Shahidul Islam

Clinical Trials, Public Health, Genetic Epidemiology

MPH
23.58

Publications

  • John F Aloia · Albert Shieh · Mageda Mikhail · Shahidul Islam
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    ABSTRACT: The objective of this study was to develop a reference range for urine calcium excretion (both 24-hour and fasting) for African American women compared to White women. In addition, the variables that determine urine calcium excretion were identified. Data were analyzed for baseline studies of healthy postmenopausal volunteers who participated in seven separate studies conducted at one site. Some studies included fasting urine Ca/Cr and others 24-hour urine calcium excretion. 24-hour urine calcium was considered with and without correction for urinary creatinine excretion. Calcium was measured initially by atomic absorption spectrophotometry and more recently by an automated method (ADVIA 2400 Chemistry System). Participants were considered healthy based on history and physical and routine laboratory studies. Those screened who had a history of nephrolithiasis were excluded. A reference range for 24-hour urine calcium and fasting urine calcium/ creatinine was developed. Reference intervals of 11 - 197 mg/24-hour urine calcium excretion and of 0.007 - 0.222 of fasting Ca/Cr were found for African American women compared to 21 - 221 mg/24 hours and 0.019 - 0.264 in White women, respectively. Urine creatinine excretion was higher in African Americans consistent with their higher muscle mass. Urine calcium excretion is lower in postmenopausal African American than White women. The reference range developed should be considered in the diagnosis of hypocalciuric states and may also be useful in the diagnosis of hypercalciuria.
    Clinical nephrology 07/2015; DOI:10.5414/CN108548 · 1.23 Impact Factor
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    ABSTRACT: African Americans have a lower total serum 25-hydroxyvitamin D [25(OH)D] but superior bone health. This has been referred to as a "paradox". A recent publication found that free serum 25(OH)D is the same in black and white individuals. However, the study was criticized because an indirect method was used to measure free 25(OH)D. A direct method has recently been developed. We hypothesized that although total serum 25(OH)D is lower in African Americans, free serum 25(OH)D measured directly would not differ between races. White and black healthy postmenopausal women were matched for age and BMI. Serum total 25(OH)D, PTH, 1,25(OH)2D, vitamin D binding Protein (VDBP) and bone density were measured. Measurement of free 25(OH)D was carried out using an ELISA. Ambulatory research unit in a teaching hospital. Cross-racial comparison of serum free 25(OH)D. A propensity match resulted in selection of a total of 164 women. Total 25(OH)D was lower in black women (19.5±4.7 vs. 26.9±6.4 ng/ml) but direct measurement of free 25(OH)D revealed almost identical values (5.25±1.2 vs. 5.25±1.3 ng/ml) between races. VDBP was significantly lower in blacks when using a monoclonal based ELISA, but higher with a polyclonal based ELISA. Serum PTH, 1,25(OH)2D and bone density were higher in African Americans. Free serum 25(OH)D is the same across races despite the lower total serum 25(OH)D in black women. Results comparing VDBP between races using a monoclonal vs. a polyclonal assay were discordant.
    The Journal of Clinical Endocrinology and Metabolism 07/2015; DOI:10.1210/JC.2015-2066 · 6.31 Impact Factor
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    ABSTRACT: The purpose of the study was to examine survival in the implantable defibrillator subset of implanted leads at a large-volume implanting hospital. Implantable lead survival has been the subject of many multicenter studies over the past decade. Fewer large implanting volume single-hospital studies have examined defibrillator lead failure as it relates to patient survival and lead construction. This investigator-initiated retrospective study examined defibrillator lead failure in those who underwent implantation of a defibrillator between February 1, 1996 and December 31, 2011. Lead failure was defined as: failure to capture/sense, abnormal pacing and/or defibrillator impedance, visual insulation defect or lead fracture, extracardiac stimulation, cardiac perforation, tricuspid valve entrapment, lead tip fracture and/or lead dislodgment. Patient characteristics, implant approach, lead manufacturers, lead models, recalled status, patient mortality, and core lead design elements were compared using methods that include Kaplan Meier analysis, univariate and multivariable Cox regression models. A total of 4078 defibrillator leads were implanted in 3802 patients (74% male; n = 2812) with a mean age of 70 ± 13 years at Winthrop University Hospital. Lead manufacturers included: Medtronic: [n = 1834; 801 recalled]; St. Jude Medical: [n = 1707; 703 recalled]; Boston Scientific: [n = 537; 0 recalled]. Kaplan-Meier analysis adjusted for multiple comparisons revealed that both Boston Scientific's and St. Jude Medical's leads had better survival than Medtronic's leads (P<.001 and P=.01, respectively). Lead survival was comparable between Boston Scientific and St. Jude Medical (P=.80). A total of 153 leads failed (3.5% of all leads) during the study. There were 99 lead failures from Medtronic (5.4% failure rate); 56 were recalled Sprint Fidelis leads. There were 36 lead failures from St. Jude (2.1% failure rate); 20 were recalled Riata or Riata ST leads. There were 18 lead failures from Boston Scientific (3.35% failure rate); none were recalled. Kaplan Meier analysis also showed lead failure occurred sooner in the recalled leads (P=.01). A total of 1493 patients died during the study (mechanism of death was largely unknown). There was a significant increase in mortality in the recalled lead group as compared with non-recalled leads (P=.01), but no significant difference in survival when comparing recalled leads from Medtronic with St. Jude Medical (P=.67). A multivariable Cox regression model revealed younger age, history of percutaneous coronary intervention, baseline rhythm other than atrial fibrillation or atrial flutter, combination polyurethane and silicone lead insulation, a second defibrillation coil, and recalled lead status all contributed to lead failure. This study demonstrated a significantly improved lead performance in the Boston Scientific and St. Jude leads as compared with Medtronic leads. Some lead construction variables (insulation and number of coils) also had a significant impact on lead failure, which was independent of the manufacturer. Recalled St. Jude leads performed better than recalled Medtronic leads in our study. Recalled St. Jude leads had no significant difference in lead failure when compared with the other manufacturer's non-recalled leads. Defibrillator recalled lead status was associated with an increased mortality as compared with non-recalled leads. This correlation was independent of the lead manufacturer and clinically significant even when considering known mortality risk factors. These results must be tempered by the largely unknown mechanism of death in these patients.
    The Journal of invasive cardiology 06/2015; 27(6):292-300. · 0.82 Impact Factor
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    ABSTRACT: A computerized physician order entry (CPOE) system provides opportunity for real-time alerts to prescribers. Winthrop University Hospital began using CPOE in 2009. We sought to improve prescribing among older hospitalized patients by adding alerts to the CPOE system for potentially inappropriate medications. In January 2011, informational alerts were integrated into the CPOE system for selected high-risk medications: diphenhydramine, metoclopramide, and all antipsychotics. We evaluated the effect of these alerts on prescribing frequency by comparing the number of prescriptions during the second quarters of 2010 ("pre-alert") with the second quarters of 2011 through 2013 ("post-alert"). Prescribing patterns were evaluated through a pharmacy database of medication orders. Frequency of prescribing was adjusted for total discharges. A comparison was made to ages 18-64 years, and comparing "as needed" vs standing orders. In the 65 years of age and older group, there were significant reductions in prescription rates pre-alert vs post-alert for diphenhydramine (p < 0.001) and metoclopramide (p < 0.001). There was no decrease in prescription rates for antipsychotics in older patients (p = 0.80). In the younger comparison group, no decreases in prescription rates for those drugs were observed. Our analysis is based on numbers of written prescriptions and not actual doses administered; therefore, no conclusions concerning the effect of these alerts on communication or documentation of risk/benefits of these medications can be ascertained. The data suggest that prescribing rates for drugs with the least efficacy and potential for harm and with alternative agents (i.e., diphenhydramine and metoclopramide) can be modified by CPOE alerts for older patients.
    Drugs & Aging 03/2015; 32(3). DOI:10.1007/s40266-015-0244-2 · 2.50 Impact Factor
  • J F Aloia · M Mikhail · G Usera · R Dhaliwal · S Islam
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    ABSTRACT: Summary Trabecular bone score (TBS) is a newly developed parameter that can be derived from DXA scans of the spine and may reflect bone quality. This study provides TBS values in healthy postmenopausal women of African descent. Introduction African American women have a lower risk for osteoporotic fractures as a result of higher bone density and better bone quality. We examined TBS in postmenopausal African American women since there are no previous reports in this population. Methods This was a study of healthy African American volunteers using baseline values prior to their participation in two vitamin D intervention studies conducted at an ambulatory research center of an academic health center. Results The study population consisted of 518 healthy postmenopausal African American women with a mean age of 66 years and a BMI of 30.1. Mean TBS (L1 to L4) was 1.300(.100 SD). Significant negative correlations were found between TBS and age and BMI. None of the biochemical variables were significantly correlated with TBS whereas the various bone density sites were correlated with TBS. Conclusion TBS values for African American women are higher than those reported in the literature for white women and are inversely related to age and BMI.
    Osteoporosis International 10/2014; 26(3). DOI:10.1007/s00198-014-2928-6 · 4.17 Impact Factor
  • International Journal of Angiology 07/2014; 23(02):125-130. DOI:10.1055/s-0034-1376158
  • Gynecologic Oncology 06/2014; 133:74. DOI:10.1016/j.ygyno.2014.03.200 · 3.69 Impact Factor
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    ABSTRACT: Background: Although histologic chorioamnionitis (HCA) is known to be associated with poor outcomes in preterm infants, its clinical significance among term infants is not clearly known. Objectives: To investigate the utility of HCA in determining early onset clinical sepsis (EOCS) among term newborns. Methods: The incidence of HCA and EOCS in term infants born during 2008–2009 was evaluated in a single center retrospective study (n = 3417). The predictive value of HCA for determining EOCS in term infants admitted to the neonatal intensive care unit (NICU) for suspected sepsis (n = 388) was quantified. Outcome of otherwise healthy term infants in the nursery with HCA was also investigated. Results: Overall, 11% of term infants with HCA also had EOCS. HCA was associated with increased risk for EOCS (OR 2.6, 95% confidence interval 1.6–4.2, P < 0.001) among term infants admitted to the NICU for suspected sepsis. No cases of EOCS were found among otherwise well-appearing infants in the nursery with HCA. Multiple logistic regression analysis indicated that addition of HCA does not increase the power of a model combining C-reactive protein (CRP) and immature to total neutrophil ratio in determining EOCS. Conclusion: Although HCA in term infants is associated with EOCS, it did not improve the ability of CRP and immature to total neutrophil ratio to predict EOCS. Routine placental examination may not contribute to the diagnosis of EOCS in term infants.
    Frontiers in Pediatrics 04/2014; 2:27. DOI:10.3389/fped.2014.00027
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    ABSTRACT: Excision repair cross-complementation group 1 (ERCC1) expression by non-small cell lung cancer (NSCLC) has been reported to predict resistance to platinum-based therapies. On this basis, several commercial laboratories have offered ERCC1 testing to facilitate clinical decision making, but the reliability of such assays has recently been called into question.Methods.First, three large commercial laboratories were queried for their cumulative ERCC1 test results in NSCLC patients to compare their independent rates of ERCC1 expression. Second, identical tumor blocks from individual NSCLC patients underwent round-robin analysis to evaluate interlaboratory concordance for ERCC1 expression. Third, a retrospective review of medical records from NSCLC patients identified those who were both highly responsive and resistant to platinum-based chemotherapies. Tumor blocks from these patients were then used in a gold standard analysis to determine individual laboratory sensitivity and specificity for ERCC1 results.Results.Significant differences were observed in independent laboratory ERRC1 expression rates (Clarient 70% vs. Genzyme 60% vs. Third Laboratory 44%, p < .0001 for all two-way comparisons). Only 4 of 18 tumors examined in round-robin analysis were fully concordant (κ ≤ 0.222 for all two-way comparisons). In preselected platinum responsive and resistant specimens, none of these three commercially marketed laboratory assays achieved a specificity of greater than 50%.Conclusion.The results of commercial laboratory testing for ERCC1 are inconsistent and unreliable. Better validation and postmarketing surveillance should be mandated before tumor biomarker assays are allowed to enter the clinical arena.
    The Oncologist 04/2014; 19(5). DOI:10.1634/theoncologist.2013-0311 · 4.54 Impact Factor
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    ABSTRACT: PediatricsSESSION TYPE: Slide PresentationsPRESENTED ON: Sunday, March 23, 2014 at 12:15 PM - 01:15 PMPURPOSE: The primary objective of our study is to identify the most common abnormalities of pulmonary function testing (PFT) in a pediatric non-asthmatic obese cohort. We aim to determine a possible correlation between the degree of PFT abnormalities and the severity of obesity. Thirty two patients underwent standardized PFT at the time of enrollment in the study. The PFT consist of measurements in airway flows (spirometry), static lung volumes, and lung diffusion capacity for carbon monoxide (DLCO) determined using a single breath nitrogen washout technique, and was corrected for alveolar volume. All the measurements were reported as percent predicted value for age, gender, height and ethnicity. Thirteen girls and nineteen boys between 10 and 20 years of age were studied. None of the patients had clinical evidence of cardiopulmonary disease. The average BMI was 34.4 Kg/m2 with a range between 25 and 48 Kg/m2. A reduction in FEF25%-75%(a measure suggestive of small airway obstruction) was observed in eight patients (25%). Other observed abnormalities were a reduction in the functional residual capacity (FRC, a measure of lung parenchymal recoil) in six patients (18%) and an increase in residual volume (suggestive of air trapping) in twelve patients (37.5%). DLCO was increased in twelve patients (37.5%). A negative correlation between BMI and FRC was found (Rho -0.39, p-value 0.021). Similarly there was a negative correlation between BMI and DLCO (Rho -0.42, p-value 0.015). In our cohort of obese non-asthmatic subjects we observed PFT changes consistent with small airway obstructive defect. With increasing BMI we observed PFT abnormalities suggestive of diffusion impairment (DLCO) and changes in the elastic recoil properties of the lung (FRC). Childhood obesity has doubled in children and tripled in adolescents in the past 30 years. Data on the effects of obesity in children and adolescents on pulmonary function are scarce and controversial. We aim to increase our knowledge regarding the relationship between obesity and pulmonary function in order to improve this population's potential clinical management. The following authors have nothing to disclose: Angela Webb, Roopa Saddaiah, Claudia Halaby, Christina Valsamis, Shahidul Islam, Melodi PirzadaNo Product/Research Disclosure Information.
    Chest 03/2014; 145(3 Suppl):453A. DOI:10.1378/chest.1822432 · 7.13 Impact Factor
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    ABSTRACT: To determine factors associated with newborns having their first outpatient visit (FOV) beyond 3 days after postpartum hospital discharge. Retrospective cohort analysis of all newborns born at a large urban university hospital during a 1-year period, discharged home within 96 hours of birth, and with an outpatient visit with an affiliated provider within 60 days after discharge. Of 3282 newborns, 1440 (44%) had their FOV beyond 3 days after discharge. Newborns born to first-time mothers, breast-feeding, at high risk for hyperbilirubinemia, or with a pathological diagnosis were significantly (P < .05) less likely to have FOV beyond 3 days in adjusted multivariable analysis, while newborns born via Caesarian section, of older gestational age, with Medicaid insurance, or discharged on a Thursday or Friday were more likely to have FOV beyond 3 days. Discharging provider characteristics independently associated with FOV beyond 3 days included family medicine providers, providers out of residency longer, and providers practicing at the institution longer. In addition, practice of outpatient follow-up had an independent impact on timing of FOV. Having an appointment date and time recorded on the nursery record or first appointment with a home nurse decreased the odds that time to FOV was beyond 3 days of discharge. Physician decisions regarding timing of outpatient visit after newborn discharge may take into account newborn medical and social characteristics, but certain patient, provider, and practice features associated with this timing may represent unrecognized barriers to care.
    Academic pediatrics 01/2014; 14(1):77-83. DOI:10.1016/j.acap.2013.09.009 · 2.23 Impact Factor
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    ABSTRACT: Pediatric Critical Care PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: There are different medical reasons why children receive a tracheostomy tube and it is known that its presence can cause speech delay. The Passy-Muir Tracheostomy-Speaking Valve (PMSV) was designed to allow verbal communication for patients with tracheostomy tubes. PMSV is a one-way valve that attaches to the tracheostomy and assists in redirecting the air flow through the upper airway resulting in phonation. PMSV also improves swallowing, oxygenation, respiratory secretion management, and expedites decannulation. The use of PMSV is only approved by FDA for use during wake hours. The aim of this study was to evaluate the safety of PMSV overnight so these children can benefit from its advantages during sleep.METHODS: This clinical trial was approved both by FDA and IRB. Inpatients from St Mary's Hospital, ages 1 to 18 years, with a tracheostomy tube who were using a PMSV during daytime/awake period were included in the study. The subjects had baseline records of heart rate (HR), respiratory rate (RR), oxygen saturation (HbO2), and end tidal carbon dioxide (ETCO2) the night prior to the study night at scheduled times throughout the night. PMSV was placed the following night, and the same parameters were recorded (study night).RESULTS: A total of 7 patients were recruited with the age range of 2 years to 11 years. The mean of the parameters pre and post intervention in all subjects showed no significant clinical changes between baseline and the study night. Repeated measure ANOVA analysis did not reveal any significant differences in the HR, RR, HbO2 and ETCO2 between the preintervention night and study night. No major adverse events were recorded during the study night.CONCLUSIONS: This pilot study showed that extended use of PMSV while the child is asleep was not associated with adverse cardiopulmonary events. The limitation of this study is that it has a small cohort of patientsCLINICAL IMPLICATIONS: This is the first study to show that a speaking valve can be used safely during sleep.DISCLOSURE: The following authors have nothing to disclose: Giselle Barraza, Claudia Halaby, Shahidul Islam, William Gutekunst, Edwin Simpser, Melodi PirzadaThe Passy Muir speaking valve is only approved for day time use by FDA. It is not approved for night time use.
    Chest 10/2013; 144(4_MeetingAbstracts):771A. DOI:10.1378/chest.1692327 · 7.13 Impact Factor
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    ABSTRACT: Context:Bone health is influenced by the intake of both calcium and vitamin D.Objective:Our objective was to evaluate the influence of calcium and vitamin D supplementation on PTH and bone turnover.Setting, Patients, and Design:At an ambulatory research center, 159 postmenopausal healthy white women participated in this double-blind, placebo-controlled parallel, longitudinal factorial study that began in December 2008 and ended in April 2011. It was 6 months in duration.Interventions:Subjects were randomly allocated to 4 groups: 1) double placebo, 2) calcium (1200 mg daily) plus placebo, 3) vitamin D3 (100 μ g) plus placebo, and 4) vitamin D3 and calcium. Serum and urine were collected fasting and 2 hours after a calcium load at baseline and at 3 and 6 months.Main Outcome Measures:Serum PTH, cross-linked C-telopeptide (CTX), and procollagen type I N-terminal propeptide (P1NP) were measured.Results:Before study medication, a calcium load resulted in a decline in PTH and CTX and an increase in urinary calcium excretion. Serum CTX and P1NP declined over time with calcium supplementation but did not change with increased vitamin D intake. There was a decline in PTH in the vitamin D groups in the fasting state compared with placebo. Suppression of PTH was greater after a calcium load in the vitamin D groups. A calcium load decreased PTH and CTX and raised urinary calcium.Conclusions:Fasting PTH declines with vitamin D supplementation. PTH declines after calcium intake. Supplementation of the diet with 1200 mg calcium/d reduces bone turnover markers, whereas supplementation with up to100 μ g vitamin D3/d does not.
    The Journal of Clinical Endocrinology and Metabolism 09/2013; 98(11). DOI:10.1210/jc.2013-2121 · 6.31 Impact Factor
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    ABSTRACT: OBJECTIVES: To determine effect of first medical contact type on symptom onset-to-door time (SODT). BACKGROUND: Shorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction. METHODS: From 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services). RESULTS: Of 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [P < .013], age [P < .0001] and peripheral vascular disease [P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during "on-hours" (weekdays) were more likely to first contact a physician compared with those presenting during "off-hours" (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001). CONCLUSIONS: Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during "on-hours." Educational efforts aimed at both patient and physician office practices are warranted.
    The American journal of emergency medicine 04/2013; 31(6). DOI:10.1016/j.ajem.2013.03.005 · 1.15 Impact Factor
  • David E Friedman · Shahidul Islam · Alan B Ettinger
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    ABSTRACT: Seizure-related head injury (SRHI) is an under-recognized condition frequently experienced by people with epilepsy (PWE). The purpose of this study is to investigate the potential impact of SRHI on health-related quality of life (HRQOL) among PWE receiving care in a tertiary epilepsy center. Consecutive adult PWE receiving care at the Baylor Comprehensive Epilepsy Center (BCEC) were recruited for the study. After their informed consent was obtained, patients were administered the QOLIE-31 to measure HRQOL and the NDDI-E to screen for depression. Simple linear regression was used to identify clinical variables associated with HRQOL and that included SRHI obtained systematically at each clinic visit. Data were also compared between the SRHI and non-SRHI groups. Participants included 172 subjects. Recurrent mild SRHI occurred in 50 (29%) subjects. Factors with a negative effect on HRQOL included depression (slope=-19.99 [95% CI -25.16, -14.81]; p<.0001), recurrent SRHI (-17.02 [-22.35, -11.69]; p<.0001), past SRHI (-13.46 [-18.43, -8.48]; p<.0001), and seizure frequency (-0.17 [-0.26, -0.07]; p=0.001) on univariate analysis. With stepwise multiple regression, depression and recurrent SRHI significantly impacted HRQOL with slopes (95% CI; p-value) of (-17.53 [-22.34, -12.73]; p<.0001) and (-14.03 [-18.78, -9.28]; p<.0001), respectively. Patient-derived HRQOL is negatively associated with depression and recurrent SRHI, independently. There has been a justifiable increased awareness of the potential effects of head injuries among healthy individuals. Our data suggest that head injuries can certainly be detrimental among PWE, and greater efforts should be made to recognize and formulate prevention strategies for SRHI.
    Epilepsy & Behavior 04/2013; 27(3). DOI:10.1016/j.yebeh.2013.02.009 · 2.06 Impact Factor
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    ABSTRACT: This study evaluated the efficacy of intraoperative extrinsic manual compression on the bladder, or Crede maneuver (CM) for tape adjustment during transobturator tape (TOT) sling procedure versus the traditional method where tension-free tape is adjusted the same for all patients. All patients undergoing TOT sling procedure for stress urinary incontinence (SUI) between May 2008 and June 2011 by the first author were assessed. Tape adjustment was either performed in a traditional manner, leaving a tonsil clamp-size space between the sling and posterior urethra, or by using CM after filling the bladder to 300 ml capacity. Patients were considered cured at postoperative visits if they had no SUI symptoms and negative Cough Stress Test (CST) result, improved if they had some SUI symptoms and negative CST result, and failed if symptomatic and had positive CST result. The Fisher exact test and the Wilcoxon rank sum test were used to evaluate the baseline differences between the 2 groups, along with multiple logistic regression to evaluate independent predictors of cure. The continence rate was 77.67% in the traditional group (87/112) and 79.65% (137/172) in the CM group (P = 0.76). Older patients and smokers were less likely to be continent (odds ratio, 0.95; P = 0.015; and odds ratio, 0.22; P = 0.003, respectively). Five (4.5%) of the 112 patients in the traditional group and 12 (6.9%) of the 172 patients in the CM group had adverse outcomes including transient urinary retention, mesh erosion, or dysuria (P = 0.45). Using CM for intraoperative tape adjustment does not improve continence rates compared to the traditional method of TOT sling placement.
    Journal of Pelvic Medicine and Surgery 01/2013; 19(6):369-73. DOI:10.1097/SPV.0000000000000034
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    ABSTRACT: Abstract OBJECTIVE: To assess the role of the referees in assisting with the peer review process of systematic reviews and meta-analyses. STUDY DESIGN: A one-page questionnaire was mailed to 1,391 referees of two journals, the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology. The referees were asked how often they verified by their own independent analysis 11 key items related to the methodology and statistical analysis of systematic reviews and meta-analyses. Response categories included "always", "frequently" (> 50% of the time), "infrequently" (< 50% of the time) and "never". A second and a third mailing was sent to the non-respondents. RESULTS: 42 mailings were returned because of change of address. Of the remaining 1,349 referees, 272 responded (response rate 20%). Of the 272 respondents, 159 (58%) had previously reviewed articles dealing with systematic reviews or meta-analyses. The responses varied according to the key items in the questions but the referees used their own independent analyses "always" in only 2-17% of the time. The rates of "infrequently" or "never" responses combined together ranged from 51% to 86% for the various key items. CONCLUSION: The overwhelming majority of the referees do not verify, by their own independent analysis, key items related to methodology and statistical analysis of submitted systematic reviews and meta-analyses. (Key words: evidence based medicine, peer-review, questionnaire, survey).
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 12/2012; 26(8). DOI:10.3109/14767058.2012.755161 · 1.21 Impact Factor
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    ABSTRACT: Obesity and diabetes are closely associated with hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis. In this study the diet-induced obese C57Bl/6 mouse was used to test the hypothesis that chronically elevated metabolic parameters associated with the development of obesity such as cholesterol and glucose can aggravate basal HPA axis activity. Because the lipocalin-type prostaglandin D2 synthase (L-PGDS) knock-out (KO) mouse is a model of accelerated insulin resistance, glucose intolerance and obesity it was further hypothesized that HPA activity would be greater in this model. Starting at 8-weeks of age, the L-PGDS KO and C57BL/6 mice were maintained on a low-fat (LF) or high-fat (HF) diet. After 20 weeks or 37 weeks, fasting metabolic parameters and basal HPA axis hormones were measured and compared between genotypes. Correlation analyses were performed to identify associations between obesity related chronic metabolic changes and changes in the basal activity of the HPA axis. Our results have identified strong positive correlations between total cholesterol, LDL cholesterol, glucose and HPA axis hormones that increase with age in the C57BL/6 mice. These data confirm that obesity related elevations in cholesterol and glucose can heighten basal HPA activity. Additionally, the L-PGDS KO mice show early elevations in HPA activity with no age-related changes relative to the C57BL/6 mice.
    Journal of Endocrinology 11/2012; 216(2). DOI:10.1530/JOE-12-0275 · 3.59 Impact Factor
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    Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61802-0 · 15.34 Impact Factor
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    ABSTRACT: The National Research Council recently reviewed the capabilities of health care software implemented in the United States and described a health care information technology chasm that is threatening the medical community's ability to meet the health care quality goals enumerated in Institute of Medicine reports. Among the critical gaps is the inability of health care software systems to allow users to convert data into meaningful information supporting quality improvement, analysis, and research. In this article, the authors describe the Montefiore Medical Center's decade-long experience developing software for the purpose of converting data into useful information and integrating software use into the clinical culture. The program at Montefiore could serve as a potential national model.
    Academic medicine: journal of the Association of American Medical Colleges 05/2010; 85(8):1362-8. DOI:10.1097/ACM.0b013e3181df0f3b · 3.47 Impact Factor

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