Publications by authors named "Sanjay Sharma"

692 Publications

Mucormycosis and COVID-19: An epidemic within a pandemic in India.

Mycoses 2021 Jul 13. Epub 2021 Jul 13.

Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Importance: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection.

Methods: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded.

Results: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation.

Conclusions: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.
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http://dx.doi.org/10.1111/myc.13353DOI Listing
July 2021

Age matters: differences in exercise-induced cardiovascular remodelling in young and middle aged healthy sedentary individuals.

Eur J Prev Cardiol 2021 Jul;28(7):738-746

Institute of Cardiovascular Science, University College London, UK.

Aims: Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing.

Methods: A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35).

Results: Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% (P = 0.020) and, especially in O35, also systemic vascular resistance (-4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial -4/-3 mmHg, central -4/-2 mmHg, all P < 0.001; O35: brachial -6/-3 mmHg, central -6/-4 mmHg, all P < 0.001).

Conclusion: Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.
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http://dx.doi.org/10.1177/2047487320926305DOI Listing
July 2021

Efficacy of Nebulized Glycopyrrolate on Lung Hyperinflation in Patients with COPD.

Pulm Ther 2021 Jul 7. Epub 2021 Jul 7.

Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.

Introduction: Lung hyperinflation in chronic obstructive pulmonary disease (COPD) is associated with activity limitation, impaired cardiac output, and mortality. Several studies have demonstrated that long-acting muscarinic antagonists (LAMAs) delivered by dry powder inhalers can promote lung deflation; however, the potential of nebulized LAMAs on improving hyperinflation in COPD is currently unknown.

Methods: This single-center, randomized, double-blind, two-way crossover study (NCT04155047) evaluated the efficacy of a single dose of nebulized LAMA [glycopyrrolate (GLY) 25 µg] versus placebo in patients with COPD and lung hyperinflation. Patients with moderate-to-severe COPD and a residual volume (RV) ≥ 130% of predicted normal were included. The primary endpoint was changed from baseline in RV at 6 h post-treatment. Other endpoints included changes from baseline in spirometric and plethysmographic measures up to 6 h post-treatment.

Results: A total of 22 patients (mean pre-bronchodilator RV, 153.7% of predicted normal) were included. The primary objective of the study was not met; the placebo-adjusted least squares (LS) mean [95% confidence interval (CI) change from baseline in RV with GLY at 6 h post-treatment was - 0.323 l (- 0.711 to 0.066); p = 0.0987]. A post hoc evaluation of the primary analysis was conducted after excluding a single statistical outlier; substantial improvements in RV with GLY compared with placebo was observed after exclusion of this outlier [placebo-adjusted LS mean change from baseline (95% CI) in RV was - 0.446 l (- 0.741 to - 0.150)]. Improvements from baseline were also observed with GLY compared with placebo in spirometric and plethysmographic measures up to 6 h post-treatment. GLY was generally safe, and no new safety signals were detected.

Conclusions: This is the first study to evaluate the effect of nebulized GLY on lung deflation. Nebulized GLY resulted in marked improvements in RV up to 6 h post-treatment, compared with placebo. Improvements were also observed with GLY in spirometric and plethysmographic parameters of lung function.

Trial Registration: ClinicalTrials.gov identifier, NCT04155047.
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http://dx.doi.org/10.1007/s41030-021-00166-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260570PMC
July 2021

Forgotten Contributors in the Brick Sector in Nepal.

Int J Environ Res Public Health 2021 06 16;18(12). Epub 2021 Jun 16.

International Centre for Integrated Mountain Development, Lalitpur, G.P.O. Box 3226, Kathmandu 44700, Nepal.

Brick making in Nepal is an informal sector that is still highly labor intensive. It employs transient workers who are extremely marginalized and exposed to poor working and living conditions. This study assesses the working and living conditions of male and female brick workers and their children and looks to address the main issues and challenges to promote decent living and working conditions in the brick factories through action research. A rapid needs assessment was conducted to take stock of the working and living conditions of male and female workers across five provinces in Nepal. Subsequently, selected pilot interventions through stakeholder consultations were initiated to address these issues and challenges. There are a host of challenges faced by these workers in the factories, with the main issues being occupational health and safety and childcare/education for workers' children. The study suggests that the working and living conditions of the workers can be improved by incentivizing the brick entrepreneurs to invest in them, thus creating a more productive workforce. Moreover, the findings from the pilot interventions can help in the design of effective solutions.
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http://dx.doi.org/10.3390/ijerph18126479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296312PMC
June 2021

Bevacizumab based chemotherapy is a promising option in metastatic gallbladder adenocarcinoma.

Mol Clin Oncol 2021 Aug 7;15(2):153. Epub 2021 Jun 7.

Department of Medical Oncology, Asian Cancer Institute, Mumbai, Maharashtra 400036, India.

Gallbladder cancer (GBC) is one of the most frequently observed cancers in India that is usually diagnosed at an advanced stage. Although surgery remains the only curative option, the majority of GBCs are unresectable. Palliative chemotherapy with gemcitabine and cisplatin is the recommended treatment in such cases. The current study reports a case of a 47-year-old female who exhibited GBC that had metastasized to the liver and peritoneum. She was administered palliative chemotherapy with gemcitabine and cisplatin, but due to disease progression the regimen was changed and an aggressive treatment initiated with gemcitabine and oxaliplatin with additional biosimilar bevacizumab (modified Gemox-B regimen). The patient completed six chemotherapy cycles with partial response and received bevacizumab (7.5 mg/kg 3-weekly) based maintenance treatment for an additional 6 cycles, after which she demonstrated disease progression, thus having a progression free survival of ~11 months. The patient is currently receiving palliative chemotherapy with capecitabine.
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http://dx.doi.org/10.3892/mco.2021.2315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220675PMC
August 2021

Neuro-ophthalmic manifestations of tuberculosis.

Eye (Lond) 2021 Jun 14. Epub 2021 Jun 14.

Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Neuro-ophthalmic features are a known association in tuberculosis, especially common in central nervous system tuberculosis (CNS-TB). They are mostly the result of the visual pathway and/or ocular motor and other cranial nerve involvement. Furthermore, toxic optic neuropathy and paradoxical response to anti-tubercular drugs (ATT) are also not uncommon. The etiopathogenesis is by the complex interplay of various factors like exudates, vasculitis, arachnoiditis, presence of tuberculomas, hydrocephalus, brain infarcts and/or immune-mediated reaction. The entity often poses a diagnostic dilemma for the ophthalmologists/neuro-ophthalmologists and may lead to irreversible vision loss. The presence of neuro-ophthalmic features not only affect the visual outcome but are also predictors of systemic morbidity of the disease. Therefore, understanding and knowledge about this entity are necessary for the comprehensive management of the disease. While various forms of TB including CNS-TB have been well-dealt with in literature, little is discussed specifically about the neuro-ophthalmic manifestations of tuberculosis. Therefore, the purpose of this review is to highlight current understanding of the types of neuro-ophthalmic involvement in tuberculosis, its etiopathogenesis, diagnosis and management.
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http://dx.doi.org/10.1038/s41433-021-01619-6DOI Listing
June 2021

Effects of horizontal versus vertical bolster alignment on anatomical orientation of kidney as applied to prone percutaneous nephrolithotomy.

World J Urol 2021 May 21. Epub 2021 May 21.

Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Purpose: To evaluate the anatomical changes in kidney orientation in prone position with use of horizontal or vertical bolster alignment.

Methods: Patients having renal stone(s) on ultrasonogram or X-ray underwent split bolus computed-tomo-urography (CTU) in prone position with horizontal and vertical bolster positions. CTUs were read by a single radiologist to quantify the cranio-caudal, antero-posterior, side to side and rotational movements of kidneys as relevant to prone percutaneous nephrolithotomy.

Results: 19 adult patients with 38 renal units and mean basal metabolic index of 25.6 kg/m underwent CTU. Greater inferior displacement of both kidneys was seen with horizontal bolsters as compared to vertical bolsters. The right upper calyceal-diaphragm distance was 2.1 ± 1.5 cm and the lower calyceal-diaphragm distance was 2.0 ± 1.6 cm greater with the horizontal bolsters (p < 0.01). Similarly, the displacement on the left side was 1.5 ± 0.8 cm and 1.4 ± 0.8 cm, respectively (p < 0.01). Horizontal bolsters also result in significantly longer calyceal-skin distance at both poles of both kidneys [right upper: 0.4 ± 0.5 cm (p < 0.01), right lower: 0.8 ± 0.7 cm (p < 0.01), left upper: 0.4 ± 0.6 cm (p = 0.02), left lower: 0.8 ± 1.1 cm (p < 0.01)] and wider erector spinae-mid posterior calyceal-colon angle (124.8 v/s 110.0 on the right and 96.2 v/s 85.7 on the left) (p < 0.01).

Conclusion: Horizontal bolsters provide significantly more caudal displacement of the kidneys; the right kidney being displaced more as compared to the left. However, there is also an increase in the skin-calyceal distance with horizontal as compared to the vertical bolsters. These assessments may help the surgeons decide optimal bolster position individualized to the patient.
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http://dx.doi.org/10.1007/s00345-021-03728-zDOI Listing
May 2021

The Global Reading Room: An Indeterminate Renal Mass.

AJR Am J Roentgenol 2021 May 19. Epub 2021 May 19.

Department of Radiology, First Medical Center, Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing, China, 100853.

You are consulted regarding an 83-year-old healthy woman who underwent renal protocol CT for a 3.6 cm renal mass. The CT was degraded by motion artifact but showed indeterminate (17 HU) enhancement in the mass, reported as suspicious for papillary renal cell carcinoma. What do you recommend for further management?
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http://dx.doi.org/10.2214/AJR.21.26126DOI Listing
May 2021

Chemistry, Pharmacokinetics, Pharmacodynamics and Analytical methods of Bilastine, a histamine H1 receptor antagonist: An update

Mini Rev Med Chem 2021 05 21. Epub 2021 May 21.

Pharmaceutics, School of Pharmacy and Technology Management, SVKM’S NMIMS, Shirpur, India

Bilastine (BIL) is the new generation antihistamine that is used to relieve the symptoms of hayfever, chronic urticaria and other forms of allergic rhinitis. Chemically it is known 2-[4-[2-[4-[1-(2-ethoxyethyl) benzimidazole-2-yl] piperidine-1-yl] ethyl] phenyl]-2-methylpropane acid. The chemical structure of BIL having hydrophilic carboxylic substituent. BIL has a longer duration of action due to potent binding affinity to the H1 receptor. This review summarizes the properties, characteristics, chemistry along with analytical and bioanalytical methods used for estimation of BIL from different scientific articles. The literature has demonstrated some methods for quantification of BIL in various sample matrix and pharmaceutical products. Frequently and extensively used antihistaminics are in the clinic practice, a novel, effective, economical and safe analytical methodology is required for routine quality control analysis, bioavailability and bioequivalence studies. Furthermore, this narrative review summarizes available data on chemistry, pharmacology and analysis of BIL in different matrix.
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http://dx.doi.org/10.2174/1389557521666210520171457DOI Listing
May 2021

Reflux, Intraocular Pressure Variation and Pain Following Intravitreal Ranibizumab Injections Using 30-Gauge or 32-Gauge Needles for Patients With Retinal Pathologies: A Randomized Clinical Trial.

Cureus 2021 Apr 6;13(4):e14320. Epub 2021 Apr 6.

Ophthalmology, Queens University, Kingston, CAN.

Purpose: To compare reflux, intraocular pressure (IOP) variation and pain following intravitreal (IV) injections using 30-gauge and 32-gauge needles in patients with retinal pathologies in Saudi Arabia.

Methods: A double-blind randomized clinical trial was conducted in 2018. Participants were randomized to receive IV injections of Ranibizumab using 30-gauge (Gr) or 32-gauge (Gr) needles. The amount of reflux of injected material, IOP before (IOP) and five minutes after injection (IOP) were measured. The patient-perceived pain score was assessed using a visual analogue score (VAS). Outcome variables were compared.

Results: The study sample was comprised of 86 eyes (86 patients) in each group. Gender (P=0.76), laterality (P=0.55) and age (P=1.0) were not different between groups. The reflux in Gr [34.9% (95% confidence interval {CI}, 24.8; 45.0)] was significantly higher compared to Gr [22.1% (95% CI, 13.3; 30.9)] (P=0.007). The median pain score was 1 in both Gr [interquartile range (IQR) 1.0: 3.0] and Gr (IQR 0.0; 2.0) (P=0.04). Among 56 eyes without reflux in Gr, the IOP and IOP were 13.6±2.7 mmHg and 16.4±5.0 mmHg, respectively. Among 67 eyes without reflux in Gr, the IOP and IOP2 were 13.6±2.9 mmHg and 17.0±5.2 mmHg, respectively. The change in percentage in IOP in Gr and Gr was not significantly different (Mann Whiney P=0.3).

Conclusions: IV injection given by 30-gauge needle compared to 32-gauge needle resulted in greater patient-perceived pain and more reflux of injected material from the injection site. An increase in IOP was not associated with the gauge of the needle used for IV injection.
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http://dx.doi.org/10.7759/cureus.14320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101509PMC
April 2021

Chronic Manganese Toxicity in Indian Mines-An Historical Account of the Contributions of Dr. T.P. Niyogi.

Ann Indian Acad Neurol 2021 Jan-Feb;24(1):81-83. Epub 2020 Oct 7.

Emeritus Director, Jaslok Hospital and Research Centre and Professor Emeritus, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India.

The mining of manganese ore in India started in the year 1899, in Nagpur district of the Central Provinces. Almost six decades later, in 1957, Dr. T. P. Niyogi examined several young men involved in dry drilling of Manganese ore, who had symptoms of muscular pain, weakness, clumsy movements, asthenia, anorexia, insomnia, and gait difficulties. These patients were also emotionally disturbed and prone to falls and accidents. He concluded that these symptoms were due to chronic manganese toxicity with parkinsonian features and psychiatric manifestations which he published in 1958. This lead to the formation of an Enquiry Committee by the Ministry of Labour and Employment, Government of India which instituted corrective measures in mining of manganese in India. Very few reports of chronic toxicity due to inhalation of manganese have been reported subsequently. This paper highlights the contributions of Dr. T.P. Niyogi who was the Civil Surgeon in Chhindwara, MP during that period.
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http://dx.doi.org/10.4103/aian.AIAN_630_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061501PMC
October 2020

Impact of Comorbidity Prevalence and Cardiovascular Disease Status on the Efficacy and Safety of Nebulized Glycopyrrolate in Patients with COPD.

Int J Chron Obstruct Pulmon Dis 2021;16:1061-1073. Epub 2021 Apr 19.

Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.

Purpose: Patients with COPD often have multiple coexisting comorbidities, affecting quality of life, morbidity and mortality. However, the prevalence and impact of comorbidities on the efficacy of bronchodilators in COPD is poorly understood.

Patients And Methods: In this post hoc analysis, pooled data from the 12-week, placebo-controlled GOLDEN 3 and 4 studies of nebulized glycopyrrolate (GLY) in individuals with moderate-to-very-severe COPD were used to quantify comorbidities and assess their impact on treatment efficacy and safety.

Results: Comorbidities that were most prevalent in the GOLDEN 3 and 4 study population were hypertension, high cholesterol and osteoarthritis. Participants were grouped based on their pre-specified comorbidity count into Group A (≤2 comorbidities; n=439) and Group B (>2 comorbidities; n=854). Treatment with GLY resulted in significant improvements in forced expiratory volume in 1 second (FEV) and St George's Respiratory Questionnaire (SGRQ) total scores, independent of comorbidity prevalence. A higher prevalence of cardiovascular disease (CVD) comorbidities was observed among individuals in Group B, compared with Group A. In a sub-analysis based on prevalence of CVD, treatment with GLY resulted in significant FEV improvements independent of CVD prevalence, although values were numerically higher in the CVD group. GLY also led to higher improvements in SGRQ scores in the CVD group. GLY was well tolerated regardless of comorbidity or CVD prevalence, with a lower incidence of serious adverse events compared with placebo.

Conclusion: A simple comorbidity count demonstrated that a majority of patients with COPD in the GOLDEN 3 and 4 studies had multiple comorbidities, with CVD being common in those with high comorbidity count. Results from this post hoc analysis demonstrate that GLY improved FEV and SGRQ scores in individuals with COPD, independent of their comorbidities or CVD status.
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http://dx.doi.org/10.2147/COPD.S302088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064685PMC
April 2021

Novel water soluble sterile natamycin formulation (Natasol) for fungal keratitis.

Eur J Pharm Sci 2021 Aug 18;163:105857. Epub 2021 Apr 18.

Ocular Pharmacology and Pharmacy Division, All India Institute of Medical Sciences, New Delhi110029, India.

The purpose of this study was to develop, characterize and evaluate novel water soluble formulation for its topical and intrastromal application. Natamycin complexed with cyclodextrin was characterized by Fourier-transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The complexed powder was used to formulate 1% w/v aqueous natamycin formulation (Natasol 1%) for topical use. The developed formulation was subjected to stability testing at various conditions. Single and multi-dose trans-corneal permeation of Natasol 1% was evaluated in New Zealand Albino rabbits in comparison with marketed 5% natamycin suspension. Sterile unpreserved Natasol (0.01% w/v natamycin) formulation was also developed for intrastromal injection. Both formulations were evaluated for the ocular toxicity. FTIR and DSC studies revealed successful complexation of natamycin that further protected the degradation at various stability conditions. Single dose trans-corneal permeation studies revealed that Natasol 1% attained Cmax at one hr and maintain its intraocular concentration 5 and 2.5 times higher at 4 and 6 hr compared to 5% natamycin suspension. Multi-dose kinetics revealed the steady state pharmacokinetics after hourly and two hourly dosing schedules. Topical Natasol 1% and sterile unpreserved Natasol 0.01% intrastromal injection, did not show any ocular toxicity in the animals. To conclude, the newly developed topical 1% w/v natamycin formulation was found to be non-inferior to 5% natamycin topical suspension. It is expected to increase patient compliance for the treatment of fungal keratitis.
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http://dx.doi.org/10.1016/j.ejps.2021.105857DOI Listing
August 2021

Utility of first order MRI-Texture analysis parameters in the prediction of histologic grade and muscle invasion in urinary bladder cancer: a preliminary study.

Br J Radiol 2021 Jun 29;94(1122):20201114. Epub 2021 Apr 29.

Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Objective: To explore the utility of first-order MRI-texture analysis (TA) parameters in predicting histologic grade and muscle invasion in urinary bladder cancer (UBC).

Methods: After ethical clearance, 40 patients with UBC, who were imaged on a 3.0-Tesla scanner, were retrospectively included. Using the TexRAD platform, two readers placed freehand ROI on the sections demonstrating the largest dimension of the tumor, evaluating only one tumor per patient. Interobserver reproducibility was assessed using the intraclass correlation coefficient (ICC). Mann-Whitney test and ROC curve analysis were used to identify statistical significance and select parameters with high class separation capacity (AUC >0.8), respectively. Pearson's test was used to identify redundancy in the results.

Results: All texture parameters showed excellent ICC. The best parameters in differentiating high and low-grade tumors were mean/ mean of positive pixels (MPP) at SSF 0 (AUC: 0.897) and kurtosis at SSF 5 (AUC: 0.828) on the ADC images. In differentiating muscle invasive from non-muscle invasive tumors, mean/ MPP at SSF 0 on the ADC images showed AUC >0.8; however, this finding resulted from the confounding effect of high-grade histology on the ADC values of muscle invasive tumors.

Conclusion: MRI-TA generated few parameters which were reproducible and useful in predicting histologic grade. No independent parameters predicted muscle invasion.

Advances In Knowledge: There is lacuna in the literature concerning the role of MRI-TA in the prediction of histologic grade and muscle invasion in UBC. Our study generated a few first-order parameters which were useful in predicting high-grade histology.
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http://dx.doi.org/10.1259/bjr.20201114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173695PMC
June 2021

Effect of SGRQ-Defined Chronic Bronchitis at Baseline on Treatment Outcomes in Patients with COPD Receiving Nebulized Glycopyrrolate.

Int J Chron Obstruct Pulmon Dis 2021;16:945-955. Epub 2021 Apr 12.

Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.

Background: Chronic bronchitis (CB) is one of the conditions that contribute to chronic obstructive pulmonary disease (COPD). Despite its widespread prevalence among patients with COPD and overall negative impact on treatment outcomes, the effect of CB on the efficacy of bronchodilator therapy has not been evaluated. The objective of this post hoc analysis is to assess the effect of nebulized glycopyrrolate (GLY) on lung function and health-related quality of life outcomes in patients with St George's Respiratory Questionnaire (SGRQ)-defined CB at baseline.

Methods: Pooled data from the replicate, 12-week GOLDEN 3 and 4 studies (N=861) were grouped by CB status at baseline. The endpoints reported are changes from baseline in trough forced expiratory volume in 1 second (FEV), SGRQ and EXAcerbations of Chronic Pulmonary Disease Tool-Respiratory Symptoms (EXACT-RS) scores. Safety of GLY was evaluated by monitoring the incidence of adverse events (AEs).

Results: Following 12 weeks of treatment, GLY 25 μg twice-daily (BID) resulted in placebo-adjusted improvements from baseline in FEV of 77.1 mL and 124.4 mL in the CB and non-CB groups, respectively (p<0.0001 vs placebo in both groups). Significant improvements in SGRQ total scores were observed with GLY 25 μg BID compared with placebo, regardless of baseline CB status. Although EXACT-RS improvements were noted in both CB and non-CB groups, significant improvements were observed only in the CB group. GLY 25 μg BID was generally well tolerated through 12 weeks of treatment, with a low incidence of AEs.

Conclusion: Treatment with nebulized GLY 25 μg BID for 12 weeks resulted in significant improvements in lung function and SGRQ total scores, compared with placebo. Significant improvements in EXACT-RS total scores were observed only in the CB group. Together, these results support the use of GLY 25 μg BID in patients with COPD, regardless of their CB status.
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http://dx.doi.org/10.2147/COPD.S304182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051958PMC
April 2021

Validation of whole genome sequencing from dried blood spots.

BMC Med Genomics 2021 Apr 20;14(1):110. Epub 2021 Apr 20.

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, 02115, USA.

Background: Dried blood spots (DBS) are a relatively inexpensive source of nucleic acids and are easy to collect, transport, and store in large-scale field surveys, especially in resource-limited settings. However, their performance in whole-genome sequencing (WGS) relative to that of venous blood DNA has not been analyzed for various downstream applications.

Methods: This study compares the WGS performance of DBS paired with venous blood samples collected from 12 subjects.

Results: Results of standard quality checks of coverage, base quality, and mapping quality were found to be near identical between DBS and venous blood. Concordance for single-nucleotide variants, insertions and deletions, and copy number variants was high between these two sample types. Additionally, downstream analyses typical of population-based studies were performed, such as mitochondrial heteroplasmy detection, haplotype analysis, mitochondrial copy number changes, and determination of telomere lengths. The absolute mitochondrial copy number values were higher for DBS than for venous blood, though the trend in sample-to-sample variation was similar between DBS and blood. Telomere length estimates in most DBS samples were on par with those from venous blood.

Conclusion: DBS samples can serve as a robust and feasible alternative to venous blood for studies requiring WGS analysis.
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http://dx.doi.org/10.1186/s12920-021-00951-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056537PMC
April 2021

Research productivity and impact of Canadian academic ophthalmologists: trends in H-index, sex, subspecialty, and faculty appointment.

Can J Ophthalmol 2021 Apr 15. Epub 2021 Apr 15.

Department of Ophthalmology, Queen's University, Kingston, Ont.. Electronic address:

Objective: H-index has historically functioned as a metric of academic success for acquisition of research grants, awards, and faculty appointments. Our objective was to characterize the landscape of Canadian academic ophthalmology on the basis of research productivity and impact-as measured by H-index-with sex, subspecialty, and faculty appointment.

Design: Cross-sectional study based on data abstracted from publicly available databases.

Participants: Academic ophthalmologists from all schools in Canada with an ophthalmology residency program.

Methods: Academic ophthalmologists and their faculty appointments were identified from university websites. Sex was determined from available provincial College of Physicians and Surgeons or Ophthalmology Society databases. H-indices were collected from Scopus and Web of Science. Descriptive, univariate, and multivariate statistics were used to analyze the relationship of H-index with sex, faculty appointment, and subspecialty.

Results: We included data from 696 academic ophthalmologists. The mean H-indices for lecturers and assistant, associate, and full professors were 4.0 (±5.6), 5.6 (±5.0), 8.8 (±6.3), and 15 (±12), respectively. H-index had a significant positive correlation with faculty appointment (0.521, 95% confidence interval 0.469-0.579, p = 1.77e-41). The mean H-index was 6.7 (±8.2) for women and 8.1(±8.4) for men (p = 0.0635). Women comprised 27% of faculty positions, and men were more likely to have a higher faculty appointment than women (p = 0.0073). The top subspecialties for underrepresentation of women were surgical retina, medical retina, and oculoplastics.

Conclusions: Faculty appointments are associated with research productivity, as measured by H-index. There are significant sex disparities in faculty appointments and subspecialty representation. Future directions include exploring other contributory factors to success in academic ophthalmology.
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http://dx.doi.org/10.1016/j.jcjo.2021.03.011DOI Listing
April 2021

Athletes with valvular heart disease and competitive sports: a position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2021 Apr 13. Epub 2021 Apr 13.

Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

This article provides an overview of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology on sports participation in individuals with valvular heart disease (VHD). The aim of these recommendations is to encourage regular physical activity including sports participation, with reasonable precaution to ensure a high level of safety for all affected individuals. Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is an increasing group of younger individuals with valvular defects. The diagnosis of cardiac disorders during routine cardiac examination often raises questions about on-going participation in competitive sport with a high dynamic or static component and the level of permissible physical effort during recreational exercise. Although the natural history of several valvular diseases has been reported in the general population, little is known about the potential influence of chronic intensive physical activity on valve function, left ventricular remodelling pulmonary artery pressure, and risk of arrhythmia. Due to the sparsity of data on the effects of exercise on VHD, the present document is largely based on clinical experience and expert opinion.
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http://dx.doi.org/10.1093/eurjpc/zwab058DOI Listing
April 2021

Improvement in Lung Function and Patient-Reported Outcomes in Patients with COPD with Comorbid Anxiety and Depression Receiving Nebulized Glycopyrrolate in the GOLDEN 3 and 4 Studies.

Int J Chron Obstruct Pulmon Dis 2021;16:865-875. Epub 2021 Mar 31.

Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.

Background: Anxiety and depression (A/D) are common in patients with chronic obstructive pulmonary disease (COPD) and are often associated with lower adherence to treatment and worse patient-related outcomes. However, studies on the impact of comorbid A/D on responses to bronchodilators are limited.

Methods: This post hoc analysis of pooled data (N=861) from the GOLDEN 3 and 4 studies compared the efficacy and safety of nebulized glycopyrrolate (GLY) 25 µg in patients with moderate-to-very-severe COPD, grouped by self-reported A/D. Changes in forced expiratory volume in 1 second (FEV) and health-related quality of life determined by St George's Respiratory Questionnaire (SGRQ) scores in patients with or without comorbid A/D (A/D [+] or A/D [-]) were examined following 12 weeks of GLY 25 µg twice-daily (BID) or placebo treatment.

Results: A/D (+) patients were predominantly female, younger, included a higher proportion of current smokers, and had higher baseline SGRQ scores compared with the A/D (-) group. At 12 weeks, GLY resulted in placebo-adjusted improvements from baseline in FEV of 46.9 mL (p=0.19; not significant) and 106.7 mL (p<0.0001), in the A/D (+) and A/D (-) groups, respectively. Improvements were observed with GLY compared to placebo in SGRQ scores, regardless of baseline A/D status; the placebo-adjusted least squares mean change from baseline in SGRQ total scores was -3.16 (p>0.05) and -3.34 (p<0.001), for the A/D (+) and A/D (-) groups, respectively. Despite numerical improvements in SGRQ scores with GLY in the A/D (+) group, a higher response to placebo was observed. GLY was generally well tolerated throughout 12 weeks of treatment; incidence of adverse events was higher in the A/D (+) group compared with the A/D (-) group in both treatment arms.

Conclusion: GLY 25 µg BID resulted in numerical improvements in FEV, SGRQ total scores and SGRQ responder rates in patients with moderate-to-very-severe COPD, regardless of A/D status at baseline; significant improvements were noted only in the A/D (+) group. The results emphasize the importance of considering underlying comorbidities including A/D when evaluating the efficacy of COPD treatments.
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http://dx.doi.org/10.2147/COPD.S294053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020329PMC
June 2021

Unveiling the confusion in renal fusion anomalies: role of imaging.

Abdom Radiol (NY) 2021 Apr 3. Epub 2021 Apr 3.

Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Renal fusion anomalies are common congenital anomalies of the urogenital tract and have their genesis in the early embryonic period. They are classified into partial fusion anomalies (e.g., crossed fused ectopia, and horseshoe kidney) and complete fusion anomalies (e.g., fused pelvic kidney). Horseshoe kidney is the most common renal fusion anomaly and is characterized by the presence of two distinct functioning kidneys on either side of the vertebral column, with fusion occurring at the inferior poles in majority of the cases. Crossed fused ectopia is characterized by the presence of an ectopic kidney that crosses the midline and fuses with the orthotopic contralateral kidney, whereas fused pelvic (pancake) kidney is a complete fusion anomaly characterized by extensive medial fusion of both kidneys in the pelvis. Fusion anomalies are often associated with abnormalities of renal rotation, migration, and vascular supply, which predispose the kidneys to a number of complications and create difficulty during retroperitoneal surgeries and interventions. They are also associated with other congenital abnormalities of the urogenital tract, gastrointestinal tract, cardiovascular system, and skeletal system. Hence, a thorough understanding of the etiopathogenesis and radiological features of fusion anomalies is important for directing patient management. This review summarizes the embryological basis, clinical presentation and imaging approach to renal fusion anomalies, followed by detailed anatomical and radiological description of the morphological types, and the complications associated with these anomalies.
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http://dx.doi.org/10.1007/s00261-021-03072-1DOI Listing
April 2021

The heart of the ageing endurance athlete: the role of chronic coronary stress.

Eur Heart J 2021 Jul;42(28):2737-2744

Cardiology Clinical and Academic Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.

Moderate physical exercise is associated with an irrefutable reduction in cardiac morbidity and mortality. The current guidelines recommend at least 150 min of moderate exercise or 75 min of vigorous exercise per week. Endurance athletes perform exercise at a level that is 10- to 20-fold greater than these recommendations. These athletes reveal several structural and functional cardiac adaptations including increased cardiac size, enhanced ventricular filling, and augmentation of stroke volume even at the highest heart rates. The long-term effects of endurance exercise on the heart are unknown. Endurance exercise is associated with a transient increase in serum concentrations of biomarkers of cardiac damage and ventricular dysfunction which improves within 72 h. Over the past decade, there have been emerging studies reporting attenuated mortality benefit amongst individuals who perform the highest volume of exercise. Studies in lifelong male athletes aged above 40 years old show a higher prevalence of high coronary artery calcium scores (>300 Agatston units), a higher coronary plaque burden, and myocardial fibrosis compatible with subclinical myocardial infarction compared with relatively sedentary healthy controls, raising speculation that lifelong intense exercise imposes chronic coronary stress on the heart. This review article will provide a critical analysis of the existing data.
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http://dx.doi.org/10.1093/eurheartj/ehab095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294842PMC
July 2021

Utility of Ultrasound Guidance During Direct Intrahepatic Portal Shunt Placement in Pediatric Patients With Budd-Chiari Syndrome.

AJR Am J Roentgenol 2021 05 17;216(5):W15. Epub 2021 Mar 17.

All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.2214/AJR.20.24556DOI Listing
May 2021

CT-Guided Lumbar Sympathectomy as a Last Option for Chronic Limb-Threatening Ischemia of the Lower Limbs: Evaluation of Technical Factors and Long-Term Outcomes.

AJR Am J Roentgenol 2021 05 3;216(5):1273-1282. Epub 2021 Mar 3.

Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029.

The purpose of this study was to assess the effects of anatomic and technical factors on the long-term outcome of CT-guided lumbar sympathectomy in patients with chronic limb-threatening ischemia. Thirty patients (28 men, two women; mean age, 45.8 years) with chronic limb-threatening ischemia and diffuse tibial arterial disease not amenable to revascularization were included. CT-guided lumbar sympathectomy was performed at the L2-L3 level with a 22-gauge Chiba needle and absolute alcohol. Any periprocedural complication was noted. Numeric pain score (1-10 scale) and skin ulcers were assessed before the procedure and 3 weeks, 3 months, and 1 and 2 years after the procedure. According to spread of alcohol, patients were categorized into those with medial spread and those without medial spread (lateral spread group) with the lateral edge of the vertebral body as the reference point. Treatment results were categorized as improved, unchanged, or worsened on the basis of clinical response. There were 22 (73.3%) patients in the medial spread group and eight (26.7%) in the lateral spread group. The mean volumes of alcohol injected per side were not significantly different ( = .50). One major complication occurred in the group with medial spread. Mean numeric pain scores before the procedure and 3 weeks, 3 months, and 1 and 2 years afterward were 7.31, 2.95, 2.47, 2.10, and 2.04 in the medial spread group and 6.25, 4.13, 4.50, 4.35 and 4.32 in the lateral spread group ( < .001). At 2 years, 16 patients in the medial spread group and two patients in the lateral spread group showed clinical improvement ( < .001), and the limb salvage rates were 100% and 87.5%, respectively. Multivariate analysis showed a trend in improvement with smoking cessation, but the difference was not statistically significant ( = .15). The direction of spread of the neurolytic agent, however, was a major determinant of outcome. CT-guided lumbar sympathectomy is a simple, safe, and effective procedure. Ensuring medial spread of the neurolytic agent significantly improves long-term results.
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http://dx.doi.org/10.2214/AJR.20.23089DOI Listing
May 2021

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic.

Br J Sports Med 2021 Feb 22. Epub 2021 Feb 22.

Wits Sport and Health (WiSH), School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa.

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.
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http://dx.doi.org/10.1136/bjsports-2020-103622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902323PMC
February 2021

Vision-related quality-of-life estimates in adolescent youths.

Can J Ophthalmol 2021 Feb 13. Epub 2021 Feb 13.

Hotel Dieu Hospital, Queens University School of Medicine, Kingston, Ont.

Objective: To estimate perceptions of quality-of-life (QOL) associated with vision loss in youths under age 21 and compare them with adult general community perceptions and those of ophthalmic patients with vision loss.

Design: Cross-sectional, time tradeoff (TTO), utility analysis.

Participants: Consecutive youths aged 13-20 years who agreed to participate in the study.

Methods: Vision utilities were acquired from adolescents asked to estimate the QOL associated with 3 vision scenarios using a validated, reliable, interviewer-administered TTO utility instrument. The scenarios modeled included: (i) mild vision loss (20/40-20/60), (ii) moderate vision loss (20/70-20/100), and (iii) severe vision loss (≤20/200). Results were compared with utilities previously gathered from the adult general community and from vision-impaired patients with acuity loss to the level of the modeled scenarios.

Results: Mean TTO vision utilities were: scenario 1: youths (0.96) versus patients (0.79) (p < 0.0001); scenario 2: youths (0.88) versus patients (0.72) (p < 0.0001); scenario 3: (analysis of variance p < 0.0001) Tukey's Honestly Significant Difference Test, youths (0.79) versus patients (0.60) (p < 0.01), youths (0.79) versus adult general community (0.85) (p < 0.01), adult general community (0.85) versus patients (0.60) (p < 0.01).

Conclusions: Adolescents underestimated the effects of mild, moderate, and severe vision loss upon QOL referent to patients with actual vision loss (p < 0.0001), and thus are not good patient surrogates for utilities used in cost-utility analysis. Nonetheless, youth estimates were closer to those of patients with vision loss than were adult general community estimates. These findings emphasize the importance of using patient utilities in cost-utility analysis.
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http://dx.doi.org/10.1016/j.jcjo.2021.01.012DOI Listing
February 2021

Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young.

Europace 2021 02 11. Epub 2021 Feb 11.

Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK.

Aims: There is limited information on the role of screening with electrocardiography (ECG) for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a non-select group of adolescents and young adults in the general population.

Methods And Results: Between 2012 and 2014, 26 900 young individuals (aged 14-35 years) were prospectively evaluated with a health questionnaire and ECG. Individuals with abnormal results underwent secondary investigations, the costs of which were being based on the UK National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these individuals received medical intervention beyond lifestyle modification advice in the follow-up period of 24 months. The overall cost of the evaluation process was €97 per person screened, €17 834 per cardiovascular disease detected, and €29 588 per cardiovascular disease associated with SCD detected. Inclusion of ECG was associated with a 36% cost reduction per diagnosis of diseases associated with SCD compared with the health questionnaire alone.

Conclusion: The inclusion of an ECG to a health questionnaire is associated with a five-fold increase in the ability to detect disease associated with SCD in young individuals and is more cost effective for detecting serious disease compared with screening with a health questionnaire alone.
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http://dx.doi.org/10.1093/europace/euab021DOI Listing
February 2021

Utility and Safety of Transjugular Liver Biopsy in Children.

Indian J Pediatr 2021 Jul 2;88(7):709-711. Epub 2021 Feb 2.

Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Transjugular liver biopsy (TJLB) is widely used in adults when percutaneous liver biopsy (PLB) is contraindicated. The authors evaluated the safety, efficacy and utility of TJLB in pediatric patients with contraindications to PLB. Twenty-three children and adolescents (13 male) underwent 24 (one patient had two separate biopsies) consecutive biopsies (TJLB) under general anaesthesia (18) or intravenous sedation (6). PLB was contraindicated because of elevated prothrombin time (PT)/international normalized ratio (INR) (˃ 15.5/1.5) in 19 (79.2%) and thrombocytopenia (< 60,000/dL) in 15 (62.5%) procedures. Derangement in both INR and platelet count were found in 12 (50%) cases. Significant ascites was present in 10 (41.7%) procedures. Technical success rate with adequate biopsy sample was 95.8% (23/24) with no major complications. A new diagnosis was established in 9 (37.5%) cases. Another 14 (58.34%) biopsies confirmed the initial diagnoses. Four cases also revealed additional information guiding overall management and prognosis. Thus, TJLB is a safe and useful procedure in children.
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http://dx.doi.org/10.1007/s12098-020-03650-zDOI Listing
July 2021

Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal.

BMC Infect Dis 2021 Jan 29;21(1):128. Epub 2021 Jan 29.

Baldwin Wallace University, 275 Eastland Rd., Berea, OH, 44017, USA.

Background: Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions.

Methods: In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma.

Results: Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67-0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01-1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20-0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03-1.78; p = 0·03; aPR 1.45; 95% CI 1.03-2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work.

Conclusions: Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.
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http://dx.doi.org/10.1186/s12879-021-05803-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845103PMC
January 2021

Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review.

Br J Sports Med 2021 Jan 20. Epub 2021 Jan 20.

Cardiology, Clinical Academic Group, St George's, University of London, London, UK.

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the 'blanket' disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.
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http://dx.doi.org/10.1136/bjsports-2020-102921DOI Listing
January 2021
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