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Liu PY, Gragnani CM, Timmerman J, Newhouse CN, Soto G, Lopez L, Spronz R, Mhaskar A, Yeganeh N, Fernandes P, Kuo AA. Pediatric Household Transmission of Severe Acute Respiratory Coronavirus-2 Infection-Los Angeles County, December 2020 to February 2021. Pediatr Infect Dis J 2021; 40:e379-e381. [PMID: 34387617 PMCID: PMC8443424 DOI: 10.1097/inf.0000000000003251] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
This brief report presents transmission rates from a prospective study of 15 households with pediatric index cases of severe acute respiratory coronavirus-2 in Los Angeles County from December 2020 to February 2021. Our findings support ongoing evidence that transmission from pediatric index cases to household contacts is frequent but can be mitigated with practicing well-documented control measures at home, including isolation, masking and good hand hygiene.
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Affiliation(s)
| | | | - Jason Timmerman
- Department of Medicine, David Geffen School of Medicine at UCLA
| | | | - Gabriela Soto
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Lizzet Lopez
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Rachel Spronz
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Aditi Mhaskar
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Nava Yeganeh
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA
| | | | - Alice A Kuo
- Department of Pediatrics, Division of Child Health Policy, David Geffen School of Medicine at UCLA, Los Angeles, California
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Dwarkanath P, Kurpad AV, Muthayya S, Thomas T, Mhaskar A, Mhaskar R, Thomas A, Vaz M, Jahoor F. Glucose kinetics and pregnancy outcome in Indian women with low and normal body mass indices. Eur J Clin Nutr 2009; 63:1327-34. [PMID: 19471289 DOI: 10.1038/ejcn.2009.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Fetal energy demands are met from the oxidation of maternally supplied glucose and amino acids. During the fasted state, the glucose supply is thought to be met by gluconeogenesis. Underweight women with low body mass index (BMI) might be unable to adequately supply amino acids to satisfy the demands of gluconeogenesis. SUBJECTS/METHODS Glucose kinetics were measured during the first and second trimesters of pregnancy in 10 low-BMI and 10 normal-BMI pregnant women at the 12th hour of an overnight fast using a primed 6 h U-(13)C glucose infusion and was correlated to maternal dietary and anthropometric variables and birth weight. RESULTS Low-BMI mothers consumed more energy, carbohydrates and protein, had faster glucose production (R (a)) and oxidation rates in the first trimester. In the same trimester, dietary energy and carbohydrate correlated with glucose production, glycogenolysis and glucose oxidation in all women. Both groups had similar rates of gluconeogenesis in the first and second trimesters. Glucose R (a) in the second trimester was weakly correlated with the birth weight (r=0.4, P=0.07). CONCLUSIONS Maternal energy and carbohydrate intakes, not BMI, appear to influence glucose R (a) and oxidation in early and mid pregnancy.
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Affiliation(s)
- P Dwarkanath
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Kumar A, Mhaskar A, Vadaparampil S, Djulbegovic B, Quinn G. Fertility preservation and timing of cancer treatment. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20629] [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
e20629 Background: Cancer survival rates have increased steadily over time and young cancer survivors desire quality of life, including the ability to have a family. Cancer treatments, due to its toxic nature, can permanently or temporarily affect fertility. However, advanced fertility preservation measures are available and should be pursued before toxic chemo or radiation therapy. Evidence from observational studies indicate patients want to be informed of the adverse effects of cancer treatments on their fertility. Despite conflicting evidence on the efficacy of early treatment, the urgency of starting treatment early for maximum benefit has been cited as the most common reason for not discussing fertility preservation with patients.Accordingly, we conducted a systematic review and meta-analysis to assess if early treatment leads to better outcomes. Methods: A comprehensive literature search was performed of MEDLINE and Cochrane databases from 1966–2008 for all phase III randomized controlled trials (RCT) comparing early versus late treatment in cancer patients as first line therapy. Data were extracted and pooled on benefits (overall survival) and harms (treatment related mortality). Results: Initial search yielded 570 trials, of which 8 RCTs met the inclusion criteria. 3 RCTs assessed the efficacy of early versus deferred treatment in prostate cancer, 3 in multiple myeloma, and 1 each in lung cancer and chronic lymphocytic leukemia (CLL). Overall, pooled data showed survival benefit with early treatment (Hazard ratio [HR]=1.16,95%CI 1.05–1.28). However, the benefit with early treatment was restricted to prostate cancer(HR=1.21,95%CI 1.09–1.35). There was no survival difference between early and deferred treatment in multiple myeloma (HR=1.11,95%CI 0.67–1.84), CLL (HR=0.89,95%CI 0.49–1.59) or lung cancer (HR=0.95,95%CI 0.72–1.24). Pooled results excluding prostate cancer RCTs did not show a survival benefit with early treatment (HR=0.97,95%CI 0.78–1.21). No trial reported data on harms. There was no significant heterogeneity among trials. Conclusions: The totality of the evidence shows except in prostate cancer, deferment of treatment does not lead to decreased survival, and provides a unique window to oncologists to address the issues related to fertility preservation if desired by patients. No significant financial relationships to disclose.
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Affiliation(s)
- A. Kumar
- Moffitt Cancer Center & Research Institute, Tampa, FL; University of South Florida, College of Medicine, Tampa, FL; The Moffitt Fertility Preservation Group
| | - A. Mhaskar
- Moffitt Cancer Center & Research Institute, Tampa, FL; University of South Florida, College of Medicine, Tampa, FL; The Moffitt Fertility Preservation Group
| | - S. Vadaparampil
- Moffitt Cancer Center & Research Institute, Tampa, FL; University of South Florida, College of Medicine, Tampa, FL; The Moffitt Fertility Preservation Group
| | - B. Djulbegovic
- Moffitt Cancer Center & Research Institute, Tampa, FL; University of South Florida, College of Medicine, Tampa, FL; The Moffitt Fertility Preservation Group
| | - G. Quinn
- Moffitt Cancer Center & Research Institute, Tampa, FL; University of South Florida, College of Medicine, Tampa, FL; The Moffitt Fertility Preservation Group
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Kurpad AV, Kao C, Dwarkanath P, Muthayya S, Mhaskar A, Thomas A, Vaz M, Jahoor F. In vivo arginine production and nitric oxide synthesis in pregnant Indian women with normal and low body mass indices. Eur J Clin Nutr 2009; 63:1091-7. [PMID: 19436322 PMCID: PMC2834371 DOI: 10.1038/ejcn.2009.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Nitric oxide (NO) has been proposed as a mediator of vascular expansion during pregnancy. Inability to increase NO synthesis and/or production of its precursor, arginine, may be a contributor to pregnancy-induced hypertension or preeclampsia. Because maternal weight is associated with blood pressure and risk of preeclampsia during pregnancy, it may also influence arginine and/or NO production. The purpose of this study was to determine the in vivo arginine production and NO synthesis rate in pregnant women with normal (n=10) and low (n=10) body mass indices (BMIs). SUBJECTS/METHODS Arginine flux and NO synthesis rate were measured in the postabsorptive state with constant infusions of 15N2-arginine and 13C,2H4-citrulline. Plasma concentrations of arginine and NO metabolites were also measured. Kinetic parameters were correlated to maternal variables, gestational age, birth weight and blood pressure. RESULTS Endogenous arginine flux was significantly faster in the low-BMI compared with normal-BMI women in the first trimester (63.1+/-3.4 vs 50.2+/-2.0 micromol/kg per h, P<0.01), but not in the second. Plasma NO concentration was higher (44.7+/-5.3 vs 30.4+/-1.9 micromol/l, P=0.03) and its rate of synthesis trended faster in the low-BMI compared with normal-BMI group in the second trimester. Maternal weight and BMI were negatively correlated with arginine flux in both trimesters and NO synthesis in the second trimester. CONCLUSIONS These findings suggest, but do not prove, that maternal BMI may be a factor in the ability to produce NO during pregnancy and may be one way by which BMI influences blood pressure during pregnancy.
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Affiliation(s)
- A V Kurpad
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
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Muthayya S, Dwarkanath P, Thomas T, Ramprakash S, Mehra R, Mhaskar A, Mhaskar R, Thomas A, Bhat S, Vaz M, Kurpad AV. The effect of fish and omega-3 LCPUFA intake on low birth weight in Indian pregnant women. Eur J Clin Nutr 2007; 63:340-6. [PMID: 17957193 DOI: 10.1038/sj.ejcn.1602933] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and omega-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women. SUBJECTS/METHODS In a prospective cohort study, data on maternal fish intake and omega-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%. RESULTS Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g day(-1) at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg day(-1), respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P<0.001). Women who did not eat fish during the third trimester had a significantly higher risk of LBW (OR: 2.49, P=0.019). Similarly, low EPA intake during the third trimester had an association with a higher risk of LBW (OR: 2.75, P=0.011). CONCLUSIONS Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with omega-3 LCPUFA during pregnancy may have important implications for fetal development in India.
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Affiliation(s)
- S Muthayya
- Division of Nutrition, Maternal and Child Health Unit, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India.
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Muthayya S, Dwarkanath P, Thomas T, Vaz M, Mhaskar A, Mhaskar R, Thomas A, Bhat S, Kurpad A. Anthropometry and body composition of south Indian babies at birth. Public Health Nutr 2007; 9:896-903. [PMID: 17010256 DOI: 10.1017/phn2006943] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition. DESIGN Prospective observational study. SETTING Bangalore City, India. SUBJECTS A total of 712 women were recruited at 12.5+/-3.1 weeks of gestation (mean+/-standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital. RESULTS The mean+/-SD birth weight of all newborns was 2.80+/-0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the baby's length at birth. CONCLUSIONS Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the baby's skinfold thicknesses and maternal fat-free mass (P<0.02).
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Affiliation(s)
- S Muthayya
- Institute of Population Health and Clinical Research, St. John's National Academy of Health Sciences, Bangalore 560 034, India.
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Muthayya S, Kurpad AV, Duggan CP, Bosch RJ, Dwarkanath P, Mhaskar A, Mhaskar R, Thomas A, Vaz M, Bhat S, Fawzi WW. Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians. Eur J Clin Nutr 2006; 60:791-801. [PMID: 16404414 DOI: 10.1038/sj.ejcn.1602383] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR). DESIGN Prospective observational study. SETTING Bangalore City, India. SUBJECTS A total of 478 women were recruited at 12.9+/-3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%. INTERVENTIONS None. MAIN OUTCOME MEASURES Birth weight was measured at hospital delivery. RESULTS The mean birth weight was 2.85+/-0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B(12) concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1-3, respectively). CONCLUSIONS The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B(12) status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B(12) deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.
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Affiliation(s)
- S Muthayya
- Division of Nutrition, Institute of Population Health and Clinical Research, St John's National Academy of Health Sciences, Bangalore, India.
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Thomas T, Jophy R, Mhaskar A, Misquith D. Are we increasing serious maternal morbidity by postponing termination of pregnancy in severe pre-eclampsia/eclampsia? J OBSTET GYNAECOL 2005; 25:347-51. [PMID: 16091314 DOI: 10.1080/01443610500119648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to evaluate the impact of admission--delivery interval on maternal morbidity in patients with severe pre-eclampsia/eclampsia. This was a retrospective study, which involved review of case sheets of 188 women (admitted to St John's Medical College Hospital during the year 2000--2001 with the above diagnosis). The incidence of severe pre-eclampsia and eclampsia was 5.18% (188/3,627) with 119 primigravida and 69 multigravida. The incidence of serious maternal complications in the post partum period was 17% (11/68) in the category of women who delivered within 12 hours of admission compared with 40.6% (28/69) in the 12--48-h category and 60.8% (31/51) in the>48-h category. The incidence of serious maternal complications in the subset with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome was 33.4% (7/21) in the<or=12-h category compared with 90.9% (20/22)in the>12-h. We concluded that termination of pregnancy within 12 hours of admission in severe pre-eclampsia/eclampsia especially in patients with HELLP syndrome helps to prevent avoidable serious maternal morbidity.
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Affiliation(s)
- T Thomas
- Department of Obstetrics and Gynaecology, St. John's Medical College Hospital, Bangalore, Karnataka, India.
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Padmanabhan LD, Mhaskar R, Mhaskar A, Ross CR. Factor XIII deficiency: a rare cause of repeated abortions. Singapore Med J 2004; 45:186-7. [PMID: 15094990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Factor XIII deficiency is a rare cause of early abortion. The obstetrical outcome of four pregnancies in two women with factor XIII deficiency is reported. Both women were treated with substitution therapy using locally-prepared cryoprecipitate. The outcome in these two women demonstrated the need for substitution therapy in early pregnancy leading to an increased chance of obstetrical success.
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Affiliation(s)
- L D Padmanabhan
- Department of Obstetrics and Gynaecology, St. John's Medical College Hospital, Bangalore 560034, India.
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Padmanabhan LD, Mhaskar R, Mhaskar A, Vallikad E. Trophoblastic hyperthyroidism. J Assoc Physicians India 2003; 51:1011-3. [PMID: 14719595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Hyperthyroidism can occur secondary to gestational trophoblastic disease. The clinical and biochemical data of four women who had hyperthyroidism secondary to gestational trophoblastic disease was analyzed. The parity ranged from primi to gravida four and the period of amenorrhoea from six weeks to sixteen weeks. Three women had vomiting, two had bleeding per vaginum and two had tachycardia and minimal thyromegaly. The betahCG was more than 5,00,000 mlu/ml in all the cases. Three women required treatment for the hypermetabolic status and one woman had biochemical hyperthyroidism. Two of them had molar pregnancy, one had partial mole and one had persistent trophoblastic disease.
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Affiliation(s)
- L D Padmanabhan
- Department of Obstetric and Gynaecology, St. John's Medical College Hospital, Bangalore 560 034, Karnataka, India
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Buckshee K, Mhaskar A. Detection of auto-antibodies to zona pellucida in human sera. Indian J Med Res 1984; 80:288-92. [PMID: 6526435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
khe study was conducted to detect autoantibodies to zona pellucida by indirect immunofluorescence technique. A total of 60 human sera was examined, which included 15 tubectomized , 15 pregnant, 15 nonpregnant fertile women, and 15 fertile men. In the unabsorbed sera, anti-zona activity was observed in 53.3% of the tubectomized women and in 40.0% of the nonpregnant fertile women, 20.0% of the pregnant women and 26.7% of the fertile men. All the positive sera were then absorbed with porcine red blood cells and retested to exclude the false positive reaction due to nonspecific serum components. After absorption, immunological response was retained in 26.7% of the tubectomized women and lost in all the other women and men. The positive sera were further absorbed with zona-coated eggs and were retested. Fluorescence was lost in all the positive sera. This observation demonstrates the presence of antibodies, specific to zona antigens, in tubectomized women. To date, however, antibodies to zona antigen have not been demonstrated in the tubectomized women. Presence of anti-zona activity in tubectomized women may be an autoimmune response, possibly due to absorption and degradation of the ova into the peritoneal cavity or in the reproductive tract and the subsequent exposure of the degradation products to the immune system.
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