6 results on '"Prakash Satwani"'
Search Results
2. Financial impact of post-transplant complications among children undergoing allogeneic hematopoietic cell transplantation
- Author
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Zhezhen Jin, Wallace Bourgeois, Monica Bhatia, Laurie Davis, Prakash Satwani, Angela Ricci, Larisa Broglie, Jenny Ruiz, Diane George, James Garvin, and Matthew Hall
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Transplantation ,medicine.medical_specialty ,Hematopoietic cell ,business.industry ,Hematopoietic Stem Cell Transplantation ,MEDLINE ,Graft vs Host Disease ,Hematology ,Disease ,Lung injury ,medicine.disease ,Intensive care unit ,Post transplant ,law.invention ,Risk Factors ,law ,Internal medicine ,Bacteremia ,medicine ,Humans ,Transplantation, Homologous ,Child ,business ,Retrospective Studies - Abstract
Complications following allogeneic hematopoietic cell transplantation (alloHCT) continue to be a significant challenge that often result in significant morbidity/mortality and increased healthcare utilization and cost. In this study, we analyzed the impact of post-alloHCT complications on healthcare utilization and cost during first year post-transplant. We analyzed data on 240 pediatric patients. Complications analyzed included kidney injury, liver injury, lung injury, viral infections, bacterial infections, fungal infections, and acute graft-versus-host disease (GVHD). Patients were divided into three groups based on the number of complications (0–1, 2–3, and >3). Cost was estimated from charges recorded in the Pediatric Health Information System database and hospital accounting records. Patients with >3 complications had higher healthcare utilization and cost, primarily driven by inpatient hospitalization and intensive care unit admissions. Multivariable analysis of risk factors identified bacteremia ($90,166, SE = 26,636, p more...
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- 2020
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3. Healthcare utilization and financial impact of acute-graft-versus host disease among children undergoing allogeneic hematopoietic cell transplantation
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Larisa Broglie, Diane George, Prakash Satwani, James Garvin, Angela Ricci, Matthew Hall, Zhezhen Jin, and Monica Bhatia
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medicine.medical_specialty ,Graft vs Host Disease ,Single Center ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,Acute graft versus host disease ,Humans ,Medicine ,Risk factor ,Child ,Retrospective Studies ,Transplantation ,integumentary system ,Hematopoietic cell ,business.industry ,Incidence (epidemiology) ,Hematopoietic Stem Cell Transplantation ,Hematology ,surgical procedures, operative ,Healthcare utilization ,030220 oncology & carcinogenesis ,Acute Disease ,business ,Delivery of Health Care ,030215 immunology ,Cohort study - Abstract
The impact of AGVHD on healthcare utilization and cost is not well described. In this retrospective single center cohort study of 240 pediatric patients, we analyzed cost, healthcare utilization and patient outcomes for the first year post-alloHCT. Costs were estimated from charges recorded in the Pediatric Health Information System database and the hospital’s accounting system. The overall incidence of grade I–IV aGVHD was 40.4%. The incidence of grade I, grade II, and grade III–IV aGVHD was 6.6%, 16.2%, and 17.5%, respectively. The overall incidence of steroid refractory (SR)-aGVHD was 10.8%. The median number of days of hospitalization in the first year post-alloHCT was significantly higher for patients with aGVHD vs. no aGVHD: 113 days (range: 35–354 days) vs. 63 days (range: 25–298 days), p more...
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- 2019
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4. Two-Dimensional Speckle Tracking Echocardiography-Derived Strain Measurements in Survivors of Childhood Cancer on Angiotensin Converting Enzyme Inhibition or Receptor Blockade
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Marc E. Richmond, Jamie K. Harrington, Serge Kobsa, Prakash Satwani, Amee Shah, and Arielle W. Fein
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Adult ,Male ,Cardiac function curve ,medicine.medical_specialty ,Adolescent ,Heart Ventricles ,Population ,Angiotensin-Converting Enzyme Inhibitors ,Antineoplastic Agents ,Speckle tracking echocardiography ,Strain (injury) ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Cohort Studies ,Angiotensin Receptor Antagonists ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Neoplasms ,Internal medicine ,medicine ,Humans ,Anthracyclines ,Child ,education ,Retrospective Studies ,education.field_of_study ,biology ,business.industry ,Reproducibility of Results ,Angiotensin-converting enzyme ,Vascular surgery ,medicine.disease ,Cardiac surgery ,Echocardiography ,030220 oncology & carcinogenesis ,Heart failure ,Pediatrics, Perinatology and Child Health ,biology.protein ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Speckle tracking echocardiography (STE)-derived strain indices are believed to detect early cardiac dysfunction in survivors of childhood cancer and have potential to identify patients who may benefit from early heart failure treatment. However, effects of heart failure treatment on STE-derived strain measurements in this population are unknown. The aim of this study was to assess STE-derived strain measurements in survivors of childhood cancer treated with angiotensin converting enzyme inhibition or receptor blockade (ACEi/ARB). Two-dimensional speckle tracking analysis was retrospectively performed on echocardiograms from childhood cancer survivors before and during therapy with ACEi/ARB. Global left ventricular longitudinal and circumferential strain (GLS and GCS) and strain rates (LSR and CSR) were assessed and correlated with conventional echocardiographic measures of function. In 22 childhood cancer survivors (median age: 14.8, range 6.4–21.6 years), mean GLS (− 13.83 ± 0.74% to − 15.94 ± 0.74%, p = 0.002), GCS (− 18.79 ± 1.21% to − 20.74 ± 0.84%, p = 0.027), LSR (− 0.78 ± 0.04 to − 0.88 ± 0.04 s−1, p = 0.022), and CSR (− 1.08 ± 0.07 to − 1.21 ± 0.06 s−1, p = 0.027) improved on therapy. Improvement in GLS was maintained for greater than 1 year on ACEi/ARB (p = 0.02). Measures of strain and strain rate correlated with standard echocardiographic measures of function and were reproducible. These findings support the use of ACEi/ARB to treat post-chemotherapy-related cardiovascular changes in childhood cancer survivors, provide proof-of-concept that STE-derived strain and strain rate may be used to reliably monitor cardiac function during therapy, and support continued investigation into the clinical benefit of strain measurements in this population. more...
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- 2018
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5. Reduced toxicity, myeloablative conditioning with BU, fludarabine, alemtuzumab and SCT from sibling donors in children with sickle cell disease
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Mark B. Geyer, R. Hawks, M T Lee, Erin Morris, Joseph Schwartz, Prakash Satwani, M Licursi, Mitchell S. Cairo, Courtney Baker, G. Del Toro, Elana Smilow, Warren A. Zuckerman, D. George, Kavita Radhakrishnan, Monica Bhatia, Zhezhen Jin, James Garvin, and L.A. Baxter-Lowe more...
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Adult ,Male ,medicine.medical_specialty ,Transplantation Conditioning ,Adolescent ,Anemia ,medicine.medical_treatment ,Pilot Projects ,Anemia, Sickle Cell ,Hematopoietic stem cell transplantation ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Young Adult ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Prospective Studies ,Child ,Alemtuzumab ,Busulfan ,Transplantation Chimera ,Transplantation ,business.industry ,Siblings ,Hematopoietic Stem Cell Transplantation ,Hematology ,medicine.disease ,Tissue Donors ,Fludarabine ,Regimen ,Child, Preschool ,Immunology ,Female ,business ,Vidarabine ,medicine.drug - Abstract
BU and CY (BU/CY; 200 mg/kg) before HLA-matched sibling allo-SCT in children with sickle cell disease (SCD) is associated with ~85% EFS but is limited by the acute and late effects of BU/CY myeloablative conditioning. Alternatives include reduced toxicity but more immunosuppressive conditioning. We investigated in a prospective single institutional study, the safety and efficacy of a reduced-toxicity conditioning (RTC) regimen of BU 12.8-16 mg/kg, fludarabine 180 mg/m(2), alemtuzumab 54 mg/m(2) (BFA) before HLA-matched sibling donor transplantation in pediatric recipients with symptomatic SCD. Eighteen patients, median age 8.9 years (2.3-20.2), M/F 15/3, 15 sibling BM and 3 sibling cord blood (CB) were transplanted. Mean whole blood and erythroid donor chimerism was 91% and 88%, at days +100 and +365, respectively. Probability of grade II-IV acute GVHD was 17%. Two-year EFS and OS were both 100%. Neurological, pulmonary and cardiovascular function were stable or improved at 2 years. BFA RTC and HLA-matched sibling BM and CB allo-SCT in pediatric recipients result in excellent EFS, long-term donor chimerism, low incidence of GVHD and stable/improved organ function. more...
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- 2014
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6. Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease
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Mitchell S. Cairo, Joseph E. Schwartz, C. van de Ven, C. Kleinman, M.B. Bradley, Prakash Satwani, James Garvin, D. George, Michelle Neier, Monica Bhatia, Eric S. Silver, Erin Morris, Zhezhen Jin, and L. Baldinger more...
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medicine.medical_specialty ,Transplantation Conditioning ,Heart Diseases ,Population ,Transplantation, Autologous ,Pericardial effusion ,Pericardial Effusion ,Risk Factors ,immune system diseases ,Internal medicine ,medicine ,Humans ,Child ,education ,Survival rate ,Retrospective Studies ,Transplantation ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Hematopoietic Stem Cell Transplantation ,Retrospective cohort study ,Hematology ,respiratory system ,medicine.disease ,respiratory tract diseases ,Surgery ,Survival Rate ,Treatment Outcome ,Effusion ,Child, Preschool ,Cohort ,business ,circulatory and respiratory physiology - Abstract
The objective of this study was to assess the incidence, risk factors, outcome and impact on OS of pericardial effusion (PEF) in a cohort of 156 pediatric SCT recipients. The mean age was 8.15±6.25 years. In all, 74% of the patients had malignant disease and 35% of the patients received autologous stem cell grafts. Twenty-three subjects developed effusion at 2.75±3.54 months after SCT. The overall probability of developing a PEF after SCT was 16.9%. In the multivariate analysis of risk factors associated with time to PEF, increased age, allogeneic risk status and conditioning type, were all significant factors. In a multivariate analysis of time to death, PEF, CMV status and risk status were all independent risk factors. PEF, however, had the highest HR of 3.334. Of the 23 patients with PEF, 19 died (82.6%); however, none died as a direct result of pericardial tamponade. In summary, our results suggest that PEF is a significant risk factor for post transplant mortality. These results suggest a need for more frequent evaluation and monitoring for development of PEF. Studies are needed to determine the etiology of, and new therapeutic strategies for, PEF in the post-SCT population. more...
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- 2010
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