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Belair JA, Jung J, Desai V, Morrison WB, DeLuca PF, Zoga AC. Bone bruise vs. non-displaced fracture on MRI: a novel grading system for predicting return-to-play. Skeletal Radiol 2024; 53:947-955. [PMID: 37993556 DOI: 10.1007/s00256-023-04504-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To devise an MRI grading scheme for osseous contusion patterns in elite hockey players for predicting return-to-play (RTP). METHODS A retrospective review was performed to identify traumatic lower extremity osseous injuries in professional hockey players. A total of 28 injuries (17 players) were identified over a 10-year period. All had MRIs acquired at ≥ 1.5 T within a mean interval of 2 days from initial injury. MRIs were retrospectively reviewed by 3 musculoskeletal radiologists for osseous contusion pattern, classified as grade 1 (mild), 2 (moderate), or 3 (severe). Grade 3 contusions were further subdivided by the presence or absence of fracture, defined as discrete cortical disruption on MRI or follow-up CT. RTP was calculated from date of injury to next game played based on game log data. Statistical analysis was performed using ANOVA and post hoc unpaired t test. RESULTS Mean RTP for grade 1, 2, and 3 injuries was 2.8, 4.5, and 20.3 days, respectively. Grade 3 injuries without and with cortical fractures had mean RTP of 18.3 and 21.4 days, respectively. ANOVA analysis between groups achieved statistical significance (p < 0.001). Post hoc t test demonstrated statistically significant differences between grade 3 and grades 1 (p < 0.001) and 2 (p < 0.001) injuries. There was no statistical difference in RTP between grade 3 subgroups without and with fracture (p = 0.327). CONCLUSION We propose a novel MRI grading system for assessing severity of osseous contusions and predicting RTP. Clinically, there was no statistically significant difference in RTP between severe osseous contusions and nondisplaced fractures in elite hockey players.
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Affiliation(s)
- Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA.
| | - Jin Jung
- Larchmont Medical Imaging, Mt Laurel Township, NJ, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - William B Morrison
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | | | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
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Gulati A, Kamel SI, Desai V, Belair JA. Presence of subchondral fracture in cases diagnosed as transient osteoporosis of the hip: a retrospective independent reader-based study. Skeletal Radiol 2024; 53:871-879. [PMID: 37932432 DOI: 10.1007/s00256-023-04500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Transient osteoporosis of the hip (TOH) is an uncommon, typically self-limited diagnosis of uncertain etiology. We hypothesize that TOH represents an underlying subchondral fracture, and a discrete fracture line can often be detected on high-resolution MRI. MATERIALS AND METHODS A retrospective PACS query identified patients meeting imaging criteria for TOH with intense bone marrow edema (BME) in the femoral head on MRI. Those with poor quality studies, other underlying pathologies, or antecedent trauma were excluded. Three musculoskeletal radiologists independently reviewed each case for presence of a definite subchondral fracture line on small field of view (FOV) MR images of the affected hip. Extent of BME, reciprocal acetabular BME, and joint effusion size were also recorded. Binomial logistic regression was performed to determine statistically significant predictors of subchondral fracture. RESULTS Fifty patients met inclusion criteria (29 females, 0 pregnant). Mean age was 62±12 years (range 35-84). Average duration of symptoms before MRI was 102±135 days. Ten patients had bone densitometry within 2 years of MRI, six demonstrating osteopenia or osteoporosis. Subchondral fractures were unanimously identified in 44/50 (88%). Interclass correlation coefficient with absolute agreement was 0.73, 95% CI (0.57-0.84), indicating near-excellent agreement. Most cases demonstrated a large joint effusion (23/50, 46%) and acetabular BME (31/50, 62%). Increasing size of joint effusion was a statistically significant predictor of subchondral fracture (p=0.05), with 6.9 higher odds. There was a strong correlation with osteopenia/osteoporosis and fracture (p<0.001). CONCLUSION Discrete subchondral fractures were identified unanimously on small FOV imaging in the majority of TOH cases.
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Affiliation(s)
- Aishwarya Gulati
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street Suite 1085, Philadelphia, PA, 19107, USA.
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Gulati A, Desai V. Return to Play in the Professional Athlete. Semin Musculoskelet Radiol 2024; 28:107-118. [PMID: 38484763 DOI: 10.1055/s-0043-1778028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The management of any injury in elite athletes poses unique challenges distinct from the general population because the goal is rapid recovery and return to play (RTP) while simultaneously managing residual symptoms and minimizing risk of reinjury. The time required for treatment, recovery, and return to peak performance can have consequences for both the athlete and his or her team: financial implications, psychological stressors, team dynamics, and future performance. RTP after an injury in the professional athlete requires a complex decision-making process with many stakeholders. Several factors influence this decision, not the least of which is the type and mechanism of injury. This article provides an overview of the RTP process including nonmedical factors that may influence this decision, common injuries seen in professional athletes, injury patterns particular to certain popular sports, and imaging guidelines for such injuries.
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Affiliation(s)
- Aishwarya Gulati
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Desai V. The Future of Artificial Intelligence in Sports Medicine and Return to Play. Semin Musculoskelet Radiol 2024; 28:203-212. [PMID: 38484772 DOI: 10.1055/s-0043-1778019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Artificial intelligence (AI) has shown tremendous growth over the last decade, with the more recent development of clinical applications in health care. The ability of AI to synthesize large amounts of complex data automatically allows health care providers to access previously unavailable metrics and thus enhance and personalize patient care. These innovations include AI-assisted diagnostic tools, prediction models for each treatment pathway, and various tools for workflow optimization. The extension of AI into sports medicine is still early, but numerous AI-driven algorithms, devices, and research initiatives have delved into predicting and preventing athlete injury, aiding in injury assessment, optimizing recovery plans, monitoring rehabilitation progress, and predicting return to play.
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Affiliation(s)
- Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Belair JA, Desai V. Return to Play in Sport: The Role of the Radiologist. Semin Musculoskelet Radiol 2024; 28:105-106. [PMID: 38484762 DOI: 10.1055/s-0043-1778079] [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: 03/19/2024]
Affiliation(s)
- Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Hoy MK, Desai V, Mutasa S, Hoy RC, Gorniak R, Belair JA. Deep Learning-Assisted Identification of Femoroacetabular Impingement (FAI) on Routine Pelvic Radiographs. J Imaging Inform Med 2024; 37:339-346. [PMID: 38343231 DOI: 10.1007/s10278-023-00920-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 03/02/2024]
Abstract
To use a novel deep learning system to localize the hip joints and detect findings of cam-type femoroacetabular impingement (FAI). A retrospective search of hip/pelvis radiographs obtained in patients to evaluate for FAI yielded 3050 total studies. Each hip was classified separately by the original interpreting radiologist in the following manner: 724 hips had severe cam-type FAI morphology, 962 moderate cam-type FAI morphology, 846 mild cam-type FAI morphology, and 518 hips were normal. The anteroposterior (AP) view from each study was anonymized and extracted. After localization of the hip joints by a novel convolutional neural network (CNN) based on the focal loss principle, a second CNN classified the images of the hip as cam positive, or no FAI. Accuracy was 74% for diagnosing normal vs. abnormal cam-type FAI morphology, with aggregate sensitivity and specificity of 0.821 and 0.669, respectively, at the chosen operating point. The aggregate AUC was 0.736. A deep learning system can be applied to detect FAI-related changes on single view pelvic radiographs. Deep learning is useful for quickly identifying and categorizing pathology on imaging, which may aid the interpreting radiologist.
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Affiliation(s)
| | - Vishal Desai
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert C Hoy
- Temple University Hospital, Philadelphia, PA, USA
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7
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Choi W, Nourzadeh H, Chen Y, Ainsley C, Desai V, Kubli A, Vinogradskiy Y, Mooney K, Werner-Wasik M, Mueller A. Novel Deep Learning Segmentation Models for Accurate GTV and OAR Segmentation in MR-Guided Adaptive Radiotherapy for Pancreatic Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e462. [PMID: 37785478 DOI: 10.1016/j.ijrobp.2023.06.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided adaptive radiotherapy (MRgART) improves target coverage and organ-at-risk (OAR) sparing in pancreatic cancer radiation therapy (RT). Inter-fractional changes in patients undergoing RT require time intensive re-delineation of gross tumor volume (GTV) and OARs prior to adaptive optimization. Accurate automatic segmentation has the potential to significantly improve efficiency of the adaptive workflow. We hypothesized that state-of-the-art deep learning (DL) segmentation models could adequately segment GTV and OARs in both planning and daily fractional MR scans. MATERIALS/METHODS The study included 21 patients with pancreatic cancer treated with MRgART (10 Gy x 5 fractions). The planning MR as well as all daily MR images and registrations were collected (6 image sets per patient and a total of 126 image sets). The planning MR and fraction 1-4 image sets were used as the training set (N = 105), while the test set (N = 21) comprised images for fraction 5, to simulate the last step of incremental learning from planning to final fraction. Evaluated contours included the GTV, Small Bowel, Large Bowel, Duodenum, Left and Right Kidney, Liver, Spinal Cord, and Stomach. To mimic clinical conditions, contour accuracy was evaluated within the ring structure surrounding the PTV, inside of which daily adaptive re-contouring is applied (2 cm expansion in the cradio-caudal direction, 3 cm expansion otherwise). We evaluated three DL model architectures: SegResNet, SegResNet 2D, and SwinUNETR to autosegment GTV and OARs. The segmentation models were trained on the training set using 5-fold cross-validation (CV) and quantitatively analyzed by comparing against clinically used contours with DICE scores. Qualitative analysis was performed by a radiation oncologist using a scoring scale: 1 = perfect, 2 = minor discrepancy, 3 = moderate discrepancy, and 4 = rejected. RESULTS Overall, the DL segmentations were in acceptable agreement with clinical contours. The best performing model was the SwinUNETR model with overall training DICE = 0.88±0.06, test DICE = 0.78±0.11, and qualitative score of 1.6±0.8. The agreement between the DL model and clinical segmentation for the GTV was 0.79±0.08, with a qualitative score of 2.2±0.9. The highest and lowest OAR DICE scores were for the Left Kidney (DICE = 0.93) and Small Bowel (DICE = 0.68), respectively. The highest qualitative OAR scores were for the Kidney, Liver, and Spinal Cord (score = 1.0) and the lowest qualitative score was for the Duodenum (score = 2.3) CONCLUSION: We report here the most comprehensive work on DL segmentation for pancreatic cancer MRgART, including quantitative and clinically-pertinent qualitative evaluations of 126 image sets and 3 DL architectures. Our data show good quantitative agreement between DL and clinical contours, and acceptable clinician evaluations for the majority of GTVs and OARs. The current work has great potential to significantly reduce a major bottleneck in the MRgART workflow for pancreatic cancer patients.
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Affiliation(s)
- W Choi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - H Nourzadeh
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - C Ainsley
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - V Desai
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - A Kubli
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Vinogradskiy
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - K Mooney
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - M Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Desai V, Mutsaers A, Fu R, Khoury M, Khalil C, Leventis P, Eskander A, Husain ZA. Surgeon, Pathologist and Pathology Technician Effects on Nodal Yield after a Neck Dissection. Int J Radiat Oncol Biol Phys 2023; 117:e590-e591. [PMID: 37785787 DOI: 10.1016/j.ijrobp.2023.06.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A minimum nodal count of 18 lymph nodes has been associated with improved survival after neck dissection and has been suggested as a head and neck cancer quality metric. Despite its critical importance, factors affecting nodal yield are poorly studied. In particular, the relative contribution of surgeons, pathologists, and pathology technicians has not been evaluated. The purpose of this study was to understand both patient and provider related factors that affect nodal yield after neck dissection for patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS/METHODS This retrospective cohort study involved review of all adult patients with OCSCC undergoing primary neck dissection between 2000-2020 at an academic medical center. The outcome of interest was a continuous variable denoting the number of nodes removed per side during neck surgery. Surgeon and pathologist year of experience were calculated and represented in quartiles. A multilevel multivariable linear regression model was used to assess the association of surgeon/pathologist experience quartiles with nodal yield, controlling for patient age, comorbidity index, previous cancer, tumor grade, and clinical nodal status. RESULTS The 508 patients included in our cohort were treated by 5 surgeons and 6 pathologists and involved 44 pathology technicians. Of these patients, 310 (61.0%) were male with a mean age of 63. Oral tongue primary tumors were 46.7% of the cohort, while 64.4% of patients had cT1-T2 tumors, and 65.2% were cN0. The mean nodal yield was 24.2 nodes. The ANOVA analysis revealed significant difference in mean nodal yield by surgeon (p-value = 0.03), pathologist (p-value<0.01) and pathology technician (p-value = 0.037). After accounting for patient-level characteristics and patient clustering by surgeon, increasing surgeon experience was found to be significantly associated with a higher nodal yield (joint significance of surgeon years of experience quartiles < 0.01). Specifically, when compared to surgeons with the least experience (1st quartile), those whose years of experience fell into the 2nd, 3rd, and 4th quartile removed 4.69 (95% CI: 0.97 to 7.92), 4.47 (95% CI: 0.33 to 7.87), and 7.37 (95% CI: 0.73 to 11.27) more lymph nodes. Meanwhile, there was no association between pathologist experience and nodal yield (joint significance of pathologist years of experience quartiles = 0.27). Additionally, previous cancer diagnosis and cN0 disease were significantly associated with lower nodal yield (all p-values = 0.02). CONCLUSION This study demonstrates an independent association between increasing surgeon experience and higher nodal yields. Importantly, it also demonstrates that pathologists and pathology technicians contribute to the variation in nodal yield, and their contribution should not be overlooked in the implementation of a lymph node yield-based quality metric.
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Affiliation(s)
- V Desai
- Queens University School of Medicine, Kingston, ON, Canada
| | - A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - R Fu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Khoury
- University of Toronto School of Medicine, Toronto, ON, Canada
| | - C Khalil
- University of Toronto School of Medicine, Toronto, ON, Canada
| | - P Leventis
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Eskander
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Z A Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Southern California Permanente Medical Group, Los Angeles, CA
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9
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Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
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Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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Alexander J, Desai V, Denden S, Alianello N. Assessment of a Novel Augmented Closure Technique for Surgical Wounds Associated with Transmetatarsal Amputation: A Preliminary Study. J Am Podiatr Med Assoc 2022; 112:20-256. [PMID: 36251595 DOI: 10.7547/20-256] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transmetatarsal amputation (TMA) is a viable option to avoid major amputation and limb loss in patients with forefoot sepsis, infection, or tissue loss. However, TMAs are associated with a significant incidence of dehiscence, readmission, and reoperation rates ranging from 26% to 63%. To encourage tissue healing, neovascularization, and durable closure, a nonwoven, resorbable, synthetic hybrid-scale fiber matrix whose architecture is similar to native human extracellular matrix was used in an augmented closure technique. We comparatively evaluated clinical outcomes and complication rates in TMA procedures with and without augmented closure. METHODS A retrospective analysis of ten patients who underwent TMA with augmented closure using the synthetic matrix and ten patients who underwent TMA with standard primary closure was conducted. RESULTS After TMA, 80% of the patients who underwent augmented closure demonstrated complete wound healing compared with 60% of the control group. Patients undergoing augmented closure demonstrated five instances of wound dehiscence and 20% limb loss compared with eight instances of wound dehiscence and 40% limb loss in the control group. After TMA and augmented closure, patients required eight interventional procedures before complete healing compared with patients undergoing standard closure, who required 13 interventional procedures before complete healing. CONCLUSIONS Augmented closure of surgical wounds after TMA using a synthetic hybrid-scale fiber matrix provided a unique means of reducing time to healing (18%), wound dehiscence (29%), number of procedures performed (39%), and rate of limb loss (20%). Augmented closure, therefore, offers a means of improving quality of life and reducing risk for patients undergoing TMA, and potentially reducing total cost of care.
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Affiliation(s)
- Jeffery Alexander
- *Podiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL
| | - Vishal Desai
- *Podiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL
| | - Sharif Denden
- *Podiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL
| | - Nicholas Alianello
- *Podiatry Section, Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL
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Santos-Vega M, Martinez PP, Vaishnav KG, Kohli V, Desai V, Bouma MJ, Pascual M. The neglected role of relative humidity in the interannual variability of urban malaria in Indian cities. Nat Commun 2022; 13:533. [PMID: 35087036 PMCID: PMC8795427 DOI: 10.1038/s41467-022-28145-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/03/2022] [Indexed: 11/09/2022] Open
Abstract
The rapid pace of urbanization makes it imperative that we better understand the influence of climate forcing on urban malaria transmission. Despite extensive study of temperature effects in vector-borne infections in general, consideration of relative humidity remains limited. With process-based dynamical models informed by almost two decades of monthly surveillance data, we address the role of relative humidity in the interannual variability of epidemic malaria in two semi-arid cities of India. We show a strong and significant effect of humidity during the pre-transmission season on malaria burden in coastal Surat and more arid inland Ahmedabad. Simulations of the climate-driven transmission model with the MLE (Maximum Likelihood Estimates) of the parameters retrospectively capture the observed variability of disease incidence, and also prospectively predict that of 'out-of-fit' cases in more recent years, with high accuracy. Our findings indicate that relative humidity is a critical factor in the spread of urban malaria and potentially other vector-borne epidemics, and that climate change and lack of hydrological planning in cities might jeopardize malaria elimination efforts.
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Affiliation(s)
- M Santos-Vega
- Department of Ecology and Evolution, University of Chicago, Chicago, USA
- Departamento de Ingeniería Biomédica, Grupo de Investigación en Biología Matemática y Computacional BIOMAC, Universidad de los Andes, Bogotá, Colombia
| | - P P Martinez
- Department of Microbiology and Department of Statistics, University of Illinois at Urbana, Champaign, Champaign, IL, USA
| | - K G Vaishnav
- Vector Borne Diseases Control Department, Health Department, Surat Municipal Corporation, Surat, India
| | - V Kohli
- Ahmedabad Municipal Corporation, Ahmedabad, India
| | - V Desai
- Urban Health and Climate Resilience Center of Excellence, (UHCRCE), Surat, India
| | | | - M Pascual
- Department of Ecology and Evolution, University of Chicago, Chicago, USA.
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12
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Ghany JF, Kamel S, Zoga A, Farrell T, Morrison W, Belair J, Desai V. Extensor mechanism tendinopathy in patients with lateral patellar maltracking. Skeletal Radiol 2021; 50:2205-2212. [PMID: 33876276 DOI: 10.1007/s00256-021-03787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. MATERIALS AND METHODS Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. RESULTS The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2 years versus 48.2 years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49 mm versus 14.99 mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4 mm versus 15.4 mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). CONCLUSION Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.
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Affiliation(s)
- Jehan F Ghany
- Musculoskeletal Radiology, Department of Radiology, The Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Sarah Kamel
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Adam Zoga
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Terence Farrell
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - William Morrison
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Jeffrey Belair
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Musculoskeletal Imaging, Department of Radiology, Thomas Jefferson University Hospital, 1087 Main Building, 132 S. 10th Street, Philadelphia, PA, 19107, USA
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13
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Kamel SI, Kanesa-Thasan RM, Dave JK, Zoga AC, Morrison W, Belair J, Desai V. Prevalence of lateral patellofemoral maltracking and associated complications in patients with Osgood Schlatter disease. Skeletal Radiol 2021; 50:1399-1409. [PMID: 33404668 DOI: 10.1007/s00256-020-03684-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate adults with history of Osgood Schlatter disease (OSD) for imaging features of lateral patellofemoral maltracking. METHODS In a span of four years, 10,181 unique non-contrast knee MRIs were performed on patients aged 20-50. Patients with acute trauma, prior surgery, and synovial pathologies were excluded. 171 exams had imaging findings of OSD, and an age-matched control group of 342 patients without OSD was randomly selected. Two radiologists retrospectively reviewed MRIs for features of lateral patellofemoral maltracking. Maltracking was defined as edema in superolateral Hoffa's fat or a tibial tuberosity-trochlear groove (TT-TG) distance ≥20 mm with either patellar tilt/translation. Binomial logistic regression identified predictors of maltracking in OSD. Optimal TT-TG distance to indicate maltracking was determined by receiver operating characteristic curve. RESULTS 59% (101/171) of the knees with OSD showed findings of maltracking, with patella alta, trochlear dysplasia, and quadriceps tendinosis as significant predictors of maltracking (p < 0.001). Patellofemoral chondrosis was present in 63% (107/171), with maltracking contributing to higher grade chondrosis more so than increasing age (OR 8.4 versus 1.07). 13 mm was the optimal cut-off TT-TG distance to indicate maltracking (sensitivity 83%, specificity 80%). The prevalence of maltracking in the control group was 15% (p < 0.001 compared with the OSD group). CONCLUSION Adults with sequelae of OSD are at high risk of maltracking and are likely to develop patellofemoral chondrosis. A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk. Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention.
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Affiliation(s)
- Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Riti M Kanesa-Thasan
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - William Morrison
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jeffrey Belair
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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14
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Ho M, Park BY, Rosenblum NG, Al Mukaddam M, Kaplan FS, Kucherov V, Hubosky SG, Kane G, Desai V, Kramer MR, Ku BS, Schwenk ES, Baratta JL, Harshavardhana D, Grunwald Z. Surgical and Radiological Management of Complicated Uterine Leiomyoma Aided by 3D Models in a Patient with Fibrodysplasia Ossificans Progressiva. Am J Case Rep 2021; 22:e931614. [PMID: 34108438 PMCID: PMC8207543 DOI: 10.12659/ajcr.931614] [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: 11/30/2022]
Abstract
Patient: Female, 27-year-old Final Diagnosis: Fibrodysplasia ossificans progressiva Symptoms: Fever Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Obstetrics and Gynecology
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Affiliation(s)
- Michelle Ho
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA
| | - Beau Y Park
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Norman G Rosenblum
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mona Al Mukaddam
- Departments of Medicine and Orthopedic Surgery, Center for Research in FOP and Related Disorders, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frederick S Kaplan
- Departments of Medicine and Orthopedic Surgery, Center for Research in FOP and Related Disorders, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Kucherov
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott G Hubosky
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory Kane
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael R Kramer
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bon S Ku
- Health Design Lab, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Deepti Harshavardhana
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zvi Grunwald
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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15
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Scott ER, Morano S, Quinn A, Mann E, Ho M, Karp A, Boyd K, Singh A, Chandrasekar T, Mann MJ, Trabulsi EJ, Desai V, Lallas CD. The use of 3D printed models on trainee and patient experience for partial nephrectomies. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
363 Background: 3D printing is a growing tool in surgical education due to the ability to visualize organs, tissue, and masses from multiple angles before operating on a patient. Previous studies using highly detailed and expensive 3D models costing between $1,000-250 per model have been shown to enhance patient and trainee comprehension of tumor characteristics, goals of surgery, and planned surgical procedure for partial nephrectomies. In our study we aim to use simpler and less expensive models in a greater range of patients receiving partial nephrectomies to determine the use of 3D models in patient, resident, and fellow education. Methods: 3D models of the effected kidney, mass, renal artery, and renal vein were created using preoperative imaging of undergoing partial nephrectomies at Thomas Jefferson University Hospital (TJUH) costing $35 per model. Residents and fellows filled out 3 surveys assessing their surgical plan and their confidence in the chosen plan at 3 time points: 1) Before seeing the model, 2) After seeing the model before surgery, and 3) After surgery. Ten patients filled out 2 surveys about their understanding of the kidney, their disease, the surgery they will undergo, and the risks involved with surgery before and after seeing the model. Results: Based on surveys to assess for surgical plan and confidence given to resident and fellow surgeons before and after seeing the 3D model, confidence significantly increased. Surveys given after surgery assessing anatomic and surgical comprehension found that resident and fellow surgeons rated the helpfulness of the models on their anatomical comprehension 7.6 out of 10 and the help of the models on their surgical confidence 7 out of 10. Patient understanding of their kidney, disease, and surgery significantly increased after seeing the 3D model, but the risks associated with surgery did not significantly increase. The extent that the model helped the patients learn about the kidney, their disease, the surgery, and the risks related to surgery were rated an average of 8.33, 9.67, 9.5, and 8.83 out of 10, respectively. Conclusions: Patient-specific 3D models for partial nephrectomies increase resident and fellow confidence in surgical approach and helped patients learn about their disease and feel comfortable going into surgery. Thus, it is important to continue to explore 3D models as an educational tool for both trainees and patients and potentially include 3D models as part of the standard of care. Further research could continue to explore the utility of 3D models as a pre-operative educational tool for both patients and trainees in other surgical fields.
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Affiliation(s)
- E. Reilly Scott
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Samuel Morano
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Andrea Quinn
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Erica Mann
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Michelle Ho
- Jefferson Health Design Lab, Philadelphia, PA
| | - Alice Karp
- Jefferson Health Design Lab, Philadelphia, PA
| | | | - Abhay Singh
- Thomas Jefferson University Hospital, Department of Urology, Philadelphia, PA
| | | | | | - Edouard John Trabulsi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Vishal Desai
- Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA
| | - Costas D. Lallas
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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16
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Kamel SI, Belair JA, Hegazi TM, Halpern EJ, Desai V, Morrison WB, Zoga AC. Painful type II os naviculare: introduction of a standardized, reproducible classification system. Skeletal Radiol 2020; 49:1977-1985. [PMID: 32556471 DOI: 10.1007/s00256-020-03503-y] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide a novel MRI classification system for the symptomatic type II os naviculare by creating a standardized grading of associated bone marrow edema (BME) and correlating with patient symptoms. METHODS BME was classified on an ordinal scale: grade 1, faint signal immediately adjacent to the synchondrosis; grade 2, intermediate signal within the os and navicular tuberosity without extending to the navicular body; grade 3, intense signal extending to the navicular body. BME on 59 MRIs was independently graded by three radiologists. Inter- and intra-observer agreement was analyzed using intraclass correlation coefficient. Univariate and multivariate analyses assessed for patient and imaging characteristics predictive of subjective pain score. A cohort of 82 patients without BME represented a control group. RESULTS Inter-observer agreement of BME grade was 0.95 (CI 0.93-0.97) and intra-observer was 0.92 (CI 0.87-0.96), indicating excellent agreement. In patients with BME, predictors of more severe pain were longer duration of pain (p = 0.02) and presence of soft tissue edema overlying the os naviculare (p < 0.001). One hundred percent of subjects with BME localized their pain to the medial midfoot (59/59) versus 25.6% (21/82) of controls (p < 0.001). CONCLUSIONS This novel grading system provides reliable quantification of BME associated with os naviculare, which is a specific cause of medial foot/ankle pain. Early diagnosis is important as pain severity worsens with longer duration of symptoms. Pain severity is correlated with soft tissue edema overlying the os, which may be secondary to extrinsic compression, reactive to biomechanical stress, or reflect direct trauma.
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Affiliation(s)
- Sarah I Kamel
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA
| | - Jeffrey A Belair
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA.
| | - Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia
| | - Ethan J Halpern
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA
| | - Vishal Desai
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA
| | - William B Morrison
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA
| | - Adam C Zoga
- Department of Musculoskeletal Radiology, Thomas Jefferson University Hospital, Main Building 1090, Philadelphia, PA, 19107, USA
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17
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Kamel SI, Zoga AC, Randolph F, Rao VM, Desai V. Impact of the Closure of a Large, Urban Safety-Net Hospital on a Neighboring Academic Center: A Philadelphia Case Study. J Am Coll Radiol 2020; 17:1123-1129. [DOI: 10.1016/j.jacr.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/30/2022]
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18
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Desai V, Patel K, Sheth R, Barlass U, Chan YM, Sclamberg J, Bishehsari F. Pancreatic Fat Infiltration Is Associated with a Higher Risk of Pancreatic Ductal Adenocarcinoma. Visc Med 2020; 36:220-226. [PMID: 32775353 DOI: 10.1159/000507457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has a poor survival rate, partly due to delayed diagnosis. Identifying high-risk individuals could lead to early detection and improve survival. A number of risk factors such as alcohol consumption and metabolic syndrome are associated with fatty infiltration of the pancreas. Experimental models show that a fatty pancreas promotes tissue inflammation and fibrosis, which could promote PDAC. Methods We conducted a case-control study in a single-university tertiary hospital. Sixty-eight PDAC cases with recent non-contrast computed tomography (CT) and 235 controls were studied. The controls had no history of malignancy and underwent CT colonography for cancer screening in the same period. Pancreatic fat was estimated by calculating pancreatic (P) attenuation, corrected to splenic (S) attenuation, measured in three 1.0-cm2 regions of the pancreas. The P.S100 value calculated was used to estimate fatty infiltration of the pancreas (FIP), with a lower P.S100 representing a higher FIP. Results The PDAC patients had a lower BMI and a higher rate of type 2 diabetes mellitus. The P.S100 was lower in cases than in controls (86.452 vs. 92.414, p = 4.016e-06), suggesting that FIP is higher with PDAC. The risk of developing PDAC steadily increased significantly for the quartiles with a higher FIP compared to the low FIP quartile. No correlation between BMI and FIP (r = -0.1031179; 95% confidence interval [CI] -0.22267106 to 0.01949092) was found. Adjusting for confounders (age, sex, BMI, and DM), the risk of developing PDAC according to the FIP was estimated to be 3.75 (95% CI 1.9234408-7.993337; p = 0.000171). FIP was stable before and after the diagnosis of PDAC in 9 cases with prior CT scans when no pancreatic tumor was identifiable. Conclusion Fatty pancreas is associated with an increased risk of pancreatic cancer. Once confirmed in larger-scale studies, these findings could help to identify at-risk individuals, particularly in high-risk groups such as chronic alcohol consumers.
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Affiliation(s)
- Vishal Desai
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin Patel
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ravi Sheth
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Usman Barlass
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Yuet-Ming Chan
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Joy Sclamberg
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Faraz Bishehsari
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
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19
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Ghany J, Desai V, Morrison W. Advanced MRI Techniques for Assessing Marrow Abnormalities of the Spine. Instr Course Lect 2020; 69:625-640. [PMID: 32017756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
It is important to review the physics of current MRI developments in nontraumatic spinal imaging and their specific applications for assessing the bone marrow. Techniques include chemical shift imaging and its use in differentiating aggressive from benign lesions and in confirming the presence of diffuse red marrow conversion, which may mimic diffuse marrow infiltration in metastatic disease. The principles of dynamic contrast MRI and its uses in multiple myeloma and discriminating between postoperative change/scarring versus recurrence in soft-tissue tumors warrant discussion. The basic physics of diffusion-weighted imaging (DWI) in bone marrow pathologies are distinguished from the principles of DWI as applied to solid organs, and DWI is used in the staging of multiple myeloma and in differentiating between benign versus malignant compressive vertebral fractures. The orthopaedic surgeon should be knowledgeable about whole-body MRI principles and its uses in staging multiple myeloma and sarcoma. Knowledge about PET-MRI principles and its limitations as well as its potential use in assessing the subchondral bone plate and bony remodeling is also important. This technique may play a role in the future for predicting progression to osteoarthritis.
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20
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Vardy MD, Vardy AS, Desai V. Endosee for Office Cystoscopy: A Single Site Experience. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.512] [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: 10/25/2022]
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21
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Camp CL, Desai V, Conte S, Ahmad CS, Ciccotti M, Dines JS, Altchek DW, D'Angelo J, Griffith TB. Revision Ulnar Collateral Ligament Reconstruction in Professional Baseball: Current Trends, Surgical Techniques, and Outcomes. Orthop J Sports Med 2019; 7:2325967119864104. [PMID: 31453203 PMCID: PMC6696849 DOI: 10.1177/2325967119864104] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Ulnar collateral ligament (UCL) reconstruction of the elbow is commonly performed on professional baseball pitchers. Recent reports have suggested that revision rates are on the rise and may be higher than previously thought. Purpose: To provide a comprehensive report on current trends, surgical techniques, and outcomes of revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Study Design: Case series; Level of evidence, 4. Methods: The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all revision UCL reconstructions performed on professional baseball pitchers between 2010 and 2016. Player data and outcomes were obtained from HITS, and surgical details were obtained from operative reports. Descriptive statistical analysis was performed on epidemiologic data. Outcomes (return to play [RTP] rates, RTP times, subsequent injuries, and subsequent surgeries) were compared across the most common surgical techniques (docking vs modified Jobe) and graft sources (palmaris longus autograft vs hamstring autograft). Results: A total of 69 professional baseball pitchers underwent revision UCL reconstruction from 2010 to 2016 at an average of 1424 days (47 months) after their primary surgery. A trend was seen toward increasing numbers of revision surgeries over time (R2 = 0.441; P = .104). The most commonly used tunnel configuration was the modified Jobe technique (n = 41; 59.4%), and the most commonly used graft was hamstring autograft (n = 34; 49.3%). A majority (76.6%) of pitchers achieved RTP, and 55.3% were able to return to the same level of play. Mean time to RTP was 436 days (14.5 months) for players with a palmaris longus autograft versus 540 days (18 months) for those with a hamstring autograft (P = .108). Further, the mean time to RTP was 423 days (14 months) for the docking technique versus 519 days (17 months) for the modified Jobe technique (P = .296). Similar rates of subsequent injuries and surgeries were noted between the 2 revision techniques and 2 most commonly used graft constructs. Conclusion: Revision UCL reconstruction showed relatively high RTP rates (77%), but only 55% of players returned to their same level of play. Mean time to RTP was shorter than that found in other, smaller investigations. Although general trends were seen toward decreased time to RTP for the docking technique and palmaris longus autograft, these differences did not reach statistical significance.
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Affiliation(s)
- Christopher L Camp
- Sports Medicine Center, Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
| | - Vishal Desai
- Sports Medicine Center, Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
| | - Stan Conte
- Conte Injury Analytics, San Carlos, California, USA
| | - Christopher S Ahmad
- Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
| | | | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - David W Altchek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - John D'Angelo
- Office of the Commissioner, Major League Baseball, New York, New York, USA
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22
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Berger D, Desai V, Janardhan S. Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2019; 13:114-116. [PMID: 31061705 PMCID: PMC6491029 DOI: 10.1002/cld.740] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/20/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Daniel Berger
- Rush University Medical Center, Section of HepatologyChicagoIL
| | - Vishal Desai
- Rush University Medical Center, Section of HepatologyChicagoIL
| | - Sujit Janardhan
- Rush University Medical Center, Section of HepatologyChicagoIL
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Abstract
Although advancements in the last decade have automated much of the radiology workflow, there are several areas in the complex imaging process where standardization and innovation can be implemented. We discuss multiple tools and integrations that can help improve operational efficiency, quality, and safety.
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Affiliation(s)
- Vishal Desai
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Flanders
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam C Zoga
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
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24
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Desai V, Cox M, Deshmukh S, Roth CG. Contrast-enhanced or noncontrast CT for renal colic: utilizing urinalysis and patient history of urolithiasis to decide. Emerg Radiol 2018; 25:455-460. [DOI: 10.1007/s10140-018-1604-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/29/2018] [Indexed: 11/29/2022]
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25
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Bishehsari F, Magno E, Swanson G, Desai V, Voigt RM, Forsyth CB, Keshavarzian A. Alcohol and Gut-Derived Inflammation. Alcohol Res 2017; 38:163-171. [PMID: 28988571 PMCID: PMC5513683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In large amounts, alcohol and its metabolites can overwhelm the gastrointestinal tract (GI) and liver and lead to damage both within the GI and in other organs. Specifically, alcohol and its metabolites promote intestinal inflammation through multiple pathways. That inflammatory response, in turn, exacerbates alcohol-induced organ damage, creating a vicious cycle and leading to additional deleterious effects of alcohol both locally and systemically. This review summarizes the mechanisms by which chronic alcohol intake leads to intestinal inflammation, including altering intestinal microbiota composition and function, increasing the permeability of the intestinal lining, and affecting the intestinal immune homeostasis. Understanding the mechanisms of alcohol-induced intestinal inflammation can aid in the discovery of therapeutic approaches to mitigate alcohol-induced organ dysfunctions.
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26
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Swanson GR, Gorenz A, Shaikh M, Desai V, Kaminsky T, Van Den Berg J, Murphy T, Raeisi S, Fogg L, Vitaterna MH, Forsyth C, Turek F, Burgess HJ, Keshavarzian A. Night workers with circadian misalignment are susceptible to alcohol-induced intestinal hyperpermeability with social drinking. Am J Physiol Gastrointest Liver Physiol 2016; 311:G192-201. [PMID: 27198191 PMCID: PMC4967173 DOI: 10.1152/ajpgi.00087.2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/14/2016] [Indexed: 01/31/2023]
Abstract
Alcohol-induced intestinal hyperpermeability (AIHP) is a known risk factor for alcoholic liver disease (ALD), but only 20-30% of heavy alcoholics develop AIHP and ALD. The hypothesis of this study is that circadian misalignment would promote AIHP. We studied two groups of healthy subjects on a stable work schedule for 3 mo [day workers (DW) and night workers (NW)]. Subjects underwent two circadian phase assessments with sugar challenge to access intestinal permeability between which they drank 0.5 g/kg alcohol daily for 7 days. Sleep architecture by actigraphy did not differ at baseline or after alcohol between either group. After alcohol, the dim light melatonin onset (DLMO) in the DW group did not change significantly, but in the NW group there was a significant 2-h phase delay. Both the NW and DW groups had no change in small bowel permeability with alcohol, but only in the NW group was there an increase in colonic and whole gut permeability. A lower area under the curve of melatonin inversely correlated with increased colonic permeability. Alcohol also altered peripheral clock gene amplitude of peripheral blood mononuclear cells in CLOCK, BMAL, PER1, CRY1, and CRY2 in both groups, and inflammatory markers lipopolysaccharide-binding protein, LPS, and IL-6 had an elevated mesor at baseline in NW vs. DW and became arrhythmic with alcohol consumption. Together, our data suggest that central circadian misalignment is a previously unappreciated risk factor for AIHP and that night workers may be at increased risk for developing liver injury with alcohol consumption.
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Affiliation(s)
- Garth R. Swanson
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Annika Gorenz
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Maliha Shaikh
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Vishal Desai
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Thomas Kaminsky
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Jolice Van Den Berg
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Terrence Murphy
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Shohreh Raeisi
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Louis Fogg
- 4ommunity, Systems and Mental Health Nursing, Rush University, Chicago, Illinois;
| | - Martha Hotz Vitaterna
- 2Department of Neurobiology, Center for Sleep and Circadian Biology, Northwestern University, Evanston, Illinois; ,3Northwestern University Feinberg School of Medicine, Chicago, Illinois;
| | - Christopher Forsyth
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Fred Turek
- 2Department of Neurobiology, Center for Sleep and Circadian Biology, Northwestern University, Evanston, Illinois; ,3Northwestern University Feinberg School of Medicine, Chicago, Illinois;
| | - Helen J. Burgess
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois; ,5Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois; and
| | - Ali Keshavarzian
- 1Department Digestive Diseases, Rush University Medical Center, Chicago, Illinois; ,6Departments of Pharmacology; Molecular Biophysics & Physiology, Rush University Medical Center, Chicago, Illinois
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Desai V, Labby Z, Culberson W. SU-F-T-312: Identifying Distinct Radiation Therapy Plan Classes Through Multi-Dimensional Analysis of Plan Complexity Metrics. Med Phys 2016. [DOI: 10.1118/1.4956497] [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: 11/07/2022] Open
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Kissick M, Campos D, Desai V, Che Fru L. WE-FG-BRA-03: Oxygen Interplay in Hypofractionated Radiotherapy: A Hidden Opportunity. Med Phys 2016. [DOI: 10.1118/1.4957903] [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: 11/07/2022] Open
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Patel M, Doherty M, Desai V, Gogda N, Nalamothu V. 539 Design of experiments approach using an in vitro skin model to evaluate irritancy of topical formulations. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andiman S, Desai V, Whitbread M, Rillstone H, Boyce J, Fan L. 14: Perioperative bundles and timely feedback for surgical site infection prevention in hysterectomy: An institutional experience. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cox M, Li Z, Desai V, Brown L, Deshmukh S, Roth CG, Needleman L. Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients. Emerg Radiol 2016; 23:155-60. [DOI: 10.1007/s10140-016-1376-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
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Lamont LS, Bobb J, Blissmer B, Desai V. Pretest variables that improve the predictive value of exercise testing in women. J Sports Med Phys Fitness 2015; 55:1578-1583. [PMID: 25373467] [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: 06/04/2023]
Abstract
AIM Graded exercise testing (GXT) is used in coronary artery disease (CAD) prevention and rehabilitation programs. In women, this test has a decreased accuracy and predictive value but there are few studies that examine the predictors of a verified positive test. The aim of this study was to determine those pretest variables that might enhance the predictive value of the GXT in women clients. METHODS Medical records of 1761 patients referred for GXT's over a 5 yr period of time were screened. Demographic, medical, and exercise test variables were analyzed. The GXT's of 403 women were available for inclusion and they were stratified into 3 groups: positive responders that were subsequently shown to have CAD (N.=28 verified positive [VP]), positive responders that were not shown to have CAD (N.=84 non-verified positive [NVP]) and negative GXT responders (N.=291). Both univariate and a multivariate step-wise regression statistics were performed on this data. RESULTS Pretest variables that differentiated between VP and NVP groups are: (an older age=65.8 vs. 60.2 yrs. P<0.05; a greater BMI=30.8 vs. 28.8 kg/m2; diabetes status or an elevated fasting glucose =107.4 vs. 95.2 mg/dL P<0.05; and the use of some cardiovascular medications. Our subsequent linear regression analysis emphasized that HDL cholesterol and beta blocker usage were the most predictive of a positive exercise test in this cohort. CONCLUSION The American Heart Association recommends GXT's in women with an intermediate pretest probability of CAD. But there are only two clinical variables available prior to testing to make this probability decision: age and quality of chest pain. This study outlined that other pre-exercise test variables such as: BMI, blood chemistry (glucose and lipoprotein levels) and the use of cardiovascular medications are useful in clinical decision making. These pre-exercise test variables improved the predictive value of the GXT's in our sample.
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Affiliation(s)
- L S Lamont
- Department of Kinesiology, University of Rhode Island, Kingston, USA -
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Melson J, Desai V, Greenspan M, Yau S, Abdalla M, Dhanekula R, Mobarhan S, Shapiro D, Losurdo J, Jakate S. Negative surveillance endoscopy occurs frequently in patients with short-segment non-dysplastic Barrett's esophagus. Dis Esophagus 2015; 28:660-5. [PMID: 24943293 DOI: 10.1111/dote.12250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Surveillance endoscopy of non-dysplastic Barrett's esophagus (NDBE) that fails to detect intestinal metaplasia (IM), or negative surveillance, is known to occur in clinical practice, although the frequency and possible outcomes in a large cohort in clinical practice is not well described. The goals of this study were to define frequency in which negative surveillance occurs and endoscopic outcomes in a screening cohort of short segment NDBE. A retrospective cohort (n = 184) of patients newly diagnosed with short segment NDBE at an outpatient academic tertiary care center between 2003 and 2011 were reviewed. Only those with one or more surveillance endoscopies were included to define a frequency of negative surveillance. Included patients were further assessed if they had two or more surveillance endoscopies and were classified into groups as sampling error or negative IM on consecutive surveillances based on the results of their surveillance endoscopies. The frequency of a negative surveillance endoscopy in all short-segment NDBE patients was 19.66% (92 endoscopic exams were negative for IM of 468 total surveillance exams). A negative surveillance endoscopy occurred in 40.76% (n = 75) patients. Sampling error occurred in 44.12% and negative IM on consecutive surveillance endoscopies in 55.88% of those with ≥ 2 surveillance endoscopies and an initially negative surveillance exam. The frequency of negative IM on consecutive surveillances was 19.00% of all patients who had two surveillance endoscopies. When the index diagnostic Barrett's esophagus segment length was < 1 cm, 32.14% (18/56) of all patients (with ≥ 2 surveillance endoscopies) had negative IM on consecutive surveillance endoscopies. Negative surveillance occurs frequently in short-segment NDBE. When an initial negative surveillance endoscopy occurs, it may be due to either a sampling error or lack of detectable IM on surveillance exam. When a <1 cm segment of NDBE is diagnosed, a significant proportion of patients may go on to have continuously undetected IM on consecutive surveillance endoscopic exams without intervention.
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Affiliation(s)
- J Melson
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - V Desai
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - M Greenspan
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - S Yau
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - M Abdalla
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - R Dhanekula
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - S Mobarhan
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - D Shapiro
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - J Losurdo
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - S Jakate
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
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Swanson GR, Gorenz A, Shaikh M, Desai V, Forsyth C, Fogg L, Burgess HJ, Keshavarzian A. Decreased melatonin secretion is associated with increased intestinal permeability and marker of endotoxemia in alcoholics. Am J Physiol Gastrointest Liver Physiol 2015; 308:G1004-11. [PMID: 25907689 PMCID: PMC4469868 DOI: 10.1152/ajpgi.00002.2015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/15/2015] [Indexed: 01/31/2023]
Abstract
Chronic heavy alcohol use is known to cause gut leakiness and alcoholic liver disease (ALD), but only 30% of heavy drinkers develop increased intestinal permeability and ALD. The hypothesis of this study was that disruption of circadian rhythms is a potential risk factor in actively drinking alcoholics for gut leakiness and endotoxemia. We studied 20 subjects with alcohol use disorder (AD) and 17 healthy controls (HC, 6 day workers, 11 night workers). Subjects wore a wrist actiwatch for 7 days and underwent a 24-h dim light phase assessment and urine collection for intestinal permeability. The AD group had significantly less total sleep time and increased fragmentation of sleep (P < 0.05). AD also had significantly lower plasma melatonin levels compared with the HC [mean area under the curve (AUC) 322.78 ± 228.21 vs. 568.75 ± 304.26 pg/ml, P = 0.03]. In the AD group, AUC of melatonin was inversely correlated with small bowel and colonic intestinal permeability (lactulose-to-mannitol ratio, r = -0.39, P = 0.03; urinary sucralose, r = -0.47, P = 0.01). Cosinor analysis of lipopolysaccharide-binding protein (marker of endotoxemia) and lipopolysaccharide every 4 h for 24 h in HC and AD subjects had a midline estimating statistic of rhythm of 5,026.15 ± 409.56 vs. 6,818.02 ± 628.78 ng/ml (P < 0.01) and 0.09 ± 0.03 vs. 0.15 ± 0.19 EU/ml (P < 0.05), respectively. We found plasma melatonin was significantly lower in the AD group, and lower melatonin levels correlated with increased intestinal permeability and a marker of endotoxemia. Our study suggests the suppression of melatonin in AD may promote gut leakiness and endotoxemia.
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Affiliation(s)
- Garth R. Swanson
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Annika Gorenz
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Maliha Shaikh
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Vishal Desai
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Christopher Forsyth
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois;
| | - Louis Fogg
- 4Community, Systems and Mental Health Nursing, Rush University, Chicago, Illinois
| | - Helen J. Burgess
- 2Departments of Behavioral Sciences and Internal Medicine, Rush University Medical Center, Chicago, Illinois;
| | - Ali Keshavarzian
- 1Department of Digestive Diseases, Rush University Medical Center, Chicago, Illinois; ,3Departments of Pharmacology, Molecular Biophysics & Physiology, Rush University Medical Center, Chicago, Illinois; and
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Wijesooriya K, Seitter K, Desai V, Dharia I, Read P, Larner J. SU-E-T-158: Catching Errors with Trajectory Log Files. Med Phys 2015. [DOI: 10.1118/1.4924520] [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: 11/07/2022] Open
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Desai V, Hammer C, Kunugi K, Culberson W, DeWerd L. SU-E-T-172: Characterization of TLD-100 (LiF:Mg,Ti) Microcube Energy Response in a Cylindrical Chamber Phantom. Med Phys 2015. [DOI: 10.1118/1.4924534] [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: 11/07/2022] Open
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Taneja S, Fru LC, Desai V, Lentz J, Lin C, Scarpelli M, Simiele E, Trestrail A, Bednarz B. SU-F-BRA-16: Development of a Radiation Monitoring Device Using a Low-Cost CCD Camera Following Radionuclide Therapy. Med Phys 2015. [DOI: 10.1118/1.4925227] [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: 11/07/2022] Open
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38
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Wijesooriya K, Seitter K, Desai V, Read P, Larner J. SU-E-T-248: Near Real-Time Analysis of Radiation Delivery and Imaging, Accuracy to Ensure Patient Safety. Med Phys 2014. [DOI: 10.1118/1.4888579] [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: 11/07/2022] Open
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Wood M, Desai V, Simiele E, Taneja S, DeWerd L. TU-F-BRE-06: Flattening-Filter-Free Beam Quality Correction Factor Determination Using Experimental and Monte Carlo Methods. Med Phys 2014. [DOI: 10.1118/1.4889314] [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: 11/07/2022] Open
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40
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Desai V, Fagerstrom J, Bayliss A, Kissick M. SU-E-J-81: Interplay Effect in Non-Gated Dynamic Treatment Delivery of a Lung Phantom with Simulated Respiratory Motion. Med Phys 2014. [DOI: 10.1118/1.4888133] [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: 11/07/2022] Open
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41
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Wijesooriya K, Desai V, Read P, Larner J. Comparison of 3D Dose Delivery Accuracy and Efficiency for VMAT Between 2 Linear Accelerators Using Linac Log Files. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1912] [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]
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Prabodh S, Prakash DSRS, Sudhakar G, Chowdary NVS, Desai V, Shekhar R. Status of copper and magnesium levels in diabetic nephropathy cases: a case-control study from South India. Biol Trace Elem Res 2011; 142:29-35. [PMID: 20552294 DOI: 10.1007/s12011-010-8750-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 06/07/2010] [Indexed: 12/23/2022]
Abstract
Diabetic nephropathy is a complication of diabetes mellitus. This present study investigates the status of copper and magnesium in diabetic nephropathy cases to establish a possible relation. Forty patients of diabetic nephropathy participated in the study as cases. Forty age- and sex-matched healthy individuals served as controls. Blood samples were collected from both cases and controls for determination of FBS, PPBS, HbA1c, microalbumin, copper, and magnesium levels. The mean concentrations of FBS, PPBS, HbA1c, and microalbumin of cases were significantly higher than that of controls. The mean magnesium levels of cases (1.60 ± 0.32 meq/L) were significantly lower than controls 2.14 ± 0.16 meq/L (p < 0.05). But the mean copper levels of cases, 165.42 ± 5.71 μg/dl, shows no significant difference with controls, 166.6 ± 5.48 μg/dl, (p > 0.05).The findings in the present study suggest that hypomagnesemia may be linked with development of diabetic nephropathy.
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Affiliation(s)
- S Prabodh
- Department of Biochemistry, NRI Medical College, General Hospital, Chinakakani, Guntur district, Andhra Pradesh, India
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Desai V, Donsante A, Swoboda KJ, Martensen M, Thompson J, Kaler SG. Favorably skewed X-inactivation accounts for neurological sparing in female carriers of Menkes disease. Clin Genet 2011; 79:176-82. [PMID: 20497190 DOI: 10.1111/j.1399-0004.2010.01451.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Classical Menkes disease is an X-linked recessive neurodegenerative disorder caused by mutations in ATP7A, which is located at Xq13.1-q21. ATP7A encodes a copper-transporting P-type ATPase and plays a critical role in development of the central nervous system. With rare exceptions involving sex chromosome aneuploidy or X-autosome translocations, female carriers of ATP7A mutations are asymptomatic except for subtle hair and skin abnormalities, although the mechanism for this neurological sparing has not been reported. We studied a three-generation family in which a severe ATP7A mutation, a 5.5-kb genomic deletion spanning exons 13 and 14, segregated. The deletion junction fragment was amplified from the proband by long-range polymerase chain reaction and sequenced to characterize the breakpoints. We screened at-risk females in the family for this junction fragment and analyzed their X-inactivation patterns using the human androgen-receptor (HUMARA) gene methylation assay. We detected the junction fragment in the proband, two obligate heterozygotes, and four of six at-risk females. Skewed inactivation of the X chromosome harboring the deletion was noted in all female carriers of the deletion (n = 6), whereas random X-inactivation was observed in all non-carriers (n = 2). Our results formally document one mechanism for neurological sparing in female carriers of ATP7A mutations. Based on review of X-inactivation patterns in female carriers of other X-linked recessive diseases, our findings imply that substantial expression of a mutant ATP7A at the expense of the normal allele could be associated with neurologic symptoms in female carriers of Menkes disease and its allelic variants, occipital horn syndrome, and ATP7A-related distal motor neuropathy.
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Affiliation(s)
- V Desai
- Unit on Human Copper Metabolism, Molecular Medicine Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1832, USA
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Wallqvist A, Zavaljevski N, Vijaya Satya R, Bondugula R, Desai V, Xin Hu, Kumar K, Lee M, Yeh IC, Chenggang Yu, Reifman J. Accelerating Biomedical Research in Designing Diagnostic Assays, Drugs, and Vaccines. Comput Sci Eng 2010. [DOI: 10.1109/mcse.2010.53] [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: 11/07/2022]
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Mital D, Desai V, Chin K. Kikuchi-Fujimoto syndrome presenting to a sexual health clinic. Int J STD AIDS 2009; 20:140-1. [PMID: 19182065 DOI: 10.1258/ijsa.2008.008291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report on a 37-year-old woman who presented with a six-week history of bilateral, tender lymph nodes in her groin. An initial biopsy was done with the histology 'suggestive of lymphogranuloma venereum (LGV)'. She had not had sexual intercourse for over two years and had no symptoms or signs of note to report. Examination revealed large, smooth tender lymph nodes above the inguinal ligament bilaterally with no other areas of lymphadenopathy. Due to a possible diagnosis of LGV, three weeks of doxycycline was given. A further review of the histology slides revealed 'subacute necrotizing lymphadenitis' highly suggestive of Kikuchi-Fujimoto syndrome of unknown cause, which is usually self-limiting. Subsequent follow-up of the patient revealed a reduction in the lymph nodes size with little tenderness.
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Affiliation(s)
- D Mital
- Sexual Health Department, Milton Keynes NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, UK.
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Tang J, Donsante A, Desai V, Patronas N, Kaler SG. Clinical outcomes in Menkes disease patients with a copper-responsive ATP7A mutation, G727R. Mol Genet Metab 2008; 95:174-81. [PMID: 18752978 PMCID: PMC2654537 DOI: 10.1016/j.ymgme.2008.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 06/26/2008] [Accepted: 06/26/2008] [Indexed: 11/28/2022]
Abstract
Menkes disease is a fatal neurodegenerative disorder of infancy caused by defects in an X-linked copper transport gene, ATP7A. Evidence from a recent clinical trial indicates that favorable response to early treatment of this disorder with copper injections involves mutations that retain some copper transport capacity. In three unrelated infants, we identified the same mutation, G727R, in the second transmembrane segment of ATP7A that complemented a Saccharomyces cerevisiae copper transport mutant, consistent with partial copper transport activity. Quantitative reverse transcription-polymerase chain reaction studies showed approximately normal levels of ATP7A(G727R) transcript in two patients' fibroblasts compared to wild-type controls, but Western blot analyses showed markedly reduced quantities of ATP7A, suggesting post-translational degradation. We confirmed the latter by comparing degradation rates of mutant and wild-type ATP7A via cyclohexamide treatment of cultured fibroblasts; half-life of the G727R mutant was 2.9h and for the wild-type, 11.4h. We also documented a X-box binding protein 1 splice variant in G727R cells-known to be associated with the cellular misfolded protein response. Patient A, diagnosed 6 months of age, began treatment at 228days (7.6 months) of age. At his current age (2.5 years), his overall neurodevelopment remains at a 2- to 4-month level. In contrast, patient B and patient C were diagnosed in the neonatal period, began treatment within 25 days of age, and show near normal neurodevelopment at their current ages, 3years (patient B), and 7 months (patient C). The poor clinical outcome in patient A with the same missense mutation as patient A and patient B with near normal oucomes, confirms the importance of early medical intervention in Menkes disease and highlights the critical potential benefit of newborn screening for this disorder.
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Affiliation(s)
- Jingrong Tang
- Unit on Pediatric Genetics, Program in Molecular Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Anthony Donsante
- Unit on Pediatric Genetics, Program in Molecular Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Vishal Desai
- Unit on Pediatric Genetics, Program in Molecular Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Nicholas Patronas
- Imaging Sciences Program, Mark O. Hatfield Clinical Center, National Institutes of Health, Bethesda, MD
| | - Stephen G. Kaler
- Unit on Pediatric Genetics, Program in Molecular Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
- Correspondent: Stephen G. Kaler, MD, National Institutes of Health, Building 10; Room 5-2571, 10 Center Drive MSC 1832, Bethesda, Maryland 20892-1832, Phone: 301 496-8368; FAX: 301 402-1073, E-mail:
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Abstract
Copper is a trace element present in all tissues and is required for cellular respiration, peptide amidation, neurotransmitter biosynthesis, pigment formation, and connective tissue strength. Copper is a cofactor for numerous enzymes and plays an important role in central nervous system development; low concentrations of copper may result in incomplete development, whereas excess copper maybe injurious. Copper may be involved in free radical production, via the Haber-Weiss reaction, that results in mitochondrial damage, DNA breakage, and neuronal injury. Evidence of abnormal copper transport and aberrant copper-protein interactions in numerous human neurological disorders supports the critical importance of this trace metal for proper neurodevelopment and neurological function. The biochemical phenotypes of human disorders that involve copper homeostasis suggest possible biomarkers of copper status that may be applicable to general populations.
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Affiliation(s)
- Vishal Desai
- Unit on Pediatric Genetics, Program in Molecular Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Abstract
High reliability organisations (HROs) are those in which errors rarely occur. To accomplish this they conduct relatively error free operations over long periods of time and make consistently good decisions resulting in high quality and reliability. Some organisational processes that characterise HROs are process auditing, implementing appropriate reward systems, avoiding quality degradation, appropriately perceiving that risk exists and developing strategies to deal with it, and command and control. Command and control processes include migrating decision making, redundancy in people or hardware, developing situational awareness, formal rules and procedures, and training. These processes must be tailored to the specific organisation implementing them. These processes were applied to a paediatric intensive care unit (PICU) where care was derived from problem solving methodology rather than protocol. After a leadership change, the unit returned to the hierarchical medical model of care. Important outcome variables such as infant mortality, patient return to the PICU after discharge, days on the PICU, air transports, degraded. Implications for clinical practice include providing caregivers with sufficient flexibility to meet changing situations, encouraging teamwork, and avoiding shaming, naming, and blaming.
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MESH Headings
- Adolescent
- California
- Child
- Child, Preschool
- Clinical Protocols
- Decision Making, Organizational
- Employee Incentive Plans
- Humans
- Intensive Care Units, Pediatric/organization & administration
- Intensive Care Units, Pediatric/standards
- Leadership
- Medical Errors/prevention & control
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Organizational Case Studies
- Organizational Culture
- Problem Solving
- Process Assessment, Health Care
- Quality Assurance, Health Care
- Reproducibility of Results
- Respiration, Artificial/methods
- Respiration, Artificial/standards
- Risk Assessment
- Safety Management/methods
- Safety Management/organization & administration
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Affiliation(s)
- K H Roberts
- Walter A Haas School of Business, 545 Student Services Building, University of California, Berkeley, CA 94720, USA.
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Chandramohan D, Carneiro I, Kavishwar A, Brugha R, Desai V, Greenwood B. A clinical algorithm for the diagnosis of malaria: results of an evaluation in an area of low endemicity. Trop Med Int Health 2001; 6:505-10. [PMID: 11469942 DOI: 10.1046/j.1365-3156.2001.00739.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We conducted a study of 1945 children and 2885 adults who presented with fever to a hospital outpatients clinic in an urban area of India order to develop and evaluate a clinical algorithm for the diagnosis of malaria. Only 139 (7%) children and 349 (12%) adults had microscopically confirmed malaria. None of the symptoms or signs elicited from the respondents were good predictors of clinical malaria. Simple scores were derived through combining clinical features which were associated with slide positivity or were judged by clinicians to be important. The best-performing algorithms were a score of 4 clinical features in children (sensitivity 60.0% and specificity 61.2%) and a score of 5 in adults (sensitivity 54.6% and specificity 57.5%). The clinical features differed and algorithm performances were poorer than in previous studies in highly endemic areas. The conclusion is that malaria diagnosis in areas of low endemicity requires microscopy to be accurate.
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Affiliation(s)
- D Chandramohan
- London School of Hygiene and Tropical Medicine, London, UK.
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