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Martin A, Sullivan SD, Weng S, Yang S, Deb A, Kwiatek J. COMMENT ON MODEL INPUTS AND ASSUMPTIONS FOR THE COST-MINIMIZATION MODEL USED TO COMPARE COST OF BIOLOGICS IN SEVERE ASTHMA. J Manag Care Spec Pharm 2024; 30:397-398. [PMID: 38555627 PMCID: PMC10981967 DOI: 10.18553/jmcp.2024.30.4.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Alan Martin
- Value Evidence and Outcomes, GSK, London, UK
| | | | | | - Shibing Yang
- Value Evidence and Outcomes, GSK, Collegeville, PA
| | - Arijita Deb
- Value Evidence and Outcomes, GSK, Collegeville, PA
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Casale TB, Corbridge T, Germain G, Laliberté F, MacKnight SD, Boudreau J, Duh MS, Deb A. Real-world association between systemic corticosteroid exposure and complications in US patients with severe asthma. Allergy Asthma Clin Immunol 2024; 20:25. [PMID: 38532489 DOI: 10.1186/s13223-024-00882-y] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Systemic corticosteroid (SCS) use remains widespread among patients with severe asthma, despite associated complications. OBJECTIVE Evaluate the association between cumulative SCS exposure and SCS-related complications in severe asthma. METHODS This retrospective, longitudinal study used claims data from the Optum Clinformatics Data Mart database (GSK ID: 214469). Eligible patients (≥ 12 years old) had an asthma diagnosis and were divided into two cohorts: SCS use and non/burst-SCS use. Patients in the SCS use cohort had a claim for a daily prednisone-equivalent dose ≥ 5 mg SCS following ≥ 6 months of continuous SCS use; those in the non/burst-SCS cohort had no evidence of continuous SCS use and had a non-SCS controller/rescue medication initiation claim. For each cohort, the date of the qualifying claim was the index date. SCS users were further stratified by SCS use during each quarter of follow-up: low (≤ 6 mg/day), medium (> 6-12 mg/day), high (> 12 mg/day), and continuous high (≥ 20 mg/day for 90 days). SCS-related complications were evaluated in the quarter following SCS exposure. The adjusted odds ratios (OR) of experiencing SCS-related complications during follow-up in each of the SCS use groups versus the non/burst SCS cohort were calculated using generalized estimating equations models. RESULTS SCS and non/burst-SCS use cohorts included 7473 and 89,281 patients (mean follow-up: 24.6 and 24.2 months), respectively. Compared with the non/burst-SCS use cohort, medium, high, and continuous high SCS use was associated with greater odds of any SCS-related complication (adjusted OR [95% confidence interval]: 1.30 [1.21, 1.39], 1.49 [1.35, 1.64] and 1.63 [1.40, 1.89], respectively) including increased acute gastrointestinal, cardiovascular, and immune system-related complications, and chronic cardiovascular, metabolic/endocrine, central nervous system, bone-/muscle-related, ophthalmologic, and hematologic/oncologic complications. Low-dose SCS use was also associated with significantly increased odds of acute gastrointestinal and immune system-related complications, and chronic bone-/muscle-related and hematologic/oncologic complications versus the non/burst-SCS use cohort. CONCLUSION SCS use, even at low doses, is associated with increased risk of SCS-related complications among patients with severe asthma.
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Affiliation(s)
- Thomas B Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
| | | | - Guillaume Germain
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - François Laliberté
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Sean D MacKnight
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Julien Boudreau
- Health Economics and Outcomes Research, Groupe d'analyse, Montréal, QC, Canada
| | - Mei S Duh
- Health Economics and Outcomes Research, Analysis Group Inc, Boston, MA, USA
| | - Arijita Deb
- Value Evidence and Outcomes, GSK, Upper Providence, PA, USA.
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Silver J, Deb A, Laliberté F, Gao C, Bhattacharyya N. Real-world effectiveness of mepolizumab in severe asthma and chronic rhinosinusitis in the United States: Impact of comorbidity and sinus surgery. Int Forum Allergy Rhinol 2024; 14:5-17. [PMID: 37365852 DOI: 10.1002/alr.23220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Trial data demonstrate that mepolizumab, a humanized anti-interleukin 5 monoclonal antibody, is effective for patients with severe asthma and comorbid chronic rhinosinusitis (CRS) with nasal polyps. This real-world, retrospective cohort study investigated mepolizumab for US patients with severe asthma and CRS with/without sinus surgery. METHODS IQVIA PharMetrics Plus claims data from baseline and follow-up (12 months before and after mepolizumab initiation) were used to analyze three patient cohorts: cohort 1 (severe asthma only); cohort 2 (severe asthma + comorbid CRS without sinus surgery); and cohort 3 (severe asthma+comorbid CRS+sinus surgery), allowing for cross-cohort comparisons. RESULTS The analysis included 495, 370, and 85 patients in cohort 1, cohort 2, and cohort 3, respectively. Systemic and oral corticosteroid use was lower for all cohorts after mepolizumab initiation. In cohort 3, asthma rescue inhaler and antibiotic use were lower during follow-up than baseline. Asthma exacerbations were reduced by 28% to 44% comparing follow-up versus baseline, with the largest reduction in cohort 3 (ratio of incidence rate ratio [RR] vs cohort 1: 0.76; p = 0.036). Reductions in oral corticosteroid claims were greater following mepolizumab initiation for cohort 3 versus cohort 1 (RR, 0.72; p = 0.011) and cohort 2 (RR, 0.70; p < 0.01). In cohorts 1 through 3, outpatient and emergency department visits were reduced by 1 to 2 and 0.4 to 0.6 visits annually, asthma-related and asthma exacerbation-related total costs were reduced by $387 to $2580 USD, and medical costs were reduced by $383 to $2438 USD during follow-up. CONCLUSIONS Consistent with trial data, mepolizumab use in real-world practice shows benefits across comorbid patient cohorts with more a pronounced impact in those with severe asthma+comorbid CRS + sinus surgery.
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Affiliation(s)
| | | | | | - Chi Gao
- Analysis Group Inc, Boston, Massachusetts, USA
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Silver J, Deb A, Packnett E, McMorrow D, Morrow C, Bogart M. Characteristics and Disease Burden of Patients With Eosinophilic Granulomatosis With Polyangiitis Initiating Mepolizumab in the United States. J Clin Rheumatol 2023; 29:381-387. [PMID: 37779234 PMCID: PMC10662597 DOI: 10.1097/rhu.0000000000002033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND/OBJECTIVE Although the high disease burden associated with eosinophilic granulomatosis with polyangiitis (EGPA) has been established, the disease burden in patients initiating mepolizumab in real-world practice is poorly understood. This study aimed to assess characteristics and burden of real-world patients with EGPA initiating mepolizumab. METHODS This was a database study (GSK study ID: 214156) of US patients (≥12 years old) with EGPA and ≥1 mepolizumab claim (index date) identified from the Merative MarketScan Commercial and Medicare Supplemental Databases (November 1, 2015, to March 31, 2020). Outcomes assessed in the 12-month baseline period before index (inclusive) included patient characteristics, treatment use, EGPA relapses, asthma exacerbations, health care resource utilization, and costs. RESULTS In the 103 patients included (mean age, 51.1 years; 63.1% female), the most common manifestations were asthma (89.3%), chronic sinusitis (57.3%), and allergic rhinitis (43.7%). In total, 91.3% of patients had ≥1 oral corticosteroid (OCS) claim (median dose, 7.4 mg/d prednisone-equivalent), 45.6% were chronic OCS users (≥10 mg/d during the 90 days preindex), 99.0% had ≥1 EGPA-related relapse, and 62.1% ≥1 asthma exacerbation. During the baseline period, 26.2% and 97.1% of patients had EGPA-related inpatient admissions and office visits, respectively. Median all-cause total health care costs per patient were $33,298, with total outpatient costs ($16,452) representing the largest driver. CONCLUSIONS Before initiating mepolizumab, a substantial real-world EGPA disease burden is evident for patients, with resulting impact on health care systems, and indicative of unmet medical needs. Mepolizumab treatment, with a demonstrated positive clinical benefit-risk profile may represent a useful treatment option for reducing EGPA disease burden.
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Affiliation(s)
| | - Arijita Deb
- Value, Evidence and Outcomes, GSK, Upper Providence, PA
| | | | - Donna McMorrow
- Real-World Data Research and Analytics, Merative, Cambridge, MA
| | - Cynthia Morrow
- Real-World Data Research and Analytics, Merative, Cambridge, MA
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Wechsler M, Kovalszki A, Silver J, Brian B, McCann W, Huynh L, Khanal A, Ye M, Duh MS, Deb A. Patient Profiles in Eosinophilic Granulomatosis with Polyangiitis (EGPA) - Insights from Allergy Practice. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.347] [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: 02/05/2023]
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Kovalszki A, Wechsler M, Silver J, Stone B, McCann W, Huynh L, Khanal A, Ye M, Duh MS, Deb A. Real-World Insights on the burden of Hypereosinophilic Syndrome (HES). J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.353] [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: 02/05/2023]
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Corbridge T, Casale T, Germain G, Laliberté F, Macknight S, Boudreau J, Duh MS, Deb A. Real-World Impact of Systemic Corticosteroid (SCS) Exposure on Healthcare Resource Utilization (HRU) due to SCS-Related Complication among Patients with Asthma in the US. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.501] [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: 02/05/2023]
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Silver J, Strobel M, Gratie D, Guisinger A, Schmitt C, Ahmed W, Deb A. PATIENTS’ PERSPECTIVE ON THE BURDEN OF HYPEREOSINOPHILIC SYNDROME. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.998] [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: 11/11/2022]
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Silver J, Steffens A, Chastek B, Deb A. REAL WORLD EFFECTIVENESS OF MEPOLIZUMAB IN PATIENTS WITH ALLERGIC AND NON-ALLERGIC ASTHMA. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.624] [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: 11/11/2022]
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Deb A, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Haeckl D, Boellinger T, Johnson KD, Weiss T. Pneumococcal vaccination coverage in individuals (16-59 years) with a newly diagnosed risk condition in Germany. BMC Infect Dis 2022; 22:753. [PMID: 36171549 PMCID: PMC9517976 DOI: 10.1186/s12879-022-07736-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite recommendations from the German Standing Committee on Vaccination (STIKO), pneumococcal vaccination coverage remains low in vulnerable populations. This study estimated the pneumococcal vaccination coverage rate (VCR) and timing among individuals aged 16–59 years in Germany who were recommended to receive pneumococcal vaccination, according to STIKO. Methods A retrospective cohort analysis was conducted using the German InGef database. Individuals aged 16 to 59 years diagnosed with at least one “at-risk” (chronic disease) or “high-risk” (e.g., immunocompromising) condition considered to be at-risk of pneumococcal infection were identified at the time of first diagnosis, between January 1, 2016 and December 31, 2018, and followed up until December 31, 2019. The percentage of cumulative pneumococcal VCR with 95% confidence interval (CI) was reported for each calendar year of follow-up. Results There were 334,292 individuals followed for a median of 2.38 (interquartile range (IQR) 1.63–3.13) person years. For individuals aged 16–59 years diagnosed with an incident risk condition in 2016, pneumococcal VCR increased from 0.44% (95% CI 0.41–0.48) in 2016 to 1.24% (95% CI 1.18–1.30) in 2019. In 2019, VCRs were higher in individuals with high-risk conditions compared with at-risk conditions (2.24% (95% CI 2.09–2.40) vs. 0.90% (95% CI 0.85–0.96)). In 2019, VCRs were higher in individuals aged 50 to 59 years compared with individuals aged 16 to 49 years (2.25% (95% CI 2.10–2.41) vs. 0.90% (95% CI 0.84–0.96)). Similar trends were observed in individuals with newly diagnosed risk conditions identified in 2017 and in 2018. Older age, influenza vaccination and increasing number of risk conditions increased the likelihood of pneumococcal vaccination. Median time to vaccination from diagnosis of the risk condition was shorter for high-risk conditions (369.5 days (IQR 155.8–702.0)) compared to at-risk conditions (435.5 days (IQR 196.3–758.8)). Conclusion Despite recommendations from STIKO, pneumococcal vaccination coverage remains very low and with long delays in vulnerable individuals aged 16–59 in Germany. Further efforts are required to increase immunization levels and shorten time to vaccination among individuals 16–59 years of age developing conditions with higher susceptibility to pneumococcal infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07736-1.
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Affiliation(s)
| | - Bélène Podmore
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Wolfgang Galetzka
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Nawab Qizilbash
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
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Owusu-Edusei K, Deb A, Johnson KD. Correction to: Estimates of the Health and Economic Burden of Pneumococcal Infections Attributable to the 15-Valent Pneumococcal Conjugate Vaccine Serotypes in the USA. Infect Dis Ther 2022; 11:1001. [PMID: 35249201 PMCID: PMC9124261 DOI: 10.1007/s40121-022-00613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kwame Owusu-Edusei
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| | - Arijita Deb
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Kelly D Johnson
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
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Deb A, Guggisberg P, Mutschler T, Owusu-Edusei K, Bencina G, Johnson KD, Ignacio T, Mathijssen D, Qendri V. Cost-effectiveness of the 15-valent pneumococcal conjugate vaccine for high-risk adults in Switzerland. Expert Rev Vaccines 2022; 21:711-722. [PMID: 35220875 DOI: 10.1080/14760584.2022.2046468] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND : Vaccination against pneumococcal disease (PD) has shown a favourable cost-effectiveness profile for national immunization programs in multiple countries. While vaccination efforts have concentrated on children, many adults with underlying illnesses face elevated risks of PD and death. A 15-valent pneumococcal conjugate vaccine (V114) is currently available that offers protection against 15 different serotypes and can be used in adults. RESEARCH DESIGN AND METHODS : We examined the cost-effectiveness of V114 vaccination in high-risk adults, aged 18+, in Switzerland. To this end, a Markov model was constructed estimating the lifetime direct medical costs and clinical effectiveness of V114 vaccination on invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) among high-risk adults. RESULTS : Considering 60% vaccine uptake and direct effects of vaccination, in total 760 IPD and 4,396 NBPP in- and outpatient cases could be prevented. Vaccinating high-risk adults with V114 led to CHF 37.4 million additional vaccination costs but saved CHF 14.4 million of medical treatment costs. V114 vaccination produced a gain of 2,095 QALYs and 6,320 LYs compared with no vaccination, leading to incremental cost-effectiveness ratios of CHF 17,866/QALY and CHF 15,616/QALY gained from a health care payer and societal perspective, respectively. Conclusions: This evidence justifies the implementation of V114 vaccination among high-risk adults in Switzerland.
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Affiliation(s)
- Arijita Deb
- CORE, Merck & Co., Inc., Kenilworth, NJ, USA
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Astengo M, Paganino C, Amicizia D, Trucchi C, Tassinari F, Sticchi C, Sticchi L, Orsi A, Icardi G, Piazza MF, Di Silverio B, Deb A, Senese F, Prandi GM, Ansaldi F. Economic Burden of Pneumococcal Disease in Individuals Aged 15 Years and Older in the Liguria Region of Italy. Vaccines (Basel) 2021; 9:vaccines9121380. [PMID: 34960127 PMCID: PMC8706914 DOI: 10.3390/vaccines9121380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 11/23/2022] Open
Abstract
Despite the availability of vaccines against Streptococcus pneumoniae, the global incidence and economic cost of pneumococcal disease (PD) among adults is still high. This retrospective cohort analysis estimated the cost of emergency department (ED) visits/hospitalizations associated with non-invasive pneumonia and invasive pneumococcal disease among individuals ≥15 years of age in the Liguria region of Italy during 2012–2018. Data from the Liguria Region Administrative Health Databases and the Ligurian Chronic Condition Data Warehouse were used, including hospital admission date, length of stay, discharge date, outpatient visits, and laboratory/imaging procedures. A ≥30-day gap between two events defined a new episode, and patients with ≥1 ED or inpatient claim for PD were identified. The total mean annual number of hospitalizations for PD was 13,450, costing ~€49 million per year. Pneumonia accounted for the majority of hospitalization costs. The median annual cost of hospitalization for all-cause pneumonia was €38,416,440 (per-capita cost: €26.78) and was €30,353,928 (per-capita cost: €20.88) for pneumococcal and unspecified pneumonia. The total number and associated costs of ED visits/hospitalizations generally increased over the study period. PD still incurs high economic costs in adults in the Liguria region of Italy.
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Affiliation(s)
- Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Correspondence: ; Tel.: +39-0105488257
| | - Chiara Paganino
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Cecilia Trucchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Federico Tassinari
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Laura Sticchi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Bruno Di Silverio
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
| | - Arijita Deb
- Merck & Co., Inc., Kenilworth, NJ 07033, USA;
| | | | | | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (C.P.); (D.A.); (C.T.); (F.T.); (C.S.); (M.F.P.); (B.D.S.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy; (L.S.); (A.O.); (G.I.)
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Deb A, Mohanty S, Ou W, Rajagopalan S, Johnson KD. Pneumococcal vaccination coverage among adults aged 19 to 64 years with immuno-compromising conditions, cerebrospinal fluid (CSF) leaks, or cochlear implants in the US. Expert Rev Vaccines 2021; 20:331-345. [PMID: 33724134 DOI: 10.1080/14760584.2021.1898377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/05/2023]
Abstract
Background: Adults with immuno-compromising conditions, CSF leaks, or cochlear implants are at increased risk for pneumococcal disease (high-risk patients), yet pneumococcal vaccination rates in the US for this group are low.Methods: A retrospective cohort analysis was conducted from 2010 to 2018 using the Truven Health MarketScan database to estimate pneumococcal vaccination coverage among adults aged 19 to 64 years newly diagnosed with high-risk conditions, and to assess factors associated with receiving the recommended pneumococcal vaccines.Results: The study sample included 2,497,799 adults aged 19 to 64 years old with newly diagnosed high-risk conditions. Most of the study cohort had seven or more annual physician office (52%) and pharmacy (56%) visits. The proportion of high-risk adults who received at least one pneumococcal vaccination increased from 5.4% after 1 year of follow-up to 14.2% after 6 years of follow-up. Compared to those who received no pneumococcal vaccination, high-risk adults who received any pneumococcal vaccination were more likely to be older, female, enrolled in an HMO, had more healthcare encounters, and were treated by a primary care provider.Conclusion: Despite numerous healthcare encounters annually, very few high-risk adults received pneumococcal vaccines, highlighting the need for implementing targeted interventions to increase vaccine uptake in this vulnerable population.
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Affiliation(s)
- Arijita Deb
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, USA
| | - Salini Mohanty
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, USA
| | - Wanmei Ou
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, USA
| | | | - Kelly D Johnson
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, USA
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Desai S, Pandya A, Deb A, Desai D. High cost of medications for Parkinson's Disease patients in a rural population of Gujarat, India. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deb A, Sukarom I, Park J, Yang G, Johnson K, Malik T. PIN14 Health and Economic IMPACT of 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Adults 65 YEARS and Older in Korea. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.261] [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: 10/23/2022]
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Deb A, Sukarom I, Mears G, Johnson K, Malik T. PIN12 Health and Economic IMPACT of 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Adults 70 YEARS and Older in Australia. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.259] [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: 10/23/2022]
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Deb A, Johnson KD, Ou W. 2205. Clinical Burden of Pneumococcal Disease in US Adults Aged 65 Years and Above with Chronic or Immunocompromising Conditions. Open Forum Infect Dis 2019. [PMCID: PMC6810874 DOI: 10.1093/ofid/ofz360.1885] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The presence of chronic and immunocompromising conditions is associated with a disproportionately high risk of developing pneumococcal disease at older ages. The objective of this study was to quantify the risk of all-cause pneumonia (ACP) and invasive pneumococcal disease (IPD) in older US adults aged 65 years and older with underlying medical conditions. Methods A retrospective observational study was conducted using the Humana claims database. The study cohorts were identified at January 1 of each calendar year of observation from 2012 to 2017 and comprised adults aged 65 years and older with continuous enrollment for at least one year before and at least one year after January 1 of each year. For each yearly cohort, medical conditions were identified during the one year before each calendar year and episodes of ACP and IPD were identified during the corresponding 1-year follow-up period from January 1 to December 31. Individuals were stratified into 3 groups: those without any medical conditions of interests (healthy), those with chronic conditions (at-risk) and those with immunocompromising conditions (high-risk). Rate of ACP or IPD was expressed as the number of cases per 100,000 person-years and the rate ratio (RR) was expressed as the rate of pneumococcal disease of patients with medical conditions divided by the rate of pneumococcal disease in healthy adults. Results Of the 10,766,827 adults included in the study, 75% of adults had an underlying medical condition linked to an increased risk of pneumococcal disease. In adults with at-risk conditions, rates of ACP and IPD were 3.1 and 3.6 times the rate in healthy adults, respectively. In adults with high-risk conditions, rates of ACP and IPD were 4.1 and 5 times the rate in healthy adults, respectively. Rate of pneumococcal disease increased substantially with the addition of medical conditions: RR for ACP and IPD increased from 2.1 and 2.2, respectively, in adults with one at-risk conditions to 4.8 and 6.2, respectively, among adults with 2 or more at-risk conditions. Conclusion Despite recommendations of universal pneumococcal vaccination in older adults aged 65 years and above in the United States, the burden of pneumococcal disease remains high, particularly among those with chronic and immunocompromising conditions. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Arijita Deb
- Merck & Co., Inc., North Wales, Pennsylvania
| | | | - Wanmei Ou
- Merck & Co., Inc., North Wales, Pennsylvania
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Deb A, Dwibedi N, LeMasters T, Hornsby JA, Wei W, Sambamoorthi U. Tumor Necrosis Factor Inhibitor Therapy and the Risk for Depression Among Working-Age Adults with Rheumatoid Arthritis. Am Health Drug Benefits 2019; 12:30-38. [PMID: 30972151 PMCID: PMC6404801] [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] [Grants] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Individuals with rheumatoid arthritis (RA) are at high risk for depression because of the overall burden of systemic inflammation. Although some evidence suggests that treatment with powerful anti-inflammatory drugs, such as tumor necrosis factor (TNF) inhibitors, may be effective in reducing the risk for depression in patients with RA, it is unclear whether such reduction in risk is dependent on the response to TNF inhibitor therapy. OBJECTIVE To evaluate the association between the response to TNF inhibitor therapy and the risk for depression among working-age adults with RA. METHOD This retrospective, observational cohort study design was based on data derived from commercial claims data in the QuintilesIMS Real World Data Adjudicated Claims database between October 1, 2009, and September 30, 2015. A total of 4222 working-age adults (18-62 years) with RA who started treatment with TNF inhibitor therapy and were continuously enrolled during the 3 observation periods (ie, 1-year baseline, 1-year treatment, and 1-year follow-up periods) were included in the study. Treatment response to a TNF inhibitor was measured using prescription drug claims based on a published validated algorithm. Multivariable logistic regression was used to examine the association between treatment response to TNF inhibitor therapy and the risk for depression, after controlling for baseline demographic characteristics, clinical characteristics, and RA-related medication use. An inverse probability of treatment weighting technique was used to control for observable differences in TNF inhibitor responders' characteristics versus TNF inhibitor nonresponders. RESULTS Overall, 359 (8.5%) patients with RA had depression during the follow-up period and 1679 (39.8%) patients responded to TNF inhibitor treatment during the 1-year treatment period. A significantly lower percentage of TNF inhibitor responders (7.1%, N = 119) had depression than TNF inhibitor nonresponders (9.4%, N = 239). After controlling for other risk factors, responders to TNF inhibitors were 20% less likely to have depression during the follow-up period (adjusted odds ratio, 0.80; 95% confidence interval, 0.64-0.98) than nonresponders to TNF inhibitor therapy. CONCLUSION The risk for depression was significantly reduced among patients with RA who responded to TNF inhibitor therapy compared with those who did not respond to such therapy. To determine whether the lower rate of depression observed with TNF inhibition is a direct effect of treatment with a TNF inhibitor, or whether it could be attributed to improvement in RA disease secondary to treatment, future studies need to also incorporate a control population of patients with RA who receive other antirheumatic regimens, such as disease-modifying antirheumatic drugs.
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Affiliation(s)
- Arijita Deb
- Associate Director, Outcomes Research, Merck, and was a PhD candidate during this study
| | | | - Traci LeMasters
- Research Assistant Professor, all at School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown
| | - Jo Ann Hornsby
- Rheumatology Associate Professor and Section Chief, School of Medicine, Rheumatology, West Virginia University
| | - Wenhui Wei
- Senior Director, Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY
| | - Usha Sambamoorthi
- Professor, School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University
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Deb A, Dwibedi N, LeMasters T, Hornsby JA, Wei W, Sambamoorthi U. Burden of Depression among Working-Age Adults with Rheumatoid Arthritis. Arthritis 2018; 2018:8463632. [PMID: 29971163 PMCID: PMC6008693 DOI: 10.1155/2018/8463632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/08/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study estimated the excess clinical, humanistic, and economic burden associated with depression among working-age adults with Rheumatoid Arthritis (RA). METHODS A retrospective cross-sectional study was conducted among working-age (18 to 64 years) RA patients with depression (N = 647) and without depression (N = 2,015) using data from the nationally representative Medical Expenditure Panel Survey for the years 2009, 2011, 2013, and 2015. RESULTS Overall, 25.8% had depression. In adjusted analyses, adults with RA and depression compared to those without depression were significantly more likely to have pain interference with normal work (severe pain: AOR = 2.22; 95% CI = 1.55, 3.18), functional limitations (AOR = 2.17; 95% CI = 1.61, 2.94), and lower mental health HRQoL scores. Adults with RA and depression had significantly higher annual healthcare expenditures ($14,752 versus 10,541, p < .001) and out-of-pocket spending burden. Adults with RA and depression were more likely to be unemployed and among employed adults, those with depression had a significantly higher number of missed work days annually and higher lost annual wages due to missed work days. CONCLUSIONS This study highlights the importance of effectively managing depression in routine clinical practice of RA patients to reduce pain and functional limitations, improve quality of life, and lower direct and indirect healthcare costs.
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Affiliation(s)
- Arijita Deb
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
| | - Nilanjana Dwibedi
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
| | - Traci LeMasters
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
| | - Jo Ann Hornsby
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Wenhui Wei
- Regeneron Pharmaceuticals, Tarrytown, NJ, USA
| | - Usha Sambamoorthi
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
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Deb A, Sambamoorthi U, Thornton JD, Schreurs B, Innes K. Direct medical expenditures associated with Alzheimer's and related dementias (ADRD) in a nationally representative sample of older adults - an excess cost approach. Aging Ment Health 2018; 22:619-624. [PMID: 28282733 PMCID: PMC5548651 DOI: 10.1080/13607863.2017.1286454] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To estimate the excess direct annual healthcare expenditures associated with Alzheimer's and related dementias(ADRD) among community-dwelling older adults in the United States. METHODS This retrospective cross-sectional study compared the annual healthcare expenditures between elderly individuals aged 65 years and older with ADRD (n = 662) and without ADRD (n = 13,398) using data from the Medical Expenditure Panel Survey (MEPS) for the years 2007, 2009, 2011 and 2013. Adjusted total annual medical expenditures was estimated using generalized linear model with gamma distribution and log link in 2013 U.S. dollars. Adjusted inpatient, outpatient, emergency, home healthcare and prescription drug expenditures, were estimated using two-part logit-generalized linear regression models. RESULTS The adjusted mean total healthcare expenditures were higher for the ADRD group as compared to the no ADRD group($14,508 vs. $10,096). Among those with ADRD, 34.3% of the expenditures were for home healthcare as compared to 4.4% among those without ADRD. Among users, the ADRD group had significantly higher home healthcare ($3,240 vs. $566) and prescription drug expenditures($3,471 vs. $2,471). There were no statistically significant differences in inpatient, emergency room and outpatient expenditures between the ADRD and no ADRD group. CONCLUSION ADRD in U.S. community-dwelling elders is associated with significant financial burden, primarily driven by increased home healthcare use.
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Affiliation(s)
- Arijita Deb
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, United States
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, United States
| | - James Douglas Thornton
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, United States
| | - Bernard Schreurs
- Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Kim Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, United States
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Sambamoorthi U, Garg R, Deb A, Fan T, Boss A. Persistence with rapid-acting insulin and its association with A1C level and severe hypoglycemia among elderly patients with type 2 diabetes. Curr Med Res Opin 2017; 33:1309-1316. [PMID: 28393573 PMCID: PMC5520976 DOI: 10.1080/03007995.2017.1318121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the persistence with rapid-acting insulin (RAI) and its association with clinical outcomes among elderly patients with type 2 diabetes (T2D). METHODS This observational, retrospective cohort study analyzed RAI persistence and its association with change in glycated hemoglobin A1c and risk of severe hypoglycemia among elderly (≥65 years) Medicare beneficiaries with T2D who added RAI to their basal insulin regimen. RESULTS Among T2D patients with >1 RAI prescriptions (n = 3927), only 21% were persistent. Baseline factors positively associated with RAI persistence (adjusted odds ratio [95% CI]) were: age ≥75 vs. 65-74 years: 1.20 (1.01-1.43); use of ≥3 oral antidiabetes drugs: 1.63 (1.16-2.28); cognitive impairment: 1.34 (1.03-1.73); and A1C >9.0%: 1.58 (1.15-2.17). Elderly T2D patients having emergency department visits (0.73 [0.59-0.91]) and higher RAI out-of-pocket costs (≥$75 vs. $0 - <$6.40: 0.56 [0.44-0.70]) were less likely to be persistent. Persistent RAI users had a significantly higher reduction in A1C (beta coefficient [standard error]): -0.24 (0.10) and lower odds of severe hypoglycemia (adjusted odds ratio [95% CI]): 0.73 (0.53-0.99). CONCLUSION Among elderly T2D patients, persistence with RAI added to basal insulin was associated with improved glycemic control and lower risk of severe hypoglycemia. Despite treatment effectiveness, RAI persistence was poor and might be improved by reducing RAI out-of-pocket costs.
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Affiliation(s)
- Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Rahul Garg
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Arijita Deb
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Tao Fan
- Sanofi US, Inc., Bridgewater, NJ, USA
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Deb A, Thornton JD, Sambamoorthi U, Innes K. Direct and indirect cost of managing alzheimer's disease and related dementias in the United States. Expert Rev Pharmacoecon Outcomes Res 2017; 17:189-202. [PMID: 28351177 DOI: 10.1080/14737167.2017.1313118] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [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: 12/17/2022]
Abstract
INTRODUCTION Care of individuals with Alzheimer's Disease and Related Dementias (ADRD) poses special challenges. As the disease progresses, individuals with ADRD require increasing levels of medical care, caregiver support, and long-term care which can lead to substantial economic burden. Areas covered: In this expert review, we synthesized findings from studies of costs of ADRD in the United States that were published between January 2006 and February 2017, highlighted major sources of variation in costs, identified knowledge gaps and briefly outlined directions for future research and implications for policy and program planning. Expert commentary: A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, non-medical, and indirect costs of individuals with ADRD are higher than those without ADRD, despite the differences in the methods of identifying ADRD, duration of the study, payer type and settings of study population. The economic burden of ADRD may be underestimated because many components such as direct non-medical costs for home safety modifications and adult day care services and indirect costs due to the adverse impact of ADRD on caregivers' health and productivity are not included in cost estimates.
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Affiliation(s)
- Arijita Deb
- a School of Pharmacy , Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, USA
| | - James Douglas Thornton
- a School of Pharmacy , Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, USA
| | - Usha Sambamoorthi
- a School of Pharmacy , Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, USA
| | - Kim Innes
- b School of Public Health, Department of Epidemiology , West Virginia University, Morgantown, USA
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Abstract
OBJECTIVE To estimate rates and patterns of depression treatment among adults with chronic obstructive pulmonary disease (COPD) and depression. METHODS We used a retrospective, cross-sectional study design, pooling data from 2010 and 2012 Medical Expenditure Panel Survey (MEPS). The study sample consisted of 527 individuals aged 21 years or older, diagnosed with COPD and depression. Depression treatment was grouped into three categories based on those who received: (1) neither antidepressant nor psychotherapy; (2) antidepressants only; and (3) psychotherapy combined with antidepressants (combination therapy). We conducted chi-squared tests and multinomial logistic regressions to examine factors (demographic, socio-economic characteristics, healthcare access, health status, and personal health practices) associated with depression treatment among adults with COPD and depression. KEY FINDINGS The mean age of the study sample was 55.96 years (SD = 13.36). Overall, 18.8% of the sample adults did not report any use of antidepressants or psychotherapy, 58.3% reported antidepressants use only and 23% reported using combination therapy. Females (adjusted odds ratio [AOR] = 1.89, 95% CI = 1.02, 3.55), older adults (≥65 years: AOR = 3.69, 95% CI = 1.62, 8.41), adults with fair/poor physical health status (AOR = 3.32, 95% CI = 1.29, 8.56) and those suffering from anxiety (AOR = 1.94, 95% CI = 1.09, 3.46) were more likely to receive antidepressant treatment. Older adults (AOR =2.94, 95% CI = 1.05, 8.22), those who were never married (AOR = 3.17, 95% CI = 1.18, 8.56), suffered from anxiety (AOR =6.01, 95% CI = 3.11, 11.61) and current smokers (AOR = 2.29, 95% CI = 1.05, 4.98) were more likely to receive combination therapy. Whereas, adults who were uninsured (AOR = 0.21, 95% CI = 0.05, 0.86) and did not lacked regular physical activity (AOR = 0.33, 95% CI = 0.16, 0.67) were less likely to receive combination therapy. A key limitation of our study is that we could not control for the severity of depression or COPD which may have influenced depression treatment. CONCLUSION Efforts to improve depression care among adults with co-occurring COPD and depression may need to be tailored for different subgroups.
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Affiliation(s)
- Arijita Deb
- a West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center , Morgantown , WV , USA
| | - Usha Sambamoorthi
- a West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center , Morgantown , WV , USA
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Srinivas G, Deb A, Sanketh R, Gupta N. An Enhanced Methodology for Lightweighting a Vehicle Design Considering Front Crashworthiness and Pedestrian Impact Safety Requirements. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.proeng.2016.12.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The prevalence of multiple chronic conditions (MCC) is increasing among individuals of all ages. MCC are associated with poor health outcomes. The presence of MCC has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families. Investigators have used a variety of definitions for MCC to evaluate costs associated with MCC. The objective of this article is to examine the current literature in estimating excess costs associated with MCC among adults. The discussion highlights some of the theoretical and technical merits of various MCC definitions and models used to estimate the excess costs associated with MCC.
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Affiliation(s)
| | - Xi Tan
- a Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV, USA
| | - Arijita Deb
- a Department of Pharmaceutical Systems and Policy, West Virginia University, School of Pharmacy, Morgantown, WV, USA
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Sambamoorthi U, Deb A, Zhou S, Garg R, Fan T, Boss A. Rapid Acting Insulin Use and Persistence among Elderly Type 2 Diabetes Patients Adding RAI to Oral Antidiabetes Drug Regimens. J Diabetes Res 2016; 2016:5374931. [PMID: 27761472 PMCID: PMC5059557 DOI: 10.1155/2016/5374931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/19/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022] Open
Abstract
We examined the real-world utilization and persistence of rapid acting insulin (RAI) in elderly patients with type 2 diabetes who added RAI to their drug (OAD) regimen. Insulin-naïve patients aged ≥65 years, with ≥1 OAD prescription during the baseline period, who were continuously enrolled in the US Humana Medicare Advantage insurance plan for 18 months and initiated RAI were included. Among patients with ≥2 RAI prescriptions (RAIp), persistence during the 12-month follow-up was assessed. Multivariate logistic regression analyses identified factors affecting RAI use and persistence. Of 3734 patients adding RAI to their OAD regimen, 2334 (62.5%) had a RAIp during follow-up. Factors associated with RAIp included using ≤2 OADs; cognitive impairment, basal insulin use during follow-up; and higher RAI out-of-pocket costs ($36 to <$56 versus $0 to $6.30). Patients were less likely to persist with RAI when on ≤2 OADs versus ≥3 OADs and when having higher RAI out-of-pocket costs ($36 to <$56 versus $0 to $6.30) and more likely to persist when they had cognitive impairment and basal insulin use during follow-up. Real-world persistence of RAI in insulin-naïve elderly patients with type 2 diabetes was very poor when RAI was added to an OAD regimen.
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Affiliation(s)
- Usha Sambamoorthi
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
- *Usha Sambamoorthi:
| | - Arijita Deb
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | | | - Rahul Garg
- School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Tao Fan
- Sanofi US, Inc., Bridgewater, NJ, USA
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Gao S, Basu S, Yang Z, Deb A, Hu M. Bioavailability challenges associated with development of saponins as therapeutic and chemopreventive agents. Curr Drug Targets 2013; 13:1885-99. [PMID: 23140297 DOI: 10.2174/138945012804545498] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/24/2012] [Accepted: 11/03/2012] [Indexed: 11/22/2022]
Abstract
Saponins, a major class of natural phytochemicals, hold great promises for being developed into chemopreventive and chemotherapeutic drugs. However, one of the major factors limiting their pharmacological effects in vivo is poor bioavailability. This paper reviews the factors that determine the absorption and bioavailability of saponins including their physicochemical properties, and their absorption and disposition in the gastrointestinal tract. A critical review of the current research papers suggests that poor permeability and microflora hydrolysis of saponins are the primary factors that limit their bioavailabilities. Future investigations should be directed towards further optimization of the bioavailability of saponins to enhance their chemopreventive and chemotherapeutic effects in vivo.
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Affiliation(s)
- Song Gao
- Department of Pharmacological and Pharmaceutical Sciences University of Houston, 1441 Moursund Street, Houston, TX 77030, USA
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Deb A, Haorongbam B, Gupta NK. Thin-Walled Steel Hat Section Components as Protective Counter-Measures for Vehicle Impact Safety. Proceedings of the Indian National Science Academy 2013. [DOI: 10.16943/ptinsa/2013/v79i4/47997] [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: 11/13/2022]
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Bauri R, Ranjan R, Deb A, Ranjan R. Prevalence and sustainable control of Balantidium coli infection in pigs of Ranchi, Jahrkahnd, India. Vet World 2012. [DOI: 10.5455/vetworld.2012.94-99] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Caravan P, Kay J, Mandal RV, Uppal R, Welby J, Deb A, Penner-Hahn JE. CMR2009: 5.04: Post-mortem analysis of gadolinium distribution in NSF subjects. Contrast Media Mol Imaging 2009. [DOI: 10.1002/cmmi.323] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Luján L, Crespo T, Deb A, Arif A, Borjal R, Salazar E, Álvarez N, Pérez M, Dorrestein G, Hammer S. Aa Amyloidosis in Captive Beira Antelopes (Dorcatragus Megalotis) Linked to Mycoplasmal Pleuropneumonia. J Comp Pathol 2009. [DOI: 10.1016/j.jcpa.2009.08.074] [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: 10/20/2022]
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Raguraman M, Deb A, Gupta N, Kharat D. Numerical Simulation of Projectile Impact on Mild Steel Armour Platesusing LS-DYNA, Part II: Parametric Studies. DEFENCE SCI J 2008. [DOI: 10.14429/dsj.58.1679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Deb A, Raguraman M, Gupta N, Madhu V. Numerical Simulation of Projectile Impact on Mild Steel Armour Plates using LS-DYNA: Part I: Validation. DEFENCE SCI J 2008. [DOI: 10.14429/dsj.58.1664] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Biswas D, Deb A, Gupta P, Prasad R, Negi KS. Evaluation of the usefulness of phage amplification technology in the diagnosis of patients with paucibacillary tuberculosis. Indian J Med Microbiol 2008; 26:75-8. [PMID: 18227605 DOI: 10.4103/0255-0857.38865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The present study was undertaken to assess the performance of the Fast Plaque TB(TM) (FPTB) test in the diagnostically difficult group of paucibacillary tuberculosis (TB) and to compare its results with the conventional bacteriological methods. The study was conducted on a total of 139 patients, who were negative for TB in sputum-smear examination. Bronchoalveolar lavage (BAL) or pleural biopsy specimens collected from these patients were subjected to smear examination, LJ culture and FPTB test. The smear, culture and the FPTB positivity rates were compared between patients with pulmonary and pleuro-pulmonary involvement. The FPTB test was found to register an overall sensitivity of 58.8% and specificity of 97.9%. The positive and negative predictive values of the test were 98.1 and 56.5, respectively. Among patients with paucibacillary TB, on head-to-head comparison, we found that the sensitivity and specificity values of the FPTB test were marginally better than smear-microscopy and inferior to culture on LJ media.
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Affiliation(s)
- D Biswas
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun - 248 140, India.
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Lindenberg AM, Engemann S, Gaffney KJ, Sokolowski-Tinten K, Larsson J, Hillyard PB, Reis DA, Fritz DM, Arthur J, Akre RA, George MJ, Deb A, Bucksbaum PH, Hajdu J, Meyer DA, Nicoul M, Blome C, Tschentscher T, Cavalieri AL, Falcone RW, Lee SH, Pahl R, Rudati J, Fuoss PH, Nelson AJ, Krejcik P, Siddons DP, Lorazo P, Hastings JB. X-ray diffuse scattering measurements of nucleation dynamics at femtosecond resolution. Phys Rev Lett 2008; 100:135502. [PMID: 18517965 DOI: 10.1103/physrevlett.100.135502] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Indexed: 05/26/2023]
Abstract
Femtosecond time-resolved small and wide angle x-ray diffuse scattering techniques are applied to investigate the ultrafast nucleation processes that occur during the ablation process in semiconducting materials. Following intense optical excitation, a transient liquid state of high compressibility characterized by large-amplitude density fluctuations is observed and the buildup of these fluctuations is measured in real time. Small-angle scattering measurements reveal snapshots of the spontaneous nucleation of nanoscale voids within a metastable liquid and support theoretical predictions of the ablation process.
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Affiliation(s)
- A M Lindenberg
- PULSE Center, Stanford Linear Accelerator Center, Menlo Park, California 94025, USA
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37
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Hillyard PB, Gaffney KJ, Lindenberg AM, Engemann S, Akre RA, Arthur J, Blome C, Bucksbaum PH, Cavalieri AL, Deb A, Falcone RW, Fritz DM, Fuoss PH, Hajdu J, Krejcik P, Larsson J, Lee SH, Meyer DA, Nelson AJ, Pahl R, Reis DA, Rudati J, Siddons DP, Sokolowski-Tinten K, von der Linde D, Hastings JB. Carrier-density-dependent lattice stability in InSb. Phys Rev Lett 2007; 98:125501. [PMID: 17501133 DOI: 10.1103/physrevlett.98.125501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Indexed: 05/15/2023]
Abstract
The ultrafast decay of the x-ray diffraction intensity following laser excitation of an InSb crystal has been utilized to observe carrier dependent changes in the potential energy surface. For the first time, an abrupt carrier dependent onset for potential energy surface softening and the appearance of accelerated atomic disordering for a very high average carrier density have been observed. Inertial dynamics dominate the early stages of crystal disordering for a wide range of carrier densities between the onset of crystal softening and the appearance of accelerated atomic disordering.
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Affiliation(s)
- P B Hillyard
- Department of Chemistry, Stanford University, Stanford, California 94305, USA
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38
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Sur D, Sarkar BL, Manna B, Deen J, Datta S, Niyogi SK, Ghosh AN, Deb A, Kanungo S, Palit A, Bhattacharya SK. Epidemiological, microbiological & electron microscopic study of a cholera outbreak in a Kolkata slum community. Indian J Med Res 2006; 123:31-6. [PMID: 16567865] [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: 05/08/2023] Open
Abstract
BACKGROUND & OBJECTIVE Epidemics of cholera caused by Vibrio cholerae O1 or O139 have been reported from different parts of India. Factors such as unsafe water supply, poor environmental sanitation, indiscriminate defaecation and lack of personal hygiene are mainly responsible for continued transmission of this disease. We report here epidemiological and microbiological findings of a localized outbreak of cholera, which occurred during March and April 2004 in the eastern part of Kolkata city. METHODS The affected slum area has a population of 4409, predominantly muslims. Patients suffering from acute watery diarrhoea attended the health outposts organized by National Institute of Cholera and Enteric Diseases, Kolkata and International Vaccine Institute, South Korea as part of a routine surveillance programme at the locality as well as the emergency medical camp organized by the Kolkata Municipal Corporation. Stool and water samples were collected and tested for diarrhoeagenic pathogens in the laboratory. Bacteriophages specific for V. cholerae were isolates and studied electron microscopically for morphology. RESULTS A total of 89 diarrhoea cases were reported giving an attack rate of 2 per cent. V. cholerae O1 biotype ElTor, serotype Ogawa was isolated as a sole pathogen from 15 (15.8%) of 89 stool samples screened. Water samples (2 from tube wells, 3 from municipal taps and 1 from well) showed presence of coliform bacilli with high MPN (Most Probable Number) count. Bacteriophages specific to V. cholerae were isolated from 2 of 6 water samples examined. A leakage was detected in the main pipeline supplying drinking water to that area. INTERPRETATION & CONCLUSION The outbreak was caused by V. cholerae O1 (Ogawa) biotype ElTor. The presence of phages in the water samples was an additional indicator for V. cholerae contamination in this community. Occurrences of such outbreaks support vaccination against cholera as an alternative strategy.
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Affiliation(s)
- Dipika Sur
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India
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39
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Saini V, Nadal R, Kochar S, Mohapatra PR, Deb A. Wood-smoke exposure: an unusual cause of miliary mottling on X-ray chest. Indian J Chest Dis Allied Sci 2003; 45:273-6. [PMID: 12962464] [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: 03/04/2023]
Abstract
A case of wood smoke inhalation related lung disease presenting with miliary mottling on radiography is described. Transbronchial lung biopsy showed the presence of coal macules.
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Affiliation(s)
- V Saini
- Department of Chest Diseases and Tuberculosis, Government Medical College and Hospital, Chandigarh, India.
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40
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Mohapatra PR, Das SK, Deb A, Saini V. Mediastinal widening in a patient of ulcerative colitis. Indian J Chest Dis Allied Sci 2003; 45:131-3. [PMID: 12715937] [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: 04/20/2023]
Abstract
A case of ulcertaive colitis on long-term corticosteroid therapy presenting with mediastinal widening and diagnosed to have mediastinal lipomatosis an thoracic computed tomography is presented.
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Affiliation(s)
- P R Mohapatra
- Department of Chest Diseases and Tuberculosis, Government Medical College and Hospital, Chandigarh
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41
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Deb A, Hiraoka N, Itou M, Sakurai Y, Koizumi A, Tomioka Y, Tokura Y. Magnetic Compton scattering study of double perovskite Sr 2FeMoO 6. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302086026] [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: 11/11/2022] Open
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42
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Deb A, Haque SJ, Mogensen T, Silverman RH, Williams BR. RNA-dependent protein kinase PKR is required for activation of NF-kappa B by IFN-gamma in a STAT1-independent pathway. J Immunol 2001; 166:6170-80. [PMID: 11342638 DOI: 10.4049/jimmunol.166.10.6170] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The IFN-inducible dsRNA-activated protein kinase PKR regulates protein synthesis through phosphorylation of eukaryotic initiation factor-2alpha. It also acts as a signal transducer for transcription factors NF-kappaB, IFN regulatory factor-1, and activating transcription factor-2. IFN-gamma, a pleiotropic cytokine, elicits gene expression by activating the Janus kinase-STAT signaling pathway. IFN-gamma can synergize with TNF-alpha to activate NF-kappaB in a number of cell lines. Here we show that IFN-gamma alone can activate NF-kappaB, by a Janus kinase-1-mediated, but Stat1-independent, mechanism. NF-kappaB activation by IFN-gamma is associated with degradation of IkappaB beta. The IFN-gamma response can be blocked by 2',5'-oligoadenylate-linked antisense chimeras against PKR mRNA. There was no activation of NF-kappaB by IFN in PKR-null cells, indicating that PKR is required for IFN-gamma signaling to NF-kappaB.
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Affiliation(s)
- A Deb
- Department of Cancer Biology, The Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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43
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Chattopadhyay UK, Dutta S, Deb A, Pal D. Verotoxin-producing Escherichia coli--an environment-induced emerging zoonosis in and around Calcutta. Int J Environ Health Res 2001; 11:107-112. [PMID: 11260792 DOI: 10.1080/09603120020019692] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
With changes in livestock management practices and food processing industry, along with changes in people's food habits, many diseases have emerged. Infection with verotoxin-producing Escherichia coli (VTEC) is one such illness. In the present study an attempt was made to isolate, identify and characterize VTEC strains with reference to the O157:H7 serotype from animal, human sources and some food products with the aid of the available modern methods. A total of 876 samples (330 animal, 184 human, 362 food samples) were screened for the presence of VTEC by conventional as well as PCR technique. Seventeen VTEC strains (12 animal, one human and four food samples) were isolated. The isolation rate was higher in diarrhoeic animals (6.02%), followed by diarrhoeic handler (3.12%) and raw beef (1.78%) samples. All strains showed the presence of the VT gene by PCR tests and were uniformly sensitive to common antibiotics except tetracycline, cephalexin, dicloxacillin, erythromycin and lincomycin. Since all strains were isolated from various sources of animal and human origin and all strains showed the presence of the VT gene and uniform antibiogram, a zoonotic association is suggested. This study marks the first report of isolation of VTEC strains from animal sources in India.
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Affiliation(s)
- U K Chattopadhyay
- All India Institute of Hygiene & Public Health, Government of India, 110, Chittaranjan Avenue, Calcutta - 700 073, India
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Dutta S, Deb A, Chattopadhyay UK, Tsukamoto T. Isolation of Shiga toxin-producing Escherichia coli including O157:H7 strains from dairy cattle and beef samples marketed in Calcutta, India. J Med Microbiol 2000; 49:765-7. [PMID: 10933264 DOI: 10.1099/0022-1317-49-8-765] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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45
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Bhattacharya MK, Ghosh S, Mukhopadhyay AK, Deb A, Bhattacharya SK. Outbreak of cholera caused by Vibrio cholerae 01 intermediately resistant to norfloxacin at Malda, West Bengal. J Indian Med Assoc 2000; 98:389-90. [PMID: 11143861] [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: 02/18/2023]
Abstract
During the end of September 1997, an unusual outbreak of severe dehydrating watery diarrhoea cases and deaths were reported from Malda town. Vibrio cholerae 01 El tor, the causative agent responsible for this episode was isolated from 56.5% of cases sampled. Three of the five drinking water samples were also positive for V cholerae 01. Majority of cases were adults. Isolated strains were uniformly resistant to furazolidone and intermediately to norfloxacin. Indiscriminate use of antibiotic should be discouraged for development of multidrug resistant strains.
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Affiliation(s)
- M K Bhattacharya
- National Institute of Cholera & Enteric Diseases(ICMR), Calcutta 700010
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46
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Bhattacharya MK, Dutta D, Deb A, Garg P, Chakraborty S, Mukhopadhyay AK, Bhattacharya SK, Moitra A. Acute secretory traveller's diarrhoea caused by Vibrio cholerae which does not belong to the O1 or O139 serogroup. Natl Med J India 1998; 11:248-9. [PMID: 10997178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Dutta D, Bhattacharya MK, Deb A, Chowdhury AS, Nair GB, Ramakrishna BS, Bhattacharya SK. Uncooked rice powder in oral rehydration solution: an alternative to glucose or cooked rice powder. Indian J Med Res 1998; 107:257-62. [PMID: 9701893] [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: 02/08/2023] Open
Abstract
Glucose-based or rice-based ORS is the standard treatment in acute dehydrating diarrhoea. However, glucose may not be easily available in remote villages and the rice needs to be cooked for rice-based ORS. We embarked on a study to examine whether uncooked rice powder could be used as an alternative to glucose or cooked rice powder in ORS. Initially, 50 adult male patients (aged 18 to 55 yr) were randomized to receive glucose-ORS or uncooked rice ORS, in two equal groups. Subsequently, 20 male children (aged 3 to 12 yr) were also enrolled in the study and received either WHO-ORS or study ORS. All the adult patients and the children could be successfully rehydrated with ORS containing uncooked rice powder. As compared to WHO-ORS, the study ORS significantly reduced stool output (6.60 +/- 1.24 vs. 5.88 +/- 1.34 l), ORS intake (9.17 +/- 1.54 vs 8.24 +/- 1.69 l) and duration of diarrhoea (45.68 +/- 6.91 vs 41.32 +/- 6.03 h). In children also similar results were obtained. No clinical complication (e.g., vomiting, abdominal pain etc.) or abnormality in serum electrolyte concentrations was encountered either in the adults or in the children. Uncooked rice powder containing ORS can be considered as an alternative to glucose-based ORS or rice-based ORS.
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Affiliation(s)
- D Dutta
- National Institute of Cholera & Enteric Diseases, Calcutta
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Hazra BR, Saha SK, Mazumder AK, Deb A, Sinha S. Incidence of hepatitis B virus (HBV) infection amongst clinically diagnosed acute viral hepatitis cases and relative risk of development of HBV infection in high risk groups in Calcutta. Indian J Public Health 1998; 42:56-8. [PMID: 10389512] [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: 02/13/2023] Open
Abstract
The present study revealed that 30.5% of acute infective hepatitis were due to the infection of Hepatitis B virus (HBV) however, 8% controls also showed HBV positivity. The possible route of infection of HBV in our country were Parenteral in 51.9%, Sexual in 24% and Unidentified in 24.1% cases. HBV marker positivity was 45.5% amongst health care workers 33.3% in recipients of multiple blood and blood product transfusion, 25% in sexual partners and their children, 20% in S.T.D. clinic attendants and 10% in patients on haemodialysis.
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Affiliation(s)
- B R Hazra
- Department of Medicine, Medical College, Calcutta
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50
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Bhattacharya MK, Dutta D, Bhattacharya SK, Deb A, Mukhopadhyay AK, Nair GB, Shimada T, Takeda Y, Chowdhury A, Mahalanabis D. Association of a disease approximating cholera caused by Vibrio cholerae of serogroups other than O1 and O139. Epidemiol Infect 1998; 120:1-5. [PMID: 9528811 PMCID: PMC2809342 DOI: 10.1017/s0950268897008352] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/07/2023] Open
Abstract
One hundred and six patients suffering from severe dehydrating diarrhoea were studied of whom 36 patients were positive for Vibrio cholerae. Out of 36, 15 were positive for V. cholerae O1, 10 for V. cholerae O139 and 11 for V. cholerae non-O1 non-O139. O1 and O139 were positive for the 301-bp ctxA amplicon and 471-bp tcpA amplicon indicating that the strains possessed toxigenic capability whereas no non-O1 non-O139 strain possessed ctxA or tcpA genes. Post-admission severity of purging and amount of ORS required were less in the V. cholerae non-O1 non-O139 group (P < 0.05) compared to the V. cholerae O1 and O139 groups. It appears from this study that a cholera-like clinical condition can be caused in the absence of CT as exemplified by strains of non-O1 non-O139.
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Affiliation(s)
- M K Bhattacharya
- National Institute of Cholera & Enteric Diseases, Beliaghata, Calcutta, India
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