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Articles by A. Patel
Total Records ( 6 ) for A. Patel
  S. S. Jhee , M. Yen , L. Ereshefsky , M. Leibowitz , M. Schulte , B. Kaeser , L. Boak , A. Patel , G. Hoffmann , E. P. Prinssen and C. R. Rayner
  Oseltamivir is a potent, well-tolerated antiviral for the treatment and prophylaxis of influenza. Although no relationship with treatment could be demonstrated, recent reports of abnormal behavior in young individuals with influenza who were receiving oseltamivir have generated renewed interest in the central nervous system (CNS) tolerability of oseltamivir. This single-center, open-label study explored the pharmacokinetics of oseltamivir and oseltamivir carboxylate (OC) in the plasma and cerebrospinal fluid (CSF) of healthy adult volunteers over a 24-hour interval to determine the CNS penetration of both these compounds. Four Japanese and four Caucasian males were enrolled in the study. Oseltamivir and OC concentrations in CSF were low (mean of observed maximum concentrations [Cmax], 2.4 ng/ml [oseltamivir] and 19.0 ng/ml [OC]) versus those in plasma (mean Cmax, 115 ng/ml [oseltamivir] and 544 ng/ml [OC]), with corresponding Cmax CSF/plasma ratios of 2.1% (oseltamivir) and 3.5% (OC). Overall exposure to oseltamivir and OC in CSF was also comparatively low versus that in plasma (mean area under the concentration-time curve CSF/plasma ratio, 2.4% [oseltamivir] and 2.9% [OC]). No gross differences in the pharmacokinetics of oseltamivir or OC were observed between the Japanese and Caucasian subjects. Oseltamivir was well tolerated. This demonstrates that the CNS penetration of oseltamivir and OC is low in Japanese and Caucasian adults. Emerging data support the idea that oseltamivir and OC have limited potential to induce or exacerbate CNS adverse events in individuals with influenza. A disease- rather than drug-related effect appears likely.
  D. J Ross Anderson , C Ferguson and A. Patel
  Background

Management of the airway is difficult in patients with pharyngeal or laryngeal pathology caused by malignancy, extensive surgery, or radiotherapy scarring, particularly when undergoing pharyngolaryngeal surgery. Tracheal intubation, with or without fibreoptic guidance, is often impractical because of the severe glottic stenosis and primary tracheostomy under local anaesthesia has been the preferred technique. However, complication rates as high as 30% have been reported after primary tracheostomy and there is the potential for long-term morbidity. High-frequency jet ventilation (HFJV) has several advantages over other techniques in the management of the difficult airway and can be delivered by supraglottic and infraglottic routes. To date, no large series has described the use of transtracheal HFJV (TTHFJV) in adult patients with stridor and critical airway obstruction.

Methods

We report a prospective, descriptive audit of the safe use of TTHFJV in patients with severe airway compromise and stridor undergoing pharyngolaryngeal surgery (50 consecutive procedures in 44 patients).

Results

TTHFJV was successful in all 50 cases. There were no major complications and the incidence of minor complications was 20% with no subsequent morbidity.

Conclusions

We attribute this low incidence to the use of an automated jet ventilator with airway pressure monitoring and control, and the alteration of ventilator parameters by an experienced anaesthetist.

  A. Patel , P. Chester , E. D. Kennedy and D. Matthews
  Not available
  C. C. Lee , R. P. Stolk , A. I. Adler , A. Patel , J. Chalmers , B. Neal , N. Poulter , S. Harrap , M. Woodward , M. Marre , D. E. Grobbee and J. W. Beulens
  Aims  We investigated the association between alcohol consumption and diabetic retinopathy and deterioration of visual acuity in individuals with Type 2 diabetes.

Methods  We conducted a cohort analysis of 1239 participants with Type 2 diabetes aged 55-81 years enrolled in the AdRem study, a sub-study of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Current and past consumption of wine, spirits and beer was measured by self-report. Moderate and heavy alcohol consumption was defined as 1-14 and > 14 drinks/week, respectively. Diabetic retinopathy, measured by mydriatic stereoscopic seven-field retinal photography, was defined by a 2-step progression in the Early Treatment of Diabetic Retinopathy Study (ETDRS) score or the presence of any retinal vascular lesions. Deterioration of visual acuity was defined by a decrease of two lines in best vision in either eye, measured corrected, or through a pinhole using a Snellen chart.

Results  In a mean follow-up of 5.5 years, we identified 182 participants with a 2-step progression in the ETDRS score, 640 participants with the presence of any retinal vascular lesions and 693 participants with a deterioration of visual acuity. Current moderate consumption of alcohol, compared with no current consumption, was not associated with presence or progression of diabetic retinopathy; however, it was associated with higher risk of deterioration of visual acuity (multivariable-adjusted OR 1.83; 95% CI 1.34-2.48; P < 0.001).

Conclusions  Alcohol consumption is associated with increased risk of deterioration of visual acuity, but not with retinopathy in individuals with Type 2 diabetes.

  A. Patel , E. Maissi , H.-C. Chang , I. Rodrigues , M. Smith , S. Thomas , T. Chalder , U. Schmidt , J. Treasure and K. Ismail
  Aims  To assess the cost-effectiveness of motivational enhancement therapy and cognitive behaviour therapy for poorly controlled Type 1 diabetes.

Methods  Within-trial prospective economic evaluation from (i) health and social care and (ii) societal perspectives. Three hundred and forty-four adults with Type 1 diabetes for at least 2 years and persistent, suboptimal glycaemic control were recruited to a three-arm multi-centre randomized controlled trial in London and Manchester, UK. They were randomized to (i) usual care plus four sessions of motivational enhancement therapy (ii) usual care plus four sessions of motivational enhancement therapy and eight sessions of cognitive behaviour therapy or (iii) usual care alone. Outcomes were (i) costs, (ii) Quality-Adjusted Life Year gains measured by the EuroQol 5-dimensional health state index and the 36-item Short Form and (iii) diabetes control measured by change in HbA1c level at 1 year.

Results  Both intervention groups had significantly higher mean health and social care costs (+ £535 for motivational enhancement therapy and + £790 for combined motivational enhancement and cognitive behavioural therapy ), but not societal costs compared with the usual-care group. There were no differences in Quality Adjusted Life Years. There was a significantly greater HbA1c improvement in the combined motivational enhancement and cognitive behavioural therapy group (+ 0.45%; incremental cost-effectiveness ratio = £1756), but the not in the motivational enhancement therapy group. Cost-effectiveness acceptability curves suggested that both interventions had low probabilities of cost-effectiveness based on Quality Adjusted Life Years (but high based on HbA1c improvements). Imputing missing costs and outcomes confirmed these findings.

Conclusions  Neither therapy was undisputedly cost-effective compared with usual care alone, but conclusions vary depending on the relative importance of clinical and quality-of-life outcomes.

  M. J. Zaman , A. Patel , J. Chalmers , M. Woodward , P. Clarke , Q. Li and S. Zoungas
 

Aims

The ADVANCE trial recruited participants from 20 countries worldwide. We analyse here regional variations and causes of hospitalization for people with Type 2 diabetes from Asia, Established Market Economies and Eastern Europe.

Methods

A cohort analysis examining the effects of region on causes of first hospitalization, and the association of participant characteristics on all-cause first hospitalization across regions, using multivariable (adjusted for clinical, physiological, behavioural and socio-demographic factors) Cox models.

Results

Of 11 140 individuals (6407 men), all-cause hospitalization rates were highest in Established Market Economies, followed by Eastern Europe then Asia. Eastern Europe had rates of hospitalization for diabetic causes four times greater than Established Market Economies [multivariable-adjusted hazard ratio 4.02 (95% CI 2.86-5.63)]. There were no significant regional variations in hospitalization rates for cardiovascular disease (P = 0.534), but much lower rates for musculoskeletal and non-specific causes in Eastern Europe [multivariable-adjusted hazard ratio 0.44 (95% CI 0.32-0.60) and 0.19 (95% CI 0.12-0.29)] and Asia [hazard ratio 0.21 (95% CI 0.16-0.29) and 0.09 (95% CI 0.06-0.14)] compared with Established Market Economies. In all regions, participants hospitalized for any cause were more likely to be older, male, hypertensive, smokers, have higher glycated haemoglobin and a history of macrovascular or macrovascular disease.

Conclusions

Across three markedly different regions of the world, regional rates and causes of hospitalization varied widely in patients with Type 2 diabetes. Adjustment for a range of patient characteristics did not explain these regional differences in hospitalization, which appear to be attributable to health system factors.

 
 
 
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