DSIR recognized | FWA approved-FWA00012971
 

Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort study.

10 July, 2014 Publications

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Objectives: To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are > or = 75 years of age. BACKGROUND: CS after AMI continues to pose formidable therapeutic challenges in elderly patients. METHODS: We conducted survival analyses of 310 consecutive subjects (including 80 patients > or = 75 years of age) who developed cardiogenic shock after AMI at two study centers – Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis. RESULTS: Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients > or = 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p = 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients > or = 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort. CONCLUSIONS: These retrospective data suggest a significant survival benefit of early revascularization in elderly patients > or = 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.
J Invasive Cardiol. 2009;21:305-12.

 

By: Amin AP, Nathan S, Prodduturi P, DSilva O, Gupta A, Kumar A, Senter S, Mamtani M, Kulkarni H, Klein LW, Kelly RF

Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial.

10 July, 2014 Publications

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Background: Diarrhea causes an estimated 2.5 million child deaths in developing countries each year, 35% of which are due to acute diarrhea. Zinc and copper stores in the body are known to be depleted during acute diarrhea. Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with standard treatment to children with acute watery or bloody diarrhea. METHODS: We conducted a double-blind randomized controlled clinical trial in the Department of Pediatrics at Indira Gandhi Government Medical College Nagpur, India. Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn+Cu) together with standard treatment for acute diarrhea. RESULTS: The mean duration of diarrhea from enrollment and the mean stool weight during hospital stay were 63.7 hours and 940 grams, respectively, and there were no significant differences in the adjusted means across treatment groups. Similarly, the adjusted means of the amount of oral rehydration solution or intravenous fluids used, the proportion of participants with diarrhea more than 7 days from onset, and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrollment, did not differ across the three groups. CONCLUSION: The expected beneficial effects of zinc supplementation for acute diarrhea were not observed. Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children.
BMC Med. 2009;7:22.

 

By: Patel A, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H

Bone recovery after zoledronate therapy in thalassemia-induced osteoporosis: a meta-analysis and systematic review.

10 July, 2014 Publications

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Background: Zoledronate is a promising bisphosphonate that improves the bone mineral density by 0.69 standard deviations in thalassemia-induced osteoporosis, but the entire range of its actions and side effects is currently not fully understood. INTRODUCTION: Zoledronate is a promising bisphosphonate for the treatment of thalassemia-induced osteoporosis; however, a quantitative summary of its beneficial effect and its effects on the markers of bone turnover are not established. METHODS: We conducted a meta-analysis of the published randomized controlled trials using standardized mean difference and a random effects model for improvement in bone mineral density (BMD). We also conducted a systematic review for the influence of zoledronate on markers of bone turnover and bone pain. RESULTS: We found that zoledronate improves the baseline BMD by 0.69 (95% confidence interval 0.47-0.90) standard deviations-an effect that was more pronounced when BMD was measured at the lumbar spine. However, the mechanistic interpretations of the effects on the markers of bone turnover are not completely clear. CONCLUSION: Sufficient evidence exists to demonstrate that 4 mg zoledronate given every 3 months markedly improves the BMD; however, more qualitative and quantitative evidence is required to understand the mechanisms of its action and the potential side effects.
Osteoporos Int. 2009 Feb 26. [Epub ahead of print]

 

By: Mamtani M, Kulkarni H

Value of early cardiac troponin I to predict long-term adverse events after coronary artery bypass graft surgery in patients presenting with acute coronary syndromes.

10 July, 2014 Publications

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BACKGROUND: High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. HYPOTHESIS: Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long-term outcomes after CABG. METHODS: We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. RESULTS: In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%- 5%, p < 0.001) faster progression to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05-6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. CONCLUSION: Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long-term adverse events after CABG.
Clin Cardiol. 2009;32:386-92.

 

By: Amin AP, Mukhopadhyay E, Napan S, Mamtani M, Kelly RF, Kulkarni H

Factors influencing the benefit of adjunctive devices during percutaneous coronary intervention in ST-segment elevation myocardial infarction: meta-analysis and meta-regression

10 July, 2014 Publications

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Background: Routine use of adjunctive devices to percutaneous coronary intervention (PCI) for the treatment of patients of ST-segment elevation myocardial infarction (STEMI) is questionable. Also, the clinical characteristics of STEMI patients that can modulate the treatment benefits of adjunctive devices are not fully understood. Objective: To synthesize the existing literature to summarize the therapeutic benefit of the adjunctive devices and to identify the patient characteristics which relate to this therapeutic benefit. METHODS: We conducted (i) meta-analyses of the randomized controlled trials (RCT) comparing the performance of the adjunctive devices with PCI for three reperfusion-related outcomes: myocardial blush grade (MBG) < 3, failed ST-segment resolution (STR), and Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3; (ii) stepwise meta-regressions of the effect of trial characteristics on between-trial heterogeneity; and (iii) analyses to examine whether the reperfusion-related end-points explained the between-trial difference in cardiac death and major adverse cardiac events (MACE). RESULTS: Our meta-analyses represent data from 23 RCT and 5,728 subjects. The overall therapeutic benefit attributable ranged from 32 to 35% for the reperfusion-related outcomes, and thrombectomy devices were more beneficial than the distal protection devices.Meta-regression identified gender, receipt of glycoprotein (GP) IIb/IIIa inhibitor, and baseline TIMI flow grade as significant predictors of improved reperfusion across trials. The available clinical trials were individually underpowered and not designed to detect the influence of adjunctive devices on death or MACE. CONCLUSIONS: Routine use of adjunctive devices cannot be recommended. Thrombus burden, treatment with GPIIb/IIIa inhibitors, and gender may modify the reperfusion benefit of adjunctive devices.
J Interv Cardiol. 2009;22:49-60.

 

By: Amin AP, Mamtani MR, Kulkarni H

A clinical tool to predict failed response to therapy in children with severe pneumonia.

10 July, 2014 Publications

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Background: Severe pneumonia in children under 5 years of age continues to be an important clinical entity with treatment failure rates as high as 20%. Where severe pneumonias are common, predictive tools for treatment failure like chest radiography and pulse oximetry are not available or affordable. Thus, there is a need for development of simple, accurate and inexpensive clinical tools for prediction of treatment failure. Using clinical, chest radiographic and pulse oximetry data from 1702 children recruited in the Amoxicillin Penicillin Pneumonia International Study (APPIS) trial we developed and validated a simple clinical tool. For development, a randomly derived development sample (n = 889) was used. The tool which was based on the results of multivariate logistic regression models was validated on a separate sample of 813 children. The derived clinical tool in its final form contained three clinical predictors: age of child, excess age-specific respiratory rate at baseline and at 24 hr of hospitalization. This tool had a 70% and 66% predictive accuracy in the development and validation samples, respectively. The tool is presented as an easy-to-use nomogram. It is possible to predict the likelihood of treatment failure in children with severe pneumonia based on clinical features that are simple and inexpensive to measure.
Pediatr Pulmonol. 2009;44:379-86.

 

By: Mamtani M, Patel A, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Radovan IM, Thea DM, Qazi S, Kulkarni H

Blood lead levels in children with encephalopathy.

10 July, 2014 Publications

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Objective: To determine the prevalence of elevated blood lead levels (EBLL i.e blood lead >10 micrograms/dL, Centers Disease Control criteria) in children with encephalopathy. SETTING: Hospital. DESIGN: Case control study. PARTICIPANTS: 100 children, 49 with encephalopathy and 51 consecutive hospital controls. OUTCOME MEASURES: Blood lead levels, demographics, clinical, environmental correlates and residual neurological sequel or death at discharge. RESULTS: 42 (encephalopathy) and 49 (hospital controls) children were available for analysis. The overall (n=91) mean blood lead was 7.88+/-10.44 micrograms/dL (range 0.07-67.68 micrograms/dL). The predictors of EBLL were presence of wasting (P<0.03), anemia (P<0.04), use of surma (P< 0.02), recent removal of house paint (P<0.01) or recently repainted (P<0.01). The mean blood lead levels were significantly higher (P<0.01) in patients of encephalopathy (12.18+/- 13.90 micrograms/dL) than in controls (4.19+/- 2.84 micrograms/dL). EBLL was present in 3/17 (17.6%) patients with infective encephalopathy and in 18/25 (72%) with non-infective encephalopathy. The proportion of children with residual neurological sequelae, or death increased when associated with EBLL (0 to 21%, and 69% to 100% respectively). CONCLUSION: Children hospitalized with encephalopathy have elevated blood lead levels.
Indian Pediatr. 2009;46:845-8.

 

By: Patel A, Athawale A

Breastfeeeding and infant feeding practices in India – A review of demographic and health surveys and national family health surveys.

10 July, 2014 Publications

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No Abstract available.
MCH Community Newsletter August 2008.

 

By: Patel AB, Badhoniya N, Dibley MJ

Value of chest radiography in predicting treatment response in children aged 3-59 months with severe pneumonia.

10 July, 2014 Publications

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SETTING: International multicentric study at nine tertiary care centres. OBJECTIVE: The World Health Organization (WHO) currently does not recommend chest radiographs (CXRs) for routine management of pneumonia. We evaluated the use of CXR for the prediction of treatment failure in children with severe pneumonia. DESIGN: We used WHO vaccine trials radiographic assessment, clinical and nasopharyngeal microbiological data from 1121 3-59-month-old children recruited using the WHO definition of severe pneumonia in the Amoxicillin Penicillin Pneumonia International Study (APPIS). Using Poisson regression, we estimated the relative risk of developing clinical treatment failure and predictive preventive benefit of the CXR and examined the concordance of the CXR findings with the nasopharyngeal microbiological data. RESULTS: A CXR with significant pathology (defined by the WHO algorithm as end-point consolidation, pleural fluid and other infiltrates) was associated with a high risk of treatment failure, especially in children who received penicillin as compared to oral amoxicillin. Significant pathology was also associated with nasopharyngeal isolation of penicillin-resistant Streptococcus pneumoniae. Children with a normal CXR had a reduced risk of clinical treatment failure. CONCLUSIONS: CXR with significant pathology independently and additively predicts clinical treatment failure. If CXR and the WHO tool are available, they can be used in the management of severe pneumonia.
Int J Tuberc Lung Dis. 2008;12:1320-6.

 

By: Patel A, Mamtani M, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Maulen-Radovan I, Thea DM, Qazi S, Kulkarni H

Use of the QuantiFERON-TB Gold In-Tube test to monitor treatment efficacy in active pulmonary tuberculosis.

10 July, 2014 Publications

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Setting: Cohort study at a tertiary care hospital. OBJECTIVE: To assess the potential use of QuantiFERON-TB Gold In-Tube (QFT-G) in monitoring clinical response to anti-tuberculosis treatment. DESIGN: We conducted a cohort study of 76 active pulmonary tuberculosis patients with serial testing by QFT-G at baseline and after 2 and 6 months of treatment. At these time points, we compared the performance of QFT-G with sputum culture status of the study subjects. RESULTS: Compared to baseline, 59 (77.6%) cases showed a decline whereas 17 (22.4%) showed persistent or stronger interferon-gamma (IFN-gamma) responses at 2 months. Using robust statistical methods, we observed that QFT-G assessment at 2 months independently and significantly predicted the likelihood of remaining sputum culture-positive at the end of the intensive phase of anti-tuberculosis treatment. A higher IFN-gamma concentration by 1 international unit (IU)/ml corresponded to a 45% (95%CI 8-97) higher likelihood of failing to convert to a negative culture, whereas a rising or persistent IFN-gamma response was associated with a 17.3 (P = 0.007) times higher likelihood of remaining culture-positive at 2 months. CONCLUSIONS: Our results suggest that QFT-G can potentially be used as a tool to monitor the efficacy of anti-tuberculosis treatment.
nt J Tuberc Lung Dis. 2008;12:1146-52.

 

By: Katiyar SK, Sampath A, Bihari S, Mamtani M, Kulkarni H