Publications by authors named "Kiran Patel"

130 Publications

Real-world efficacy and safety of switching to bictegravir/emtricitabine/tenofovir alafenamide in older people living with HIV.

Medicine (Baltimore) 2021 Sep;100(38):e27330

Orlando Immunology Center, Orlando, FL.

Abstract: Approximately 50% of people living with HIV (PLWH) in the United States are ≥50 years old. Clinical trials of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) demonstrated potent efficacy and favorable safety in older PLWH; however, real-world data would be useful to validate these results.Retrospective cohort study.We evaluated records from PLWH aged ≥50 years at the Orlando Immunology Center who were switched to B/F/TAF between February 2018 and August 2019. Eligible patients had baseline HIV-1 RNA <50 copies/mL and 48 weeks of follow-up data. The primary endpoint was maintenance of HIV-1 RNA <50 copies/mL at Week 48. The impact of switching to B/F/TAF on drug-drug interactions (DDIs) and safety parameters were also assessed.Three-hundred and fifty patients met inclusion criteria, median age was 57 years, 20% were women, and 43% were non-White. Fifty-five percent of patients switched from integrase inhibitor-based regimens; the most common reason for switch was simplification. At Week 48, 330 (94%) patients maintained an HIV-1 RNA <50 copies/mL and 20 (6%) had an HIV-1 RNA between 50 and 400 copies/mL. One-hundred and forty potential DDIs were identified in 121 (35%) patients taking a boosting agent or rilpivirine at baseline that were resolved after switching to B/F/TAF. Treatment-related adverse events occurred in 51 (15%) patients (all Grade 1-2) and led to 8 discontinuations.In this real-world cohort, switching to B/F/TAF was associated with maintenance of virologic control, and avoidance of DDIs in a large proportion of patients. These data support use of B/F/TAF as a treatment option in older PLWH.
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http://dx.doi.org/10.1097/MD.0000000000027330DOI Listing
September 2021

Basal Implants: An Asset for Rehabilitation of Atrophied Resorbed Maxillary and Mandibular Jaw - A Prospective Study.

Ann Maxillofac Surg 2021 Jan-Jun;11(1):64-69. Epub 2021 Jul 24.

Department of Oral and Maxillofacial Surgery, College of Dental Sciences and Research Centre, Ahmedabad, Gujarat, India.

Introduction: Conventional implants have great limitations in case of atrophic maxillary and mandibular ridges. Ultimately, patients who have severely atrophied jawbones paradoxically receive little or no treatment, as long as conventional implants are considered the device of first choice. Basal implants were developed with the goal to overcome the limitations of conventional implantology, primarily for atrophied ridges or inadequate bone with the protocol of immediate loading. However, studies regarding the rehabilitation followed by placement of screwable basal implants in atrophied ridges are limited. The purpose of the study was to conduct a prospective evaluation for the feasibility of placing strategic basal implants in clinical practice along with its merits and demerits.

Materials And Methods: A prospective study was designed to evaluate the protocol of immediate functional loading using the technology of strategic basal implants for fixed complete arch prostheses and segmental teeth prostheses. A minimal of 10 patients selected in the age group of 20-80 years were restored with strategic basal implants irrespective of the quality and quantity of cancellous/alveolar bone following immediate functional loading protocols.

Results: About 157 various designs of basal implants were placed in 10 patients, out of which four failed with the survival rate of 97.5% of basal implants.

Discussion: The new concepts laid by basal implantology eliminate all drawbacks of conventional implantology and should be used as an adjunct to improve the quality of life of our patients. The concept of strategic implantology is innovative but reliable technique for patients in need of permanent rehabilitation.
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http://dx.doi.org/10.4103/ams.ams_446_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407620PMC
July 2021

Healthcare Staff Perceptions Following Inoculation with the BNT162b2 mRNA COVID-19 Vaccine at University Hospitals Coventry & Warwickshire NHS Trust.

Int J Environ Res Public Health 2021 09 6;18(17). Epub 2021 Sep 6.

COVID Clinical Research Department, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.

 COVID-19 vaccination programmes offer hope for a potential end to the acute phase of the COVID-19 pandemic. We present perceptions following from a cohort of healthcare staff at the UK NHS hospital, which first initiated the BNT162b2 mRNA COVID-19 ("Pfizer") vaccination program. A paper-based survey regarding perceptions on the BNT162b2 mRNA COVID-19 vaccine was distributed to all healthcare workers at the University Hospitals Coventry & Warwickshire NHS Trust following receipt of the first vaccine dose. Results: 535 healthcare workers completed the survey, with a 40.9% response rate. Staff felt privileged to receive a COVID-19 vaccine. Staff reported that they had minimised contact with patients with confirmed or suspected COVID-19. Reported changes to activity following vaccination both at work and outside work were guarded. Statistically significant differences were noted between information sources used by staff groups and between groups of different ethnic backgrounds to inform decisions to receive vaccination. NHS staff felt privileged to receive the COVID-19 vaccine, and felt that their actions would promote uptake in the wider population. Concerns regarding risks and side effects existed, but were minimal. This research can be used to help inform strategies driving wider vaccine uptake amongst healthcare staff and the public.
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http://dx.doi.org/10.3390/ijerph18179378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430614PMC
September 2021

T follicular helper cell expansion and chronic T cell activation are characteristic immune anomalies in Evans syndrome.

Blood 2021 Aug 23. Epub 2021 Aug 23.

Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States.

Pediatric Evans syndrome (pES) is increasingly identified as the presenting manifestation of several inborn errors of immunity (IEI). Despite an improved understanding of genetic defects in pES, the underlying immunobiology of pES is poorly defined, and characteristic diagnostic immune parameters are lacking. We describe the immune characteristics of 24 patients with pES and compared them with 22 patients with chronic immune thrombocytopenia (cITP) and 24 healthy controls (HC). Compared to patients with cITP and HC, patients with pES had increased circulating T-follicular helper cells (cTfh), increased T cell activation, and decreased naïve CD4+ T cells for age. Despite normal or high IgG in the majority of pES at presentation, class-switched memory B cells (CSMB) were decreased. Within the cTfh subset, we noted features of post-activation exhaustion with upregulation of several canonical checkpoint inhibitors. TCR-b repertoire analysis of cTfh cells revealed increased oligoclonality in patients with pES compared with HC. Among patients with pES, those without a known gene defect had a similar characteristic immune abnormality as patients with defined genetic defects. Similarly, patients with pES with normal IgG had similar T cell abnormalities as patients with low IgG. Since genetic defects have been identified in only less than half of patients with pES, our findings of similar immune abnormalities across all pES patients help establish a common characteristic immunopathology in pES irrespective of the underlying genetic etiology.
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http://dx.doi.org/10.1182/blood.2021012924DOI Listing
August 2021

Completion of annual diabetes care processes and mortality: A cohort study using the National Diabetes Audit for England and Wales.

Diabetes Obes Metab 2021 Aug 17. Epub 2021 Aug 17.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.

Aim: To conduct an analysis to assess whether the completion of recommended diabetes care processes (glycated haemoglobin [HbA1c], creatinine, cholesterol, blood pressure, body mass index [BMI], smoking habit, urinary albumin, retinal and foot examinations) at least annually is associated with mortality.

Materials And Methods: A cohort from the National Diabetes Audit of England and Wales comprising 179 105 people with type 1 and 1 397 790 people with type 2 diabetes, aged 17 to 99 years on January 1, 2009, diagnosed before January 1, 2009 and alive on April 1, 2013 was followed to December 31, 2019. Cox proportional hazards models adjusting for demographic characteristics, smoking, HbA1c, blood pressure, serum cholesterol, BMI, duration of diagnosis, estimated glomerular filtration rate, prior myocardial infarction, stroke, heart failure, respiratory disease and cancer, were used to investigate whether care processes recorded January 1, 2009 to March 31, 2010 were associated with subsequent mortality.

Results: Over a mean follow-up of 7.5 and 7.0 years there were 26 915 and 388 093 deaths in people with type 1 and type 2 diabetes, respectively. Completion of five or fewer, compared to eight, care processes (retinal screening not included as data were not reliable) had a mortality hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.28-1.46) in people with type 1 and 1.32 (95% CI 1.30-1.35) in people with type 2 diabetes. The HR was higher for respiratory disease deaths and lower in South Asian ethnic groups.

Conclusions: People with diabetes who have fewer routine care processes have higher mortality. Further research is required into whether different approaches to care might improve outcomes for this high-risk group.
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http://dx.doi.org/10.1111/dom.14528DOI Listing
August 2021

A paramedian approach for dorsal root ganglion stimulation placement developed to limit lead migration and fracture.

Pain Pract 2021 Jul 30. Epub 2021 Jul 30.

The Spine & Pain Institute of New York, New York, New York, USA.

Introduction: Dorsal root ganglion stimulation (DRG-S), has demonstrated superiority in the treatment of complex regional pain syndrome and causalgia. Lead migration and fracture impact DRG-S therapeutic stability. Lead anchoring reduces DRG-S lead migration without increasing lead fracture. Lead fracture may be related to lead entrapment in the superficial fascial plane. A novel medialized approach for lead placement and anchoring is presented to address these issues.

Methods: We suggest an alternative technique for implanting percutaneous DRG-S leads at the T10-L5 levels.

Results: A novel medialized ipsilateral technique for lead placement and anchoring for single, bilateral, and adjacent segment placement is presented. The Tuohy needle puncture site is medial to the pedicle and adjacent to the spinous process, two vertebral levels caudad to the target foramen. Trajectory is maintained in the sagittal plane, to access the caudad interlaminar space near the midline. This technique allows for ipsilateral or contralateral lead placement. After epidural access, the introducer sheath is rotated toward the targeted foramen and advanced. The guidewire followed by the lead is passed, and once lead position is confirmed, tension "S" loops are created, followed by anchoring to the deep fascia.

Conclusion: We describe a new paramedian technique for DRG-S lead placement. We propose it will decrease DRG-S complication rates through anchoring to reduce migration and by avoiding the fascial planes thought to be responsible for fracture. Long-term outcomes applying our proposed techniques are required for determining the true impact, however, early anecdotal results suggest that these new techniques are favorable.
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http://dx.doi.org/10.1111/papr.13063DOI Listing
July 2021

Differential perceptions regarding personal protective equipment use during the COVID-19 pandemic by NHS healthcare professionals based on ethnicity, sex and professional experience.

Infect Prev Pract 2021 Sep 12;3(3):100141. Epub 2021 Jun 12.

University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.

Objectives: To capture perceptions regarding personal protective equipment (PPE) among healthcare professionals during the COVID-19 pandemic, including staff subgroups at high risk for severe COVID-19, such as black and minority ethnic (BAME) groups.

Design: Electronically distributed survey with semi-quantitative analysis. Survey distributed at a major academic NHS tertiary referral centre in the West Midlands with a diverse medical workforce to medically qualified staff who completed COVID-19 redeployment trainingN=121; 47% female; 49% of BAME background; 26% international medical graduates).

Results: All demographic groups reported overall good awareness of when and how to use PPE during COVID-19 pandemic. Statistically significant differences in the perceptions regarding PPE use during COVID-19 were noted between BAME non-BAME staff, international UK medical graduates, and male female participants, as well as between professionals at different stages of their career. The differences related to perceptions around availability, degree of protection provided, perceived inconvenience, ability to raise concerns about availability, confidence in sharing underlying health conditions with managers and the impact of full PPE in emergency situations causing delay patient care.

Conclusions: Amongst medically qualified staff, significant differences exist in the perceptions relating to the, availability and effectiveness of PPE during the COVID-19 pandemic depending on country of training, ethnic background and sex.

Gafrec Study Approval: Study ID GF0392.
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http://dx.doi.org/10.1016/j.infpip.2021.100141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195686PMC
September 2021

Increasing adiposity and the presence of cardiometabolic morbidity is associated with increased Covid-19-related mortality: results from the UK Biobank.

BMC Endocr Disord 2021 Jul 3;21(1):144. Epub 2021 Jul 3.

National Heart and Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London, W12 0NN, UK.

Background: Although obesity, defined by body mass index (BMI), has been associated with a higher risk of hospitalisation and more severe course of illness in Covid-19 positive patients amongst the British population, it is unclear if this translates into increased mortality. Furthermore, given that BMI is an insensitive indicator of adiposity, the effect of adipose volume on Covid-19 outcomes is also unknown.

Methods: We used the UK Biobank repository, which contains clinical and anthropometric data and is linked to Public Health England Covid-19 healthcare records, to address our research question. We performed age- and sex- adjusted logistic regression and Chi-squared test to compute the odds for Covid-19-related mortality as a consequence of increasing BMI, and other more sensitive indices of adiposity such as waist:hip ratio (WHR) and percent body fat, as well as concomitant cardiometabolic illness.

Results: 13,502 participants were tested for Covid-19 (mean age 70 ± 8 years, 48.9% male). 1582 tested positive (mean age 68 ± 9 years, 52.8% male), of which 305 died (mean age 75 ± 6 years, 65.5% male). Increasing adiposity was associated with higher odds for Covid-19-related mortality. For every unit increase in BMI, WHR and body fat, the odds of death amongst Covid19-positive participants increased by 1.04 (95% CI 1.01-1.07), 10.71 (95% CI 1.57-73.06) and 1.03 (95% CI 1.01-1.05), respectively (all p < 0.05). Referenced to Covid-19 positive participants with a normal weight (BMI 18.5-25 kg/m), Covid-19 positive participants with BMI > 35 kg/m had significantly higher odds of Covid-19-related death (OR 1.70, 95% CI 1.06-2.74, p < 0.05). Covid-19-positive participants with metabolic (diabetes, hypertension, dyslipidaemia) or cardiovascular morbidity (atrial fibrillation, angina) also had higher odds of death.

Conclusions: Anthropometric indices that are more sensitive to adipose volume and its distribution than BMI, as well as concurrent cardiometabolic illness, are associated with higher odds of Covid-19-related mortality amongst the UK Biobank cohort that tested positive for the infection. These results suggest adipose volume may contribute to adverse Covid-19-related outcomes associated with obesity.
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http://dx.doi.org/10.1186/s12902-021-00805-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254443PMC
July 2021

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non-anchoring techniques: A multicenter pooled data analysis.

Pain Pract 2021 Jun 18. Epub 2021 Jun 18.

Rijnstate Ziekenhuis, Velp, The Netherlands.

Introduction: Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures.

Methods: We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring > anchoring, anchoring > no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions.

Results: We included 756 leads (n = 565 anchored and n = 191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6 leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p < 0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5).

Discussion: We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.
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http://dx.doi.org/10.1111/papr.13052DOI Listing
June 2021

Access barriers to epinephrine autoinjectors for the treatment of anaphylaxis: A survey of practitioners.

J Allergy Clin Immunol Pract 2021 Jun 11. Epub 2021 Jun 11.

Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla.

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http://dx.doi.org/10.1016/j.jaip.2021.05.028DOI Listing
June 2021

Treatment of Painful Diabetic Neuropathy-A Narrative Review of Pharmacological and Interventional Approaches.

Biomedicines 2021 May 19;9(5). Epub 2021 May 19.

Department of Endocrinology, Saint Luke's South Hospital, Overland Park, KS 66213, USA.

Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus that is associated with a significant decline in quality of life. Like other painful neuropathic conditions, PDN is difficult to manage clinically, and a variety of pharmacological and non-pharmacological options are available for this condition. Recommended pharmacotherapies include anticonvulsive agents, antidepressant drugs, and topical capsaicin; and tapentadol, which combines opioid agonism and norepinephrine reuptake inhibition, has also recently been approved for use. Additionally, several neuromodulation therapies have been successfully used for pain relief in PDN, including intrathecal therapy, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). Recently, 10 kHz SCS has been shown to provide clinically meaningful pain relief for patients refractory to conventional medical management, with a subset of patients demonstrating improvement in neurological function. This literature review is intended to discuss the dosage and prospective data associated with pain management therapies for PDN.
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http://dx.doi.org/10.3390/biomedicines9050573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161066PMC
May 2021

Rotigaptide Infusion for the First 7 Days After Myocardial Infarction-Reperfusion Reduced Late Complexity of Myocardial Architecture of the Healing Border-Zone and Arrhythmia Inducibility.

J Am Heart Assoc 2021 05 17;10(9):e020006. Epub 2021 Apr 17.

National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom.

Background Survivors of myocardial infarction are at increased risk of late ventricular arrhythmias, with infarct size and scar heterogeneity being key determinants of arrhythmic risk. Gap junctions facilitate the passage of small ions and morphogenic cell signaling between myocytes. We hypothesized that gap junctions enhancement during infarction-reperfusion modulates structural and electrophysiological remodeling and reduces late arrhythmogenesis. Methods and Results Infarction-reperfusion surgery was carried out in male Sprague-Dawley rats followed by 7 days of rotigaptide or saline administration. The in vivo and ex vivo arrhythmogenicity was characterized by programmed electrical stimulation 3 weeks later, followed by diffusion-weighted magnetic resonance imaging and Masson's trichrome histology. Three weeks after 7-day postinfarction administration of rotigaptide, ventricular tachycardia/ventricular fibrillation was induced on programmed electrical stimulation in 20% and 53% of rats, respectively (rotigaptide versus control), resulting in reduction of arrhythmia score (3.2 versus 1.4, =0.018), associated with the reduced magnetic resonance imaging parameters fractional anisotropy (fractional anisotropy: -5% versus -15%; =0.062) and mean diffusivity (mean diffusivity: 2% versus 6%, =0.042), and remodeling of the 3-dimensional laminar structure of the infarct border zone with reduction of the mean (16° versus 19°, =0.013) and the dispersion (9° versus 12°, =0.015) of the myofiber transverse angle. There was no change in ECG features, spontaneous arrhythmias, or mortality. Conclusions Enhancement of gap junctions function by rotigaptide administered during the early healing phase in reperfused infarction reduces later complexity of infarct scar morphology and programmed electrical stimulation-induced arrhythmias, and merits further exploration as a feasible and practicable intervention in the acute myocardial infarction management to reduce late arrhythmic risk.
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http://dx.doi.org/10.1161/JAHA.120.020006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200720PMC
May 2021

Ramadan and COVID-19 vaccine hesitancy-a call for action.

Lancet 2021 04 7;397(10283):1443-1444. Epub 2021 Apr 7.

Diabetes Research Centre, University of Leicester, Leicester, UK; the Centre for Black Minority Health, University of Leicester, Leicester, UK.

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http://dx.doi.org/10.1016/S0140-6736(21)00779-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026169PMC
April 2021

Condensing and constraining WNT by TGF-β.

Nat Cell Biol 2021 03;23(3):213-214

Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.

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http://dx.doi.org/10.1038/s41556-021-00649-2DOI Listing
March 2021

An implant-supported prosthetic rehabilitation of a patient with a bilateral subtotal maxillectomy defect secondary to rhino-orbital-cerebral mucormycosis: A clinical report of a graftless approach.

J Prosthet Dent 2021 Feb 4. Epub 2021 Feb 4.

Private practice, Rzeszowska, Zary, Poland.

This clinical report presents the rehabilitation of extensive hard and soft tissue defects caused by rhino-orbital-cerebral mucormycosis as a result of untreated diabetes mellitus. The patient underwent subtotal maxillectomy and was rehabilitated with an implant-supported maxillofacial prosthesis with zygomatic and pterygoid implants by following an immediate loading protocol.
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http://dx.doi.org/10.1016/j.prosdent.2020.12.022DOI Listing
February 2021

The effect of β-alanine supplementation on high intensity cycling capacity in normoxia and hypoxia.

J Sports Sci 2021 Jun 25;39(11):1295-1301. Epub 2021 Jan 25.

School of Science and Technology, Nottingham Trent University, Nottingham, UK.

The availability of dietary beta-alanine (BA) is the limiting factor in carnosine synthesis within human muscle due to its low intramuscular concentration and substrate affinity. Carnosine can accept hydrogen ions (H), making it an important intramuscular buffer against exercise-induced acidosis. Metabolite accumulation rate increases when exercising in hypoxic conditions, thus an increased carnosine concentration could attenuate H build-up when exercising in hypoxic conditions. This study examined the effects of BA supplementation on high intensity cycling capacity in normoxia and hypoxia. In a double-blind design, nineteen males were matched into a BA group (n = 10; 6.4 g·d) or a placebo group (PLA; n = 9) and supplemented for 28 days, carrying out two pre- and two post-supplementation cycling capacity trials at 110% of powermax, one in normoxia and one in hypoxia (15.5% O). Hypoxia led to a 9.1% reduction in exercise capacity, but BA supplementation had no significant effect on exercise capacity in normoxia or hypoxia ( > 0.05). Blood lactate accumulation showed a significant trial x time interaction post-supplementation ( = 0.016), although this was not significantly different between groups. BA supplementation did not increase high intensity cycling capacity in normoxia, nor did it improve cycling capacity in hypoxia even though exercise capacity was reduced under hypoxic conditions.
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http://dx.doi.org/10.1080/02640414.2020.1867416DOI Listing
June 2021

Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation.

J Interv Card Electrophysiol 2021 Jan 4. Epub 2021 Jan 4.

Department of Cardiology, University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.

Background: Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT.

Methods: Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death.

Results: Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)).

Conclusions: This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.
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http://dx.doi.org/10.1007/s10840-020-00918-4DOI Listing
January 2021

Focused action is required to protect ethnic minority populations from COVID-19 post-lockdown.

Br J Gen Pract 2021 01 28;71(702):37-40. Epub 2020 Dec 28.

CSL Diabetes, University Hospitals of Birmingham, Birmingham; Trustee, South Asian Health Foundation.

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http://dx.doi.org/10.3399/bjgp21X714581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759346PMC
January 2021

Anatomically Coiled Internal Carotid Artery Resulting in Severe Dysphagia and Burning Mouth Syndrome.

Ann Vasc Surg 2021 May 14;73:509.e1-509.e4. Epub 2020 Dec 14.

Division of Vascular Surgery, Long Island Jewish Medical Center, New Hyde Park, NY.

This is a report of a 65-year-old female presenting with symptoms of dysphagia due to a coiled left internal carotid artery, treated with resection and primary repair. Dysphagia lusoria is more commonly caused by aortic arch anomalies, aberrant subclavian or common carotid arteries. Internal carotid tortuosity as a cause of severe dysphagia and burning mouth syndrome is highly unusual. A literature review examines the etiology, natural history, and treatment options.
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http://dx.doi.org/10.1016/j.avsg.2020.10.044DOI Listing
May 2021

Pharmacological management of South Asians with type 2 diabetes: Consensus recommendations from the South Asian Health Foundation.

Diabet Med 2021 Apr 11;38(4):e14497. Epub 2021 Feb 11.

South Asian Health Foundation, Birmingham, UK.

South Asians constitute approximately 1.6 billion people from the Indian subcontinent, comprising Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka; and make up the largest diaspora globally. Compared to the White European population, this group is at a higher risk of developing type 2 diabetes along with cardiovascular, renal and eye complications. Over the recent years, a number of new therapies for type 2 diabetes have become available for which cardiovascular outcome trials (CVOTs) have been published. The recent ADA/EASD consensus guidelines on diabetes, pre-diabetes and cardiovascular diseases' offer a transitional shift in type 2 diabetes management. The new consensus recommendations are based on recent CVOTs, many of which had a representation of South Asian cohorts. In light of this new evidence, there is urgent need for an integrated, evidence-based, cost-effective and individualised approach specific for South Asians. This review takes into consideration the evidence from these CVOTs and provides best practice recommendations for optimal management of South Asian people with type 2 diabetes, alongside the previously published consensus report from South Asian Health Foundation in 2014 [1].
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http://dx.doi.org/10.1111/dme.14497DOI Listing
April 2021

Rising to the challenge: Qualitative assessment of medical student perceptions responding to the COVID-19 pandemic.

Clin Med (Lond) 2020 11 9;20(6):e244-e247. Epub 2020 Oct 9.

University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and University of Warwick, Coventry, UK

Background: Medical students internationally have volunteered and stepped up to support frontline clinical teams during the COVID-19 pandemic. We know very little about the motivation of those volunteering, or their concerns in deploying to a new role. We aim to establish the reasons that medical students volunteered in one Trust and understand to their concerns.

Methods: Structured survey, thematic analysis and categorisation of volunteer student perceptions.

Results: Medical students volunteered for broadly four reasons: to make a contribution, to learn, to benefit from remuneration and for an activity during the national lockdown. There were disparate concerns; however, the most common involved availability of personal protective equipment, uncertainty as to expectations and becoming infected.

Conclusions: We must recognise and applaud the motivations of our future workforce who have stepped up to support the NHS at a time of unprecedented demand. The experiences and learning gained during this period will undoubtedly shape their future medical training and careers.
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http://dx.doi.org/10.7861/clinmed.2020-0219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687336PMC
November 2020

Infections in Infants with SCID: Isolation, Infection Screening, and Prophylaxis in PIDTC Centers.

J Clin Immunol 2021 01 2;41(1):38-50. Epub 2020 Oct 2.

Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA.

Purpose: The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children with severe combined immunodeficiency (SCID) in a prospective natural history study of hematopoietic stem cell transplant (HSCT) outcomes over the last decade. Despite newborn screening (NBS) for SCID, infections occurred prior to HSCT. This study's objectives were to define the types and timing of infection prior to HSCT in patients diagnosed via NBS or by family history (FH) and to understand the breadth of strategies employed at PIDTC centers for infection prevention.

Methods: We analyzed retrospective data on infections and pre-transplant management in patients with SCID diagnosed by NBS and/or FH and treated with HSCT between 2010 and 2014. PIDTC centers were surveyed in 2018 to understand their practices and protocols for pre-HSCT management.

Results: Infections were more common in patients diagnosed via NBS (55%) versus those diagnosed via FH (19%) (p = 0.012). Outpatient versus inpatient management did not impact infections (47% vs 35%, respectively; p = 0.423). There was no consensus among PIDTC survey respondents as to the best setting (inpatient vs outpatient) for pre-HSCT management. While isolation practices varied, immunoglobulin replacement and antimicrobial prophylaxis were more uniformly implemented.

Conclusion: Infants with SCID diagnosed due to FH had lower rates of infection and proceeded to HSCT more quickly than did those diagnosed via NBS. Pre-HSCT management practices were highly variable between centers, although uses of prophylaxis and immunoglobulin support were more consistent. This study demonstrates a critical need for development of evidence-based guidelines for the pre-HSCT management of infants with SCID following an abnormal NBS.

Trial Registration: NCT01186913.
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http://dx.doi.org/10.1007/s10875-020-00865-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8388237PMC
January 2021

Proarrhythmic electrophysiological and structural remodeling in rheumatoid arthritis.

Am J Physiol Heart Circ Physiol 2020 11 18;319(5):H1008-H1020. Epub 2020 Sep 18.

National Heart and Lung Institute, Imperial College London, United Kingdom.

Chronic inflammatory disorders, including rheumatoid arthritis (RA), are associated with a twofold increase in the incidence of sudden cardiac death (SCD) compared with the healthy population. Although this is partly explained by an increased prevalence of coronary artery disease, growing evidence suggests that ischemia alone cannot completely account for the increased risk. The present review explores the mechanisms of cardiac electrophysiological remodeling in response to chronic inflammation in RA. In particular, it focuses on the roles of nonischemic structural remodeling, altered cardiac ionic currents, and autonomic nervous system dysfunction in ventricular arrhythmogenesis and SCD. It also explores whether common genetic elements predispose to both RA and SCD. Finally, it evaluates the potential dual effects of disease-modifying therapy in both diminishing and promoting the risk of ventricular arrhythmias and SCD.
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http://dx.doi.org/10.1152/ajpheart.00401.2020DOI Listing
November 2020

Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases.

A A Pract 2020 Sep;14(11):e01307

Department of Pain Medicine, Ventura County Medical Center, Ventura, California; and.

We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism underlying lead fracture.
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http://dx.doi.org/10.1213/XAA.0000000000001307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523575PMC
September 2020

Lumbar Dorsal Root Ganglion Stimulation Lead Placement Using an Outside-In Technique in 4 Patients With Failed Back Surgery Syndrome: A Case Series.

A A Pract 2020 Aug;14(10):e01300

From the The Spine & Pain Institute of New York, New York City, New York.

Dorsal root ganglion stimulation (DRG-S) has shown promise as a treatment for low back pain. The traditional anterograde placement of DRG-S leads can be challenging in patients with anatomical changes from prior back surgery. We describe an "outside-in" placement technique of DRG-S leads in 4 patients with histories of multiple lumbar surgeries, which made the traditional anterograde placement not feasible. At long-term follow-up, the patients experienced substantial pain relief and improvement in quality of life, with no complications. The outside-in lead placement technique may be an efficacious alternative to the traditional techniques in patients with anomalous anatomy from prior surgery.
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http://dx.doi.org/10.1213/XAA.0000000000001300DOI Listing
August 2020

Direct amoxicillin challenge without preliminary skin testing for pediatric patients with penicillin allergy labels.

Ann Allergy Asthma Immunol 2020 08 11;125(2):226-228. Epub 2020 May 11.

Department of Pediatrics, Emory University, Atlanta, Georgia; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2020.05.004DOI Listing
August 2020

Soil quality assessment of coastal salt-affected acid soils of India.

Environ Sci Pollut Res Int 2020 Jul 2;27(21):26221-26238. Epub 2020 May 2.

Section - Natural Resource Management, ICAR - Central Coastal Agricultural Research Institute, Old Goa, Goa, 403402, India.

Soil salinity and acidity are some of the major causes of land degradation and have a negative impact on agricultural productivity. Assessing soil quality (SQ) of soils affected by soil salinity and acidity is required for their sustainable utilization for agricultural production. The aim of the present study was to evaluate the SQ of the salt-affected acid soils of the Indian West Coastal region using the additive and weighted soil quality indices (SQIs). The SQIs were developed using a total dataset (TDS) and a minimum dataset (MDS). The TDS comprised of 15 different soil properties as electrical conductivity (EC), pH, bulk density, soil available nitrogen (N), phosphorus (P), potassium (K), sulfur (S), boron (B), iron (Fe), manganese (Mn), copper (Cu), zinc (Zn) and exchangeable calcium (Ca), magnesium (Mg), and sodium (Na) measured on 300 soil samples (depth 0-0.15 m). Based on principal component analysis and correlation analysis, an MDS with soil properties like soil pH, EC, Na, Cu, Mn, and BD was formed. Using two approaches (additive and weighted), two datasets (TDS and MDS), and two scoring methods (linear and non-linear), eight SQIs were developed. The MDS-based linear weighted and non-linear weighted SQI found suitable to evaluate SQ of salt-affected acid soils and SQI had a significant and negative correlation of - 0.83 and - 0.70 (p < 0.01) with EC, respectively. Thus, it is clear that the SQ considerably reduces with an increase in soil salinity. The performance of the MDS-based SQIs was better than the TDS to discriminate different soil salinity classes. The agreement between the linear and non-linear scoring method of SQI had a linear relationship with a coefficient of determination (R) of 0.91-0.96. Thus, assessing the SQ of salt-affected acid soils using MDS, linear scoring, and weighted approach of the soil quality indexing could save the time and cost involved.
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http://dx.doi.org/10.1007/s11356-020-09010-wDOI Listing
July 2020

COVID-19: A new digital dawn?

Digit Health 2020 Jan-Dec;6:2055207620920083. Epub 2020 Apr 11.

Institute of Digital Healthcare, WMG, University of Warwick, UK.

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http://dx.doi.org/10.1177/2055207620920083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153182PMC
April 2020

Tumor progression and chromatin landscape of lung cancer are regulated by the lineage factor GATA6.

Oncogene 2020 04 10;39(18):3726-3737. Epub 2020 Mar 10.

Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.

Lineage selective transcription factors (TFs) are important regulators of tumorigenesis, but their biological functions are often context dependent with undefined epigenetic mechanisms of action. In this study, we uncover a conditional role for the endodermal and pulmonary specifying TF GATA6 in lung adenocarcinoma (LUAD) progression. Impairing Gata6 in genetically engineered mouse models reduces the proliferation and increases the differentiation of Kras mutant LUAD tumors. These effects are influenced by the epithelial cell type that is targeted for transformation and genetic context of Kras-mediated tumor initiation. In LUAD cells derived from surfactant protein C expressing progenitors, we identify multiple genomic loci that are bound by GATA6. Moreover, suppression of Gata6 in these cells significantly alters chromatin accessibility, particularly at distal enhancer elements. Analogous to its paradoxical activity in lung development, GATA6 expression fluctuates during different stages of LUAD progression and can epigenetically control diverse transcriptional programs associated with bone morphogenetic protein signaling, alveolar specification, and tumor suppression. These findings reveal how GATA6 can modulate the chromatin landscape of lung cancer cells to control their proliferation and divergent lineage dependencies during tumor progression.
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http://dx.doi.org/10.1038/s41388-020-1246-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190573PMC
April 2020
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