1
|
Srivastava S, Basak U, Naghibi M, Vijayakumar V, Parihar R, Patel J, Jadon PS, Pandit A, Dargad RR, Khanna S, Kumar S, Day R. A randomized double-blind, placebo-controlled trial to evaluate the safety and efficacy of live Bifidobacterium longum CECT 7347 (ES1) and heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in participants with diarrhea-predominant irritable bowel syndrome. Gut Microbes 2024; 16:2338322. [PMID: 38630015 PMCID: PMC11028008 DOI: 10.1080/19490976.2024.2338322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
To determine the efficacy of the probiotic Bifidobacterium longum CECT 7347 (ES1) and postbiotic heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in improving symptom severity in adults with diarrhea-predominant irritable bowel syndrome (IBS-D), a randomised, double-blind, placebo-controlled trial with 200 participants split into three groups was carried out. Two capsules of either ES1, HT-ES1 or placebo were administered orally, once daily, for 84 days (12 weeks). The primary outcome was change in total IBS-Symptom Severity Scale (IBS-SSS) score from baseline, compared to placebo. Secondary outcome measures were stool consistency, quality of life, abdominal pain severity and anxiety scores. Safety parameters and adverse events were also monitored. The change in IBS-SSS scores from baseline compared to placebo, reached significance in the ES1 and HT-ES1 group, on Days 28, 56 and 84. The decrease in mean IBS-SSS score from baseline to Day 84 was: ES1 (-173.70 [±75.60]) vs placebo (-60.44 [±65.5]) (p < .0001) and HT-ES1 (-177.60 [±79.32]) vs placebo (-60.44 [±65.5]) (p < .0001). Secondary outcomes included changes in IBS-QoL, APS-NRS, stool consistency and STAI-S and STAI-T scores, with changes from baseline to Day 84 being significant in ES1 and HT-ES1 groups, compared to the placebo group. Both ES1 and HT-ES1 were effective in reducing IBS-D symptom severity, as evaluated by measures such as IBS-SSS, IBS-QoL, APS-NRS, stool consistency, and STAI, in comparison to the placebo. These results are both statistically significant and clinically meaningful, representing, to the best of the authors' knowledge, the first positive results observed for either a probiotic or postbiotic from the same strain, in this particular population.
Collapse
Affiliation(s)
- S Srivastava
- Clinical Development & Science Communications, Vedic Lifesciences Pvt Ltd, Mumbai, India
| | - U Basak
- Clinical Development & Science Communications, Vedic Lifesciences Pvt Ltd, Mumbai, India
| | - M Naghibi
- Medical Department, ADM Health & Wellness, London, UK
| | - V Vijayakumar
- Medical Department, ADM Health & Wellness, London, UK
| | - R Parihar
- Gastroenterology Department, Gastroplus Digestive Disease Centre, Ahmedabad, India
| | - J Patel
- Gastroenterology Department, Apex Gastro Clinic and Hospital, Ahmedabad, India
| | - PS Jadon
- Medicine Department, Jaipur National University Institute for Medical Science & Research Centre, Jaipur, India
| | - A Pandit
- General Surgery Department, United Multispeciality Hospital, Maharashtra, India
| | - RR Dargad
- Medicine Department, Lilavati Hospital & Research Centre, Maharashtra, India
| | - S Khanna
- Gastroenterology Department, Criticare Asia Multispeciality hospital, Maharashtra, India
| | - S Kumar
- Independent Biostatistical Consultant, Delhi, India
| | - R Day
- Medical Department, ADM Health & Wellness, London, UK
| |
Collapse
|
2
|
Chigurupati VS, Khanna S, Kumar S, Khanna R. Efficacy of platelet-rich plasma in alleviating split skin graft morbidities. J Cutan Aesthet Surg 2024; 17:50-54. [PMID: 38736856 PMCID: PMC11086927 DOI: 10.4103/jcas.jcas_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. Aims and Objectives To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. Materials and Methods In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Results Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. Conclusion The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.
Collapse
Affiliation(s)
- Veda Samhitha Chigurupati
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
3
|
Sharma A, Khanna R, Meena RN, Mishra SP, Khanna S. A Case Series on Acute Mesenteric Ischemia (AMI) Leading to Intestinal Gangrene Following Blunt Trauma to the Abdomen. Cureus 2023; 15:e49092. [PMID: 38125260 PMCID: PMC10731625 DOI: 10.7759/cureus.49092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
The term "acute mesenteric ischemia" (AMI) refers to a set of conditions where the blood supply to various segments of the small intestine is cut off, causing ischemia and subsequent inflammatory changes that might result in bowel gangrene. Estimates place the incidence between 0.09% and 0.2% of all acute surgical hospitalizations. Early diagnosis is essential, despite the entity being a rare cause of abdominal discomfort, because if left untreated, mortality is 50%. Herein, we present a case series of three patients with bowel ischemia following blunt abdominal trauma.
Collapse
Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ram Niwas Meena
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shashi Prakash Mishra
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| |
Collapse
|
4
|
Sharma A, Khanna R, Meena RN, Mishra SP, Panigrahy P, Khanna S. Contrasting Presentations of Spigelian Hernia in a Single Surgical Unit of a Tertiary Healthcare Center: A Case Series. Cureus 2023; 15:e42238. [PMID: 37605672 PMCID: PMC10440020 DOI: 10.7759/cureus.42238] [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] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
A Spigelian hernia is a very rare type of anterior abdominal wall hernia. The etiology revolves around the dehiscence of the transverse abdominis and internal oblique aponeurosis. The majority of Spigelian hernias develop in the lower abdomen where the posterior sheath is absent. This condition is also known as a spontaneous lateral ventral hernia or hernia of the semilunar line. It is mostly asymptomatic and is generally proven by radiological diagnosis. In the worst-case scenario, strangulation of the Spigelian hernia can occur. Here, we report a case series of contrasting presentations of Spigelian hernia in a single surgical unit of a tertiary healthcare center, considering the rarity and associated complications of Spigelian hernia.
Collapse
Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ram Niwas Meena
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shashi Prakash Mishra
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Panchanana Panigrahy
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| |
Collapse
|
5
|
Sharma A, Khanna R, Panigrahy P, Meena RN, Mishra SP, Khanna S. An Incidental Finding of Morgagni Hernia in an Elderly Female and Its Successful Management: A Rare Case Report and Review of Literature. Cureus 2023; 15:e42676. [PMID: 37649941 PMCID: PMC10463937 DOI: 10.7759/cureus.42676] [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] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Morgagni hernia is one of the congenital diaphragmatic hernias, but it can also occur in adults. It usually manifests in childhood, but in rare cases, it may also present in adults. It is linked to a congenital defect during the embryological development of the diaphragm. Uncommon diaphragmatic hernias, also called the foramen of Morgagni hernias, often affect the right side and are found in the anterior mediastinum. Typically asymptomatic in adult patients, the foramen of Morgagni hernia is linked to obesity, trauma, or other causes of elevated intraabdominal pressure. Diagnostic aids include plain pulmonary roentgenograms, contrast-enhanced radiographic investigations of the gastrointestinal tract, computerised tomography, and magnetic resonance imaging tests. We report a rare case of an 85-year-old female with a Morgagni hernia that was incidentally detected on a chest X-ray and was managed successfully.
Collapse
Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Panchanana Panigrahy
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ram Niwas Meena
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shashi Prakash Mishra
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| |
Collapse
|
6
|
Rani DA, Khanna S, Mishra SP, Kumar S. A Comparative Evaluation of Topical Application Versus Perilesional Injection of Platelet-Rich Plasma in Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2023:15347346231176727. [PMID: 37226466 DOI: 10.1177/15347346231176727] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Diabetic foot ulcer (DFU) is globally a major health burden predisposing to limb amputation. Among the various treatment modalities, platelet-rich plasma (PRP) is emerging as a promising agent. It stimulates wound healing by providing a higher concentration of essential growth factors locally. Though the role of PRP in DFU healing is established, still the route of administration with maximal efficacy is yet to be defined. Our study aims to evaluate the efficacy of autologous PRP in the treatment of diabetic ulcers and compare the effect of topical and perilesional injections of PRP in DFU healing. We conducted a single-centre, prospective, interventional study on 60 patients with DFU, in 2 groups of 30 patients each. They were treated with freshly prepared autologous PRP injection perilesionally and topically respectively, once a week for 4 weeks. Ulcer size was assessed, using "imito-measure" software at presentation and 2, 4, 8, and 12 weeks post-therapy. Serum MMP-9 levels were assessed in both groups, pretreatment and post-treatment. For statistical analysis, SPSS software V-23 was used. On assessment, both groups had comparable baseline characteristics, Wagner's grading, and glycemic indices. The percentage reduction in the size of the wound at 2 weeks, 1 month, 2 months, and 3 months was greater in the perilesional group as compared to the topical PRP group.
Collapse
Affiliation(s)
- Digumarthi Asha Rani
- Department of General Surgery, Institute of medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seema Khanna
- Department of General Surgery, Institute of medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S P Mishra
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
7
|
Gupta S, Khanna S. P069 Barriers in the diagnosis and treatment of early breast cancer in a low middle income country (LMIC): an epidemiological profile of breast cancer patients from a teaching hospital in North India. Breast 2023. [DOI: 10.1016/s0960-9776(23)00187-x] [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: 03/16/2023] Open
|
8
|
Tariq R, Pardi DS, Khanna S. A268 RESOLUTION RATES IN OPEN-LABEL VERSUS RANDOMIZED CONTROLLED TRIALS FOR MICROBIOTA RESTORATION FOR RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION: AN UPDATED META-ANALYSIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991219 DOI: 10.1093/jcag/gwac036.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Microbiota restoration is highly effective to treat recurrent Clostridioides difficile infection (CDI) in observational studies (cure rates >90%) but efficacy in controlled clinical trials appears lower. Purpose We performed an updated meta-analysis to assess the efficacy of microbiota restoration for recurrent CDI in open-label registered prospective clinical trials compared to randomized controlled trials (RCTs). Method A systematic search of Embase, Web of Science and Scopus was performed up to June 2022 to identify studies of interest. Clinical trials of microbiota restoration for recurrent CDI with clinical resolution with one dose as the primary outcome were included. We calculated both unweighted and weighted pooled resolution rates (UPR and WPR) with 95% confidence intervals (CI). Result(s) Eighteen studies (9 RCTs and 9 open-label trials) with 1149 CDI patients were included. Of the patients treated with microbiota restoration, 881 experienced symptom resolution (UPR 77%%; WPR 79%, 95% CI, 72%-85%). There was significant heterogeneity among studies with an I2of 86%. Analysis of trials with a control arm (non-microbiota restoration) revealed CDI resolution in 357 of 496 patients (UPR 72%; WPR 73%, 95% CI 63%-82%) with microbiota restoration. Among the 9 open-label clinical trials, CDI resolution was seen in 524 of 653 patients after initial microbiota restoration (UPR 80%; WPR 84%, 95% CI 74%-92%). Comparison of resolution rates between RCTs and open-label trials revealed a lower cure rate in RCTs compared to open-label trials (WPR 73% vs 84%, p<0.0001). Analysis of the 10 trials with non-microbiota restoration revealed CDI resolution in 201 of 397 patients with antibiotics (WPR 52%, 95% CI 43%-60%). There was significant heterogeneity among the included studies with an I2of 61%. Comparison of cure rates with microbiota restoration vs antibiotics showed higher cure rate with microbiota restoration (WPR 73%, [95% CI 63%-82%] vs 52% [95% CI, 43%-60%]; p<0.0001). There were no serious adverse events reported. Conclusion(s) Microbiota restoration in a randomized controlled setting leads to lower resolution rates compared to open label and observational settings, likely due to stricter definitions and inclusion criteria. Resolution rates in open label studies were similar to observational studies. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
- R Tariq
- Mayo Clinic, Rochester, United States
| | - D S Pardi
- Mayo Clinic, Rochester, United States
| | - S Khanna
- Mayo Clinic, Rochester, United States
| |
Collapse
|
9
|
Tariq R, Tahir MW, Khanna S. A233 OUTCOMES OF CLOSTRIDIOIDES DIFFICILE INFECTION IN SURGICAL PATIENTS: RESULTS FROM NATIONAL INPATIENT SAMPLE 2016-2019. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991353 DOI: 10.1093/jcag/gwac036.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Clostridioides difficile infection (CDI) is the most common nosocomial infection and is associated with significant morbidity and mortality. Purpose We aimed to identify the burden of CDI in patients undergoing common gastrointestinal (GI) surgical procedures in a national inpatient cohort, as GI surgeries have been thought to be a risk factor for CDI. Method We used the National Inpatient Sample (NIS) database from Unites States for the years 2016-2019 for this study. We included adult patients (age ≥ 18), who underwent common GI surgeries (identified using ICD-10 procedure codes), and among them identified patients with diagnosis of CDI. Outcomes assessed included risk of CDI among different surgeries, inpatient mortality, length of stay (LOS) and cost of hospitalization using regression analyses Result(s) From 2016 to 2019, an estimated total of 4,438,778 patients were hospitalized and underwent any of the studied GI surgeries. CDI was reported in 32,180 admissions (0.72%). Median age for CDI was higher than non-CDI patients (66 vs 56, p<0.001). Incidence of CDI was 2.5 times higher in patients admitted emergently compared to elective admissions (1.00% vs 0.40%, p<0.0001). Among all surgeries, the incidence of CDI was the highest for small bowel resection at 2.1% followed by partial esophagectomy at 1.6% and partial colectomy at 1.4%. Logistic regression analysis showed the patients undergoing esophagectomy had the highest risk with adjusted Odds Ratio (aOR) of 2.48, (95% CI 2.01 – 3.07, p<0.0001), followed by pancreatectomy with aOR 2.03 (95% CI 1.91 – 2.16, p<0.0001). Overall, surgical patients with CDI had a significantly higher in-patient mortality compared to non-CDI patients (8.2% vs 1.4%, p<0.0001). Logistic regression analysis showed an increased risk of inpatient mortality with CDI, with aOR 1.36, 95% CI 1.30 – 1.42, p<0.0001. Median LOS for surgical patients with CDI was higher than non-CDI patients (14 days vs 3 days, p<0.0001). The linear regression analysis for length of stay showed that among patients undergoing surgical procedures, CDI was associated with an increased LOS with beta of 8.39 days ± SE 0.04 (95% CI 8.31 – 8.46, p<0.0001). The mean cost of hospitalization for surgical patients with CDI was higher than non-CDI patients ($90,590 vs $31,702, p<0.0001) after adjusting for inflation over the four-year period. The linear regression analysis showed that CDI was associated with an increased cost of hospitalization with a beta of $25,343 ± SE 166 (95% CI 25,017 – 25,670, p<0.0001). Conclusion(s) CDI among GI surgeries leads to increase in inpatient mortality, length of stay and cost of hospitalization. Although the rate of CDI is showing a downwards trend, its impact on these outcome measures makes it an important complication to prevent and promptly treat in these surgical patients. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | - M W Tahir
- Rochester General Hospital, Rochester, United States
| | | |
Collapse
|
10
|
Khanna S, Chichester K, Makiya M, Khoury P, Klion A, Saini S, Oliver E. INCREASED EOSINOPHIL GRANULE PROTEIN PRODUCTION IN CHRONIC SPONTANEOUS URTICARIA. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.598] [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]
|
11
|
Garon E, Lu S, Goto Y, De Marchi P, Paz-Ares L, Spigel D, Thomas M, Yang JH, Ardizzoni A, Barlesi F, Khanna S, Bossen C, Carbini M, Yovine A, Cho B. LBA49 CANOPY-A: Phase III study of canakinumab (CAN) as adjuvant therapy in patients (pts) with completely resected non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
12
|
Singh N, Jain S, Verma A, Khanna S, Shukla RC. Role of Diffusion-Weighted Magnetic Resonance Imaging in Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer and Its Molecular Subtypes. Indian J Radiol Imaging 2022; 32:332-338. [PMID: 36177282 PMCID: PMC9514905 DOI: 10.1055/s-0042-1750155] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose
The aim of this study was to evaluate the role of apparent diffusion coefficient (ADC) and hence diffusion-weighted imaging in prediction of pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC) and its molecular subtypes.
Methods
In this tertiary hospital-based prospective study, 30 patients aged 30 to 65 years, having clinically/cytologically diagnosed LABC, were included. Magnetic resonance imaging (MRI) was done to obtain prechemotherapy ADC (ADC
pre
), postchemotherapy ADC (ADC
post
), change in ADC (ΔADC), and ΔADC% for each tumor and its subtype. Postsurgical pCR was used as the reference standard for determining tumor response. All four ADC parameters were compared between pCR and non-pCR groups.
Results
Of the 30 patients, 19 (63.3%) patients showed pCR, while 11 (36.7%) patients did not. The pCR group showed significantly lower mean ADC
pre
(
p <
0.001) and higher mean ADC
post
(
p <
0.05), ΔADC, and ΔADC% (
p
= 0.000) than non-pCR group. The best cutoff values to differentiate responders from nonresponders with receiver operating characteristic curve analysis of ADC
pre
, ADC
post
, and ΔADC% were 0.98 × 10
−3
mm
2
/s (68.4% sensitivity, 63.6% specificity), 1.31×10
−3
mm
2
/s (68.4% sensitivity, 63.6% specificity), and 25% (84.2% sensitivity, 90.9% specificity), respectively. Human epidermal growth factor receptor 2 (HER2)-enriched subtype showed significant difference in mean ADC
pre
(
p
= 0.045), while triple-negative subtype showed significant differences in mean ADC
post
(
p
= 0.032) and mean ΔADC (
p
= 0.019) between the two groups.
Conclusion
ADC
pre
, ADC
post
, and ΔADC can predict pCR to NACT in LABC. Among molecular subtypes, ADC
pre
was predictive only in HER2-enriched subtype, while ADC
post
and ΔADC were predictive only in triple-negative subtype.
Collapse
Affiliation(s)
| | - Shivi Jain
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ram Chandra Shukla
- Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
13
|
Khanna S, Amarasekera AT, Li C, Bhat A, Chen HHL, Gan GCH, Tan TC. The role of echocardiography in the diagnosis of adult patients with myocarditis: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Transthoracic echocardiography (TTE) plays a key diagnostic role in the initial work-up of patients presenting with myocarditis. Its utility in myocarditis is for identification of structural and functional changes, which may assist with diagnosis, surveillance and prognostication.
Purpose
The purpose of this systematic review and meta-analysis was to appraise the evidence associated with the use of echocardiography for the diagnosis of myocarditis in adults.
Methods
A systematic literature search of medical databases including Pubmed, Ovid Online, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, Science Direct and grey literature was performed using PRISMA principles to identify all relevant TTE studies on myocarditis in adult patients (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of TTE parameters were individually extracted and then meta-analysed using a random-effects model for overall effect size through standard mean difference (SMD).
Results
Of the 13 relevant studies, 6 were included and revealed that myocarditis can be reliably differentiated from healthy controls, both in the acute and sub-acute phase by left ventricular (LV) global longitudinal strain, and less so by LV ejection fraction and LV end-diastolic volume (p < 0.05 for all). See Table. LV-GLS demonstrated the strongest ability to discriminate myocarditis patients from healthy controls when compared to standard two-dimensional measures of LV size and function (p < 0.05).
Conclusions
LV-GLS demonstrated the best discriminatory ability for differentiation of myocarditis from adult healthy controls. Further research is required to characterize the utility of these quantitative parameters in the diagnostic work-up of these patients. Abstract Figure.
Collapse
Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | | | - C Li
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | - HHL Chen
- Blacktown Hospital, Sydney, Australia
| | - GCH Gan
- Blacktown Hospital, Sydney, Australia
| | - TC Tan
- Blacktown Hospital, Sydney, Australia
| |
Collapse
|
14
|
Mahendran S, Sekhar P, Malaty M, Khanna S, Amarasekera A, MacIntyre R, Tan T. Association Between Troponin Elevation and Severity of COVID-19 Infection: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022. [PMCID: PMC9345546 DOI: 10.1016/j.hlc.2022.06.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.369] [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: 10/16/2022]
|
16
|
Khanna S, Wen I, Thakur A, Bhat A, Chen H, Gan G, Tan T. Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.368] [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: 10/16/2022]
|
17
|
Tantia A, Mukherjee U, Chatterjee S, Khanna S. Total Laparoscopic Hysterectomy – Analysis of Learning Points & Complications over a Span of Two Decades. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.302] [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: 11/17/2022]
|
18
|
Khanna S, Wen I, Gupta A, Thakur A, Bhat A, Chen HHL, Gan GCH, Tan TC. LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).
Purpose
The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up.
Methods
Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF <50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE).
Results
A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p<0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis.
Conclusions
Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | - I Wen
- Blacktown Hospital, Sydney, Australia
| | - A Gupta
- Blacktown Hospital, Sydney, Australia
| | - A Thakur
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | - G C H Gan
- Blacktown Hospital, Sydney, Australia
| | - T C Tan
- Blacktown Hospital, Sydney, Australia
| |
Collapse
|
19
|
Khanna S, Wen I, Gupta A, Thakur A, Bhat A, Chen HHL, Gan GCH, Tan TC. Patients with rare autoimmune inflammatory disorders demonstrate sub-clinical left ventricular dysfunction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
ANCA-associated Vasculitis (AAV) and inflammatory myositis (IM) are rare inflammatory autoimmune disorders mediated via pro-inflammatory cytokines and result in a systemic inflammatory state with multi-organ involvement. There is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF).
Purpose
The purpose of this study was to assess for subclinical cardiac dysfunction in these cohorts when compared to controls.
Methods
Consecutive patients with AAV (n=56) and IM (n=68) admitted to our institution during 2013–2021 were assessed. Patients with pre-existing cardiovascular disease, significant renal impairment (eGFR <30mL/min/1.73m2), LVEF <50% or lack of comprehensive transthoracic echocardiography during admission were excluded (n=72). LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6).
Results
A total of 52 patients (22 AAV and 30 IM) were age- and gender-matched to 52 controls. In comparison of the two study populations (AAV and IM), patients with AAV had higher rates of renal impairment (p=0.02) but lower rates of interstitial lung disease when compared to IM (p=0.02). There were no differences between the two groups in terms of cardiovascular risk factors, demographics or other laboratory investigations (p>0.05 for all). In comparison to the control population, patients with AAV and IM had higher indexed LV mass and a lower TAPSE, respectively, when compared to controls. These cohorts also demonstrated impaired LV-GLS (−17.7±2.6 vs −20.6±2.4; p<0.01) when compared to healthy controls, despite no differences in LVEF (62.6±7.8 vs 61.8±5.4; p=0.56) between both groups.
Conclusions
Our results suggest that patients with autoimmune inflammatory disorders demonstrate subclinical LV dysfunction which is likely secondary to a chronic inflammatory state.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | - I Wen
- Blacktown Hospital, Sydney, Australia
| | - A Gupta
- Blacktown Hospital, Sydney, Australia
| | - A Thakur
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | | | - G C H Gan
- Blacktown Hospital, Sydney, Australia
| | - T C Tan
- Blacktown Hospital, Sydney, Australia
| |
Collapse
|
20
|
Bishay RH, Meyerowitz-Katz G, Hng TM, Colaco CMG, Khanna S, Klein R, Sanjeev D, McLean M, Ahlenstiel G, Maberly GF. A retrospective case-control cohort analysis of comorbidity and health expenditure in hospitalized adults diagnosed with obesity utilizing ICD-10 diagnostic coding. Clin Obes 2021; 11:e12469. [PMID: 34053198 DOI: 10.1111/cob.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
The cost and comorbidity of obesity in hospitalized inpatients, is less known. A retrospective study of patients presenting to a large district hospital in Western Sydney (April 2016-February 2017) using clinical, pathological as well as diagnostic coding data for obesity as per ICD-10. Of 43 212 consecutive hospital presentations, 390 had an obesity-coded diagnosis (Ob, 0.90%), of which 244 were gender and age-matched to a non-obesity coded cohort (NOb). Weight and BMI were higher in the Ob vs NOb group (126 ± 37 vs 82 ± 25 kg; BMI 46 ± 12 vs 29 ± 8 kg/m2 , P < .001) with a medical record documentation rate of 62% for obesity among Ob. The Ob cohort had 2-5× higher rates of cardiopulmonary and metabolic complications (P < .001), greater pharmacologic burden, length of stay (LOS, 225 vs 89 hours, P < .001) and stay in intensive care but no differences in the prevalence of mental disorders. Compared with BMI <35 kg/m2 , inpatients with BMI >35 kg/m2 were 5× more likely to require intensive care (OR 5.08 [1.43-27.3, 95% CI], P = .0047). The initiation of obesity-specific interventions by clinical teams was very low. People with obesity who are admitted to hospital carry significant cost and complications, yet obesity is seldom recognized as a clinical entity or contributor.
Collapse
Affiliation(s)
- Ramy H Bishay
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - G Meyerowitz-Katz
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - T M Hng
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - C M G Colaco
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - S Khanna
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - R Klein
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - D Sanjeev
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - M McLean
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - G Ahlenstiel
- Metabolic and Weight Loss Program, Department of Endocrinology and Diabetes, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
| | - G F Maberly
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Western Sydney Diabetes, Integrated and Community Health Directorate, Blacktown Hospital Department of Endocrinology and Diabetes, Western Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
21
|
Khanna S. Microbiota restoration for recurrent Clostridioides difficile: Getting one step closer every day! J Intern Med 2021; 290:294-309. [PMID: 33856727 DOI: 10.1111/joim.13290] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
Clostridioides difficile infection (CDI) is an urgent health threat being the most common healthcare-associated infection, and its management is a clinical conundrum. Over 450 000 infections are seen in the United States with similar incidence seen in the rest of the developed world. The majority of infections seen are mild-moderate with fulminant disease and mortality being rare complications seen in the elderly and in those with comorbidities. The most common complication of CDI is recurrent infection with rates as high as 60% after three or more infections. A dilemma in the management of primary and recurrent CDI is testing due to the high sensitivity of the nucleic acid amplification tests such as the polymerase chain reaction, which leads to clinical false positives if patients are not chosen carefully (with symptoms) before testing. A newer testing regimen involving a 2-step strategy is emerging using glutamate dehydrogenase as a screening strategy followed by enzyme immunoassay for the C. difficile toxin. Microbiota restoration therapies are the cornerstone of management of recurrent CDI to prevent future recurrences. The most common modality of microbiota restoration is faecal microbiota transplantation, which has been tainted with heterogeneity and adverse events such as serious infectious transmission. The success rates for recurrence prevention from microbiota restoration therapies are over 90% compared with less than 50% of recurrence prevention with courses of antibiotics. This has led to development and emergence of standardized microbiota restoration therapies in capsule and enema forms. Capsule-based therapies include CP101 (positive phase II results), RBX7455 (positive phase I results), SER-109 (positive phase III results) and VE303 (ongoing phase II trial). Enema-based therapy includes RBX2660 (positive phase III data). This review summarizes the principles of management and diagnosis of CDI and focuses on emerging and existing data on faecal microbiota transplantation and standardized microbiota restoration therapies.
Collapse
Affiliation(s)
- S Khanna
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
22
|
Parasar E, Khanna R, Verma A, Jain S, Khanna S. Evaluation of Extra-axillary Lymph Nodes by Ultrasound in Breast Cancer Patients. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02527-x] [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] Open
|
23
|
Meenakshi, Kumar I, Dhameja N, Meena RN, Mishra SP, Khanna S, Khanna R. Preoperative Assessment of the Axilla by Ultrasonogram-Guided FNAC in Breast Cancer Patients with a Clinically Negative Axilla. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
24
|
Verma A, Kar AG, Meena RN, Patne SCU, Mishra SP, Khanna S, Khanna R. Evaluation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status Before and After Neoadjuvant Chemotherapy in Breast Cancer Patients. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02380-y] [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: 10/24/2022] Open
|
25
|
Tahir M, Alexander S, Tariq R, Wysham K, Andrews J, Aly H, Khanna S, Singh N. POS0537 TRENDS AND PREDICTORS OF INPATIENT MORTALITY IN PATIENTS WITH CLOSTRIDIODES DIFFICILE INFECTION AMONG THOSE WITH AND WITHOUT RHEUMATOID ARTHRITIS: A NATIONWIDE ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:People with rheumatoid arthritis (RA) have a higher risk of serious infections. The most common nosocomial infection in the United States (US) is Clostridioides difficile infection (CDI) and yet, little is known regarding the impact of comorbid RA on outcomes in persons hospitalized with CDI.Objectives:To evaluate the trends over time and predictors of inpatient mortality in hospitalized patients with CDI comparing those with and without RA.Methods:We used the National Inpatient Sample (NIS) database, the largest available all-payer database of inpatient hospitalizations in the US. Patients aged ≥18 years admitted with CDI from 2006-2018 were included. Patients with RA were identified using the International Classification of Diseases (ICD) 9 and 10 codes. Categorical variables between CDI patients with and without RA were compared using Chi-squared test. Temporal trends of hospitalization charges, length of stay (LOS) and inpatient mortality were assessed using the Cochrane Armitage test. Predictors of inpatient mortality were assessed using multivariable logistic regression adjusting for: age ≥65, sex, race, presence of RA, and Elixhauser comorbidity index.Results:There were 4,396,945 hospitalizations with a discharge diagnosis of CDI in the study period, of which 111,336 (2.5%) had a coexisting diagnosis of RA. Over the study period, the proportion of CDI patients with a diagnosis of RA increased from 1.7% in 2006 to 3.3% in 2018 with a statistically significant trend of rise (p trend<0.001). There were significantly more females in the RA group (78.2%) than without RA (57.5%), p <0.001. RA group was significantly younger (68.0 vs 70.7, P<0.001). Races were similar between the groups.The inflation-adjusted average charge for hospitalization for CDI without RA was significantly higher than for CDI with RA ($95,863 vs $73,025, p<0.001). There was an increasing trend in inflation-adjusted average charge for hospitalization for both CDI without RA ($76,966 in 2006 to $104,552 in 2018, p<0.001) and CDI with RA ($55,689 in 2006 to $77,295 in 2018, p<0.001). Patients with or without RA had the same median length of stay (LOS) of 7 days. But when trended over time, for patients without RA, the median LOS decreased from 8 days in 2006-08 to 6 days in 2016-18 whereas for patients with RA, the median LOS fluctuated between 6 and 7 days over the course of study period.CDI patients without RA had a significantly higher mortality over the study period than those with RA (7.8% vs 6.1%, p<0.001). Among non-RA CDI patients, mortality decreased from 9.3% in 2006 to 6.3% in 2018 (p trend <0.001). Hospitalizations of people with CDI and comorbid RA showed an overall decreasing trend (p trend <0.001).The multivariable analyses found age≥65 was associated with increased inpatient mortality (adjusted odds ratio [aOR], 1.77, 95% confidence interval [CI], 1.73-1.80), whereas a diagnosis of RA was associated with a decreased mortality (aOR 0.86, 95% CI, 0.81-0.91) (Table 1).Table 1.Predictors of inpatient mortalityaOR95% C.I. for aORP-valueLowerUpperAge ≥ 651.7651.7301.801<0.001Hospitalization years -Years 2006-2011Ref -Years 2011-20140.7070.6930.721<0.001 -Years 2015-20180.5820.5690.594<0.001Elixhauser Comorbidity Index1.0561.0551.056<0.001Rheumatoid Arthritis0.8590.8100.911<0.001Female0.8700.8550.885<0.001Race -WhiteRef -African American1.0711.0441.099<0.001 -Hispanic1.1441.1081.180<0.001 -Asian/Pacific Islander1.2671.2001.337<0.001 -Native American1.0220.9101.1470.716 -Other races1.2631.2011.329<0.001aOR = Adjusted Odds Ratio; C.I.= confidence intervalConclusion:In this nationwide study, among hospitalized patients with CDI, those with comorbid RA had significantly decreased odds of inpatient mortality than those without RA. Further studies are needed to understand this association.Figure 1.Disclosure of Interests:None declared
Collapse
|
26
|
Mansur A, Chandler J, Khanna S, Vinson M, Nguyen A. POS-814 INTRADIALYTIC RELATIVE BLOOD VOLUME MONITORING IN HEART FAILURE PATIENTS: RETROSPECTIVE DATA ANALYSIS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
27
|
Bhat A, Chen H, Khanna S, Mahajan V, Gupta A, Burdusel C, Wolfe N, Lee L, Gan G, Dobbins T, MacIntyre C, Tan T. Diagnostic and Prognostic Value of Novel Echocardiographic Biomarkers in Identification of Cardioembolism and Prediction of Outcomes in Patients with Stroke of Undetermined Source. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.006] [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]
|
28
|
Khanna S, Newman J, Gupta A, Wen I, Bhat A, Chen H, Gan G, Tan T. Left Ventricular Global Longitudinal Strain is a Predictor of Adverse Cardiovascular Outcomes in Patients With Rheumatoid Arthritis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
29
|
Wen I, Khanna S, Thakur A, Chen H, Bhat A, Gan G, Tan T. Patients With Neuro-Immunological Disorders With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.235] [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]
|
30
|
Khanna S, Amarasekera A, Li C, Bhat A, Chen H, Gan G, Tan T. Characterisation of Myocardial Structure and Function by Cardiac Magnetic Resonance Imaging in Adult Patients With Acute-Phase Myocarditis: A Systematic Review and Meta-analysis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.196] [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]
|
31
|
Khanna S, Herzog J, Gebhardt R. Influence of enzymatic cross‐linking and pH values on the internal structure of casein micelles and from them manufactured functional materials. CHEM-ING-TECH 2020. [DOI: 10.1002/cite.202055206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S. Khanna
- RWTH Aachen University Soft Matter Process Engineering (AVT. SMP) Forckenbeckstr. 51 52074 Aachen Germany
| | - J. Herzog
- RWTH Aachen University Soft Matter Process Engineering (AVT. SMP) Forckenbeckstr. 51 52074 Aachen Germany
| | - R. Gebhardt
- RWTH Aachen University Soft Matter Process Engineering (AVT. SMP) Forckenbeckstr. 51 52074 Aachen Germany
| |
Collapse
|
32
|
Srivastava V, Jha PK, Samhitha CV, Khanna S. Unusual Presentation of Benign Breast Disease in an Adolescent Girl. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
33
|
Khanna S, Tan J, Chen H, Bhat A, Gan G, Tan T. 372 Left Ventricular Sphericity Index is a Predictor of Cardiovascular Events in Patients With Anterior Transmural Myocardial Infarction but not in Takotsubo Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
34
|
Kodsi M, Gupta A, Drescher A, Oh F, Chen H, Bhat A, Kanthan A, Tan T, Khanna S. 384 Pacing Burden and Right Ventricular Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.391] [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]
|
35
|
Khanna S, Bhat A, Malaty M, Kim S, Talisayon R, Ravindran J, Garikapati K, Tsihlis G, Tan T, Burgess D. 742 Non-Traditional Predictors of Adverse Cardiovascular Outcomes Following Acute Coronary Syndromes Post-Percutaneous Coronary Intervention. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.749] [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]
|
36
|
Tan J, Tan S, Mok C, Shehab S, Chen H, Bhat A, Gan G, Tan T, Khanna S. 500 Impact of Left Ventricular Hypertrophy Phenotypes on Electrocardiographic Detection of Left Ventricular Hypertrophy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Chen H, Khanna S, Kayes T, Bhat A, Gan G, Ahlenstiel G, Tan T. 300 Characterisation of Atrial and Ventricular Myocardial Deformation Indices with Increasing Body Mass Index. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.307] [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]
|
38
|
Khanna S, Newman J, Bhat A, Chen H, Fernandez F, Gan G, Tan T. 385 Patients with Systemic Lupus Erythematosus With Normal Left Ventricular Ejection Fraction Demonstrate Impaired Left Ventricular Global Longitudinal Strain. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.392] [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]
|
39
|
Khanna S. Clostridial vaccines in the pipeline. DRUG FUTURE 2020. [DOI: 10.1358/dof.2020.45.9.3168446] [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]
|
40
|
Makarious D, Bhat A, Khanna S, Chen H, Drescher A, Stephens M, Fernandez F, Gan G, Tan T. 312 Correlation between Atrial Fibrillation Burden and Changes in Indices of Left Atrial Size and Function. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.319] [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]
|
41
|
Von Itzstein M, Gupta A, Mara K, Khanna S, Gerber D. P1.16-01 Complications Associated with Lung Biopsies in Patients with Lung Cancer: A Population Based Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
Bhat A, Chen HHL, Khanna S, Gan CH, Menzies R, Nunes CM, MacIntyre R, Tan TC. P2468Clinical and cardiac structural differences between paroxysmal and persistent/permanent non-valvular atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is a heterogeneous condition and is traditionally classified by duration (paroxysmal, persistent and permanent). There is a relationship between AF and left atrial (LA) remodeling, with increased likelihood of AF recurrence and maintenance with increasing LA volumes.
Purpose
To assess clinical and cardiac structural differences between the subtypes of AF.
Methods
We examined 1247 (68±13.4y; 50% men) consecutive admissions presenting to our institution with the primary diagnosis of AF. Repeat admissions (n=263) were excluded. Of remaining 984 subjects, a majority had diagnosed paroxysmal (72.2%), with lower numbers of persistent (23.4%) and permanent (4.4%) AF. Echo parameters of cardiac chamber size and function were examined in a subset of subjects with complete echo (n=646) performed during incident hospital admission.
Results
There were significantly higher rates of diabetes mellitus (p=0.03), ischaemic heart disease (IHD; p=0.04) and peripheral vascular disease (PVD; p=0.02) in those with persistent/permanent AF compared to paroxysmal AF. No significant differences in age (p=0.19), BMI (p=0.42), OSA (p=0.05), or hypertension (p=0.76) was noted. There were significant differences in left ventricular (LV) mass and systolic function, LA size and function between the two groups (Table 1). Receiver operator curve analysis revealed that LAEF was a discriminator for persistent/permanent AF with an area under the curve of 0.689 (95% CI, 0.646 to 0.732; p<0.001).
Echo parameters in AF subtype Echocardiographic Parameters Paroxysmal AF (n=433) Persistent and Permanent AF (n=213) Significance (p value) LVEDD (cm) 4.8±3.0 5.0±0.9 0.29 LVESD (cm) 3.3±1.3 3.7±1.1 <0.01 IVS thickness (cm) 1.2±0.7 1.1±0.3 0.44 PW thickness (cm) 1.1±0.7 1.1±0.2 0.77 LV mass (g) 92.3±28.3 108.2±35.3 <0.01 LVEF (%) 56.1±14.1 47.4±16.8 <0.01 LA Expansion Index 89.4±69.1 53.4±40.3 <0.01 Min LA Volume indexed (ml/m2) 18.9±17.2 27.3±20.6 0.01 Max LA Volume indexed (ml/m2) 32.5±19.2 37.7±15.3 <0.01 LAEF (%) 41.8±16.4 31.5±13.6 <0.01
Conclusions
Our results suggest diabetes, IHD and PVD are associated with persistent/permanent AF. Additionally, greater LA remodeling and reduced atrial function was noted in this group, suggestive of an association between duration of AF electrical burden and LA remodeling and function.
Collapse
Affiliation(s)
- A Bhat
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - H H L Chen
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - S Khanna
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - C H Gan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - R Menzies
- University of New South Wales, Sydney, Australia
| | - C M Nunes
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| | - R MacIntyre
- University of New South Wales, Sydney, Australia
| | - T C Tan
- Blacktown Hospital, Department of Cardiology, Sydney, Australia
| |
Collapse
|
43
|
Khanna S, Newman JM, Gan G, Bhat A, Chen H, Tan T. P4353Global longitudinal strain is a measure of subclinical left ventricular dysfunction in chronic inflammatory autoimmune conditions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial deformation indices are proposed to be a more sensitive marker of subclinical dysfunction compared to standard measures of left ventricular (LV) systolic function. We hypothesize that subclinical myocardial dysfunction is present in chronic inflammatory autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), despite both conditions being mediated by different pro-inflammatory modulators.
Purpose
Identify subclinical myocardial dysfunction through assessment of global longitudinal strain in two different chronic autoimmune conditions, SLE and RA.
Methods
Consecutive patients admitted to our institution with known history of SLE or RA (>1 year disease activity) were examined. Patients with preexisting cardiac disease, LVEF <50% and those without comprehensive transthoracic echocardiograms (TTE) were excluded. Mean longitudinal LV strain was performed offline using vendor-independent software (TomTec v4.6) and compared to age- and gender-matched controls with normal LV function and no history of cardiac disease.
Results
Of the 86 patients examined (mean age 53.01±21.74, 85.4% female), 51 (59.3%) had SLE and 35 (40.7%) had RA. No significant difference in BMI, hypertension, hypercholesterolemia, diabetes, obesity, obstructive sleep apnea and stroke was observed between controls and patients with SLE or RA. While there was no significant difference in LVEF between RA patients and matched controls, there was a significantly lower GLS in the RA cohort. Conversely, patients with SLE had significantly lower LVEF and GLS when compared to matched controls, despite LVEF being in the normal range. See Table 1. Receiver operator curve analysis revealed that mean GLS is a better discriminator for autoimmune disease with an area under the curve of 0.829 (95% CI, 0.77 to 0.89; p<0.01) compared to LVEF with an area under the curve of 0.632 (95% CI, 0.55 to 0.72; p<0.01).
Echocardiographic Parameters SLE (n=51) Controls (n=51) Sig (p value) RA (n=35) Controls (n=35) Sig (p value) LVEDV (mls) 102±30 85±20 <0.01 84±28 89±30 0.43 LVESV (mls) 36±17 29±9 0.02 26±14 30±12 0.24 Biplane LVEF % 59±6 63±4 <0.01 62±6 62±5 0.81 LV Mass (grams/m2) 96±34 72±20 <0.01 79±26 82±23 0.67 LV Mean GLS % 16.7±2.8 21.3±2 <0.01 17.8±1.7 19.1±2.5 0.02
Conclusions
Our results suggest that chronic inflammatory conditions (SLE and RA) are associated with subclinical cardiac dysfunction. Impaired GLS may reflect early myocardial damage and be used as a tool for screening of patients with inflammatory conditions.
Acknowledgement/Funding
None
Collapse
Affiliation(s)
- S Khanna
- Blacktown Hospital, Sydney, Australia
| | | | - G Gan
- Blacktown Hospital, Sydney, Australia
| | - A Bhat
- Blacktown Hospital, Sydney, Australia
| | - H Chen
- Blacktown Hospital, Sydney, Australia
| | - T Tan
- Blacktown Hospital, Sydney, Australia
| |
Collapse
|
44
|
Saha S, Tariq R, Tosh PK, Pardi DS, Khanna S. Faecal microbiota transplantation for eradicating carriage of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 2019; 25:958-963. [PMID: 30986562 DOI: 10.1016/j.cmi.2019.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multidrug-resistant (MDR) microorganism development in the gut is frequently the result of inappropriate antibiotic use. Faecal microbiota transplantation (FMT) restores normal gut microbiota in patients with Clostridium difficile infection. We hypothesized that it may help in decolonizing MDR organisms (MDROs) and in preventing recurrent MDR infections. OBJECTIVES To assess FMT efficacy (eradication rate) for decolonizing MDROs and preventing recurrent MDR infections. DATA SOURCES Medline, Embase and Web of Science (inception through 11 February 2019). STUDY ELIGIBILITY CRITERIA Clinical trials, retrospective studies, case reports and case series. PARTICIPANTS Patients with MDR infections or MDRO colonization treated with FMT. INTERVENTIONS FMT. METHODS Systematic review. RESULTS Twenty-one studies (one randomized clinical trial, seven uncontrolled clinical trials, two retrospective cohort studies, two case series, nine case reports) assessing 192 patients were included. Three studies assessed FMT efficacy in preventing MDR infections; 16 assessed its effect on MDRO colonization; two assessed both. Data from 151 patients were included in the final analyses. In studies with low to moderate risk of bias, the eradication rate was 37.5% to 87.5%. Efficacy was similar in studies looking at infection or colonization and did not differ by length of follow-up. No serious adverse events from FMT were reported. Seven patients died of other causes. CONCLUSIONS FMT could be used as a treatment for eradicating MDR colonization and possibly preventing recurrent MDR infections, once more supporting efficacy and safety data are available. Larger well-designed randomized controlled trials are needed to further explore this therapy.
Collapse
Affiliation(s)
- S Saha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - R Tariq
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - P K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - D S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
45
|
Khanna S, Gan G, Gupta K, Khan W, Bhat A, Chen H, Tan T. Characterisation of Right Ventricular Size and Systolic Function in a Cohort of Myocarditis Patients with Normal LVEF. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Khanna S, Gan G, Gupta K, Khan W, Tan W, Chen H, Bhat A, Tan T. Characterisation of Left Ventricular Shape Change as Defined by Sphericity Index in Patients with Acute Phase Takotsubo Cardiomyopathy and Anterior STEMI Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.250] [Citation(s) in RCA: 1] [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: 11/24/2022]
|
47
|
Ravindran J, Talisayon R, Bhat A, Khanna S, Garikapati K, Chen H, Tsihlis G, Latumahina A, Hall G, Gan G, Changsiri B, Burgess D. Acute Coronary Syndromes (ACS) in Western Sydney: 1-year follow-up of ACS patients at Blacktown Hospital. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
48
|
Khanna S. Ridinilazole. Antibacterial drug, Treatment of Clostridioides difficile infection. DRUG FUTURE 2019. [DOI: 10.1358/dof.2019.44.5.2978058] [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: 10/26/2022]
|
49
|
Chen H, Bhat A, Makarious D, Ng C, Khanna S, Gan G, Tan T. Characterisation of Right Heart Function in Patients with Non-Ischaemic Cardiomyopathy. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.251] [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: 11/26/2022]
|
50
|
Chen H, Chiang B, Bhat A, Khanna S, Kayes T, Gan G, Tan T. Changes in Left Ventricular Structure and Function with Increasing Body Mass Index. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.248] [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: 10/26/2022]
|