Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - U Beller
- Department of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - I Jacobs
- University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
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23
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Doshi R, Cangal K, Gupta R, Sha J, Patel K, Desai R. Comparison of Outcomes and Cost of Endovascular Management vs Surgical Bypass for the Management of Lower Extremity Peripheral Arterial Disease. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Mouthon L, Kaveri SV, Spalter SH, Lacroix-Desmazes S, Lefranc C, Desai R, Kazatchkine MD. Mechanisms of action of intravenous immune globulin in immune-mediated diseases. Clin Exp Immunol 2019. [DOI: 10.1111/cei.1996.104.s1.3] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Bakre T, Puntambekar S, Puntambekar S, Desai R, Chitale M. Laparoscopic Ureteric Dissection in Case of Difficult Broad Ligament Fibroid with Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.639] [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: 11/16/2022]
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Abstract
Lipoprotein lipase (LPL) deficiency is an autosomal recessive metabolic disorder with varying presentation in infancy and childhood, whereas clinical manifestations are rare in neonatal period. The estimated prevalence is one in a million births. A 23-day-old baby was admitted with complaints of fever, vomiting, and lethargy. Blood sample drawn appeared lipemic. Lipemia retinalis was noted on funduscopic examination. Biochemical analysis revealed abnormal lipid profile with severe hypertriglyceridemia (10,300 mg/dL) and elevated serum lipase level (517 IU/L) indicative of LPL deficiency with acute pancreatitis. LPL deficiency was suspected and was confirmed by molecular genetic testing, which revealed a novel mutation in LPL gene. Dietary management and gemfibrozil were started following which serum triglyceride level decreased and serum lipase level normalized. The patient is following up regularly for growth and development monitoring.
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Affiliation(s)
- M H Shah
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - R Roshan
- Department of Clinical Hematology, Sahyadri Specialty Hospital, Pune, Maharashtra, India
| | - R Desai
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - S S Kadam
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, Maharashtra, India
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27
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Metrebian N, Weaver T, Pilling S, Hellier J, Byford S, Shearer J, Mitcheson L, Astbury M, Bijral P, Bogdan N, Bowden-Jones O, Day E, Dunn J, Finch E, Forshall S, Glasper A, Morse G, Akhtar S, Bajaria J, Bennett C, Bishop E, Charles V, Davey C, Desai R, Goodfellow C, Haque F, Little N, McKechnie H, Morris J, Mosler F, Mutz J, Pauli R, Poovendran D, Slater E, Strang J. Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management. Contemp Clin Trials 2018; 71:124-132. [PMID: 29908336 DOI: 10.1016/j.cct.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.
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Affiliation(s)
- N Metrebian
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - T Weaver
- Imperial College London, London, UK; Middlesex University, London, UK
| | - S Pilling
- University College London, London, UK
| | - J Hellier
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Shearer
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - L Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Astbury
- Dudley & Walsall Mental Health Partnership Trust, Dudley, UK
| | - P Bijral
- Change, Grow, Live Charity, Management Offices, London, UK
| | - N Bogdan
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - O Bowden-Jones
- Central and North West London NHS Foundation Trust, London, UK
| | - E Day
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Dunn
- Camden & Islington NHS Foundation Trust, London, UK
| | - E Finch
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Forshall
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - A Glasper
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - G Morse
- Turning Point Charity, London, UK
| | - S Akhtar
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Bajaria
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - C Bennett
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - E Bishop
- University College London, London, UK
| | - V Charles
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - C Davey
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - R Desai
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - F Haque
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - N Little
- University College London, London, UK
| | | | - J Morris
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - F Mosler
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Mutz
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - R Pauli
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | | | - E Slater
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - J Strang
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Werner-Lin A, Ersig AL, Mueller R, Young JL, Hoskins LM, Desai R, Greene MH. Catalysts towards cancer risk management action: A longitudinal study of reproductive-aged women with BRCA1/2 mutations. J Psychosoc Oncol 2018; 36:529-544. [DOI: 10.1080/07347332.2018.1469565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Allison Werner-Lin
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | - Anne L. Ersig
- School of Nursing and American Family Children's Hospital, University of Wisconsin-Madison, Madison, WI
| | - Rebecca Mueller
- Department of Philosophy, School of Arts of Sciences, University of Pennsylvania, Philadelphia, PA
| | - Jennifer L. Young
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, Bethesda, MD
| | | | - Ria Desai
- School of Arts of Sciences, University of Pennsylvania, Philadelphia, PA
| | - Mark H. Greene
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute, Bethesda, MD
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29
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Desai R, Nesper P, Goldstein DA, Fawzi AA, Jampol LM, Gill M. OCT Angiography Imaging in Serpiginous Choroidopathy. ACTA ACUST UNITED AC 2018; 2:351-359. [DOI: 10.1016/j.oret.2017.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/05/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
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30
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Werner-Lin A, Zaspel L, Carlson M, Mueller R, Walser SA, Desai R, Bernhardt BA. Gratitude, protective buffering, and cognitive dissonance: How families respond to pediatric whole exome sequencing in the absence of actionable results. Am J Med Genet A 2018; 176:578-588. [DOI: 10.1002/ajmg.a.38613] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Allison Werner-Lin
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Lori Zaspel
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Mae Carlson
- School of Social Policy and Practice; University of Pennsylvania; Philadelphia Pennsylvania
| | - Rebecca Mueller
- Department of History and Sociology of Science; University of Pennsylvania; Philadelphia Pennsylvania
| | - Sarah A. Walser
- Department of Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ria Desai
- College of Arts and Science; University of Pennsylvania; Philadelphia Pennsylvania
| | - Barbara A. Bernhardt
- Department of Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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31
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Naidoo P, Sewpaul R, Nyembezi A, Reddy P, Louw K, Desai R, Stein DJ. The association between biopsychosocial factors and disability in a national health survey in South Africa. PSYCHOL HEALTH MED 2017; 23:653-660. [PMID: 29280386 DOI: 10.1080/13548506.2017.1417606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 10/18/2022]
Abstract
The association between psychosocial factors and disability is less clear. This study investigated the biological and psychosocial (employment and psychological distress) factors associated with level of disability in an adult sample in South Africa. Data were analysed from a cross-sectional survey among adults aged 18-64 (n = 4974). Multiple linear regression was used to investigate the associations of the selected variables with disability. The mean percentage score on the WHODAS scale of disability was 5.31% (95% CI: 4.74-5.88). Age (p < 0.001) and race (p = 0.0002) were significantly associated with disability, and history of stroke (β = 7.19, 95% CI: 3.19-11.20) and heart-related conditions (β = 2.08, 95% CI: [0.23-3.93) showed positive associations. Of the psychosocial variables, psychological distress (β = 10.49 [8.63-12.35]) showed a strong positive association while employment (-1.62 [-2.36 to -0.88]) showed a negative association with disability. The association between demographic factors, medical conditions and increased disability confirms the findings in the literature. The finding that psychological distress is associated with increased disability has not been frequently reported. This study highlights specific psychosocial targets that may be usefully addressed by health policies and interventions in order to improve disability management.
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Affiliation(s)
- P Naidoo
- a Department of Psychology , University of the Western Cape , Cape Town , South Africa.,b Heart and Stroke Foundation South Africa , Cape Town , South Africa
| | - R Sewpaul
- c Human Sciences Research Council , Cape Town , South Africa
| | - A Nyembezi
- c Human Sciences Research Council , Cape Town , South Africa
| | - P Reddy
- c Human Sciences Research Council , Cape Town , South Africa.,d Faculty of Community and Health Sciences, Department of Social Work , University of the Western Cape , Cape Town , South Africa
| | - K Louw
- e Department of Psychiatry and MRC Unit on Anxiety & Stress Disorders , University of Cape Town , Cape Town , South Africa
| | - R Desai
- c Human Sciences Research Council , Cape Town , South Africa
| | - D J Stein
- e Department of Psychiatry and MRC Unit on Anxiety & Stress Disorders , University of Cape Town , Cape Town , South Africa
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Stupp R, Taphoorn M, Driven L, Taillibert S, Honnorat J, Chen T, Sroubek J, Paek S, Escuder J, Easaw J, David C, Kim C, Desai R, Olivi A, Kew Y, Hottinger A, Hegi M, Kirson E, Lavy-Shahaf G, Ram Z. Tumor Treating Fields (TTFields)—A Novel Cancer Treatment Modality: Translating Preclinical Evidence and Engineering Into a Survival Benefit with Delayed Decline in Quality of Life. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stupp R, Taphoorn M, Dirven L, Taillibert S, Honnorat J, Chen T, Sroubek J, Paek S, Bruna Escuder J, Easaw J, David C, Kim C, Desai R, Kew Y, Olivi A, Hottinger A, Kirson E, Lavy-Shahaf G, Hegi M, Ram Z. Tumor Treating Fields (TTFields) – A novel cancer treatment modality: Translating preclinical evidence and engineering into a survival benefit with delayed decline in quality of life. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx366.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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34
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Handelsman D, Teede H, Desai R, Norman R, Moran L. Performance of mass spectrometry steroid profiling for diagnosis of polycystic ovary syndrome. Hum Reprod 2017; 32:1540. [DOI: 10.1093/humrep/dex212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Tackett S, Gaglani S, Slinn K, Marshall T, Desai R, Haynes M. Open Osmosis: Promoting the Global Diffusion of Open Education
Resources. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.318] [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: 11/16/2022] Open
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36
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Iyer R, Mok SF, Savkovic S, Turner L, Fraser G, Desai R, Jayadev V, Conway AJ, Handelsman DJ. Pharmacokinetics of testosterone cream applied to scrotal skin. Andrology 2017; 5:725-731. [DOI: 10.1111/andr.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R. Iyer
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. F. Mok
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - S. Savkovic
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - L. Turner
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - G. Fraser
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - R. Desai
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - V. Jayadev
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - A. J. Conway
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
| | - D. J. Handelsman
- Andrology Department; Concord Hospital and ANZAC Research Institute; University of Sydney; Sydney NSW Australia
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Ma J, Desai R, Nesper P, Gill M, Fawzi A, Skondra D. Optical Coherence Tomographic Angiography Imaging in Age-Related Macular Degeneration. Ophthalmol Eye Dis 2017; 9:1179172116686075. [PMID: 28579843 PMCID: PMC5422508 DOI: 10.1177/1179172116686075] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is emerging as a rapid, noninvasive imaging modality that can provide detailed structural and flow information on retinal and choroidal vasculature. This review contains an introduction of OCTA and summarizes the studies to date on OCTA imaging in age-related macular degeneration.
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Affiliation(s)
- Jeffrey Ma
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ria Desai
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manjot Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dimitra Skondra
- Department of Ophthalmology & Visual Science, The University of Chicago, Chicago, IL, USA
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Handelsman D, Teede H, Desai R, Norman R, Moran L. Performance of mass spectrometry steroid profiling for diagnosis of polycystic ovary syndrome. Hum Reprod 2016; 32:418-422. [DOI: 10.1093/humrep/dew328] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/12/2016] [Accepted: 12/01/2016] [Indexed: 01/01/2023] Open
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Alkhawam H, El-Hunjul M, Nguyen J, Desai R, Syed U, Vittorio TJ. Natriuretic peptide hormones in congestive heart failure: challenges, clinical interpretation and review of studies. Acta Cardiol 2016; 71:417-424. [PMID: 27594357 DOI: 10.2143/ac.71.4.3159694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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40
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Palisoul M, Nguyen M, Pan H, Lohrey A, Desai R, Wickline S, Powell M, Mutch D, Fuh K. AXL, a receptor tyrosine kinase, mediates platinum and taxane resistance in ovarian and uterine cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alkhawam H, Sogomonian R, Desai R, Jolly J, Vyas N, Sayanlar J, Rubinstein D, Kabach M. ID: 74: A RETROSPECTIVE STUDY OF CORONARY ARTERY DISEASE IN PATIENTS WITH BODY MASS INDEX ≥30. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.10] [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
IntroductionCoronary Artery Disease (CAD) is a major cause of morbidity and mortality worldwide, and although mortality is decreasing, prevalence of CAD is increasing. A number of modifiable risk factors (smoking) and non-modifiable risk factors (gender, age) have well established association with CAD, whereas other potential risk factors (such as obesity) are less well established. In this study, we evaluated the obesity as a single risk factor for CAD and evaluated the synergistic effect of obesity with the other risk factors.MethodA retrospective study of 7,567 patients admitted to hospital for chest pain from 2005–2014 and underwent cardiac catheterization. Patients were divided into two groups: obese and normal with body mass index (BMI) calculated as ≥30 kg/m2 and ≤25, respectively. Patients with BMIs between 26 and 29 were excluded. We assessed the modifiable and non-modifiable risk factors in obese patients and the degree of CAD with coronary angiography as obstructive CAD (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries.ResultsOf the 7,567 patients who underwent cardiac catheterization, 414 (5.5%) had a BMI ≥30. Of 414 obese patients, 332 (80%) had evidence of CAD. Obese patients displayed evidence of CAD at the age of 57 versus 63.3 in non-obese patients (p<0.001).Of the 332 patients with CAD and obesity, 55.4% had obstructive CAD versus 44.6% with non-obstructive CAD. In obese patients with CAD, Male gender and history of smoking were major risk factors for development of obstructive CAD (p=0.001 and 0.01, respectively) while dyslipidemia was a major risk factor for non-obstructive CAD (p 0.01). Additionally, obese patients with more than one risk factor; developed obstructive CAD compared to non-obstructive CAD (p=0.003). Approximately 40% presented with STEMI, 30% with NSTEMI and 30% had stable angina as a primary diagnosis.Of the 332 obese patients with CAD, 24% received medical treatment, 58% underwent percutaneous coronary intervention (PCI) and 18% obtained coronary artery bypass grafting (CABG).In a gender comparison, average age of CAD in obese males were 55 years of age compared to 59 in females (p <0.001). Approximately 67% of males underwent PCI (OR: 2.4, 95% CI: 1.5–3.6, p<0.001) and 24% obtained CABG (OR: 3, 95% CI: 1.6–5.6, p<0.001), whereas in obese females 43% received medical therapy (OR: 9, 95% CI: 5–17, p<0.001).ConclusionHaving a BMI ≥30 appears to correlate as a risk factor for early development of CAD. Severity of CAD in obese patients is depicted on non-modifiable and modifiable risk factors such as the male gender and smoking or greater than one risk factor, respectively. Early lifestyle modification and education may provide benefit in striving to aid decreasing incidents of CAD and possibly lowering cardiovascular events.
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Heslin M, Desai R, Lappin JM, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P, Fisher HL, Demjaha A, Craig T, Morgan C. Biological and psychosocial risk factors for psychotic major depression. Soc Psychiatry Psychiatr Epidemiol 2016; 51:233-45. [PMID: 26520449 PMCID: PMC4748002 DOI: 10.1007/s00127-015-1131-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
Abstract
AIMS Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. METHODS Based on the aetiology and ethnicity in schizophrenia and other psychoses (ÆSOP) study, we used a case-control study to identify and recruit, at baseline and 10-year follow-up, all first episode cases of psychosis, presenting for the first time to specialist mental health services in defined catchment areas in the UK. Population-based controls were recruited from the same areas. Data were collected on: sociodemographics; social isolation; childhood adversity; life events; minor physical anomalies; and neurological soft signs. RESULTS Living alone (aOR = 2.26, CI = 1.21-4.23), basic level qualification (aOR = 2.89, CI = 1.08-7.74), being unemployed (aOR = 2.12, CI = 1.13-3.96), having contact with friends less than monthly (aOR = 4.24, CI = 1.62-11.14), having no close confidants (aOR = 4.71, CI = 2.08-10.68), having experienced childhood adversity (aOR = 2.57, CI = 1.02-6.44), family history of mental illness (aOR = 10.68, CI = 5.06-22.52), family history of psychosis (aOR = 12.85, CI = 5.24-31.51), and having more neurological soft signs (aOR = 1.15, CI = 1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia. Few variables associated with PMD were also associated with a diagnosis of bipolar disorder. Minor physical anomalies were associated with a follow-up diagnosis of schizophrenia and bipolar disorder, but not PMD. CONCLUSIONS Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the 'specifier' between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change.
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Affiliation(s)
- M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - R Desai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - J M Lappin
- University of New South Wales, Sydney, Australia
| | - K Donoghue
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - B Lomas
- University of Nottingham, Nottingham, UK
| | - U Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Maastricht University, Maastrict, The Netherlands
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | | | - P B Jones
- University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - P Fearon
- Trinity College, Dublin, Ireland
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - H L Fisher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
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Limaye D, Kale M, Chitre N, Deshapande D, Desai R, Limaye V, Fortwengel G. Cost-effectiveness Study of Antihypertensive Drugs in Mumbai, India. Curr Ther Res Clin Exp 2016. [DOI: 10.1016/j.curtheres.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Limaye V, Limaye D, Desai R, Sheth J, Prabhu S, Fortwengel G. Prevalence of musculoskeletal disorders among dentists from Mumbai, India. Curr Ther Res Clin Exp 2016. [DOI: 10.1016/j.curtheres.2016.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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45
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Miyamoto D, Zheng Y, Wittner B, Lee R, Zhu H, Broderick K, Desai R, Brannigan B, Arora K, Dahl D, Sequist L, Smith M, Kapur R, Wu C, Shioda T, Ramaswamy S, Ting D, Toner M, Maheswaran S, Haber D. Single Cell RNA Profiling of Circulating Tumor Cells in Patients With Prostate Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jain M, Chatterjee A, Mohapatra J, Bandhyopadhyay D, Ghoshdostidar K, Bhatnagar U, Patel H, Srivastava B, Ramanathan V, Patel P, Desai R. 325 Identification of a novel efficacious and safe poly (ADP-ribose) polymerase (PARP) and tankyrase inhibitor for treatment of various types of solid tumors. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Naidu R, Sankar A, Shaila MS, Shivananda I, Desai R. Diagnostic Disparity in Solitary Cysticercosis of the Forearm in a Child. J Nepal Health Res Counc 2015; 13:160-162. [PMID: 26744203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Solitary cysticercosis of muscle is a rare disease causing diagnostic dilemma. Cysticercosis commonly affects the central nervous system and other tissues by dissemination imposing a serious health problem. We report this rare presentation of solitary cysticercosis of flexor digitorum superficialis in a five year old otherwise healthy child. The fine needle aspiration cytology and histopathological diagnosis were inconclusive but ultrasonography of the muscle clinched the diagnosis.
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Affiliation(s)
- R Naidu
- Karnataka Institute of Medical Science, Hulbi, Karnataka, India
| | - A Sankar
- Karnataka Institute of Medical Science, Hulbi, Karnataka, India
| | - M S Shaila
- Karnataka Institute of Medical Science, Hulbi, Karnataka, India
| | - I Shivananda
- Karnataka Institute of Medical Science, Hulbi, Karnataka, India
| | - R Desai
- Karnataka Institute of Medical Science, Hulbi, Karnataka, India
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Caldwell ASL, Eid S, Kay CR, Jimenez M, McMahon AC, Desai R, Allan CM, Smith JT, Handelsman DJ, Walters KA. Haplosufficient genomic androgen receptor signaling is adequate to protect female mice from induction of polycystic ovary syndrome features by prenatal hyperandrogenization. Endocrinology 2015; 156:1441-52. [PMID: 25643156 DOI: 10.1210/en.2014-1887] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is associated with reproductive, endocrine, and metabolic abnormalities. Because hyperandrogenism is the most consistent PCOS feature, we used wild-type (WT) and androgen receptor (AR) knockout (ARKO) mice, together with a mouse model of PCOS, to investigate the contribution of genomic AR-mediated actions in the development of PCOS traits. PCOS features were induced by prenatal exposure to dihydrotestosterone (250 μg) or oil vehicle (control) on days 16-18 of gestation in WT, heterozygote, and homozygote ARKO mice. DHT treatment of WT mice induced ovarian cysts (100% vs 0%), disrupted estrous cycles (42% vs 100% cycling), and led to fewer corpora lutea (5.0±0.4 vs 9.8±1.8). However, diestrus serum LH and FSH, and estradiol-induced-negative feedback as well as hypothalamic expression of kisspeptin, neurokinin B, and dynorphin, were unaffected by DHT treatment in WT mice. DHT-treated WT mice exhibited a more than 48% increase in adipocyte area but without changes in body fat. In contrast, heterozygous and homozygous ARKO mice exposed to DHT maintained comparable ovarian (histo)morphology, estrous cycling, and corpora lutea numbers, without any increase in adipocyte size. These findings provide strong evidence that genomic AR signaling is an important mediator in the development of these PCOS traits with a dose dependency that allows even AR haplosufficiency to prevent induction by prenatal androgenization of PCOS features in adult life.
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Affiliation(s)
- A S L Caldwell
- Andrology (A.S.L.C., S.E., M.J., R.D., C.M.A., D.J.H., K.A.W.) and Biogerontology (A.C.M.) Laboratories, ANZAC Research Institute, University of Sydney, Sydney, New South Wales 2139, Australia; and School of Anatomy, Physiology and Human Biology (C.R.K., J.T.S.), University of Western Australia, Perth, Western Australia 6009, Australia
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Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, Das N, Desai R, Gornall R, Beardmore-Gray A, Nevin J, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Varkey S, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer 2015; 112:475-84. [PMID: 25535730 PMCID: PMC4453652 DOI: 10.1038/bjc.2014.630] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/16/2014] [Accepted: 11/30/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. METHODS Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. RESULTS Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). CONCLUSIONS This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.
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Affiliation(s)
- R Iyer
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Gentry-Maharaj
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Nordin
- National Cancer Intelligence Network Gynaecology Clinical Reference Group, 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - M Burnell
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Liston
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Manchanda
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - N Das
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - R Desai
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - R Gornall
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - A Beardmore-Gray
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - J Nevin
- Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
| | - K Hillaby
- Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK
| | - S Leeson
- Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Penrhosgarnedd, Bangor, Gwynedd, North Wales LL57 2PW, UK
| | - A Linder
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Lopes
- Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK
| | - D Meechan
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - T Mould
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - S Varkey
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - A Olaitan
- Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK
| | - B Rufford
- Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - A Ryan
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - S Shanbhag
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK
| | - A Thackeray
- Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK
| | - N Wood
- Department of Gynaecological Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, North Fulwood, Preston Lancashire PR2 9HT, UK
| | - K Reynolds
- Department of Gynaecological Cancer, Barts Cancer Centre, Barts and the London NHS Trust, St Bartholomew's Hospital (Barts), West Smithfield, London EC1A 7BE, UK
| | - U Menon
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
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Abstract
Malpositioning of the trochanteric entry point during the introduction of an intramedullary nail may cause iatrogenic fracture or malreduction. Although the optimal point of insertion in the coronal plane has been well described, positioning in the sagittal plane is poorly defined. The paired femora from 374 cadavers were placed both in the anatomical position and in internal rotation to neutralise femoral anteversion. A marker was placed at the apparent apex of the greater trochanter, and the lateral and anterior offsets from the axis of the femoral shaft were measured on anteroposterior and lateral photographs. Greater trochanteric morphology and trochanteric overhang were graded. The mean anterior offset of the apex of the trochanter relative to the axis of the femoral shaft was 5.1 mm (sd 4.0) and 4.6 mm (sd 4.2) for the anatomical and neutralised positions, respectively. The mean lateral offset of the apex was 7.1 mm (sd 4.6) and 6.4 mm (sd 4.6), respectively. Placement of the entry position at the apex of the greater trochanter in the anteroposterior view does not reliably centre an intramedullary nail in the sagittal plane. Based on our findings, the site of insertion should be about 5 mm posterior to the apex of the trochanter to allow for its anterior offset.
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Affiliation(s)
- K Farhang
- Case Western Reserve University, Department of Orthopaedic Surgery, 2500 Metrohealth Drive, Cleveland, Ohio 44109, USA
| | - R Desai
- Case Western Reserve University, Department of Orthopaedic Surgery, 2500 Metrohealth Drive, Cleveland, Ohio 44109, USA
| | - J H Wilber
- Case Western Reserve University, Department of Orthopaedic Surgery, 2500 Metrohealth Drive, Cleveland, Ohio 44109, USA
| | - D R Cooperman
- Yale University School of Medicine, Department of Orthopaedics and Rehabilitation, PO Box 208071, New Haven, Connecticut 06520-8071, USA
| | - R W Liu
- Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, Ohio, 44106, USA
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