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Articles by V Patel
Total Records ( 7 ) for V Patel
  J. F Roux , E Zado , D. J Callans , F Garcia , D Lin , F. E Marchlinski , R Bala , S Dixit , M Riley , A. M Russo , M. D Hutchinson , J Cooper , R Verdino , V Patel , P. S Joy and E. P. Gerstenfeld
 

Background— Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias.

Methods and Results— We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared.

Conclusions— AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

  M. P Riley , E Zado , R Bala , D. J Callans , J Cooper , S Dixit , F Garcia , E. P Gerstenfeld , M. D Hutchinson , D Lin , V Patel , R Verdino and F. E. Marchlinski
  Background—

The endocardial substrate for ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be caused by a progressive degenerative process. Many clinical decisions and treatment plans are guided by this pathophysiologic assumption, but the extent of progression of macroscopic endocardial scar and right ventricular (RV) dilatation have not been assessed.

Methods and Results—

Eleven patients with ARVD/C and ventricular tachycardia had 2 detailed sinus rhythm electroanatomic endocardial voltage maps (average, 291±122 points per map; range, 114 to 558 points) performed a mean of 57 months apart (minimum, 9 months) as part of ventricular tachycardia ablation procedures. Voltage-defined scar (<1.5 mV) and RV volume were measured by area and volume measurement software and compared. Two of the 11 patients had a clear increase in scar area (47 cm2; 32 cm2) confirmed by visual inspection. The remaining 9 (81%; 95% CI, 48% to 98%) patients had no increase (<10-cm2 difference) in scar area between studies. In contrast, 10 of the 11 patients had a significant increase in RV volume, with an average increase of 24% (212±67 mL to 263±52 mL; P≤0.01).

Conclusions—

In patients with ARVD/C and ventricular tachycardia, progressive RV dilatation is the rule, and rapid progression of significant macroscopic endocardial scar occurs in only a subset of patients. These results have important management implications, suggesting that efforts to prevent RV dilatation in this population are needed and that an aggressive substrate-based ablation strategy offers the potential to provide long-term ventricular tachycardia control.

  J. A Chao , Y Patskovsky , V Patel , M Levy , S. C Almo and R. H. Singer
 

ZBP1 (zipcode-binding protein 1) was originally discovered as a trans-acting factor for the "zipcode" in the 3' untranslated region (UTR) of the β-actin mRNA that is important for its localization and translational regulation. Subsequently, ZBP1 has been found to be a multifunctional regulator of RNA metabolism that controls aspects of localization, stability, and translation for many mRNAs. To reveal how ZBP1 recognizes its RNA targets, we biochemically characterized the interaction between ZBP1 and the β-actin zipcode. The third and fourth KH (hnRNP K homology) domains of ZBP1 specifically recognize a bipartite RNA element located within the first 28 nucleotides of the zipcode. The spacing between the RNA sequences is consistent with the structure of IMP1 KH34, the human ortholog of ZBP1, that we solved by X-ray crystallography. The tandem KH domains are arranged in an intramolecular anti-parallel pseudodimer conformation with the canonical RNA-binding surfaces at opposite ends of the molecule. This orientation of the KH domains requires that the RNA backbone must undergo an ~180° change in direction in order for both KH domains to contact the RNA simultaneously. The RNA looping induced by ZBP1 binding provides a mechanism for specific recognition and may facilitate the assembly of post-transcriptional regulatory complexes by remodeling the bound transcript.

  P Sharan , C Gallo , O Gureje , E Lamberte , J. J Mari , G Mazzotti , V Patel , L Swartz , S Olifson , I Levav , A de Francisco , S Saxena and the World Health Organization Global Forum for Health Research Mental Health Research Mapping Pro
 

Background

Studies suggest a paucity of and lack of prioritisation in mental health research from low- and middle-income (LAMI) countries.

Aims

To investigate research priorities in mental health among researchers and other stakeholders in LAMI countries.

Method

We used a two-stage design that included identification, through literature searches and snowball technique, of researchers and stakeholders in 114 countries of Africa, Asia, Latin America and the Caribbean; and a mail survey on priorities in research.

Results

The study identified broad agreement between researchers and stakeholders and across regions regarding research priorities. Epidemiology (burden and risk factors), health systems and social science ranked highest for type of research. Depression/anxiety, substance use disorders and psychoses; and children and adolescents, women, and people exposed to violence/trauma were prioritised among the disorders and population groups respectively. Important criteria for prioritising research were burden of disease, social justice, and availability of funds. Stakeholder groups differed in the importance they gave to the personal interest of researchers as a criterion for prioritising research. Researchers’ and stakeholders’ priorities were consistent with burden of disease estimates, however suicide was underprioritised compared with its burden. Researchers’ and stakeholders’ priorities were also largely congruent with the researchers’ projects.

Conclusions

The results of this first ever conducted survey of researchers and stakeholders regarding research priorities in mental health suggest that it should be possible to develop consensus at regional and international levels regarding the research agenda that is necessary to support health system objectives in LAMI countries.

  E Fottrell , L Kanhonou , S Goufodji , D. P Behague , T Marshall , V Patel and V. Filippi
 

Background

Little is known about the impact of life-threatening obstetric complications (‘near miss’) on women’s mental health in low- and middle-income countries.

Aims

To examine the relationships between near miss and postpartum psychological distress in the Republic of Benin.

Method

One-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities.

Results

In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth.

Conclusions

A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.

  M. B Nayak , V Patel , J. C Bond and T. K. Greenfield
 

Background

The relationship between partner alcohol use and violence as risk factors for poor mental health in women is unclear.

Aims

To describe partner-related and other psychosocial risk factors for common mental disorders in women and examine interrelationships between these factors.

Method

Data are reported on 821 women aged 18–49 years from a larger population study in north Goa, India. Logistic regression models evaluated the risks for women’s common mental disorders and tested for mediation effects in the relationship between partner alcohol use and these disorders.

Results

Excessive partner alcohol use increased the risk for common mental disorders two- to threefold. Partner violence and alcohol-related problems each partially mediated the association between partner excessive alcohol use and these mental disorders. Women’s own violence-related attitudes were also independently associated with them.

Conclusions

Partner alcohol use, partner violence and women’s violence-related attitudes must be addressed to prevent and treat common mental disorders in women.

  C Hanlon , G Medhin , A Alem , M Araya , A Abdulahi , M Tomlinson , M Hughes , V Patel , M Dewey and M. Prince
 

Background

Traditional perinatal practices may protect against postnatal common mental disorders (CMD) in non-Western societies.

Aims

To evaluate the association between perinatal practices and postnatal CMD in rural Ethiopia.

Method

A population-based sample of 1065 women was followed up from pregnancy until 2 months postpartum. Qualitative investigation informed the development of scales measuring attitudes towards and adherence to perinatal practices. Postnatal CMD was measured using the Self-Reporting Questionnaire.

Results

Endorsement of sociocultural perinatal practices was associated with lower odds of antenatal CMD persisting into the postnatal period (adjusted odds ratio (OR) = 0.66, 95% CI 0.45–0.95). Women who endorsed protective and celebratory perinatal practices but were unable to complete them had increased odds of incident (adjusted OR = 7.26, 95% CI 1.38–38.04) and persistent postnatal CMD (adjusted OR = 2.16, 95% CI 1.11–4.23) respectively.

Conclusions

There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

 
 
 
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