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Nzenwa IC, Pathak S, Knight SR, Mowbray NG, O’Reilly D, Jones RP. Postoperative surveillance after surgery for colorectal liver metastasis: a cross-sectional study. Ann R Coll Surg Engl 2024; 106:213-218. [PMID: 37218655 PMCID: PMC10904262 DOI: 10.1308/rcsann.2023.0027] [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] [Accepted: 03/21/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Colorectal liver metastases (CRLM) are associated with a high recurrence rate after surgery. There is paucity of high-quality evidence regarding the nature and overall benefit of surveillance after hepatectomy for CRLM. As part of a broader programme of research, this study aimed to assess current strategies for surveillance after liver resection for CRLM and outline surgeons' opinions regarding the benefit of postoperative surveillance. METHODS An online survey was sent to clinicians performing surgery for CRLM at tertiary hepatobiliary centres in the UK. RESULTS There were responses from a total of 23 centres (88% response rate); 15/23 centres used standardised surveillance protocols for all patients. Most centres followed patients up at six months, but there is variation in postoperative surveillance at 3, 9, 18 and beyond 60 months. Patient comorbidities, indeterminate findings on imaging, margin status and assessment of recurrence risk were identified as the major factors influencing personalised surveillance strategies. There was clear clinician equipoise regarding the costs and benefits of surveillance. CONCLUSION There is heterogeneity in postoperative follow-up for CRLM in the UK. High-quality prospective studies and randomised trials are necessary to elucidate the value of postoperative surveillance and identify optimal follow-up strategies.
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Affiliation(s)
| | - S Pathak
- Leeds Teaching Hospitals NHS Trust, UK
| | | | | | - D O’Reilly
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - RP Jones
- Liverpool University Hospitals NHS Foundation Trust, UK
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Shenoy R, Rao AR, Rane PP, Noronha V, Kumar A, Pillai A, Pathak S, Gattani S, Sehgal A, Kumar S, Castelino R, Dhekale R, Krishnamurthy J, Mahajan S, Daptardar A, Sonkusare L, Deodhar J, Ansari N, Vagal M, Mahajan P, Timmanpyati S, Nokala M, Chitre A, Kapoor A, Gota V, Banavali S, Prabhash K, Ramaswamy A. Validation of the Onco-MPI in predicting short-term mortality in older Indian patients with cancer. J Geriatr Oncol 2023; 14:101550. [PMID: 37327761 DOI: 10.1016/j.jgo.2023.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The number of older patients with cancer is increasing exponentially worldwide, and a similar trend has also been noted in India. The Multidimensional Prognostic Index (MPI) strongly correlates the presence of individual comorbidities with mortality, and the Onco-MPI prognosticates patients accurately for overall mortality. However, limited studies have evaluated this index in patient populations beyond Italy. We evaluated the performance of the Onco-MPI index in predicting mortality in older Indian patients with cancer. MATERIALS AND METHODS This observational study was conducted between October 2019 and November 2021 in the Geriatric Oncology Clinic at Tata Memorial Hospital in Mumbai, India. The data of patients aged ≥60 years with solid tumors who underwent a comprehensive geriatric assessment was analysed. The study's primary aim was to calculate the Onco-MPI for patients in the study and correlate it with one-year mortality. RESULTS A total of 576 patients aged ≥60 years were included in the study. The median age (range) of the population was 68 (60-90) years, and 429 (74.5%) were male. After a median follow-up of 19.2 months, 366 (63.7%) patients had died. The proportion of patients classified as low risk (0-0.46), moderate risk (0.47-0.63) and high risk (0.64-1.0) were 38% (219 patients), 37% (211 patients) and 25% (145 patients), respectively. There was a significant difference in one-year mortality rates between the low-risk patients compared to medium and high-risk patients (40.6% vs 53.1% vs 71.7%; p < 0.001). DISCUSSION The current study validates the Onco-MPI as a predictive tool for estimating short-term mortality in older Indian patients with cancer. Further prospective studies need to build on this index to obtain a score with greater discrimination in the Indian population.
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Affiliation(s)
- Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Abhijith Rajaram Rao
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anita Kumar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anupa Pillai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Gattani
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Arshiya Sehgal
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Sharath Kumar
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Renita Castelino
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ratan Dhekale
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jyoti Krishnamurthy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarika Mahajan
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anuradha Daptardar
- Department of Physiotherapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lekhika Sonkusare
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jayita Deodhar
- Department of Psycho-oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nabila Ansari
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjusha Vagal
- Department of Occupational Therapy, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Purbi Mahajan
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Shivshankar Timmanpyati
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manjunath Nokala
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Ankita Chitre
- Department of Physiotherapy, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Center & Homi Bhabha Cancer Hospital, Varanasi, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment Research and Education in Cancer, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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3
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Patil VM, Noronha V, Menon N, Singh A, Ghosh-Laskar S, Budrukkar A, Bhattacharjee A, Swain M, Mathrudev V, Nawale K, Balaji A, Peelay Z, Alone M, Pathak S, Mahajan A, Kumar S, Purandare N, Agarwal A, Puranik A, Pendse S, Reddy Yallala M, Sahu H, Kapu V, Dey S, Choudhary J, Krishna MR, Shetty A, Karuvandan N, Ravind R, Rai R, Jobanputra K, Chaturvedi P, Pai PS, Chaukar D, Nair S, Thiagarajan S, Prabhash K. Results of Phase III Randomized Trial for Use of Docetaxel as a Radiosensitizer in Patients With Head and Neck Cancer, Unsuitable for Cisplatin-Based Chemoradiation. J Clin Oncol 2023; 41:2350-2361. [PMID: 36706347 DOI: 10.1200/jco.22.00980] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE There is a lack of published literature on systemic therapeutic options in cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) undergoing chemoradiation. Docetaxel was assessed as a radiosensitizer in this situation. METHODS This was a randomized phase II/III study. Adult patients (age ≥ 18 years) with LAHNSCC planned for chemoradiation and an Eastern Cooperative Oncology Group performance status of 0-2 and who were cisplatin-ineligible were randomly assigned in 1:1 to either radiation alone or radiation with concurrent docetaxel 15 mg/m2 once weekly for a maximum of seven cycles. The primary end point was 2-year disease-free survival (DFS). RESULTS The study recruited 356 patients between July 2017 and May 2021. The 2-year DFS was 30.3% (95% CI, 23.6 to 37.4) versus 42% (95% CI, 34.6 to 49.2) in the RT and Docetaxel-RT arms, respectively (hazard ratio, 0.673; 95% CI, 0.521 to 0.868; P value = .002). The corresponding median overall survival (OS) was 15.3 months (95% CI, 13.1 to 22.0) and 25.5 months (95% CI, 17.6 to 32.5), respectively (log-rank P value = .035). The 2-year OS was 41.7% (95% CI, 34.1 to 49.1) versus 50.8% (95% CI, 43.1 to 58.1) in the RT and Docetaxel-RT arms, respectively (hazard ratio, 0.747; 95% CI, 0.569 to 0.980; P value = .035). There was a higher incidence of grade 3 or above mucositis (22.2% v 49.7%; P < .001), odynophagia (33.5% v 52.5%; P < .001), and dysphagia (33% v 49.7%; P = .002) with the addition of docetaxel. CONCLUSION The addition of docetaxel to radiation improved DFS and OS in cisplatin-ineligible patients with LAHNSCC.[Media: see text].
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Leicester Real World Evidence Unit, Leicester University, Leicester, United Kingdom
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Suman Kumar
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shantanu Pendse
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monica Reddy Yallala
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Harsh Sahu
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sayak Dey
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jatin Choudhary
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Madala Ravi Krishna
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Alok Shetty
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Naveen Karuvandan
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Ravind
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kunal Jobanputra
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Patil VM, Noronha V, Menon N, Rai R, Bhattacharjee A, Singh A, Nawale K, Jogdhankar S, Tambe R, Dhumal S, Sawant R, Alone M, Karla D, Peelay Z, Pathak S, Balaji A, Kumar S, Purandare N, Agarwal A, Puranik A, Mahajan A, Janu A, Kumar Singh G, Mittal N, Yadav S, Banavali S, Prabhash K. Low-Dose Immunotherapy in Head and Neck Cancer: A Randomized Study. J Clin Oncol 2023; 41:222-232. [PMID: 36265101 DOI: 10.1200/jco.22.01015] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The regimens approved for the treatment of advanced head and neck squamous cell carcinoma are accessible to only 1%-3% of patients in low- and middle-income countries because of their cost. In our previous study, metronomic chemotherapy improved survival in this setting. Retrospective data suggest that a low dose of nivolumab may be efficacious. Hence, we aimed to assess whether the addition of low-dose nivolumab to triple metronomic chemotherapy (TMC) improved overall survival (OS). METHODS This was a randomized phase III superiority study. Adult patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma being treated with palliative intent with an Eastern Cooperative Oncology Group performance status of 0-1 were eligible. Patients were randomly assigned 1:1 to TMC consisting of oral methotrexate 9 mg/m2 once a week, celecoxib 200 mg twice daily, and erlotinib 150 mg once daily, or TMC with intravenous nivolumab (TMC-I) 20 mg flat dose once every 3 weeks. The primary end point was 1-year OS. RESULTS One hundred fifty-one patients were randomly assigned, 75 in TMC and 76 in the TMC-I arm. The addition of low-dose nivolumab led to an improvement in the 1-year OS from 16.3% (95% CI, 8.0 to 27.4) to 43.4% (95% CI, 30.8 to 55.3; hazard ratio, 0.545; 95% CI, 0.362 to 0.820; P = .0036). The median OS in TMC and TMC-I arms was 6.7 months (95% CI, 5.8 to 8.1) and 10.1 months (95% CI, 7.4 to 12.6), respectively (P = .0052). The rate of grade 3 and above adverse events was 50% and 46.1% in TMC and TMC-I arms, respectively (P = .744). CONCLUSION To our knowledge, this is the first-ever randomized study to demonstrate that the addition of low-dose nivolumab to metronomic chemotherapy improved OS and is an alternative standard of care for those who cannot access full-dose checkpoint inhibitors.
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Affiliation(s)
- Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Center for Cancer Epidemiology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shweta Jogdhankar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rupali Tambe
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sachin Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Riddhi Sawant
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Devanshi Karla
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Balaji
- Department of Speech and Therapy, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Suman Kumar
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gunjesh Kumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Patil VM, Menon N, Chatterjee A, Tonse R, Choudhari A, Mahajan A, Puranik AD, Epari S, Jadhav M, Pathak S, Peelay Z, Walavalkar R, Muthuluri HK, Ravi Krishna M, Chandrasekharan A, Pande N, Gupta T, Banavali S, Jalali R. Mebendazole plus lomustine or temozolomide in patients with recurrent glioblastoma: A randomised open-label phase II trial. EClinicalMedicine 2022; 49:101449. [PMID: 35747192 PMCID: PMC9156991 DOI: 10.1016/j.eclinm.2022.101449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Recurrent glioblastoma (GBM) has dismal outcomes and limited treatment options. Mebendazole (MBZ) has activity in glioma both in-vivo and in-vitro, and is well tolerated in combination with lomustine (CCNU) and temozolomide (TMZ). In this study, we sought to determine whether the addition of MBZ to CCNU or TMZ would improve overall survival (OS) in recurrent GBM. METHODS In this phase II randomized open-label trial, adult patients with ECOG PS 0-3, with recurrent GBM who were not eligible for re-radiation, were randomized 1:1 to the CCNU-MBZ and TMZ-MBZ arms. CCNU was administered at 110 mg/m2 every 6 weeks with MBZ 800 mg thrice daily and TMZ was administered at 200 mg/m2 once daily on days 1-5 of a 28 days cycle with MBZ 1600 mg thrice daily. The primary endpoint was OS at 9 months. A 9-month OS of 55% or more in any arm was hypothesized to warrant further evaluation and a value below 35% was too low to warrant further investigation. OS was analyzed using intention to treat (ITT) and per-protocol (PP) analyses. Per-protocol analysis was used for safety analysis. Clinical Trials Registry-India number, CTRI/2018/01/011542. FINDINGS Participants were recruited from 14th March 2019 to 18th June 2021, 44 patients were randomised on each arm. At 17.4 months, 68 events for OS analysis had occurred, 33 in the TMZ-MBZ and 35 in the CCNU-MBZ arm. The 9-month OS was 36.6% (95% CI 22.3-51.0) and 45% (95% CI 29.6-59.2) in the TMZ-MBZ and CCNU-MBZ arms respectively, in the ITT population. ECOG PS was the only independent prognostic factor impacting OS (HR-0.48, 95% CI 0.27-0.85; P = 0.012). Grade 3-5 adverse events were seen in 8 (18.6%; n = 43) and 4 (9.5%; n = 42) patients in the TMZ-MBZ and CCNU-MBZ arms respectively. There were no treatment related deaths. INTERPRETATION The addition of MBZ to TMZ or CCNU failed to achieve the pre-set benchmark of 55% 9-month OS. This was probably due to 28.6% of patients having poor PS of 2-3. FUNDING Brain Tumor Foundation (BTF) of India, Indian Cooperative Oncology Network (ICON), and India Cancer Research Consortium (ICRC) under ICMR (Indian Council of Medical Research).
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Affiliation(s)
- Vijay M. Patil
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Corresponding author at: Department of Medical Oncology, Tata Memorial Hospital, 1110, Homi Bhabha Block, Parel, Mumbai, India.
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Raees Tonse
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Choudhari
- Department of Radiology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Radiology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ameya D. Puranik
- Department of Nuclear Medicine, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monica Jadhav
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shruti Pathak
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rutuja Walavalkar
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Hemanth K. Muthuluri
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Madala Ravi Krishna
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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Dwivedi K, Roy AK, Kaushal P, Pathak S, Malaviya DR. Improving Salt Tolerance in Trifolium alexandrinum L. through Interspecific Hybridization, Polyploidization and Induced Variations. CYTOL GENET+ 2022. [DOI: 10.3103/s0095452722030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Peelay Z, Pathak S, Patil VM, Prabhash K, Noronha V, Menon NS. Real-world analysis of use of lenvatinib in differentiated thyroid cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18075 Background: Lenvatinib is one of the approved treatments for radioiodine refractory differentiated thyroid cancers. However, there is very limited data from India on real-world efficacy and adverse events of Lenvatinib and hence this analysis was performed. Methods: This was a retrospective analysis in which patients of radioiodine refractory differentiated thyroid cancer as per the select study criteria who received lenvatinib were selected for the study over the last 4 years. The baseline demographic characteristics, adverse events of lenvatinib, the date of progression and the date of overall survival (OS) were extracted from the electronic medical records (EMR) of the Tata Memorial Hospital. SPSS version 20 was used for analysis. Results: Thirty patients were identified. The median age was 54.5 years (25-77). The male: female ratio was1:1. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 0-1 in 21(70%), 2 in 4(13.3%) and 3 in 5(16.7%). The thyroid status was hypothyroid in 10 patients (33.3%), euthyroid in 12(40%) and hyperthyroid in 8(26.7%). In 5 patients it had to be stopped because of toxicity, these were proteinuria in 2, a hand-foot syndrome in 2 and diarrhoea in 1. The response rate was 56.7% (n = 17). The median progression-free survival (PFS) on lenvatinib was 366 days(95%CI 170.3-561.67) and the 2 year PFS was 29.3% (standard error 12.1) The median overall survival (OS) on lenvatinib was 411 days (95%CI 95.5-726.6). The 2 year OS was 38.8% (standard error -12.5%) and 5 year OS was 14.6% (standard error 12.1). Conclusions: In the real world lenvatinib provides a 2 year PFS and OS of 29.3% and 38.8% which is lower than that reported in the pivotal SELECT study.
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Menon NS, Gupta T, Chatterjee A, Choudhary A, Puranik A, Sridhar E, Dasgupta A, Sahay A, Moiyadi A, Shetty P, Singh VK, Pathak S, Karuvandan N, Peelay Z, Kumar H, Krishna MR, Jadhav M, Jalali R, Patil VM. Compliance, adverse events and quality of life of patients in a phase 3 study comparing temozolomide with PCV as adjuvant chemotherapy in grade 2 and 3 glioma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14010 Background: Both PCV and Temozolomide (TMZ) are options for adjuvant therapy in grade 2 & grade 3 gliomas after maximal safe resection. The RTOG 9802 PCV regimen is not commonly used as it is perceived as a toxic, poorly tolerated regimen. TMZ is often preferred as it is easy to administer and has fewer adverse events. There has been no head-to-head comparison of these regimens, hence we are conducting a study to compare the 2 regimens. Here, we report the adverse event profile, compliance & quality of life (QoL) of patients enrolled in this study. Methods: This is an ongoing phase 3, non-inferiority trial. Adults with grade 2 glioma with high-risk features (age ≥40 years at diagnosis or residual disease ≥1 cm) or grade 3 gliomas, with ECOG PS 0-2 were enrolled. Patients were randomized 2:1 to receive either adjuvant TMZ or PCV after adjuvant focal conformal radiation (RT). In the TMZ arm patients received RT with concurrent TMZ 75 mg/m2/day (max. 49 days) followed by adjuvant TMZ 150 mg/m2/day on days 1-5 of a 28 day cycle for cycle1, & 200 mg/m2/day cycle 2 onwards (max. 12 cycles).In the PCV arm, patients received Procarbazine 60 mg/m2/day on days 8-21, Lomustine (CCNU) 110 mg/m2 on day 1 & Vincristine (VCR) 1.4 mg/m2 on days 8 & 29 of a 56 day cycle (max. 6 cycles). The primary endpoint of the study is progression-free survival. The current analysis focuses on compliance, adverse events (as per CTCAE v4.03) & QoL (EORTC QLQ C-30 & BN-20). Results: This analysis was limited to the first 50 patients who had completed at least 1 year from the start of adjuvant chemotherapy. There were 32 patients in the TMZ arm & 18 patients in the PCV arm. Two patients each in the TMZ & PCV arms did not start adjuvant chemotherapy. Among those who started adjuvant chemotherapy, the completion rates were higher in the TMZ arm (n = 26,86.7%) as compared to the PCV arm (n = 11,68.8%; p = .241). The median number of cycles of TMZ, Procarbazine, CCNU, and VCR were 12, 5.5, 6 and 5.5 respectively. Dose delays were slightly higher in the PCV arm (81.3%) compared to the TMZ arm (73.3%) which was not statistically significant (p = .722). Chemotherapy dose reductions were needed in 11 patients (68.8%) in the PCV arm & only 1 patient (3.3%) in the TMZ arm, this was statistically significant (p = 0.000). Myelosuppression was significantly higher in the PCV arm as compared to the TMZ arm. The incidence of any grade and grade ≥ 3 anemia, neutropenia & thrombocytopenia was significantly higher with PCV. The incidence of grade 3 lymphopenia was significantly higher with PCV (p = .000). Only 2 patients in the PCV arm developed febrile neutropenia. There was no significant difference in the QoL scores between the two arms at various time points. Conclusions: The use of adjuvant PCV is feasible when administered by experienced neuro-medical oncologists with an acceptable compliance and toxicity profile, without adversely impacting the QoL of patients. Clinical trial information: CTRI/2018/07/015056.
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Affiliation(s)
| | | | | | | | | | | | | | - Ayushi Sahay
- Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
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Menon NS, Chatterjee A, Tonse R, Choudhary A, Mahajan A, Puranik A, Sridhar E, Pathak S, Jadhav M, Peelay Z, Walavalkar R, Kumar H, Krishna MR, Chandrasekharan A, Pande N, Gupta T, Banavali SD, Jalali R, Patil VM. Mebendazole in recurrent glioblastoma: Results of a phase 2 randomized study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2029 Background: Recurrent glioblastoma (GBM) has dismal outcomes and limited treatment options. Mebendazole (MBZ) is an anti-helminthic drug with in-vivo and in-vitro activity against glioma cell lines and has been demonstrated to be well tolerated in combination with lomustine (CCNU) and temozolomide (TMZ). In this phase 2 study, we sought to determine whether the addition of MBZ to CCNU or TMZ would improve overall survival (OS) in recurrent GBM. Methods: Adult patients with ECOG PS 0-3, with recurrent glioblastoma who were not eligible for re-radiation, were randomized 1:1 between CCNU-MBZ (n = 44) and TMZ-MBZ (n = 44). The primary endpoint was OS at 9 months, selected to reflect the BELOB trial. A 9-month OS of 55% or more in any arm was hypothesized to warrant further evaluation and a value below 35% was too low to warrant further investigation. Results: At 17.4 months, 68 events for OS analysis had occurred. The 9-month overall survival was 36.6% (95%CI 22.3-51) and 45% (95%CI 29.6-59.2) in the TMZ-MBZ and CCNU-MBZ arms respectively. ECOG PS was the only independent prognostic factor impacting OS (HR-0.478 95%CI 0.268-0.851; P = 0.012). Twenty-three patients (28.6%) enrolled had an ECOG PS 2-3 with inferior outcomes (median OS-5.67, HR-2.092 95%CI 1.175-3.731). Analysis restricted to ECOG PS 0-1 (n = 65) patients revealed a 9-month OS of 39.6% (95% CI 22.4-56.3) and 57.9% (95% CI 38.7-73) in TMZ-MBZ and CCNU-MBZ arms respectively. Grade 3-5 adverse events were seen in 8 (18.6%; n = 43) and 4 (9.5%; n = 42) patients in the TMZ-MBZ and CCNU-MBZ arms respectively. Conclusions: The addition of MBZ to TMZ or CCNU failed to achieve the pre-set benchmark of 55% 9-month OS. This was probably due to 28.6% of patients with poor PS of 2-3. In patients with ECOG PS 0-1, CCNU-MBZ had a 9 month OS of 57.9% and needs to be evaluated further. Clinical trial information: CTRI/2018/01/011542.
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Pathak S, Peelay Z, Patil VM, Noronha V, Menon NS, Chaturvedi P, Prabhash K. A retrospective analysis of patients administered neoadjuvant chemotherapy (NACT) with paclitaxel plus carboplatin with oral metronomic chemotherapy (OMCT) in locally advanced borderline resectable/technically unresectable head and neck cancers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6030 Background: Neoadjuvant chemotherapy with TPF though the standard is seldom used in India due to its adverse events rate. Two drug regimen of Paclitaxel and Carboplatin (PC) though favoured has inferior outcomes. Hence, we did an analysis to estimate the efficacy and adverse event rate of addition of 3 drug metronomic schedule to PC. Methods: Patients of locally advanced head and neck cancer referred from multidisciplinary board for neoadjuvant chemotherapy and unsuitable for TPF were selected for this analysis. These patients had received 2 drug regimen of intravenous PC with 3 drug regimen of weekly methotrexate 9 mg per m2, Celecoxib 200 mg twice daily, erlotinib 150 mg once daily all administered orally. All patients underwent a response assessment at 5-7 weeks post start of therapy and we're discussed in MDT for further treatment. Adverse events were recorded in accordance with CTCAE version 4.03 and response in accordance with RECIST version 1.1. PFS and OS were estimated with Kaplan Meier method. Results: 72 patients were identified with the median age being 45 (27-80) and M:F ratio (67:5). The indication for NACT were borderline resectability in all patients.. The response rate was 61.1% and grade 3 and above adverse event rate was 33.5%. A total number of 34 among 40 borderline resectable patients underwent surgery. The overall estimated PFS and OS were 18.5 (95%CI = 14.4-22.7) months and 18.05 (95%CI = 14.2-21.8) months respectively. The three most adverse events observed were grade 3 thrombocytopenia in 2 patients (2.8%), grade 3 aspartate aminotransferase (AST) derangement in 4 patients (5.6%) and grade 3 alanine aminotransferase (ALT) in 4 patients (5.6%). Conclusions: The 5 drug combination regimen is safe, tolerable and seems to have similar efficacy as a three drug TPF regimen.
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Affiliation(s)
| | | | | | | | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India, Mumbai, India
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11
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Shah D, Menon NS, Puranik A, Choudhary A, Patil VM, Pathak S, Peelay Z. Efficacy of Gemcitabine in recurrent meningioma: A phase II study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14044 Background: Systemic therapy has a limited role in meningiomas. There is in-vivo and in-vitro data that gemcitabine can potentially be useful in meningiomas. We did a phase II study with the primary objective of studying the 6-month progression-free survival (PFS) of gemcitabine in meningiomas. Methods: This was a single-arm prospective phase II study. Adult patients with recurrent meningiomas who were not eligible for local therapies with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 with normal organ and marrow function were included in this study. Patients who had received any chemotherapy within the last three weeks or on any other investigational agents were excluded. All patients received gemcitabine 1000 mg/m2 administered intravenously over 30 minutes on day 1, day 8 and day 15 every 4 weeks until disease progression or development of intolerable side effects. The response was assessed as per Response Evaluation Criteria in Solid Tumors (RECIST) criteria 1.1. The adverse events were recorded as per the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. The primary objective of this study was to assess the 6-months progression-free survival (PFS). The 6-months progression-free survival (PFS) of 50% or more was considered sufficient to warrant further studies. Results: Nine patients were recruited in this study. The median age of the patient was 56 years(24-73). The m: f ratio was 2:3. All patients had undergone previous surgeries and 8 patients had undergone previous radiotherapy. The median number of cycles of gemcitabine was 3. Any grade toxicity was observed in all patients. Grade 3 and above adverse events were not observed. The two commonest adverse events noted were anaemia in 7 (77.8%) patients and vomiting in 2 (22.2) patients. The best response was stable disease (SD) in 3 patients (33.4%) and progressive disease (PD) in 6 (66.6%) patients. At a median follow up of 18.8 months, the 6-months progression-free survival (PFS) was 33.3% (95%CI 7.8-62.3). The 1-year overall survival (OS) was 66.7 % (95%CI 28.2-87.8). Conclusions: Gemcitabine failed to meet the prespecified endpoint of 6-month PFS and does not warrant any further investigation in this setting. Clinical trial information: CTRI/2019/02/017499.
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12
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Peelay Z, Patil VM, Noronha V, Pathak S, Menon NS, Prabhash K. Real-world analysis of BRAF inhibitors with patients positive for BRAF V600E mutations diagnosed with rare tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15085 Background: BRAF mutation is seen in multiple cancers and BRAF inhibitors have a tumor agnostic nature. However there is very limited real world data for BRAF inhibitors and hence we have performed this analysis. Methods: In Tata Memorial Hospital, the medical oncology solid unit 2 maintains a prospective database of all patients who undergo molecular testing. A query was raised from this database and 17 patients were identified who were BRAF mutant positive. The demographic details of these patients, the previous treatment details, the therapy received by these patients, the response to the therapy, the date of progression and the date of death was recorded. Descriptive statistics were performed and Kaplan-Meier analysis was used to estimate the progression-free survival (PFS) and overall survival (OS). Results: In all the 17 patients the mutation was BRAF V600E.The median age of the patients was 58 years (16-77). The m:f ratio was 13:4. The Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 0-1 in 9 patients (52.9%) and 2-3 in 8 patients (47.1%). The primary sites included in the analysis were lung cancer in 8 (47.1), glioma in 3 (17.7), thyroid in 2 (11.8%) and one each of parotid, melanoma, esophagus, thymoma. BRAF inhibitors could be provided in 9 patients (52.9%) and its was dabrafenib-trametinib in 8 patients and vemurafenib then dabrafenib-trametinib in 1 patient. The median progression free survival was 203 days (95% CI 25.1-380.9) and overall survival was 220 days (95% CI 49.8-408.2) . Conclusions: The real world data suggests that the efficacy of BRAF inhibitors seems to be lower than that seen in pivotal studies. The reasons for which is unknown.
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Siripurapu I, Maka V, Majumdar S, Palassery R, Elackatt N, Mandade A, Adadadara T, Pathak S, Agrawal C, Jayaprakash P, Manmatha P, Kumar S. 140P A study on assessment of barriers to genetic counselling and testing among breast and ovarian cancer patients in a tertiary referral hospital in India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Scroggie D, Lee KS, Purves R, Sewart E, Van Laarhoven S, Robinson T, Rees J, Pathak S. 1285 Reporting of Robotic Pancreaticoduodenectomy As A Surgical Innovation: Systematic Review and Narrative Synthesis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Pancreaticoduodenectomy (PD) is most commonly performed using open surgical techniques. Minimal access approaches have reduced the morbidity of many types of surgery, however technical limitations have hindered the widespread adoption of laparoscopic methods for PD. There has been increasing use of surgical robots to facilitate a minimal access approach, motivated by improved visualisation, ergonomics and dexterity compared to standard laparoscopic methods. Methods for the safe introduction of novel techniques are lacking, and the way in which surgical innovations are reported may affect adoption into clinical practice. The aim of this study is to understand how robotic PD has been reported as a surgical innovation.
Method
A systematic review is being conducted by the trainee led RoboSurg Collaborative. A literature search was performed to identify primary research reporting outcomes of robotic PD. Articles are being screened in duplicate by title and abstract, then by full text review. The following data will be extracted: study methodology and rationale; centre, surgeons and patient details; governance and ethical considerations; learning curves; details of the intervention, including modifications; and how outcomes were reported, including use of core outcome sets. The data will be analysed using a narrative synthesis method.
Results
The search identified 1305 articles reporting on robotic pancreas surgery. An interim report of progress will be presented.
Conclusions
A rich narrative synthesis will enable innovators to understand how robotic PD has been reported. This will encourage transparent, methodical, and meaningful reporting of robotic PD, increasing the quality of clinical evidence.
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Affiliation(s)
- D Scroggie
- University of Bristol, Bristol, United Kingdom
| | - K S Lee
- University of Bristol, Bristol, United Kingdom
| | - R Purves
- University of London, London, United Kingdom
| | - E Sewart
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - S Van Laarhoven
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - T Robinson
- Great Western Hospitals NHS Foundation Trust, Swindon, United Kingdom
| | - J Rees
- University of Bristol, Bristol, United Kingdom
| | - S Pathak
- University of Bristol, Bristol, United Kingdom
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15
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Jones CS, Kirkham E, Gourbault L, Hollowood F, Dada M, Baker W, Pathak S, Blencowe N. 558 Summarising the Reporting of Outcomes in Studies of Robot Assisted Cholecystectomy: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Robot-assisted cholecystectomy (RC) has seen increasing adoption into clinical practice despite a lack of evidence to demonstrate superiority over conventional methods. Consistency in outcome selection, definition and reporting between studies is required for effective evidence synthesis and to minimise research waste. The aim of this study was to conduct an in-depth analysis of the outcomes reported in studies of RC. This work will inform the need for a core outcome set (COS).
Method
Systematic searches identified all published studies reporting RC, from inception to February 2020. Outcomes reported in each manuscript were recorded verbatim and categorised into domains. All outcomes were coded in duplicate. Where reported, the follow up period of each study was documented.
Results
Of 1425 abstracts screened, ninety studies met the criteria for inclusion. A total of 878 outcomes were reported. Each study included a median of 8 outcomes (range 3-26). Outcome selection was heterogeneous, with those relating to technical/operative factors (n = 383, 88 studies), complications (n = 245, 81 studies) and health economics (n = 139, 72 studies) used most frequently. No single outcome, or outcome domain, was reported in all studies. Only 30 studies reported a follow-up period, which ranged from 14 days to 46 months. In thirteen, the follow-up was for less than or equal to one month.
Conclusions
We identified significant heterogeneity in the selection and reporting of outcomes in studies of RC and support calls for standardisation and development of a COS.
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Affiliation(s)
- C S Jones
- Bristol Centre for Surgical Research, Bristol, United Kingdom
- North Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - E Kirkham
- Bristol Centre for Surgical Research, Bristol, United Kingdom
- University Hospitals Bristol, Bristol, United Kingdom
| | - L Gourbault
- University Hospitals Bristol, Bristol, United Kingdom
| | - F Hollowood
- University of Bristol Medical School, Bristol, United Kingdom
| | - M Dada
- University of Bristol Medical School, Bristol, United Kingdom
| | - W Baker
- University of Southampton, Southampton, United Kingdom
| | - S Pathak
- Bristol Centre for Surgical Research, Bristol, United Kingdom
- University Hospitals Bristol, Bristol, United Kingdom
| | - N Blencowe
- Bristol Centre for Surgical Research, Bristol, United Kingdom
- University Hospitals Bristol, Bristol, United Kingdom
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Salunke AA, Nandy K, Puj K, Kamani M, Pathak S, Shah J, Bhalerao RH, Jain A, Sharma M, Warikoo V, Patel K, Rathod P, Bhatt S, Tank T, Pandya S. A proposed "Radiological Evaluation Score for Bone Tumors" (REST): An objective system for assessment of a radiograph in patients with suspected bone tumor. Musculoskelet Surg 2021; 106:371-382. [PMID: 33982208 DOI: 10.1007/s12306-021-00711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although radiographs have been widely used in the evaluation of patients with suspected bone tumors, the lack of an objective radiological assessment method leads to a challenge in reaching correct diagnosis. The study aimed to propose a Radiological Evaluation Score for Bone Tumors (REST) which includes eight radiological factors [characteristics, content, cortical breach, distinctiveness, distribution, periosteal reaction, fracture, and soft tissue swelling] to form a single score along with its validation by multidisciplinary observers. METHODS We reviewed the radiographs of 100 patients with a primary bone tumor which were selected at random from the database between January 2017 and January 2019 of a tertiary cancer center. Four reviewers (two orthopedic oncologists and two surgical oncologists) independently assessed the radiographs, based on the reporting system of REST. We constituted two groups according to the probable diagnosis of bone tumor (suspected benign tumor and suspected malignant tumor). RESULTS The mean score in the suspected benign tumor group was 1.1 (range 0-3, 95% CI 0.8-1.3) and in malignant tumor group was 6.1 (range 2-8, 95% CI 5.8-6.4). A receiver operator characteristic (ROC) curve for REST was with a cutoff of 3.5, with the most diagnostic value area under curve (AUC) of 0.99. The sensitivity was 98% and specificity was 100% with a positive predictive value of 100% and a negative predictive value of 98%. The inter-observer correlation coefficient was 0.985 (p value < 0.05), and Fleiss kappa value for the prediction of the benign or malignant lesion was 0.97 (p value < 0.05). The characteristics and content of tumor, cortical erosion, distinctiveness, distribution, periosteal reaction, and soft tissue mass had a significant correlation with the aggressiveness of bone lesion p value < 0.05. CONCLUSIONS The Radiological Evaluation Score for Bone Tumors (REST) is a structured reporting and objective method for the assessment of radiographs in patients with suspected bone tumors. This method is a reliable and helpful tool for clinicians in their outdoor patient department to differentiate a radiograph of a suspected benign tumor from a malignant bone tumor.
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Affiliation(s)
- A A Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Nandy
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - K Puj
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - M Kamani
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Pathak
- Department of Orthopedics, MM Institute of Medical Sciences & Research, Ambala, India
| | - J Shah
- Osteo Care - Ortho Onco Clinic, Ahmedabad, Gujarat, India
| | - R H Bhalerao
- Department of Electrical Engineering and Computer Science, Institute of Infrastructure, Technology, Research And Management, Ahmedabad, Gujarat, India
| | - A Jain
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - M Sharma
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - V Warikoo
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - K Patel
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - P Rathod
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Bhatt
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - T Tank
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - S Pandya
- Department of Anesthesia, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India
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Salunke AA, Nandy K, Kamani M, Puj K, Pathak S, Patel K, Bhalerao RH, Jain A, Sharma M, Warikoo V, Bhatt S, Rathod P, Pandya S. A proposed ''A to Z RAM (Radiograph Assessment Method)'' for triage of patients with a suspected bone tumour. Radiography (Lond) 2021; 27:823-830. [PMID: 33487526 DOI: 10.1016/j.radi.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We propose a ''A to Z RAM (Radiograph Assessment Method)'' for evaluation of Radiograph of patients with a suspected bone tumour. METHODS In the current study, ten radiological features with letters 'A, B, C, D, E, F and Z' were used and which included the age of the patient, involved part of the bone, characteristics, content, distinctiveness, the exterior of the bone, fracture, and zone of transition. Four independent observers (orthopaedic oncologists and surgical oncologists) evaluated a set of 30 radiographs of bone tumour selected at random from our hospital database based on A to Z RAM. We classified the lesions into two groups according to the traffic signal system; Green (suspected benign lesion) and Red (suspected malignant lesion). RESULTS There were 18 (60%) benign bone lesions and 12 (40%) malignant lesions in the current study. 91.6% of malignant tumours and 88.8% of the benign tumours were identified correctly by the four observers. The inter-observer variability with Fleiss kappa was 0.884 (95% CI 0.7-1.03 p-value < 0.05), suggestive of agreement not by chance. These radiographs were again reassessed by the four observers after 3 months. The interobserver variability by Fleiss kappa was 1.0 (95% CI 0.8-1.1) suggesting complete agreement amongst the observers. Both orthopaedic oncologists had intra-observer kappa as 1.0 each and both surgical oncologists had 0.795 and 0.930 respectively. CONCLUSION The proposed A to Z RAM is an easy to use and reproducible method for reviewing radiographs in the out-patient department along with clinical findings for better management of patients with suspected bone lesions. The A to Z RAM can be a medical triage tool and subdivide bone lesions into two subgroups i.e. suspected benign lesion with a suggestion of further investigations with MRI and biopsy and suspected malignant lesion with a suggestion of MRI or early referral to a tertiary cancer center with expertise in orthopaedic oncology. IMPLICATIONS FOR PRACTICE The A to Z RAM (Radiologic Assessment Method) is a reproducible method for reviewing radiographs in the out-patient department and can be an aid for better management of patients. A to Z RAM is useful as a medical triage system, subdividing patients according to the probable diagnosis into a suspected benign lesion and suspected malignant lesion.
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Affiliation(s)
- A A Salunke
- Department of Surgical Oncology, Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Nandy
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Kamani
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - K Puj
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pathak
- Department of Orthopedics, MM University, Ambala, India.
| | - K Patel
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - R H Bhalerao
- Deptartment of Electrical Engineering, IITRAM, Ahmedabad, Gujarat, India.
| | - A Jain
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - M Sharma
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - V Warikoo
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Bhatt
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - P Rathod
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
| | - S Pandya
- Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India.
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Davey S, Rajaretnem N, Harji D, Rees J, Messenger D, Smart NJ, Pathak S. Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:663-671. [PMID: 32808799 DOI: 10.1308/rcsann.2020.0163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions. METHODS A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken. FINDINGS Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as 'other'. The pooled incidence of IH was 6.0% (2.0-10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0-19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group (p = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups. CONCLUSION Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.
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Affiliation(s)
- S Davey
- North Bristol NHS Trust, Bristol, UK
| | - N Rajaretnem
- University Hospitals Plymouth, Crownhill, Plymouth, UK
| | - D Harji
- Institute of Health and Society, Newcastle University, UK
| | - J Rees
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - D Messenger
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Pathak
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
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Thacoor A, Pathak S, Macutkiewicz C, Smith AM. AUTHORS' RESPONSE to Views on the use of intraoperative cholangiography. Ann R Coll Surg Engl 2020; 102:1. [PMID: 32594752 PMCID: PMC7388947 DOI: 10.1308/rcsann.2020.0133] [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: 11/22/2022] Open
Affiliation(s)
- A Thacoor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Pan-Thames London Plastic and Reconstructive Surgery Rotation, London, UK
| | - S Pathak
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - AM Smith
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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20
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Bekker L, Li S, Pathak S, Tolley E, Marzinke M, Justman J, Mgodi N, Chirenje M, Swaminathan S, Adeyeye A, Farrior J, Hendrix C, Piwowar-Manning E, Richardson P, Eshelman S, Redinger H, Williams P, Sista N. Safety and tolerability of injectable Rilpivirine LA in HPTN 076: A phase 2 HIV pre-exposure prophylaxis study in women. EClinicalMedicine 2020; 21:100303. [PMID: 32280940 PMCID: PMC7139112 DOI: 10.1016/j.eclinm.2020.100303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Daily oral TDF/FTC is protective against HIV infection when used for pre-exposure prophylaxis (PrEP). However, daily adherence to oral PrEP is difficult for many; therefore, finding alternative PrEP strategies remains a priority. HPTN 076 evaluated the long-acting injectable form of rilpivirine (RPV), known as RPV LA for safety, pharmacokinetics and acceptability. METHODS HPTN 076 (NTC 02165202) was a phase 2, double-blind, 2:1 randomized trial comparing the safety of 1200mg RPV LA (LA) to placebo (P). The study included a 28-day oral run-in phase of daily, self- administered oral RPV (25 mg), with directly observed oral dosing about six times. Of 136 enrolled sexually active, HIV-uninfected, low HIV-risk African (100) and US (36) adult women, injectable product was administered in two gluteal, intramuscular (IM) injections once every eight weeks to 122 participants following the oral run-in phase. A maximum of six injection time points occurred over a 48-week period. Acceptability, safety, tolerability and pharmacokinetic (PK) data were collected throughout the study. This paper includes primary endpoint data collected up to the week 52 post enrollment. FINDINGS The median age of the enrolled population was 31 years (IQR: 25,38), median weight 75 kg (IQR: 64, 89), median body mass index (BMI) 30 (IQR: 27, 35), 46% married, 94% Black and 60% unemployed. A total of 122 (80 LA, 42 P) women received at least one injection and 98 (64 LA, 34 P) received all six injections. During the injection phase, three women withdrew from the study (2 LA, 1 P) and 16 women discontinued study product (10 LA, 6 P). Fourteen women (11 LA and 3 P) discontinued oral study product and did not enter the injection phase. Study product discontinuations were not significantly different between the two arms throughout. Of the product discontinuations in the injection phase, 8% in LA and 5% in P arm were due to adverse events (AEs), including one randomized to the P arm with prolonged QTc interval on EKG. The proportion of women who experienced Grade 2 or higher AEs during the injection phase as the primary outcome was not significantly different between the two arms [73.8%, 95% CI: (63.2%, 82.1%) for LA and 73.8%, 95% CI: (58.9%, 84.7%), p>0.99]. Transient Grade ≥2 liver abnormalities occurred in 14% of women in the LA arm compared with 12% in P arm. Three LA women (4%) developed Grade 3 injection site reactions compared with none in P arm. In participants who received at least 1 injection, the geometric mean of overall RPV trough concentrations (Ctrough) was 62.2 ng/mL. In participants who received all six injections, the geometric mean of CTrough through the injection phase and after the last injection were 72.8 ng/mL and 100.9 ng/mL, respectively. At week 52 (eight weeks after last injection), the geometric mean of RPV Ctrough was 75.0 ng/mL. At the last injection visit (Week 44), 80 % of women who answered acceptability questions strongly agreed that they would think about using- and 68% that they would definitely use a PrEP injectable in the future. INTERPRETATION RPV LA IM injections every eight weeks in African and US women were safe and acceptable. Overall, despite more injection site reactions and pain in the participants receiving RPV LA the injections were well tolerated. Data from this study support the further development of injectable PrEP agents.
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Affiliation(s)
- L.G. Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - S. Li
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S. Pathak
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | - N.M. Mgodi
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - M. Chirenje
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | | | | | | | | | | | | | | | - H. Redinger
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - P. Williams
- Johnson and Johnson Global Public Health, Belgium
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21
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Gupta A, Pathak S. Bilateral Fibrothecoma: A Rare Case in Young Woman. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/43819.13680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Thakkar A, Valente T, Andesia J, Njuguna B, Miheso J, Mercer T, Mwangi E, Pastakia SD, Pillsbury MM, Pathak S, Kamano J, Naanyu V, Vedanthan R, Bloomfield GS, Akwanalo C. P6371Network characteristics of a hypertension referral system in western kenya. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) trial is creating and testing interventions to improve the effectiveness of referral networks for patients with hypertension in Western Kenya.
Purpose
Network analysis of facility-based healthcare providers was used to understand the existing network of referrals. The ultimate goal was to identify both structural gaps and opportunities for implementation of the planned intervention.
Methods
A network survey was administered to providers who deliver care to patients with hypertension asking individuals to nominate a) individuals to whom, and b) facilities to which they refer patients, both up and down the health system. We analyzed survey data using centrality measures of in-degree and out-degree (number of links each provider received and sent, respectively), as well as fitting a core-periphery (CP) model. A higher CP indicates a strong referral network, while a lower CP indicates a relatively weaker network.
Results
Data were collected from 130 providers across 39 sites within 7 geographically separate network clusters. Each cluster consists of a mix of primary, secondary, and/or tertiary facilities. Compared to a perfect CP referral network model (Correlation Score [CP] = 1.00) and a random referral network model (CP = 0.200), the provider referral networks within each cluster showed a weak tendency for CP structure. There was a large range in CP from 0.334 to 0.639. In contrast, cluster-level facility networks showed a strong tendency for CP structure, with a CP range of 0.857 to 0.949.
Core Periphery Correlation Scores [CP] Network Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Provider Referrals 0.433 0.424 0.334 0.639 0.535 0.448 0.407 Facility Referrals 0.949 0.894 0.871 0.949 0.949 0.904 0.857 Each cluster represents a geographically separate referral network. A random referral network would reveal a CP score of 0.200; while a perfect referral network would give a CP of 1.00.
Referral Network Models
Conclusions
The current health system across Western Kenya does not demonstrate a strong network of referrals between providers for patients with hypertension. While facility-to-facility referrals are more in-line with a perfect referral model, there are gaps in communication between the specific providers. These results highlight the need for STRENGTHS to design and test interventions that strengthen provider referral patterns in order to improve blood pressure control and reduce cardiovascular risk.
Acknowledgement/Funding
National Institutes of Health: National Heart Lung and Blood Institute, Doris Duke Charitable Foundation:International Clinical Research Fellowship
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Affiliation(s)
- A Thakkar
- Duke University School of Medicine, Durham, United States of America
| | - T Valente
- University of Southern California, Los Angeles, United States of America
| | - J Andesia
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - B Njuguna
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - J Miheso
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - T Mercer
- University of Texas at Austin, Austin, United States of America
| | - E Mwangi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - S D Pastakia
- Purdue University, College of Pharmacy, West Lafayette, United States of America
| | - M M Pillsbury
- University of California San Francisco, School of Medicine, San Francisco, United States of America
| | - S Pathak
- Mount Sinai School of Medicine, New York, United States of America
| | - J Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - R Vedanthan
- New York University Langone Medical Center, New York, United States of America
| | - G S Bloomfield
- Duke University School of Medicine, Durham, United States of America
| | - C Akwanalo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
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Thacoor A, Pike TW, Pathak S, Dixon J, Macutkiewicz C, Smith AM. The role of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy for acute gallstone pancreatitis: is magnetic resonance cholangiopancreatography needed? Ann R Coll Surg Engl 2019; 101:428-431. [PMID: 31155897 DOI: 10.1308/rcsann.2019.0049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intraoperative cholangiography is sporadically used in patients undergoing laparoscopic cholecystectomy to delineate common bile duct anatomy and exclude retained stones. In patients with acute gallstone pancreatitis, intraoperative cholangiography may reduce the need for preoperative magnetic resonance cholangiopancreatography. MATERIALS AND METHODS A retrospective review of a prospectively collected patient database was undertaken over a 15-year period. The primary objective was to evaluate intraoperative assessment of the common bile duct with intraoperative cholangiography in patients with acute gallstone pancreatitis. RESULTS A total of 2215 patients underwent laparoscopic cholecystectomy between October 1998 and December 2013; 113 patients (of whom 77 were women) with a mean age of 54 years (range 16-88 years) were diagnosed with acute gallstone pancreatitis. Of these, 102 patients (90%) underwent laparoscopic cholecystectomy with intraoperative cholangiography, which was normal in 89 cases. Thirteen patients had choledocholithiasis on intraoperative cholangiography, 11 of whom were managed with concomitant trans-cystic duct exploration and clearance. Two patients required postoperative endoscopic retrograde cholangiopancreatography. CONCLUSIONS In patients diagnosed with acute gallstone pancreatitis, it is reasonable to proceed directly to surgery using intraoperative cholangiography on the same admission as the definitive assessment of the common bile duct. This negates the need for magnetic resonance cholangiopancreatography and can translate into cost savings and reduced length of stay.
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Affiliation(s)
- A Thacoor
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - T W Pike
- Department of HPB and Transplant Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - S Pathak
- Department of HPB and Transplant Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - J Dixon
- School of Medicine, University of Leeds , Leeds , UK
| | - C Macutkiewicz
- Department of HPB Surgery, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road , Manchester , UK
| | - A M Smith
- Department of HPB and Transplant Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
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Ahmad MH, Pathak S, Clement KD, Aly EH. Meta-analysis of the use of sterilized mosquito net mesh for inguinal hernia repair in less economically developed countries. BJS Open 2019; 3:429-435. [PMID: 31406956 PMCID: PMC6681152 DOI: 10.1002/bjs5.50147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Inguinal hernias are common in less economically developed countries (LEDCs), and associated with significant morbidity and mortality. Tension-free mesh repair is the standard treatment worldwide. Lack of resources combined with the high cost of commercial synthetic mesh (CSM) have limited its use in LEDCs. Sterilized mosquito net mesh (MNM) has emerged as a low-cost, readily available alternative to CSM. The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of MNM for the use in hernia repair in LEDCs. Methods A systematic review and data meta-analysis of all published articles from inception to August 2018 was performed. Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases were searched. The primary outcome measure was the overall postoperative complication rate of hernia repair when using MNM. Secondary outcome measures were comparisons between MNM and CSM with regard to overall complication rate, wound infection, chronic pain and haematoma formation. Results A total of nine studies were considered relevant (3 RCTs, 1 non-randomized trial and 5 prospective studies), providing a total cohort of 1085 patients using MNM. The overall complication rate for hernia repair using MNM was 9·3 per cent. There was no significant difference between MNM and CSM regarding the overall postoperative complication rate (odds ratio 0·99, 95 per cent c.i. 0·65 to 1·53; P = 0·98), severe or chronic pain (OR 2·52, 0·36 to 17·42; P = 0·35), infection (OR 0·56, 0·19 to 1·61; P = 0·28) or haematoma (OR 1·05, 0·62 to 1·78; P = 0·86). Conclusion MNM has a low overall postoperative complication rate and is unlikely to be inferior to CSM in terms of safety and efficacy. MNM is a suitable low-cost alternative to CSM in the presence of financial constraint.
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Affiliation(s)
- M H Ahmad
- University Hospitals of Leicester Leicester UK
| | - S Pathak
- University Hospitals of Leicester Leicester UK
| | - K D Clement
- Queen Elizabeth University Hospital Glasgow UK
| | - E H Aly
- Department of General Surgery, Aberdeen Royal Infirmary Aberdeen UK.,University of Aberdeen Aberdeen UK
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Pathak S, Smart N, Rees J, Blazeby J, Messenger D. #9 An in-depth analysis and cohort study of the techniques used to repair complex incisional hernias after abdominal surgery (oral presentation). Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, Zaccardi F, Ghanchi A, Khunti K, Davies MJ, Murphy GJ. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br J Surg 2018; 106:181-189. [DOI: 10.1002/bjs.11001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/16/2018] [Accepted: 08/21/2018] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The aim was to investigate whether preoperative weight loss results in improved clinical outcomes in surgical patients with clinically significant obesity.
Methods
This was a systematic review and aggregate data meta-analysis of RCTs and cohort studies. PubMed, MEDLINE, Embase and CINAHL Plus databases were searched from inception to February 2018. Eligibility criteria were: studies assessing the effect of weight loss interventions (low-energy diets with or without an exercise component) on clinical outcomes in patients undergoing any surgical procedure. Data on 30-day or all-cause in-hospital mortality were extracted and synthesized in meta-analyses. Postoperative thromboembolic complications, duration of surgery, infection and duration of hospital stay were also assessed.
Results
A total of 6060 patients in four RCTs and 12 cohort studies, all from European and North American centres, were identified. Most were in the field of bariatric surgery and all had some methodological limitations. The pooled effect estimate suggested that preoperative weight loss programmes were effective, leading to significant weight reduction compared with controls: mean difference –7·42 (95 per cent c.i. –10·09 to –4·74) kg (P < 0·001). Preoperative weight loss interventions were not associated with a reduction in perioperative mortality (odds ratio 1·41, 95 per cent c.i. 0·24 to 8·40; I2 = 0 per cent, P = 0·66) but the event rate was low. The weight loss groups had shorter hospital stay (by 27 per cent). No differences were found for morbidity.
Conclusion
This limited preoperative weight loss has advantages but may not alter the postoperative morbidity or mortality risk.
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Affiliation(s)
- M Roman
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A Monaghan
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - G F Serraino
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - D Miller
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - S Pathak
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Lai
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - F Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - A Ghanchi
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - G J Murphy
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Glenfield Hospital, Leicester, UK
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Pathak S, Sit C. P3.15-23 Data Mining the Internet and Crowdsourcing in Guiding Patient Decision-Making. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1899] [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: 10/28/2022]
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Scambler T, Wong C, Pathak S, Lara Reyna S, Holbrook J, Jarosz-Griffiths H, Martinon F, Savic S, Peckham D, McDermott M. WS04.3 Sodium influx modulates innate immune inflammation and metabolism in cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bhatt PC, Pathak S, Kumar V, Panda BP. Attenuation of neurobehavioral and neurochemical abnormalities in animal model of cognitive deficits of Alzheimer's disease by fermented soybean nanonutraceutical. Inflammopharmacology 2018; 26:105-118. [PMID: 28791538 DOI: 10.1007/s10787-017-0381-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
The present study was performed to evaluate the efficacy of nanonutraceuticals (NN) for attenuation of neurobehavioral and neurochemical abnormalities in Alzheimer's disease. Solid-state fermentation of soybean with Bacillus subtilis was performed to produce different metabolites (nattokinase, daidzin, genistin and glycitin and menaquinone-7). Intoxication of rats with colchicine caused impairment in learning and memory which was demonstrated in neurobehavioral paradigms (Morris water maze and passive avoidance) linked with decreased activity of acetylcholinesterase (AChE). NN treatment led to a significant increase in TLT in the retention trials as compared to acquisition trial TLT suggesting an improved learning and memory in rats. Further, treatment of NN caused an increase in the activity of AChE (42%), accompanied with a reduced activity of glutathione (42%), superoxide dismutase (43%) and catalase (41%). It also decreased the level of lipid peroxidation (28%) and protein carbonyl contents (30%) in hippocampus as compared to those treated with colchicine alone, suggesting a possible neuroprotective efficacy of NN. Interestingly, in silico studies also demonstrated an effective amyloid-β and BACE-1 inhibition activity. These findings clearly indicated that NN reversed colchicine-induced behavioral and neurochemical alterations through potent antioxidant activity and could possibly impart beneficial effects in cognitive defects associated with Alzheimer's disease.
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Affiliation(s)
- Prakash Chandra Bhatt
- Microbial and Pharmaceutical Biotechnology Laboratory, Centre for Advanced Research in Pharmaceutical Sciences, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Shruti Pathak
- Microbial and Pharmaceutical Biotechnology Laboratory, Centre for Advanced Research in Pharmaceutical Sciences, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Shalom Institute of Health & Allied Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh, 211007, India
| | - Bibhu Prasad Panda
- Microbial and Pharmaceutical Biotechnology Laboratory, Centre for Advanced Research in Pharmaceutical Sciences, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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Lyons NJR, Cornille JB, Pathak S, Charters P, Daniels IR, Smart NJ. Systematic review and meta-analysis of the role of metronidazole in post-haemorrhoidectomy pain relief. Colorectal Dis 2017; 19:803-811. [PMID: 28589634 DOI: 10.1111/codi.13755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/18/2017] [Indexed: 01/13/2023]
Abstract
AIM Conventional haemorrhoidectomy is still considered the reference standard for the management of severe or recurrent haemorrhoids. Pain is reported by patients to be the most common postoperative complication. Although the literature lacks a consensus on its effectiveness, metronidazole is often used to reduce postoperative pain. We have performed a meta-analysis of all randomized controlled trials (RCTs) that investigated the use of metronidazole for pain relief after haemorrhoidectomy. METHOD A systematic review was undertaken in accordance with the PRISMA protocol using the MESH headings 'haemorrhoidectomy', 'hemorhoidectomy', 'hemorrhoidectomy', 'haemorrhoid', 'metronidazole', 'Flagyl® ' 'antibiotic' and 'pain'. The search returned 421 articles of which eight were RCTs suitable for inclusion in the review with a total population of 437 patients. The outcomes of interest were postoperative pain intensity on days 1, 2 and 7 and on first defaecation as measured using a visual analogue scale. RESULTS The meta-analysis demonstrated a significant reduction in postoperative pain for patients treated with metronidazole with a reduced mean difference for the metronidazole group on day 1 of -1.42 (95% CI: -2.14 to -0.69, P = 0.0001), on day 2 of -1.43 (95% CI: -2.45 to -0.40, P = 0.006) and on day 7 of -2.40 (95% CI: -3.10 to -1.71, P < 0.00001). Pain on first defaecation was likewise reduced with a mean difference of -1.38 (95% CI: -2.15 to -0.60, P = 0.0005). Limitations of this study include variation in the grade of haemorrhoids treated and variability in the quality of included studies. CONCLUSION Metronidazole is a cheap, safe and effective intervention for reducing postoperative pain following conventional haemorrhoidectomy.
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Affiliation(s)
- N J R Lyons
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - J B Cornille
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - S Pathak
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - P Charters
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
| | - N J Smart
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Exeter, Devon, UK
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Tynan G, Doerner R, Barton J, Chen R, Cui S, Simmonds M, Wang Y, Weaver J, Mara N, Pathak S. Deuterium retention and thermal conductivity in ion-beam displacement-damaged tungsten. Nuclear Materials and Energy 2017. [DOI: 10.1016/j.nme.2017.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Morrison J, Colbourn T, Budhathoki B, Sen A, Adhikari D, Bamjan J, Pathak S, Basnet A, Trani JF, Costello A, Manandhar D, Groce N. Disabled women's attendance at community women's groups in rural Nepal. Health Promot Int 2017; 32:464-474. [PMID: 26519006 PMCID: PMC5455254 DOI: 10.1093/heapro/dav099] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women.
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Affiliation(s)
- J. Morrison
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - T. Colbourn
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - B. Budhathoki
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - A. Sen
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - D. Adhikari
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - J. Bamjan
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - S. Pathak
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - A. Basnet
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - J. F. Trani
- Leonard Cheshire Centre for Disability and Inclusive Development, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - A. Costello
- Institute ofGlobal Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - D. Manandhar
- Mother Infant Research Activities (MIRA) Nepal, PO Box 921, Thapathali, Kathmandu, Nepal
| | - N. Groce
- Leonard Cheshire Centre for Disability and Inclusive Development, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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Ban HY, Schweiger M, Kavuri VC, Cochran JM, Xie L, Busch DR, Katrašnik J, Pathak S, Chung SH, Lee K, Choe R, Czerniecki BJ, Arridge SR, Yodh AG. Heterodyne frequency-domain multispectral diffuse optical tomography of breast cancer in the parallel-plane transmission geometry. Med Phys 2017; 43:4383. [PMID: 27370153 DOI: 10.1118/1.4953830] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The authors introduce a state-of-the-art all-optical clinical diffuse optical tomography (DOT) imaging instrument which collects spatially dense, multispectral, frequency-domain breast data in the parallel-plate geometry. METHODS The instrument utilizes a CCD-based heterodyne detection scheme that permits massively parallel detection of diffuse photon density wave amplitude and phase for a large number of source-detector pairs (10(6)). The stand-alone clinical DOT instrument thus offers high spatial resolution with reduced crosstalk between absorption and scattering. Other novel features include a fringe profilometry system for breast boundary segmentation, real-time data normalization, and a patient bed design which permits both axial and sagittal breast measurements. RESULTS The authors validated the instrument using tissue simulating phantoms with two different chromophore-containing targets and one scattering target. The authors also demonstrated the instrument in a case study breast cancer patient; the reconstructed 3D image of endogenous chromophores and scattering gave tumor localization in agreement with MRI. CONCLUSIONS Imaging with a novel parallel-plate DOT breast imager that employs highly parallel, high-resolution CCD detection in the frequency-domain was demonstrated.
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Affiliation(s)
- H Y Ban
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - M Schweiger
- Department of Computer Science, University College London, London WC1E 7JE, United Kingdom
| | - V C Kavuri
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - J M Cochran
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - L Xie
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - D R Busch
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
| | - J Katrašnik
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana 1000, Slovenia
| | - S Pathak
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - S H Chung
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - K Lee
- Daegu Gyeongbuk Institute of Science and Technology, Daegu 711-813, South Korea
| | - R Choe
- Department of Biomedical Engineering, University of Rochester, Rochester, New York 14642
| | - B J Czerniecki
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - S R Arridge
- Department of Computer Science, University College London, London WC1E 7JE, United Kingdom
| | - A G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Cornille JB, Pathak S, Daniels IR, Smart NJ. Prophylactic mesh use during primary stoma formation to prevent parastomal hernia. Ann R Coll Surg Engl 2017; 99:2-11. [PMID: 27269439 PMCID: PMC5392779 DOI: 10.1308/rcsann.2016.0186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/16/2016] [Indexed: 01/31/2023] Open
Abstract
Introduction Parastomal hernia (PSH) is a common problem following stoma formation. The optimal technique for stoma formation is unknown although recent studies have focused on whether placement of prophylactic mesh at stoma formation can reduce PSH rates. The aim of this study was to systematically review use of prophylactic mesh versus no mesh with regard to occurrence of PSH and peristomal complications. Methods A systematic search was performed using PubMed, Embase™ and the Cochrane Library to identify randomised controlled trials that analysed placement of prophylactic mesh versus no mesh at time of initial surgery. Meta-analysis was performed using random effects methods. Results A total of 506 studies were identified by our search strategy. Of these, 8 studies were included, involving 430 patients (217 mesh vs 213 no mesh). Prophylactic mesh placement resulted in a significantly lower rate of PSH formation (42/217 [19.4%] vs 92/213 [43.2%]) with a combined risk ratio of 0.40 (95% confidence interval [CI]: 0.21-0.75, p=0.004). Placement of prophylactic mesh did not result in increased peristomal complications (15/218 [6.9%] vs 16/227 [7.0%]) with a combined risk ratio of 1.0 (95% CI: 0.49-2.01, p=0.990). Conclusions Prophylactic placement of mesh at primary stoma formation may reduce the incidence of PSH, without an increase in peristomal complications. However, the overall quality of the randomised controlled trials included in the meta-analysis was poor, and should prompt caution regarding the applicability of the findings of the individual studies and the meta-analysis to everyday practice.
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Affiliation(s)
- J B Cornille
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - S Pathak
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - I R Daniels
- Royal Devon and Exeter NHS Foundation Trust , UK
| | - N J Smart
- Royal Devon and Exeter NHS Foundation Trust , UK
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Jagadeesan A, Murugesan R, Vimala Devi S, Meera M, Madhumala G, Vishwanathan Padmaja M, Ramesh A, Banerjee A, Sushmitha S, Khokhlov A, Marotta F, Pathak S. Current trends in etiology, prognosis and therapeutic aspects of Parkinson's disease: a review. Acta Biomed 2017. [PMID: 29083328 PMCID: PMC6142835 DOI: 10.23750/abm.v%vi%i.6063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Parkinson's disease (PD) is a movement disorder, mainly affecting population consisting of the aged. PD occurs chiefly due to progressive loss of dopaminergic neurons in nigrostriatal pathway. Largely, PD patients suffer from non-motor symptoms, such as depression, anxiety, fatigue, and sleep disorders, that needs further investigation and addressing during PD research. Depression in PD is a predominant and complex symptom, and its pathology exists extrinsic to the nigrostriatal system. This disease can ultimately be managed by a combination of regular physiotherapy and proper medication. Taking together the present scenario of PD, including the nature of disease, characteristics, treatment, diagnosis of the patients with PD, these outcomes were reviewed to be explored along with many speech-based solutions to PD in this study. This neurodegenerative disorder needs advancement in research and development which can help patients with PD to lead a normal life.
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Affiliation(s)
- A.J. Jagadeesan
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - R. Murugesan
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - S. Vimala Devi
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - M. Meera
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - G. Madhumala
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - M. Vishwanathan Padmaja
- Department of Genetics, Dr. A.L.M. P.G. IBMS, Taramani campus, University of Madras, Chennai
| | - A. Ramesh
- Department of Genetics, Dr. A.L.M. P.G. IBMS, Taramani campus, University of Madras, Chennai
| | - A. Banerjee
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - S. Sushmitha
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India
| | - A.N. Khokhlov
- Evolutionary Cytogerontology Sector, School of Biology, Moscow State University, Moscow, Russia
| | - F. Marotta
- ReGenera Research Group for Aging Intervention, Milano, Italy and San Babila Clinic, Healthy Aging Unit by Genomics and Biotechnology, Milano, Italy
| | - S. Pathak
- Faculty of Allied Health Sciences, Chettinad Academy of Research and Education, Kelambakkam, India,Correspondence: Dr. Surajit Pathak, M.Sc, Ph.D. Faculty of Allied Health Sciences, Chettinad Hospital & Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Kelambakkam, Chennai-603103, India Tel. +91-44-47429050, E-mail:
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Niu N, Zhang J, Zhang N, Mercado-Uribe I, Tao F, Han Z, Pathak S, Multani AS, Kuang J, Yao J, Bast RC, Sood AK, Hung MC, Liu J. Linking genomic reorganization to tumor initiation via the giant cell cycle. Oncogenesis 2016; 5:e281. [PMID: 27991913 PMCID: PMC5177773 DOI: 10.1038/oncsis.2016.75] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 12/20/2022] Open
Abstract
To investigate the mechanisms underlying our recent paradoxical finding that mitotically incapacitated and genomically unstable polyploid giant cancer cells (PGCCs) are capable of tumor initiation, we labeled ovarian cancer cells with α-tubulin fused to green fluorescent protein, histone-2B fused to red fluorescent protein and FUCCI (fluorescent ubiquitination cell cycle indicator), and tracked the spatial and time-dependent change in spindle and chromosomal dynamics of PGCCs using live-cell fluorescence time-lapse recording. We found that single-dose (500 nm) treatment with paclitaxel paradoxically initiated endoreplication to form PGCCs after massive cell death. The resulting PGCCs continued self-renewal via endoreplication and further divided by nuclear budding or fragmentation; the small daughter nuclei then acquired cytoplasm, split off from the giant mother cells and acquired competency in mitosis. FUCCI showed that PGCCs divided via truncated endoreplication cell cycle (endocycle or endomitosis). Confocal microscopy showed that PGCCs had pronounced nuclear fragmentation and lacked expression of key mitotic proteins. PGCC-derived daughter cells were capable of long-term proliferation and acquired numerous new genome/chromosome alterations demonstrated by spectral karyotyping. These data prompt us to conceptualize a giant cell cycle composed of four distinct but overlapping phases, initiation, self-renewal, termination and stability. The giant cell cycle may represent a fundamental cellular mechanism to initiate genomic reorganization to generate new tumor-initiating cells in response to chemotherapy-induced stress and contributes to disease relapse.
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Affiliation(s)
- N Niu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Mercado-Uribe
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Tao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Han
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Pathak
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A S Multani
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Kuang
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Yao
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M-C Hung
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Center for Molecular Medicine and Graduate Institute of Cancer Biology, China Medical University, Taichung, Taiwan
| | - J Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Tandon A, Shahzad K, Pathak S, Oommen CM, Nunes QM, Smart N. Parietex™ Composite mesh versus DynaMesh ®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study. Ann R Coll Surg Engl 2016; 98:568-573. [PMID: 27659375 DOI: 10.1308/rcsann.2016.0292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Laparoscopic incisional and ventral hernia repair (LIVHR) is widely accepted and safe but the type of mesh used is still debated. We retrospectively compared postoperative outcomes with two different meshes commonly used in LIVHR. METHODS This is a retrospective study of patients who underwent incisional hernia repair between January 2008 and December 2010. Two meshes were used: Parietex™ Composite (Covidien, New Haven, CT, USA) and the DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Germany). The two groups were compared with respect to recurrence rates, incidence of seroma and intestinal obstruction. RESULTS Among the 88 patients who underwent LIVHR, 75 patients (85.2%) presented with primary incisional hernia, 10 (11.4%) presented with a first recurrence and 3 (3.4%) presented with a second recurrence. Median follow-up was 53.6 months (range 40-61 months). 12.9% of patients had recurrence in the Parietex™ Composite mesh group (n=62) in comparison to 3.8% in the DynaMesh®-IPOM mesh group (n=26; P=0.20). DynaMesh®-IPOM was associated with a significantly higher incidence of intestinal obstruction secondary to adhesions (11.5% vs. 0%, P=0.006) and lower incidence of seroma and haematoma formation compared to Parietex™ composite mesh group (0% vs. 6.4% of patients; P=0.185). CONCLUSIONS LIVHR is a safe and feasible technique. Dynamesh®-IPOM is associated with a significantly higher incidence of adhesion related bowel obstruction, albeit with a lower incidence of recurrence, seroma and haematoma formation compared with Parietex™ Composite mesh. However, there is a need for further well-designed, multicentre randomised controlled studies to investigate the use of these meshes.
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Affiliation(s)
- A Tandon
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - K Shahzad
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
| | - C M Oommen
- Rotherham General Hospital , Rotherham , UK
| | - Q M Nunes
- Department of Surgery, Aintree University Hospital , Liverpool , UK
| | - N Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter NHS Foundation Trust , Exeter , UK
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Tandon A, Pathak S, Lyons NJR, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 2016; 103:1598-1607. [DOI: 10.1002/bjs.10268] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/05/2016] [Accepted: 06/10/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation.
Methods
A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.
Results
A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P < 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P < 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.
Conclusion
CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.
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Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J R Lyons
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital, Liverpool, UK
- National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Reeves N, Hughes D, Pathak S. Response to Samuelsson et al.: Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis 2016; 18:725-6. [PMID: 27149096 DOI: 10.1111/codi.13368] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Affiliation(s)
- N Reeves
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK.
| | - D Hughes
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK
| | - S Pathak
- Department of General Surgery, Bristol Royal Infirmary, Bristol, UK
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Chan KE, Pathak S, Smart NJ, Batchelor N, Daniels IR. The impact of cardiopulmonary exercise testing on patients over the age of 80 undergoing elective colorectal cancer surgery. Colorectal Dis 2016; 18:578-85. [PMID: 26417705 DOI: 10.1111/codi.13139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/20/2015] [Indexed: 12/07/2022]
Abstract
AIM Advanced age and occult cardiorespiratory disease are associated with increased morbidity and mortality following surgery. Cardiopulmonary exercise testing (CPET) may allow the identification of high-risk patients and facilitate planned postoperative critical care support. The aim of this study was to determine whether preoperative CPET in patients aged over 80 undergoing elective colorectal cancer resection was associated with improved outcome. METHOD All patients aged 80 years and above undergoing elective colorectal cancer resection between 1 March 2011 and 1 September 2013 were retrospectively analysed. Referral for CPET testing was at the discretion of the operating surgeon. Postoperative critical care unit (CCU) admission was based upon the CPET results. RESULTS Ninety-four patients were identified, of whom 48 underwent CPET testing. The CPET group were significantly older than the non-CPET group (85 vs 83 years, P = 0.04) and were more likely to have a planned admission to CCU postoperatively (P < 0.0001). Despite the increased use of CCU resources, the overall CCU length of stay (LOS) in the CPET group did not differ from the non-CPET group, but the non-CPET group had a higher proportion of Level-3 care. There were no differences in the incidence of unplanned CCU admission between the CPET and the non-CPET group (P = 0.23). There were no differences in overall LOS between the two groups (P = 0.42). There was no difference in mortality (P = 0.11), overall complications (P = 0.53) or severe complications (P = 0.3). CONCLUSION Preoperative CPET testing in patients aged over 80 undergoing elective colorectal cancer resection allows identification of higher-risk patients and mitigation of risk by preemptive admission to a CCU. This stratification allows equivalent results to be achieved in high- and low-risk elderly patients undergoing colorectal surgery.
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Affiliation(s)
- K E Chan
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - S Pathak
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
| | - N Batchelor
- Department of Anaesthesia, Royal Devon and Exeter Hospital, Exeter, UK
| | - I R Daniels
- Exeter Surgical Health Services Research Unit (HESRU), Royal Devon and Exeter Hospital, Exeter, UK
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41
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Saqib R, Pathak S. Response to: anastomotic leaks after colon cancer resections: does the individual surgeon matter? Colorectal Dis 2016; 18:624-5. [PMID: 27088893 DOI: 10.1111/codi.13354] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/22/2016] [Indexed: 02/08/2023]
Affiliation(s)
- R Saqib
- Surgery Division, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK.
| | - S Pathak
- Surgery Division, Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK
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42
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van Roon Y, Kirwin C, Rahman N, Vinayakarao L, Melson L, Kester N, Pathak S, Pradhan A. Comparison of Obstetric anal sphincter injuries (OASIS) in nulliparous women before and after introduction of the EPISCISSORS-60® at two Hospitals in the United Kingdom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583793] [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: 10/21/2022] Open
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43
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Pradhan M, Pathak S, Mathur D, Ladiwala U. Optically trapping tumor cells to assess differentiation and prognosis of cancers. Biomed Opt Express 2016; 7:943-948. [PMID: 27231599 PMCID: PMC4866466 DOI: 10.1364/boe.7.000943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
We report an optical trapping method that may enable assessment of the differentiation status of cancerous cells by determining the minimum time required for cell-cell adhesion to occur. A single, live cell is trapped and brought into close proximity of another; the minimum contact time required for cell-cell adhesion to occur is measured using transformed cells from neural tumor cell lines: the human neuroblastoma SK-N-SH and rat C6 glioma cells. Earlier work on live adult rat hippocampal neural progenitors/stem cells had shown that a contact minimum of ~5 s was required for cells to adhere to each other. We now find the average minimum time for adhesion of cells from both tumor cell lines to substantially increase to ~20-25 s, in some cases up to 45 s. Upon in vitro differentiation of these cells with all-trans retinoic acid the average minimum time reverts to ~5-7 s. This proof-of-concept study indicates that optical trapping may be a quick, sensitive, and specific method for determining differentiation status and, thereby, the prognosis of cancer cells.
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Affiliation(s)
- M Pradhan
- UM-DAE Centre for Excellence in Basic Sciences, Kalina Campus, Mumbai 400 098, India
| | - S Pathak
- UM-DAE Centre for Excellence in Basic Sciences, Kalina Campus, Mumbai 400 098, India
| | - D Mathur
- Tata Institute of Fundamental Research, 1 Homi Bhabha Road, Mumbai 400 005, India;
| | - U Ladiwala
- UM-DAE Centre for Excellence in Basic Sciences, Kalina Campus, Mumbai 400 098, India;
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Alam NN, Narang SK, Pathak S, Daniels IR, Smart NJ. Methods of abdominal wall expansion for repair of incisional herniae: a systematic review. Hernia 2016; 20:191-9. [DOI: 10.1007/s10029-016-1463-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
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45
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Khanam S, Sharma S, Pathak S. Lethal and nonlethal murine malarial infections differentially affect apoptosis, proliferation, and CD8 expression on thymic T cells. Parasite Immunol 2016; 37:349-61. [PMID: 25886201 DOI: 10.1111/pim.12197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/11/2015] [Indexed: 01/14/2023]
Abstract
Although thymic atrophy and apoptosis of the double-positive (DP) T cells have been reported in murine malaria, comparative studies investigating the effect of lethal and nonlethal Plasmodium infections on the thymus are lacking. We assessed the effects of P. yoelii lethal (17XL) and nonlethal (17XNL) infections on thymic T cells. Both strains affected the thymus. 17XL infection induced DP T-cell apoptosis and a selective decrease in surface CD8 expression on developing thymocytes. By contrast, more severe but reversible effects were observed during 17XNL infection. DP T cells underwent apoptosis, and proliferation of both DN and DP cells was affected around peak parasitemia. A transient increase in surface CD8 expression on thymic T cells was also observed. Adult thymic organ culture revealed that soluble serum factors, but not IFN-γ or TNF-α, contributed to the observed effects. Thus, lethal and nonlethal malarial infections led to multiple disparate effects on thymus. These parasite-induced thymic changes are expected to impact the naïve T-cell repertoire and the subsequent control of the immune response against the parasite. Further investigations are required to elucidate the mechanism responsible for these disparate effects, especially the reversible involution of the thymus in case of nonlethal infection.
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Affiliation(s)
- S Khanam
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, Maharashtra, India
| | - S Sharma
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, Maharashtra, India
| | - S Pathak
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, Maharashtra, India
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46
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Sah SK, Joshi D, Pathak S, Marasini N. Effect of Ethanol and pH on the Adsorption of Diazepam from Simulated Gastric Fluid and Simulated Intestinal Fluid on Activated Charcoal In Vitro. Indian J Pharm Sci 2016. [DOI: 10.4172/pharmaceutical-sciences.1000161] [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: 11/09/2022] Open
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47
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Lyons NJR, Pathak S, Daniels IR, Smart NJ. Response to Heedman et al.: Variation at presentation among colon cancer patients with metastases: a population-based study. Colorectal Dis 2015; 17:1029-30. [PMID: 26250340 DOI: 10.1111/codi.13078] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/15/2015] [Indexed: 02/08/2023]
Affiliation(s)
- N J R Lyons
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK.
| | - S Pathak
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - I R Daniels
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - N J Smart
- Exeter Surgical Health Service Research Unit (HeSRU), Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, Devon, UK
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Harlaar J, Deerenberg EB, Dwarkasing RS, Kamperman AM, Jeekel J, Lange JF, Samartsev VA, Gavrilov VA, Kuchumov AG, Nyashin YI, Vildeman VE, Slovikov SV, Rubtsova EA, Parshakov AA, Morawski J, Miller A, Kallenberger G, Hannen C, Strey CW, Robin A, López-Monclús J, Melero D, Blazquez L, Moreno A, Palencia N, Cruz A, López-Quindós P, Aguilera A, Jimenez C, Becerra R, García M, Galván A, Gonzalez E, García-Ureña MA, Costa T, Abdalla R, Garcia R, Costa R, Williams Z, Kotwall C, Tenzel P, Alam N, Narang S, Pathak S, Daniels I, Smart N, Guérin G, Ordrenneau C, Bouré L, Turquier F, Abbonante F. Abdominal Wall "Closure". Hernia 2015; 19 Suppl 1:S123-6. [PMID: 26518787 DOI: 10.1007/bf03355338] [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: 11/28/2022]
Affiliation(s)
- J Harlaar
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - E B Deerenberg
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - R S Dwarkasing
- Department of Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A M Kamperman
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Jeekel
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - V A Samartsev
- Perm State Medical University named after ac. E.A Wagner, Perm, Russia
| | - V A Gavrilov
- Perm State Medical University named after ac. E.A Wagner, Perm, Russia
| | - A G Kuchumov
- Perm National Research Polytechnical University, Perm, Russia
| | - Y I Nyashin
- Perm National Research Polytechnical University, Perm, Russia
| | - V E Vildeman
- Perm National Research Polytechnical University, Perm, Russia
| | - S V Slovikov
- Perm National Research Polytechnical University, Perm, Russia
| | - E A Rubtsova
- Perm State National Research University, Perm, Russia
| | - A A Parshakov
- Perm State Medical University named after ac. E.A Wagner, Perm, Russia
| | - J Morawski
- Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - A Miller
- Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | | | - C Hannen
- Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - C W Strey
- Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - A Robin
- Hospital del Henares, Coslada (Madrid), Spain
| | | | - D Melero
- Hospital del Henares, Coslada (Madrid), Spain
| | - L Blazquez
- Hospital del Henares, Coslada (Madrid), Spain
| | - A Moreno
- Hospital del Henares, Coslada (Madrid), Spain
| | - N Palencia
- Hospital del Henares, Coslada (Madrid), Spain
| | - A Cruz
- Hospital del Henares, Coslada (Madrid), Spain
| | | | - A Aguilera
- Hospital del Henares, Coslada (Madrid), Spain
| | - C Jimenez
- Hospital del Henares, Coslada (Madrid), Spain
| | - R Becerra
- Hospital del Henares, Coslada (Madrid), Spain
| | - M García
- Hospital del Henares, Coslada (Madrid), Spain
| | - A Galván
- Hospital del Henares, Coslada (Madrid), Spain
| | - E Gonzalez
- Hospital del Henares, Coslada (Madrid), Spain
| | | | - T Costa
- University of Sao Paulo, Sao Paulo, Brazil
| | - R Abdalla
- University of Sao Paulo, Sao Paulo, Brazil
| | - R Garcia
- Hospital Sirio Libanes, Sao Paulo, Brazil
| | - R Costa
- Hospital Sirio Libanes, Sao Paulo, Brazil
| | - Z Williams
- New Hanover Regional Medical Center, Wilmington, USA
| | - C Kotwall
- New Hanover Regional Medical Center, Wilmington, USA
| | - P Tenzel
- New Hanover Regional Medical Center, Wilmington, USA
| | - N Alam
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | - S Narang
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | - S Pathak
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | - I Daniels
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | - N Smart
- HeSRU, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | | | | | - F Abbonante
- Department of Surgery-Plastic Surgery, Catanzaro City Hospital, Catanzaro, Italy
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Sreenivas K, Sekhar NS, Saxena M, Paliwal R, Pathak S, Porwal MC, Fyzee MA, Rao SVCK, Wadodkar M, Anasuya T, Murthy MSR, Ravisankar T, Dadhwal VK. Estimating inter-annual diversity of seasonal agricultural area using multi-temporal resourcesat data. J Environ Manage 2015; 161:433-442. [PMID: 25435154 DOI: 10.1016/j.jenvman.2014.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/11/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
The present study aims at analysis of spatial and temporal variability in agricultural land cover during 2005-6 and 2011-12 from an ongoing program of annual land use mapping using multidate Advanced Wide Field Sensor (AWiFS) data aboard Resourcesat-1 and 2. About 640-690 multi-temporal AWiFS quadrant data products per year (depending on cloud cover) were co-registered and radiometrically normalized to prepare state (administrative unit) mosaics. An 18-fold classification was adopted in this project. Rule-based techniques along with maximum-likelihood algorithm were employed to deriving land cover information as well as changes within agricultural land cover classes. The agricultural land cover classes include - kharif (June-October), rabi (November-April), zaid (April-June), area sown more than once, fallow lands and plantation crops. Mean kappa accuracy of these estimates varied from 0.87 to 0.96 for various classes. Standard error of estimate has been computed for each class annually and the area estimates were corrected using standard error of estimate. The corrected estimates range between 99 and 116 Mha for kharif and 77-91 Mha for rabi. The kharif, rabi and net sown area were aggregated at 10 km × 10 km grid on annual basis for entire India and CV was computed at each grid cell using temporal spatially-aggregated area as input. This spatial variability of agricultural land cover classes was analyzed across meteorological zones, irrigated command areas and administrative boundaries. The results indicate that out of various states/meteorological zones, Punjab was consistently cropped during kharif as well as rabi seasons. Out of all irrigated commands, Tawa irrigated command was consistently cropped during rabi season.
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Affiliation(s)
- K Sreenivas
- National Remote Sensing Centre, Balanagar, Hyderabad, India.
| | | | - Manoj Saxena
- National Remote Sensing Centre, Balanagar, Hyderabad, India
| | - R Paliwal
- RRSC-West, Jodhpur, Rajasthan, India
| | - S Pathak
- RRSC-West, Jodhpur, Rajasthan, India
| | - M C Porwal
- Indian Institute of Remote Sensing, 4, Kalidas Road, Dehra Dun, Uttarakhand, India
| | - M A Fyzee
- National Remote Sensing Centre, Balanagar, Hyderabad, India
| | | | - M Wadodkar
- RRSC-Central, Nagpur, Maharashtra, India
| | - T Anasuya
- National Remote Sensing Centre, Balanagar, Hyderabad, India
| | - M S R Murthy
- ICIMOD, Khumaltar, G.P.O. Box 3226, Kathmandu, Nepal
| | - T Ravisankar
- National Remote Sensing Centre, Balanagar, Hyderabad, India
| | - V K Dadhwal
- National Remote Sensing Centre, Balanagar, Hyderabad, India
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Bajpai D, Pathak S, Jain S, Singh N. P10.06 Prognostic importance of dna repair gene polymorphisms in cervical cancer patients from india. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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