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Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients

World Journal of Pediatrics 2018年第4期14卷 364-372页

作者： parth bhatt Achint Patel Varun Kumar Anusha Lekshminarayanan Viranchi Patel Srilatha Alapati Zeenia Cyrus Billimoria Texas Tech University Health Sciences Center AmarilloTXUSA University of Arkansas for Medical Sciences Little RockARUSA Mt.Sinai St.Luke's Roosevelt Hospital Center New YorkNYUSA Mercy Health CincinnatiOHUSA Tulane University School of Public Health and Tropical Medicine New OrleansLAUSA University of Washington Seattle Children's Hospital4800 Sand Point Way NESeattleWA 98105USA

Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002–2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. Results 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79–0.87,P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62–0.89,P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27–0.42,P < 0.001) were lower as compared to the 1st tertile of hospital volume. Conclusion Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.

关键词： Atrial septal defect Cardiac catheterization Children

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Trends in prevalence and mortality of gastroschisis and omphalocele in the United States from 2010 to 2018

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World Journal of Pediatrics 2022年第7期18卷 511-514页

作者： parth bhatt Frank Adusei Poku Jacob Umscheid Marian Ayensu Narendrasinh Parmar Rhythm Vasudeva Keyur Donda Harshit Doshi Fredrick Dapaah-Siakwan United Hospital Center BridgeportWVUSA University of Central Oklahoma EdmondOKUSA University of Kansas School of Medicine WichitaKSUSA Woodhull Medical Center New YorkUSA Brookdale University Hospital and Medical Center BrooklynNYUSA University of South Florida TampaFLUSA Golisano Children's Hospital of Southwest Florida FortMyersFLUSA Neonatal Intensive Care Unit Valley Children's Hospital9300 Valley Children's PlaceSE 20MaderaCA 93636USA

Gastroschisis and omphalocele are the two most common congenital defects of the anterior abdominal *** etiologies remain unclear,but while gastroschisis is associ-ated with young maternal age,maternal smoking,maternal alcohol and illicit drug use during pregnancy omphalocele is frequently associated with genetic disorders and other congenital anomalies[1].The incidence of gastroschisis in the United States(US)has increased with an estimated inci-dence of 4.6 per 10,000 live births(LB)between 2010 and 2014[2].A recent study capturing information on 20%of infants admitted to neonatal intensive care unit(NICU)in the US showed a decrease in gastroschisis hospitalizations while that of omphalocele remained stable[3].However,it lacks generalizability[3].Our aim was to provide updated trends of gastroschisis and omphalocele hospitalizations in the US between 2010 and 2018 using population-based and nationally representative databases.

关键词： admitted halo maternal

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Efficacy of a Diabetes Specific Nutritional Supplement (DSNS) on Glycemic Response in Prediabetic Adults: A Two-Armed, Open-Labelled Randomized Controlled Study

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Food and Nutrition Sciences 2024年第7期15卷 612-643页

作者： Deepti Khanna Kejal Joshi Reddy Hema S. Gopalan Jaladhi bhatt Jayanti Gupta Simran Sethi parth Joshi Manoj Pareek Department of R&D Hindustan Unilever Limited Gurugram India Mumbai India Cliantha Research Ahmedabad India

It is well known that Diabetes Specific Nutritional Supplements (DSNSs) are linked to improved glycemic control in individuals with diabetes. However, data on efficacy of DSNSs in prediabetics is limited. This was a two-armed, open-labelled, randomized controlled six-week study on 199 prediabetics [30 - 65 years;Glycosylated Hemoglobin (HbA1c) 5.7% - 6.4% and/or Fasting Blood Glucose (FBG) 100-125 mg/dl]. Two parallel phases were conducted: Acute Blood Glucose Response (ABGR) and Intervention phase. Prediabetic participants were randomized into test (n = 100) and control (n = 99). The primary objective was to assess the ABGR of DSNS versus an isocaloric snack, measured by incremental Area under the Curve (iAUC). Test and control received 60 g of DSNS and 56 g of isocaloric snack (cornflakes) respectively, both in 250 ml double-toned milk on visit days 1, 15, 29 and 43. Postprandial Blood Glucose (PPG) was estimated at 30, 60, 90, 120, 150 and 180 minutes. During the 4 weeks intervention phase, the test group received DSNS with lifestyle counselling (DSNS + LC) and was compared with the control receiving lifestyle counselling alone (LC alone). Impact was studied on FBG, HbA1C, anthropometry, body composition, blood pressure, nutrient intake, and physical activity. The impact of DSNS was also studied using CGM between two 14-day phases: CGM1 baseline (days 1 - 14) and CGM2 endline (days 28 - 42). DSNS showed significantly lower PPG versus isocaloric snack at 30 (p 12, and chromium were reported by DSNS + LC versus LC alone. No other significant changes were reported between groups. It may be concluded that DSNS may be considered as a snack for prediabetic or hyperglycemic individuals requiring nutritional support for improved glycemic control.

关键词： Diabetes Specific Nutritional Supplement Prediabetes Acute Blood Glucose Response Incremental Area under Curve Lifestyle Counselling

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Glycemic Indices of Multiple Oral Nutritional Supplements: A Randomized Cross-Over Study in Indian Adults

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Food and Nutrition Sciences 2023年第10期14卷 941-962页

作者： Deepti Khanna Jaladhi bhatt Jayanti Gupta Simran Sethi parth Joshi Manoj Pareek Divya Agrawal Hindustan Unilever Limited R&D Department Gurugram India Independent Biostatistician & Researcher Mumbai India Cliantha Research Ahmedabad India

Background: A randomized cross-over study was conducted to assess the glycemic index (GI) of seven Oral Nutritional Supplements (ONSs). These ONSs are designed to support the nutritional requirements of different age-groups, physiological states, or health conditions among Indian adults. Methods: The study had two phases viz., phase1 (n = 18) studied two ONSs: A1 and B1 and phase 2 (n = 20) studied five ONSs: A2, B2, C2, D2 & E2. The subjects were healthy, non-diabetic adults, aged between 20 - 44 years with a mean Body Mass Index of 21.2 ± 1.52 kg/m2 (Phase 1) and 21.0 ± 1.45 kg/m2 (Phase 2). All these ONSs were compared with reference drinks (glucose). The carbohydrates in one serving of each ONS were matched to carbohydrates from 25 grams of glucose following ISO 2010 guidelines. Capillary blood was assessed for blood glucose response at baseline, 15, 30, 45, 60, 90 and 120 minutes. GI was calculated as the incremental area under the curve (iAUC) for the test drinks and expressed as a percentage of the average iAUC from glucose. Results: Phase 1 indicated that the high fiber diabetes-specific nutrition supplement A1 with higher protein (23% energy), higher fat (25% energy) and reduced carbohydrates (40% energy) had a significantly (p = 0.002) lower GI [34 (±6)] as compared to B1 [63 (±7)] (protein 19%, fat 7% and carbohydrates 60% energy) even with similar amount (22%) and type of fiber. Phase 2 reported that all test products [A2 (32 ± 5), B2 (37 ± 4), C2 (31 ± 5), D2 (31 ± 5) and E2 (55 ± 4)] had a low GI. As compared to phase 1, ONSs in phase 2 had lower fiber content (1.6% - 4.6% energy). Conclusion: The glycemic index of oral nutrition supplements is influenced not only by their fiber content, but also by the overall macronutrient composition including protein (≥17% energy), fat (≥10% - 27% energy) and carbohydrates (40% - 57.5% energy).

关键词： Glycemic Index Oral Nutritional Supplements Incremental Area under the Curve Diabetes

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