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434 results on '"Herekar A"'

1. Tenapanor in the Treatment of Irritable Bowel Syndrome with Constipation: Discovery, Efficacy, and Role in Management

Author

Herekar A, Shimoga D, Jehangir A, Shahsavari D, Yan Y, Karunaratne TB, and Sharma A

Subjects
irritable bowel syndrome, irritable bowel syndrome with constipation, ibs, ibs-c, constipation, tenapanor, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Anam Herekar, Dhanush Shimoga, Asad Jehangir, Dariush Shahsavari, Yun Yan, Tennekoon Buddhika Karunaratne, Amol Sharma Department of Medicine, Augusta University, Augusta, GA, USACorrespondence: Amol Sharma, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA, Email amosharma@augusta.eduAbstract: Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction (DGBI). IBS significantly impacts the quality of life of patients. Since its pathogenesis is unclear and can be multifactorial, it highlights the need for new and improved pharmaceutical drugs that not only improve bowel symptoms, but also address global IBS symptoms, such as abdominal pain. Tenapanor, a recently Food & Drug Administration (FDA)-approved medication for IBS with constipation (IBS-C), is a small molecule inhibitor of the sodium/hydrogen exchanger isoform 3 (NHE3) that inhibits the absorption of sodium and phosphate in the gastrointestinal tract, resulting in fluid retention and softer stool. Furthermore, tenapanor reduces intestinal permeability to improve visceral hypersensitivity and abdominal pain. Due to its recent approval, tenapanor was not included in the recent IBS guidelines, however, it may be considered for IBS-C patients failing first-line treatment of soluble fiber. In this review article, we aim to provide in-depth information to the reader regarding the design of tenapanor, its development through Phase I, II and III randomized clinical trials, and its role in the treatment of IBS-C.Keywords: irritable bowel syndrome, irritable bowel syndrome with constipation, IBS, IBS-C, constipation, tenapanor

Published
2023

2. Profile of plecanatide in the treatment of chronic idiopathic constipation: design, development, and place in therapy

Author

Sharma A, Herekar AA, Bhagatwala J, and Rao SSC

Subjects
Plecanatide, Uroguanylin, Constipation, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Amol Sharma, Anam Asif Herekar, Jigar Bhagatwala, Satish SC Rao Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA Abstract: Constipation is a multifactorial disorder that can cause significant psychological distress to patients and economic burden on the health care system. Many patients are not satisfied with their current established treatment, highlighting the need for new and improved therapeutic options. Guanylate cyclase-C (GC-C)/cyclic guanosine monophosphate agonists have emerged as a safe and efficacious class of drugs for the treatment of chronic idiopathic constipation (CIC). Plecanatide, a second-in-class, US FDA-approved, synthetic GC-C agonist, has recently been approved in the US for the treatment of irritable bowel syndrome with constipation at doses of 3 and 6 mg and CIC at the 3 mg dosage. In this study, we summarize the design of this novel 16-amino acid uroguanylin analog, drug development through Phase I, II, and III clinical studies, and its role in the treatment of CIC. Keywords: plecanatide, uroguanylin, constipation

Published
2019

4. Rexobot-Simplifying Rescue Operations Using Arduino

Author

Maikap, Hritesh Rajesh, Hepat, Omkar Manohar, Barhate, Madhuri Manohar, Heda, Krishna Kiran, Hote, Gaurav Pralhad, Hirave, Avishkar Shivaji, Herekar, Ishan Rajesh, Kacprzyk, Janusz, Series Editor, Gomide, Fernando, Advisory Editor, Kaynak, Okyay, Advisory Editor, Liu, Derong, Advisory Editor, Pedrycz, Witold, Advisory Editor, Polycarpou, Marios M., Advisory Editor, Rudas, Imre J., Advisory Editor, Wang, Jun, Advisory Editor, Nanda, Satyasai Jagannath, editor, Yadav, Rajendra Prasad, editor, Gandomi, Amir H., editor, and Saraswat, Mukesh, editor

Published
2024
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5. Zinc Supplementation Initiated Prior to or During Pregnancy Modestly Impacted Maternal Status and High Prevalence of Hypozincemia in Pregnancy and Lactation: The Women First Preconception Maternal Nutrition Trial

Author

Dhaded, Sangappa M, Vernekar, Sunil S, Herekar, Veena R, Yogeshkumar, S, McClure, Elizabeth M, Das, Abhik, Thorsten, Vanessa R, Derman, Richard J, Goldenberg, Robert L, Koso-Thomas, Marion W, Kemp, Jennifer F, Hambidge, K Michael, Westcott, Jamie L, Ali, Sumera Aziz, Saleem, Sarah, Garcés, Ana, Figueroa, Lester, Somannavar, Manjunath S, Goudar, Shivaprasad S, Long, Julie M, Hendricks, Audrey E, and Krebs, Nancy F

Published
2024
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7. B-Vitamins and Choline in Human Milk Are Not Impacted by a Preconception Lipid-Based Nutrient Supplement, but Differ Among Three Low-to-Middle Income Settings—Findings From the Women First Trial

Author

Young, Bridget E, Westcott, Jamie, Kemp, Jennifer, Allen, Lindsay, Hampel, Daniela, Garcés, Ana L, Figueroa, Lester, Goudar, Shivaprasad S, Dhaded, Sangappa M, Somannavar, Manjunath, Saleem, Sarah, Ali, Sumera Aziz, Hambidge, K Michael, Krebs, Nancy F, Group, The Women First Working, Herekar, Veena, Vernekar, Sunil S, Yogeshkumar, S, Khan, Umber, Abrejo, Farina, Goldenberg, Robert K, Derman, Richard J, and McClure, Beth

Subjects
Nutrition, Clinical Trials and Supportive Activities, Clinical Research, Prevention, Pediatric, 3.3 Nutrition and chemoprevention, Prevention of disease and conditions, and promotion of well-being, Reproductive health and childbirth, Zero Hunger, lipid nutrient supplement, human milk, B vitamins, thiamin, vitamin B12, nutrition intervention, infant growth, Women First Working Group, Agricultural Biotechnology, Nutrition and Dietetics
Abstract

Introduction: Optimal human milk (HM) B-vitamin concentrations remain undefined, especially in areas where undernutrition is prevalent. The impact of supplementation pre-conception through pregnancy on HM B-vitamin composition remains unknown. Methods: Human milk (HM) was collected at 2-weeks postpartum from 200 women in Guatemala, India, and Pakistan (the Women First Trial). The women were randomized to start a lipid-based nutrient supplement before conception, at end of the first trimester, or not at all; intervention continued until delivery. HM concentrations of eight B-vitamins and choline were assessed via ultra-performance liquid chromatography-tandem mass spectrometry. Maternal diet was assessed in early pregnancy, and infant growth followed through 6 months post-delivery. Results: Despite supplement exposure averaging 15.7 (pre-conception arm) and 6.0 months (prenatal arm), HM B-vitamins did not differ between arms, but site differences were evident. Guatemala had higher HM concentrations of vitamin B3 than Pakistan and India. Pakistan had higher HM concentrations of thiamin and vitamin B6 than India and Guatemala. Cohort average HM vitamin B2 (162 ± 79 μg/L) and B6 (31.8 ± 24.6 μg/L) fell below values defined as deficient in 81.5 and 85.5% of samples, potentially reflecting sampling procedures and timing. Maternal dietary intakes of only vitamin B6 and choline were associated with the corresponding concentrations in HM (p < 0.005). No HM B-vitamin concentrations were associated with infant growth. Conclusion: Prenatal supplementation for at least 6 months had no impact on HM B-vitamin concentrations at 2-weeks postpartum. Results suggest that the adequacy of HM composition was generally maintained, with potential exceptions of vitamin B2 and B6.

Published
2021

10. Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses

Author

Pan, Hongchao, Peto, Richard, Henao Restrepo, Ana Maria, Preziosi, Marie-Pierre, Sathiyamoorthy, Vasee, Karim, Quarraisha Abdool, Alejandria, Marissa, Hernàndez García, César, Kieny, Marie-Paule, Malekzadeh, Reza, Murthy, Srinivas, Reddy, K. Srinath, Periago, Mirta Roses, Hanna, Pierre Abi, Abutidze, Akaki, Ader, Florence, Al-Bader, Abdullah, Alhasawi, Almonther, Allum, Emma, Al Mawali, Adhra, Alotaibi, Athari, Alvarez- Moreno, Carlos, Appadoo, Sheila, Arts, Derk, Asiri, Abdullah, Aukrust, Pål, Barratt-Due, Andreas, Genetu Bayih, Abebe, Beaumont, Helena, Bellani, Samir, Benassi, Virginia, Bhargava, Balram, Branca, Mattia, Cappel-Porter, Heike, Cerrato, Nery, Cheick Haidara, Fadima, Chow, Ting Soo, Como, Nadia, Eustace, Joe, Gabunia, Tamar, García, Patricia, Godbole, Sheela, Gotuzzo, Eduardo, Griskevicius, Laimonas, Hamra, Rasha, Hassan, Mariam, Hassany, Mohamed, Hutton, David, Irmansyah, Irmansyah, Jancoriene, Ligita, Khamis, Faryal, Kirwan, Jana, Kumar, Suresh, Lennon, Peter, Lopardo, Gustavo, Lydon, Patrick, Magrini, Nicola, Manevska, Suzana, Manuel, Oriol, McGinty, Sybil, Medina, Marco, Mesa Rubio, Maria Lucia, Miranda Montoya, Maria Consuelo, Nel, Jeremy, Nunes, Estevao, Perola, Markus, Portoles, Antonio, Rasmin, Menaldi, Raza, Aun, Rees, Helen, Reges, Paula, Rogers, Chris, Salami, Kolawole, Salvadori, Marina, Sauermann, Mamatha, Sinani, Narvina, Sow, Samba, Sterne, Jonathan AC, Stevanovikj, Milena, Tacconelli, Evelina, Tavares Maltez, Fernando Manuel, Teferi, Mekonnen, Tikkinen, Kari, Trelle, Sven, Tsertsvadze, Tengiz, Zaid, Hala, Røttingen, John-Arne, Swaminathan, Soumya, Ryan, Michael, Gjermeni, Nevila, Meta, Esmeralda, Aguila, Damian, Alonso, Ignacio, Altamirano, Marcos, Alvarez, María, Alzola, Rodrigo, Arce, Veronica, Arribillaga, Patricia, Avila, Rafael, Balbuena, Juan, Barcelona, Laura, Barletta, José, Benedetti, María, Berdiñas, Verónica, Burgui, Julieta, Caimi, Sabrina, Carrillo, Juan, Carrizo, Juan, Castelli, Juan, Cazaux, Alexis, Cervellino, Flavia, Chalco, Angelo, Chediack, Viviana, Cunto, Eleonora, D'Amico, Nicolàs, de Vedia, Lautaro, Delgado, Carolina, Di Pilla, Debora, Díaz, Miguel, Díaz Aguiar, Pablo, Domínguez, Cecilia, Ellero, Leonor, Farina, Javier, Fernàndez, José, Ferreyra, Roxana, Filippi, María, Fogar, Carolina, Frare, Pablo, Giudiche, Celeste, Golikow, Mariana, Gomez, Maria Georgina, Hermida, Laura, Hurtado, Mariano, Jacobo, Mariela, Jaume, Martin, Laplume, Diego, Lescano, María, Lista, Nicolàs, Loiacono, Flavia, López, Ana Belen, Losso, Marcelo, Luna, Cecilia, Lupo, Sergio, Marianelli, Leonardo, Martin, Anabella, Masciottra, Florencia, Mykietiuk, Analía, Orellano, Lorena, Pachioli, Valeria, Padilla, María José, Pallavicini, Cecilia, Patroso, Jazmin, Perez Blanco, Luz, Presas, Jose Louis, Provenzano, Matias, Lavera, Lorena, Reichert, Viviana, Riveros, Florencia, Rodríguez, Alejandra, Rolon, María José, Salvay, Carolina, Simonetta, María, Sisto, Alicia, Themines, Sandra, Tito, Fernando, Toibaro, Javier, Torales, Graciela, Verón, Luciano, Vizzotti, Carla, Egle, Alexander, Greil, Richard, Joannidis, Michael, Altdorfer, Antoine, Belkhir, Leila, Fraipont, Vincent, Hites, Maya, Arruda, Erico, Breda, Giovanni, Colussi, Arthur, Corradi, Miran, Croda, Julio, Duani, Helena, João, Esaú, Machado, Elizabeth, Mello, Fernanda, Miranda Filho, Demócrito, Monteiro, Poliana, Nunes, Ceuci, Pereira Junior, Luiz Carlos, Pinto, Gustavo, Raboni, Sonia, Ramos, Marcelo, Ruffing, Leonardo, Santos, Valdilea, Souza, Tamara, Medeiros, Melissa, Schwarzbold, Alexandre, Ali, Karim, Azher, Tanweer, Bellemare, David, Binnie, Alexandra, Borgia, Sergio, Cavayas, Yiorgos Alexandros, Chagnon, Nicholas, Cheng, Matthew, Cloutier, Eve, Conly, John, Costiniuk, Cecilia, Daneman, Nick, Douglas, James, Downey, Catarina, Duan, Erick, Durand, Medeline, English, Shane, Farjou, George, Fera, Evadiki, Fontela, Patricia, Fowler, Rob, Fralick, Mike, Gamble, David Gregory, Geagea, Anna, Grant, Jennifer, Harrison, Luke, Havey, Thomas, Hoang, Holly, Kelly, Lauren, Keynan, Yoav, Khwaja, Kosar, Klein, Marina, Kolan, Christophe, Kronfli, Nadine, Lamontagne, Francois, Lee, Nelson, Lee, Todd, Lim, Rachel, Lostun, Alexandra, MacIntyre, Erika, Malhamé, Isabelle, Martin-Carrier, Francois, McGuinty, Marlee, Munan, Matthew, O'Neil, Conar, Ovakim, Daniel, Papenburg, Jesse, Parhar, Ken, Parvathy, SeemaNair, Perez-Patrigeon, Santiago, Rishu, Asgar, Rushton, Moira, Scherr, Kim, Schwartz, Kevin, Semret, Makeda, Silverman, Micahel, Singh, Ameeta, Sligl, Wendy, Smith, Stephanie, Somayaji, Ranjani, Tan, Darrell, Tran, Tuong-Vi, Tremblay, Alain, Tsang, Jennifer, Turgeon, Alexis, Vakil, Erik, Weatherald, Jason, Yansouni, Cedric, Zarychanski, Ryan, Aristizabal, Claudia, Bravo, Juan, Caicedo, Monica, Chacón, Julio, Garzón, Diego, Guevara, Fredy, Lozano-Gonzàlez, Silvia, Macareno, Hugo, Montañez-Ayala, Anita, Oñate, Jose, Rojas-Gambasica, Jose, Rosso, Fernando, Saavedra, Carlos, Valderrama, Sandra, Vàquiro-Herrera, Eliana, Varón-Vega, Fabio, Zuluaga, Ivan, Abdel Baki, Amin, Abdelbary, Akram, Abdel-Razek, Wael, Amin, Wagdi, Asem, Noha, Elassal, Gehan, Elshesheny, Marwa, Fathy, Mohamed, Fathy, Naglaa, Fayed, Notaila, Hammam, Ahmed, Hassany, Sahar, Ibrahim, Hamdy, Kamal, Ehab, Masoud, Hossam, Mohamed, Maryam, Mohamed Gouda, Abdullah, Moustafa, Ehab, Okasha, Shaimaa, Rafik, Ahmed, Said, Ahmed, Sedky, Asmaa, Solyman Kabil, Mohamed, Tarek, Sara, Tharwat, Ahmed, Zaky, Samy, Abegaz, Emawayish Tesema, Bekele, Zelalem Mekonnen, Asfaw, Filmona Mekuria, Tegegne, Netsanet Aragaw, Teklemariam, Miheret Fikre, Nigusse, Frehiwot Tamiru, Achalu, Daniel Legesse, Weldegergs, Shewit Tesfagabr, Huluka, Dawit Kebede, Tereda, Addisu Birhanu, Ala-Kokko, Tero, Delany, Jutta, Ekroos, Heikki, Hankkio, Riina, Haukipää, Mia, Hetemäki, Iivo, Holma, Pia, Holmberg, Ville, Horstia, Saana, Jalkanen, Ville, Jämsänen, Toni, Järventie, Juuso, Järvinen, Petrus, Kalliala, Ilkka, Kauma, Heikki, Kilpeläinen, Tuomas, Kreivi, Hanna-Riikka, Kuitunen, Ilari, Lamminmäki, Satu, Mäkinen, Laura, Mäntylä, Jarkko, Mattila, Tiina, Myllärniemi, Marjukka, Niskanen, Joni, Nykänen, Taina, Nyqvist, Miro, Paajanen, Juuso, Partanen, Terhi, Patovirta, Riitta-Liisa, Paukkeri, Erja-Leena, Puusti, Emmi, Renner, Andreas, Reponen, Emma, Risku, Sari, Rosberg, Tuomas, Rutanen, Jarno, Säilä, Petrus, Salonen, Päivi, Sinisalo, Marjatta, Sivenius, Katariina, Tuominen, Susanna, Aboab, Jerone, Alfaiate, Toni, Andrejak, Claire, Andreu, Pascal, Belhadi, Drifa, Benezit, Francois, Botelho-Nevers, Elisabeth, Bouadma, Lila, Bougon, David, Bouiller, Kevin, Bounes, Fanny, Boyer, Alexandre, Bruel, Cédric, Buffet, Alexandre, Burdet, Charles, Cazanave, Charles, Chabertier, Cyrille, Clere-Jehl, Rapahel, Costagliola, Dominique, Courjon, Johan-Victor, Crockett, Flora, Danion, Francois, Dechanet, Aline, Dellamonica, Jean, Delmas, Christelle, Diallo, Alpha, Djossou, Felix, Dubost, Clement, Dupont, Axelle, Epaulard, Olivier, Faure, Emmmanuel, Faure, Karine, Fayol, Antoine, Figueiredo, Samy, Fougerou, Claire, Gaborit, Benjamin, Gaci, Rostane, Gagneux-Brunon, Amandine, Gallien, Sebastien, Garot, D, Goehringer, Francois, Gruson, Didier, Hinschberger, Olivier, Hulot, Jean-Sebastien, Jaureguiberry, Stephane, Jean-Michel, Vanessa, Kerneis, Solen, Kimmoun, Antoine, Klouche, Kada, Lachatre, Marie, Lacombe, Karine, Laine, Fabrice, Lanoix, Jean Philippe, Laribi, Samira, Launay, Odile, Laviolle, Bruno, Le Moing, Vincent, Le Pavec, Jerome, Lebeaux, David, Leroy, Sylvie, Lescure, Xavier, Livrozet, Marine, Makinson, Alain, Malvy, Denis, Marquette, Charles-Hugo, Martin-Blondel, Guillaume, Mayaux, Julien, Mekontso Dessap, Armand, Mentre, France, Mercier, Noemie, Meziani, Ferhat, Molina, Jean Michel, Mootien, Yoganaden, Mourvillier, Bruno, Navellou, Jean Christoph, Noret, M, Peiffer- Smadja, Nathan, Peytavin, Gilles, Pialoux, Gilles, Pilmis, Benoît, Piroth, Lionel, Poindron, Vincent, Poissy, Julien, Pourcher, Valerie, Quenot, Jean Pierre, Raffi, Francois, Reignier, Jean, Richard, Jean Christoph, Robert, Céline, Saillard, Juliette, Sayre, Naomi, Senneville, Eric, Stefan, Francois, Tellier, Marie Capucine, Terzi, Nicolas, Textoris, Julien, Thiery, Guillame, Timsit, Jean Francois, Tolsma, Violaine, Tubiana, Sarah, Wallet, Florent, Yazdanpanah, Yazdan, Zerbib, Yoann, Aguilar, Carlos, Erazo, Laura, Fiallos, Angel, Figueroa, Rosbinda, Flores, Juan Jose, Melendez, Lesddyy, Moncada, Wendy, Abraham, Ooriapadickal Cherian, Acharya, Chetankumar, Aedula, Vinaya Sekhar, Aggarwal, Richa, Agrawal, Nishant, Agrawal, Umang, Agrawal, Abhishekh, Ahmad, Mohammad, Atal, Shubham, Babu, Avinash, Baidya, Dalim Kumar, Balachandran, Amith, Bangar, Rakhee, Bhadade, Rakesh, Bhandari, Sudhir, Bhapal, Meghavi, Bhardwaj, Pankaj, Bhati, Gaurav, Bhatia, Pradeep, Bhatt, Krishnakant, Bingi, Thrilok Chander, Borse, Rohidas, Buch, Vyom, Chand, Dipti, Chandwani, Ashish, Charan, Jaykaran, Chaudhari, Mayur, Chaudhari, Kirti, Chaudhary, Vipul, Chauhan, Nishant, Chikara, Gaurav, Daswani, Bharti, de Souza, Rosemarie, Desai, Chetna, Divakar, Balusamy, Divhare, Sujeet, Dorairajan, Suresh Kumar, Dutt, Naveen, Ethirajan, Therani Rajan, Gamit, Amit, Gamit, Sweta, Garg, Mahendra, Goenka, Ajay, Goenka, Aniket, Guleria, Randeep, Gupta, Paras, Gupta, Nivedita, Gupta, Madhur, Harde, Minal, Ingle, Vaibhav, Iyer, Shivkumar, Jamalapuram, Vaishnavi, Jayanthi, Rangarajan, Joshi, Rajnish, Kadam, Abhijeet, Kalakuntla, Hemanth, Kalikar, Mrunalini, Kalme, Sayali, Kamble, Suchit, Kant, Ravi, Kantharia, Bansari, Kashikar, Arundhati, Kavishvar, Abhay, Kayina, Choro Athipro, Kerkar, Pranali, Khadanga, Sagar, Khandare, Sagar, Kokate, Pranjali, Komathi, Jayavelu, Krishnan, Vijay, Krishnan, Jayasree, Krishnan, Sumitra, Kulur Mukhyaprana, Sudha, Kumarasamy, N, Mahavar, Sunil, Maitra, Souvik, Majumdar, Falguni, Malhotra, Supriya, Mamulwar, Megha, Malini, Padma, Marwah, Vikas, Maurya, Akhilesh, Mehta, Kedar, Mesipogu, Rajarao, Misra, Shobha, Mitra, Sajal, Mittal, Ankit, Mohan, Bharathi, Momin, Mohmmedirfan, Nag, Vijaya, Nagarajan, Ramakrishnan, Nagmani, Kammili, Narlawar, Uday, Natarajan, Gopalakrishnan, Nischal, Neeraj, Ogale, Dhananjay, Palat, Paltial, Panda, Prasan, Panda, Samiran, Pandya, Amee, Parate, Rohit, Paritekar, Arunita, Patel, Parvati, Patel, Chetna, Patel, Sunaina, Patel, Vitan, Patel, Deep, Patel, Harshad, Patil, Girish, Peter, Deepu, Prasad, Durga, Purohit, Vimlesh, Rabindrarajan, Ebenezer, Ranganathan, Lakshmiarasimhan, Rao, Tushara, Rao, Chakradhara, Rathod, Chirag, Raval, Devang, Ray, Avik, Reddy, Kamini, Rege, Sujata, Revathi, Ayyasamy, Roy, Dhara, Saigal, Saurabh, Sane, Suvarna, Sangale, Shashi, Seetharaman, Krishnamoorthy, Selvamuthu, Poongulali, Seshaiah, Kurada Venkata, Shadrach, Benhur, Shah, Jignesh, Shah, Sonal, Sharma, Swati, Sharma, Raman, Sharma, Shrikant, Singh, Krishna, Singh, Anil, Singh, Arjeet, Singhai, Abhishek, Soneja, Manish, Soni, Kapil Dev, Subhan, Thasneem banu, Subramaniam, Sudharshini, Sudarsanam, Thambu David, Sudarsi, Ravindra Kumar, Suleman, Dawood, Suthar, Nilay, Talati, Shriraj, Tambe, Murlidhar, Tejomurtula, Tilak, Tirupakuzhi Vijayaraghavan, Bharatkumar, Trikha, Anjan, Trivedi, Aarti, Udwadia, Zarir, Upadhyay, Kamlesh, Vasava, Ashwin, Vasudevan, Damodaran, Velayudham, Rajendran, Venkatasubramanian, Ramasubramanian, Verma, Mamta, Waghmare, Rakesh, Waikar, Anushka, Wig, Naveet, Afrilia, Annisa Rizky, Amin, Muhammad, Arlinda, Dona, Avrina, Rossa, Bang, Lois, Djaharuddin, Irawaty, Djojo, Aryan, Driyah, Sri Laning, Erastuti, Mila, Fajarwati, Tetra, Harsini, Harsini, Hartantri, Yovita, Herman, Deddy, Isbaniah, Fathiyah, Karyana, Muhammad, Kusuma, Indra, Mahmudji, Harli Amir, Medison, Irvan, Nugroho, Agung, Nurhayati, Nurhayati, Opitasari, Cicih, Pitoyo, Ceva Wicaksono, Pradana, Antonius Arditya, Raharjo, Sofyan Budi, Rahmaini, Ade, Risniati, Yenni, Riyanto, Bambang Sigit, Sajinadiyasa, I Gede Ketut, Sari, Flora Eka, Sitompul, Pompini Agustina, Soedarsono, Soedarsono, Somia, I Ketut Agus, Sugiri, Yani Jane, Sugiyono, Retna Indah, Susanto, Nugroho Harry, Syarif, Armaji Kamaludi, Yulianto, Aris, Afsharian, Mandana, Akhavi Mirab, Atefehsadat, Amini, Fatemeh, Amini, Mahnaz, Ansarin, Khalil, Baba Mahmoodi, Farhang, Baghaei, Parvaneh, Barazandeh, Fateme, Bayani, Masomeh, Dastan, Farzaneh, Ebrahimpour, Soheil, Eghtesad, Sareh, Fallahi, Mohammad Javad, Fallahpoor Golmaee, Fatemeh, Foroghi Ghomi, Seyed Yaser, Ghadir, Mohammad Reza, Gheitani, Mina, Ghiasvand, Fereshteh, Hafizi Lotfabadi, Saied, Hakamifard, Atousa, Hashemi Madani, Shima Sadat, Hormati, Ahmad, Hosseini, Hamed, Janbakhsh, Alireza, Javanian, Mostafa, Joukar, Farahnaz, Kamali, Alireza, Karampour, Amin, Khajavirad, Nasim, Khodabakhshi, Behnaz, Khodadadi, Javad, Khodashahi, Rozita, Kiani Majd, Somaieh, Mahfoozi, Lida, Mahmoodiyeh, Behnam, Mansour-Ghanaei, Fariborz, Mansouri, Feizollah, Mesgarpour, Bita, Mesri, Mehdi, Mikaeili, Haleh, Miladi, Ronak, Moghadami, Mohsen, Mohamadi, Payam, Mohraz, Minoo, Mohseni Afshar, Zeinab, Moogahi, Sasan, Mousavi Anari, Seyed Alireza, Mozaffar, Seyyed Hassan, Mozdourian, Mahnaz, Najafipour, Reza, Najari, Hamidreza, Nazemiyeh, Masoud, Norouzi, Alireza, Pourkazemi, Aydin, Poustchi, Hossein, Saberhosseini, Seyedeh Naeimeh, Saberi, Marzieh, Saber-Moghaddam, Niloufar, Sadeghi, Anahita, Sadeghi Haddad Zavareh, Mahmoud, Sahraian, Mohammad Ali, Salahi, Mehrdad, Salehi, Mohammad Reza, Sarmadian, Hossein, Sayad, Babak, Shirani, Kiana, Shirvani, Maria, Shojaei, Daryanaz, Shokri, Mehran, Siami, Zeinab, Sima, Ali Reza, Soleimani, Alireza, Soltanmohammad, Saedeh, Tabarsi, Payam, Taghizadieh, Ali, Tavassoli, Samaneh, Varnasseri, Mehran, Vaziri, Siavash, Yadyad, Mohammad Jaafar, Yaghoubi, Shoeleh, Yazdanpanah, Yalda, Yousefi, Farid, Zamanian, Mohammad Hossein, Zand, Farid, Zare Hoseinzade, Elham, Bergin, Colm, Cotter, Aoife, de Barra, Eoghan, Jackson, Arthur, Laffey, John, McCarthy, Cormac, Muldoon, Eavan, Sadlier, Corinna, Maguire, Teresa, Angheben, Andrea, Bai, Francesca, Bandera, Alessandra, Barchiesi, Francesco, Bassetti, Matteo, Bisi, Luca, Bonfanti, Paolo, Calò, Federica, Campoli, Caterina, Canovari, Benedetta, Capetti, Amedeo, Castelli, Francesco, Cauda, Roberto, Cingolani, Antonella, Cocco, Nicolò, Coppola, Nicola, Corcione, Silvia, Cremonini, Eleonora, d'Arminio Monforte, Antonella, de Gaetano Donati, Katleen, De Nardo, Pasquale, De Rosa, Francesco Giuseppe, Degioanni, Maria, Della Siega, Paola, Di Bella, Stefano, Drera, Bruno, Focà, Emanuele, Fornabaio, Chiara, Galli, Massimo, Giacomazzi, Donatella, Gori, Andrea, Gustinetti, Giulia, Iannuzzi, Francesca, Kertusha, Blerta, Lamonica, Silvia, Lichtner, Miriam, Lupia, Tommaso, Luzzati, Roberto, Macera, Margherita, Menatti, Elisabetta, Merelli, Maria, Merlini, Esther, Monari, Caterina, Pan, Angelo, Pecori, Davide, Pezzani, Diletta, Riccardi, Niccolò, Rodari, Paola, Roldan, Eugenia, Rovere, Pierangelo, Rusconi, Stefano, Scabini, Silvia, Tascini, Carlo, Viale, Pierluigi, Vincenzi, Marcello, Zuccalà, Paola, Zucchi, Patrizia, Al-Roomi, Moudhi, Al-Sabah, Salman, Schrapp, Kelly, Hassoun, Mahmoud, Matar, Madonna, Dbouni, Oussaima, Yared, Nadine, Saliba, Michele, Farra, Anna, Riachi, Moussa, Zablockiene, Birute, Reuter, Jean, Staub, Therese, Ab Wahab, Suhaila, Chew, Chun Keat, Chua, Hock Hin, Goh, Pik Pin, Lee, Heng Gee, Leong, Chee Loon, Low, Lee Lee, Mak, Wen Yao, Mohamed Gani, Yasmin, Muhamad, Dzawani, Zaidan, Nor Zaila, Ducker, Camilla, Demiri, Ilir, Aballi, Saad, Berg, Åse, Blomberg, Bjørn, Dalgard, Olav, Dyrhol-Riise, Anne Ma, Eiken, Ragnhild, Ernst, Gernot, Hannula, Ranula, Haugli, Metter, Heggelund, Lars, Hoel, Hedda, Hoff, Dag Arne Lihaug, Holten, Aleksander Rygh, Johannessen, Asgeir, Kåsine, Trine, Kildal, Anders Benjamin, Kittang, Bård Reikvam, Nezvalova-Henriksen, Katerina, Olsen, Inge Christoffer, Olsen, Roy Bjørkolt, Skei, Nina Vibeche, Skudal, Hilde, Tholin, Birgitte, Thoresen, Lars, Trøseid, Marius, Tveita, Anders, Vinge, Leif, Ystrøm, Carl Magnus, Al Jahdhami, Issa, AlNaamani, Khalid, Al Balushi, Zakariya, Pandak, Nenad, Abbas, Salma, Akhtar, Nasim, Azam, Sumeyya, Begum, Dilshad, Hassan, Sadia, Herekar, Fivzia, Khan, Shahzaib, Khan, Ejaz Ahmed, Mahmood, Syed Faisal, Nasir, Nosheen, Rahim, Anum, Sarfaraz, Samreen, Shaikh, Qurat-ul-Ain, Sultan, Faisal, Walayat, Usman, Agurto-Lescano, Erika Cecilia, Alcantara-Díaz, Andrés Martín, Alva-Correa, Ana María, Alvarado-Moreno, José Gustavo, Ángeles-Padilla, Bethsabé, Arbañil-Huamàn, Hugo César, Ávila-Reyes, Pool Christopher, Azañero-Haro, Johan Alexander, Barreto-Rocchetti, Luis Guillermo, Benitez-Peche, Jorge Marko A., Bernal-Màlaga, Karla Hortencia, Cabrera-Portillo, Liliana Norma, Carazas-Chavarry, Reynaldo Javier, Càrcamo, Paloma Mariana, Casimiro-Porras, Indira Catalina, Castillo-Espinoza, Jhuliana, Chacaltana-Huarcaya, Jesús Norberto, Cornejo-Valdivia, Carla Raquel, Cruz-Chereque, Augusto, Del-Aguila-Torres, Keith Cayetano Marcelino, Díaz-Chipana, Erika, Flores-Valdez, Neil, Franco-Vàsquez, Rosanna Andrea, Gallegos-López, Roxana Consuelo, Gastiaburú-Rodriguez, Dauma Yesenia, Gianella-Malca, Gonzalo Ernesto, Gomero-Lopez, Andrés Alonso, Hercilla-Vàsquez, Luis Enrique, Hueda-Zavaleta, Miguel Ángel, Ibarcena-Llerena, Claudia Vanessa, Iberico-Barrera, Carlos Alberto, Inquilla-Castillo, Miguel Angel, Juàrez-Eyzaguirre, Jesus Alberto, Laca-Barrera, Manuel, León-Jiménez, Franco, Luna-Wilson, Carla Vanessa, Màlaga, German, Marin, Ricardo, Mejía-Cordero, Fernando, Mendoza-Laredo, Juan Arturo, Meregildo-Rodríguez, Edinson Dante, Miranda-Manrique, Gonzalo Francisco, Olivera-Chaupis, Marco, Ortega-Monasterios, Fatima Josefina, Otazú-Ybàñez, Jimmy Pedro, Paredes-Moreno, María Angélica, Peña-Mayorga, Claudia Ximena, Peña-Vàsquez, Olivia del Carmen, Peña-Villalobos, Alejandro, Ponce, Oscar J, Ponte-Fernandez, Katherin Estefania, Pro, Jose, Quispe-Nolazco, César Miguel, Ramos-Samanez, Manuel Efrain, Rojas-Murrugarra, Kory Mirtha, Samanez-Pérez, Jorge Mauro, Sànchez-Carrillo, Halbert Chrostian, Sànchez-Garavito, Epifanio, Sànchez-Sevillano, Ricardo Manuel, Sandoval-Manrique, Hernan, Santos-Revilla, Gabriela, Silva-Ramos, Julio Antonio, Solano-Ico, Manuel Alberto, Soto, Alonso, Sotomayor-Woolcott, Giannilu Michelle, Tapia-Orihuela, Ruben Kevin Arnold, Terrazas-Obregón, Carmen Sara, Terrones-Levano, Victor Francisco, Ticona-Huaroto, Cesar Eduardo, Torres-Ninapayta, Walter, Torres-Ruiz, Oscar Martin, Ugarte-Mercado, Dario, Vargas-Anahua, Orlando José, Vàsquez-Becerra, Ruben Dario, Vàsquez-Cerro, José Gabriel, Villegas-Chiroque, Miguel, Williams, Anna Larson, Yauri-Lazo, Randi Mauricio, Abad, Cybele Lara, Andales-Bacolcol, Silverose Ann, Arcegono, Marlon, Arches, Jamie, Astudillo, Mary Grace, Aventura, Emily, Awing, Arlyn, Bala, Mishelle Vonnabie, Bello, Jia An, Blanco, Peter, Benedicto, Jubert, Buno, Susana, Cabrera, Justine, Cajulao, Thea Pamela, Caoili, Janice, Casiple-Amsua, Lina, Catambing, Victor, Chin, Inofel, Chua, Ma. Bernadette, Chua, Mitzi Marie, Climacosa, Fresthel Monica, David-Wang, Aileen, De los Reyes, Virginia, Europa, Gilly May, Fernandez, Lenora, Francisco, Jorge, Garcia, Gerard, Garcia, Jemelyn, Gler, Maria Tarcela, Isidro, Marie Grace Dawn, Javier, Rozelle Jade, Kwek, Marion, Lansang, Mary Ann, Lee, Aileen, Li, Kingbherly, Llanes, Mark Ramon Victor, Llorin, Ryan, Macadato, Omar Khayyam, Malundo, Anna Flor, Mercado, Maria Elizabeth, Mujeres, Mercedes, Nepomuceno, Marisse, Ngo-Sanchez, Katha, Orden, Mary Claire, Pablo-Villamor, Maria Philina, Paez, Ruel Dionisio, Palmes, Patricio, Panaligan, Marion, Quinivista-Yoon, Jenny Mae, Ramos, Mary Shiela Ariola, Ramos -Penalosa, Christine, Reyes, Sheila Marie, Roa, Kathryn, Roman, Arthur Dessi, Rosario, Minette Claire, Roxas, Evalyn, Santos, Lourdes Ella Gonzales, Soldevilla, Helmar, Solante, Rontgene, Suaco, Jane, Tagarda, Daisy, Tang, Issa Rufina, Te, Bob, Teo, Dennis, Tibayan, Christopher John, Villalobos, Ralph Elvi, Ymbong, Duane Richard, Zabat, Gelza Mae, Batkova, Stepanka, Cardoso, Orlando, Garrote, Ana-Raquel, Lino, Sara, Manata, Maria-José, Pinheiro, Helder, Póvoas, Diana, Ramirez, Freddy, Seixas, Diana, Naji, Assem, Al Gethamy, M Al, AL-Mulaify, Mohammed Sami, Al Maghraby, Reem, Alrajhi, A, Al Sharidi, Aynaa, Alotaibi, Naif, AlShaharani, F, Barry, Mazin, Ghonem, Leen, Khalel, Anas, Kharaba, Ayman Mohammed, Alabdan, Lulwah, AlAbdullah, Mohammed Sharaf, Al Shabib, Abdullah, Bengu, Simangele, Bennet, Jacklyn, Dubula, Thozama, Howell, Pauline, Janse van Vuuren, Cloete, Kalla, Ismail, Lifson, Aimee, Maasdorp, Shaun, Magua, Nombulelo, Maluleke, Vongani, Mbhele, Nokuphiwa, Mdladla, Nathi, Mendelson, Mark, Menezes, Colin, Mwelase, Thando, Nchabeleng, Maphoshane, Palanee-Phillips, Thesla, Parker, Victoria, Rassool, Mohammed, Reeder, Paul, Sossen, Bianca, Steyn, Dewald, Tsitsi, Merika, van Blydenstein, Sarah Alex, Venter, Michelle, Van Vuuren, Janse, Venturas, Jacquie, Abad Pérez, Daniel, Abenza, Maria José, Alarcón-Payer, Carolina, Armero Garrigos, Eva, Arribas, Jose Ramon, Ascaso, Ana, Berenguer, Juan, Cabello-Clotet, Noemí, Chamorro Tojeiro, Sandra, Cuenca-Acevedo, Rafael, de la Calle, Fernando, Del Toro, Maria Dolores, Díaz Pollàn, Beatriz, Diez, Cristina, Esquillor-Rodrigo, María José, Estrada, Vicente, Fanciulli, Chiara, Fanjul, Francisco, Fernàndez de Orueta, Lucía, Ferre, Adrian, Ferreira Pasos, Eva Maria, Gainzarain-Arana, Juan-Carlos, Garcia, Felipe, García Deltoro, Miguel, Goikoetxea Agirre, Ane Josune, Gómez Barquero, Julia, Gomez-Huelgas, Ricardo, Gonzàlez Moraleja, Julio, Guijarro, Carlos, Gutierrez, Felix, Guzmàn, Jesús, Ibarguren, Maialen, Iribarren, Jose Antonio, Jerusalem, Koen, Juan Arribas, Arturo, Lalueza, A, Leone, Antonio, Lopez Azkarreta, Iñigo, Lozano-Martin, Daniel, Lucendo, Alfredo J, Luengo López, Mariella, Martín Oterino, JA, Masa, JF, Merino, Esperanza, Monge-Maillo, Begoña, Moran-Rodríguez, Miguel-Angel, Muñez Rubio, Elena, Muñoz Sanchez, Josefa, Nuñez Orantos, Maria Jose, Nuño, Enrique, Ortiz-De-Zarate-Ibarra, Zuriñe, Pagàn-Muñoz, Bàrbara, Paño-Pardo, José Ramón, Peñaranda, Maria, Pérez Chica, Gerardo, Pérez Fernàndez, AM, Pérez-López, Carmen, Polo San Ricardo, Victor, Portu-Zapirain, Joseba, Puchades, Francesco, Rivas Paterna, Ana Belen, Rodríguez Vidigal, Francisco F, Rodríguez-Baño, Jesus, Ruiz-Seco, Pilar, Ryan, Pablo, Saez-De-Adana, Ester, Salas, Rosario, Salavert Lletí, Miguel, Sandoval, Raquel, Toyas-Miazza, Carla, Valencia, Jorge, Vargas, Emilio, Velasco, Maria, Von Wichmann, Miguel Angel, Bosshard, Andreas, Calmy, Alexandra, Castro, Tiago, Cavassini, Matthias, Clerc, Olivier, Conen, Anna, Desbaillets, Nicolas, Desgranges, Florian, Duss, Francois, Emonet, Stephane, Erard, Veronique, Eyer, Myriam, Fayet-Mello, Aurélie, Flammer, Yvonne, Friedl, Andrée, Fulchini, Rosamaria, Furrer, Hansjakob, Garin, Nicolas, Gastberger, Salome, Greiner, Michael, Haefliger, David, Haubitz, Sebastian, Hoffmann, Matthias, Isenring, Egon, Jakopp, Barbara, Lampert, Markus, Marinosci, Annalisa, Martin, Yvonne, Petignat, Pierre-Auguste, Piso, Rein Jan, Prendki, Virginie, Rutishauser, Jonas, Schaefer, Elisabeth, Schmiedel, Yvonne, Schwery, Stefan, Stavropoulou, Elisavet, Stoeckle, Marcel, Suttels, Veronique, Thurnher, Maria Christine, van den Bogaart, Lorena, West, Emily, Wiegand, Jan, and Wiggli, Benedikt

Published
2022
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12. Zinc supplementation initiated prior to or during pregnancy modestly impacted maternal status and high prevalence of hypozincemia in pregnancy and lactation: the Women First Preconception Maternal Nutrition Trial

Author

Kemp, Jennifer F., primary, Hambidge, K Michael, additional, Westcott, Jamie L., additional, Ali, Sumera Aziz, additional, Saleem, Sarah, additional, Garcés, Ana, additional, Figueroa, Lester, additional, Somannavar, Manjunath S., additional, Goudar, Shivaprasad S., additional, Long, Julie M., additional, Hendricks, Audrey E., additional, Krebs, Nancy F., additional, Dhaded, Sangappa M., additional, Vernekar, Sunil S., additional, Herekar, Veena R., additional, Yogeshkumar, S., additional, McClure, Elizabeth M., additional, Das, Abhik, additional, Thorsten, Vanessa R., additional, Derman, Richard J., additional, Goldenberg, Robert L., additional, and Koso-Thomas, Marion W., additional

Published
2024
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13. Gestational weight gain in 4 low- and middle-income countries and associations with birth outcomes: a secondary analysis of the Women First Trial

Author

Bauserman, Melissa S, Bann, Carla M, Hambidge, K Michael, Garces, Ana L, Figueroa, Lester, Westcott, Jamie L, Patterson, Jackie K, McClure, Elizabeth M, Thorsten, Vanessa R, Aziz, Sumera Ali, Saleem, Sarah, Goldenberg, Robert L, Derman, Richard J, Herekar, Veena, Somannavar, Manjunath, Koso-Thomas, Marion W, Lokangaka, Adrien L, Tshefu, Antoinette K, Krebs, Nancy F, and Bose, Carl L

Published
2021
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14. Structured Q1 headache services as the solution to the ill-health burden of headache: 1. Rationale and description

Author

Timothy J. Steiner, Rigmor Jensen, Zaza Katsarava, Lars Jacob Stovner, Derya Uluduz, Latifa Adarmouch, Mohammed Al Jumah, Ali M. Al Khathaami, Messoud Ashina, Mark Braschinsky, Susan Broner, Jon H. Eliasson, Raquel Gil-Gouveia, Juan B. Gómez-Galván, Larus S. Gudmundsson, Akbar A. Herekar, Nfwama Kawatu, Najib Kissani, Girish Baburao Kulkarni, Elena R. Lebedeva, Matilde Leonardi, Mattias Linde, Otgonbayar Luvsannorov, Youssoufa Maiga, Ivan Milanov, Dimos D. Mitsikostas, Teymur Musayev, Jes Olesen, Vera Osipova, Koen Paemeleire, Mario F. P. Peres, Guiovanna Quispe, Girish N. Rao, Ajay Risal, Elena Ruiz de la Torre, Deanna Saylor, Mansoureh Togha, Sheng-Yuan Yu, Mehila Zebenigus, Yared Zenebe Zewde, Jasna Zidverc-Trajković, Michela Tinelli, and on behalf of Lifting The Burden: the Global Campaign against Headache

Subjects
Headache disorders, Public health, Health policy, Barriers to care, Needs assessment, Health-technology assessment, Medicine
Abstract

Abstract In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

Published
2021
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15. Growth from Birth Through Six Months for Infants of Mothers in the “Women First” Preconception Maternal Nutrition Trial

Author

Gado, Justin, Somannavar, Manjunath S., Herekar, Veena, Pasha, Omrana, Khan, Umber, McClure, Elizabeth M., Koso-Thomas, Marion, Krebs, Nancy F., Hambidge, K. Michael, Westcott, Jamie L., Garcés, Ana L., Figueroa, Lester, Tsefu, Antoinette K., Lokangaka, Adrien L., Goudar, Shivaprasad S., Dhaded, Sangappa M., Saleem, Sarah, Ali, Sumera Aziz, Bose, Carl L., Derman, Richard J., Goldenberg, Robert L., Thorsten, Vanessa R., Sridhar, Amaanti, Chowdhury, Dhuly, and Das, Abhik

Published
2021
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18. B-Vitamins and Choline in Human Milk Are Not Impacted by a Preconception Lipid-Based Nutrient Supplement, but Differ Among Three Low-to-Middle Income Settings—Findings From the Women First Trial

Author

Bridget E. Young, Jamie Westcott, Jennifer Kemp, Lindsay Allen, Daniela Hampel, Ana L. Garcés, Lester Figueroa, Shivaprasad S. Goudar, Sangappa M. Dhaded, Manjunath Somannavar, Sarah Saleem, Sumera Aziz Ali, K. Michael Hambidge, Nancy F. Krebs, The Women First Working Group, Veena Herekar, Sunil S Vernekar, S Yogeshkumar, Umber Khan, Farina Abrejo, Robert K Goldenberg, Richard J Derman, and Beth McClure

Subjects
lipid nutrient supplement (LNS), human milk, B vitamins, thiamin, vitamin B12, nutrition intervention, Nutrition. Foods and food supply, TX341-641
Abstract

Introduction: Optimal human milk (HM) B-vitamin concentrations remain undefined, especially in areas where undernutrition is prevalent. The impact of supplementation pre-conception through pregnancy on HM B-vitamin composition remains unknown.Methods: Human milk (HM) was collected at 2-weeks postpartum from 200 women in Guatemala, India, and Pakistan (the Women First Trial). The women were randomized to start a lipid-based nutrient supplement before conception, at end of the first trimester, or not at all; intervention continued until delivery. HM concentrations of eight B-vitamins and choline were assessed via ultra-performance liquid chromatography-tandem mass spectrometry. Maternal diet was assessed in early pregnancy, and infant growth followed through 6 months post-delivery.Results: Despite supplement exposure averaging 15.7 (pre-conception arm) and 6.0 months (prenatal arm), HM B-vitamins did not differ between arms, but site differences were evident. Guatemala had higher HM concentrations of vitamin B3 than Pakistan and India. Pakistan had higher HM concentrations of thiamin and vitamin B6 than India and Guatemala. Cohort average HM vitamin B2 (162 ± 79 μg/L) and B6 (31.8 ± 24.6 μg/L) fell below values defined as deficient in 81.5 and 85.5% of samples, potentially reflecting sampling procedures and timing. Maternal dietary intakes of only vitamin B6 and choline were associated with the corresponding concentrations in HM (p < 0.005). No HM B-vitamin concentrations were associated with infant growth.Conclusion: Prenatal supplementation for at least 6 months had no impact on HM B-vitamin concentrations at 2-weeks postpartum. Results suggest that the adequacy of HM composition was generally maintained, with potential exceptions of vitamin B2 and B6.

Published
2021
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21. Implementing the Dubowitz assessment of gestational age in India and Malawi: a cross-sectional study of participants in a training workshop

Author

Krysten North, Roopa M. Bellad, Carl Bose, Sangappa M. Dhaded, Shivaprasad S. Goudar, Veena Herekar, Irving Hoffman, Tisungane Mvalo, Melda Phiri, Friday Saidi, Sunil S. Vernekar, Linda Vesel, Anne C. C. Lee, and Katherine E. A. Semrau

Subjects
Public aspects of medicine, RA1-1270
Abstract

# Background Accurate assignment of the gestational age of newborns is important for the identification of prematurity. The Dubowitz assessment is the gold standard among postnatal examinations used to assign gestational age, but implementation has been limited because of examination complexity and training requirements. The objective of this study was to explore factors related to teaching and implementing the Dubowitz examination that may influence its uptake in India and Malawi. # Methods This cross-sectional study was conducted in India and Malawi during the preparation for a low-birthweight infant feeding exploratory study. Twenty trainees participated in a Dubowitz examination training workshop that occurred over two half-day sessions. Trainees completed pretraining and posttraining surveys related to their perceptions of the Dubowitz training, the examination, and factors affecting the administration of the examination in their setting. # Results All survey respondents expressed confidence in their ability to perform the Dubowitz examination after the training. Less than a third expressed concerns about the time required to learn (30%) or perform the examination (25%). Eighty-five percent of trainees identified concerns related to parental perception of the examination that may inhibit implementation. Trainees averaged 14 minutes (standard deviation: 4.5 minutes) to complete the examination. More than 80% of trainee answers were within one point of the trainer for 16 of the 22 Dubowitz signs. Trainee composite scores were within ±3 weeks of the trainer for 95% of assessments based on Bland-Altman analysis. # Conclusions The Dubowitz examination at birth is a method to improve identification of premature infants in the absence of prenatal dating. We found widespread acceptance for the Dubowitz assessment among participants in training workshops in India and Malawi, despite the complexity and length of the examination. The high level of trainee-trainer concordance on individual examination signs suggests that an acceptable level of competence is feasible after a short, concentrated workshop. Further investigation into barriers that hinder implementation such as negative parental perceptions is warranted. # Registration details Clinical Trials Registration: NCT04002908 (www.clinicaltrials.gov) and CTRI/2019/02/017475 (Clinical Trial Registry of India - http://ctri.nic.in).

Published
2021
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25. Antenatal Dexamethasone for Early Preterm Birth in Low-resource Countries

Author

Oladapo, O.T., Vogel, J.P., Piaggio, G., Nguyen, M.H., Althabe, F., Gülmezoglu, A.M., Bahl, R., Rao, S.P.N., De Costa, A., Gupta, S., Baqui, A.H., Khanam, R., Shahidullah, M., Chowdhury, S.B., Ahmed, S., Begum, N., D Roy, A., Shahed, M.A., Jaben, I.A., Yasmin, F., Rahman, M.M., Ara, A., Khatoon, S., Ara, G., Akter, S., Akhter, N., Dey, P.R., Sabur, M.A., Azad, M.T., Choudhury, S.F., Matin, M.A., Goudar, S.S., Dhaded, S.M., Metgud, M.C., Pujar, Y.V., Somannavar, M.S., Vernekar, S.S., Herekar, V.R., Bidri, S.R., Mathapati, S.S., Patil, P.G., Patil, M.M., Gudadinni, M.R., Bijapure, H.R., Mallapur, A.A., Katageri, G.M., Chikkamath, S.B., Yelamali, B.C., Pol, R.R., Misra, S.S., Das, L., Nanda, S., Nayak, R.B., Singh, B., Qureshi, Z., Were, F., Osoti, A., Gwako, G., Laving, A., Kinuthia, J., Mohamed, H., Aliyan, N., Barassa, A., Kibaru, E., Mbuga, M., Thuranira, L., Githua, N.J., Lusweti, B., Ayede, A.I., Falade, A.G., Adesina, O.A., Agunloye, A.M., Iyiola, O.O., Sanni, W., Ejinkeonye, I.K., Idris, H.A., Okoli, C.V., Irinyenikan, T.A., Olubosede, O.A., Bello, O., Omololu, O.M., Olutekunbi, O.A., Akintan, A.L., Owa, O.O., Oluwafemi, R.O., Eniowo, I.P., Fabamwo, A.O., Disu, E.A., Agbara, J.O., Adejuyigbe, E.A., Kuti, O., Anyabolu, H.C., Awowole, I.O., Fehintola, A.O., Kuti, B.P., Isah, A.D., Olateju, E.K., Abiodun, O., Dedeke, O.F., Akinkunmi, F.B., Oyeneyin, L., Adesiyun, O., Raji, H.O., Ande, A.B.A., Okonkwo, ., I, Ariff, S., Soofi, S.B., Sheikh, L., Zulfiqar, S., Omer, S., Sikandar, R., Sheikh, S., Giordano, D., Gamerro, H., Carroli, G., Carvalho, J., Neilson, J., Molyneux, E., Yunis, K., Mugerwa, K., and Chellani, H.K.

Published
2021
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26. Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan.

Author

Samreen Sarfaraz, Quratulain Shaikh, Syed Ghazanfar Saleem, Anum Rahim, Fivzia Farooq Herekar, Samina Junejo, and Aneela Hussain

Subjects
Medicine, Science
Abstract

A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8-49.0) compared to survivors (21.8: IQR = 12.6-36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6-12) compared to survivors (5: IQR = 3-7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6-6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6-7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9-12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.

Published
2021
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29. Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial.

Author

Sangappa M Dhaded, K Michael Hambidge, Sumera Aziz Ali, Manjunath Somannavar, Sarah Saleem, Omrana Pasha, Umber Khan, Veena Herekar, Sunil Vernekar, Yogesh Kumar S, Jamie E Westcott, Vanessa R Thorsten, Amaanti Sridhar, Abhik Das, Elizabeth McClure, Richard J Derman, Robert L Goldenberg, Marion Koso-Thomas, Shivaprasad S Goudar, and Nancy F Krebs

Subjects
Medicine, Science
Abstract

South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), in the 1st trimester (Arm 2), or not at all (Arm 3). An additional protein-energy supplement was provided if BMI

Published
2020
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31. Evaluation of bidirectional gut‐brain axis and anorectal function in Parkinson's disease with constipation.

Author

Yan, Yun, Tennekoon, Karunaratne, Eubanks, Audrey, Herekar, Anam, Shimoga, Dhanush, Ayyala, Deepak, McLeod, Colin, Kurek, Julie A., Morgan, John C., Rao, Satish S. C., and Sharma, Amol

Subjects
PARKINSON'S disease, MOVEMENT disorders, EVOKED potentials (Electrophysiology), TRANSCRANIAL magnetic stimulation, CONSTIPATION, PAIN threshold
Abstract

Background: Parkinson's disease (PD) is a neurodegenerative movement disorder with prodromal and highly prevalent gastrointestinal (GI) symptoms, especially constipation. Although PD models suggest gut‐brain axis dysfunction, the mechanistic underpinnings and their correlation with GI symptoms are poorly understood. Aim: To examine the bidirectional gut‐brain axis function in PD and correlate it with constipation severity, PD duration, and severity. Methods: Rectal sensory thresholds and afferent cortical evoked potentials (CEP) were assessed using a 4‐ring EMG electrode probe. Efferent anal and rectal motor evoked potentials (MEPs) were obtained following transcranial and lumbosacral magnetic stimulation. Bowel symptoms were assessed by prospective stool diary. The CEP and MEP latencies, rectal sensory thresholds, and anorectal sensorimotor data were compared between PD subjects and age‐adjusted healthy subjects. Key Results: Twenty‐five PD subjects with constipation (F/M = 6/19) and 20 healthy subjects (F/M = 14/6) were enrolled. The first and pain sensation thresholds were higher in PD subjects than healthy subjects (p < 0.002) but lost significance after adjustment for age. Age‐adjusted rectal CEP and right‐sided cortico‐anal MEP latencies were prolonged in PD subjects compared to healthy subjects (p < 0.04). Also, half (4 of 8) age‐adjusted spino‐anal and rectal MEP latencies in PD subjects were significantly longer. In multivariate linear analysis, first rectal sensation and right‐sided MEP latencies showed moderate correlation with constipation severity. Conclusions & Inferences: Parkinson's disease is associated with significant bidirectional gut‐brain axis dysfunction as evidenced by prolonged afferent and efferent neuronal signaling. Constipation severity in PD is correlated to abnormal rectal sensation and lateralized disturbance of efferent brain‐gut signaling. [ABSTRACT FROM AUTHOR]

Published
2024
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34. IS TOCILIZUMAB AN EFFECTIVE THERAPY FOR SEVERE COVID-19: A SINGLE CENTER STUDY

Author

Samreen, Sarfaraz, Quratulain, Shaikh, Sundus, Iftikhar, Fivzia Farooq, Herekar, Syed Ghazanfar, Saleem, and Fatima, Kanani

Subjects
General Medicine
Abstract

Background: The quest for effective therapies in Covid-19 continues. We compared the outcome of severe COVID-19 patients treated with and without Tocilizumab, an IL-6 inhibitor. Methods: This is a prospective cohort study on the clinical characteristics and outcomes of patients with Covid-19 patients admitted at The Indus Hospital and Health Network, Karachi between 24th March and 19th June 2020. Adult patients who received TCZ were compared with respect to mortality and days of hospitalization with those who did not. Results: A total of 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline demographic characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stays, days of intubation, use of inotropic agents, and use of invasive ventilation or in-hospital complications were similar between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p

Published
2022
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36. Tenapanor in the Treatment of Irritable Bowel Syndrome with Constipation: Discovery, Efficacy, and Role in Management

Author

Herekar,Anam, Shimoga,Dhanush, Jehangir,Asad, Shahsavari,Dariush, Yan,Yun, Karunaratne,Tennekoon Buddhika, Sharma,Amol, Herekar,Anam, Shimoga,Dhanush, Jehangir,Asad, Shahsavari,Dariush, Yan,Yun, Karunaratne,Tennekoon Buddhika, and Sharma,Amol

Abstract

Anam Herekar, Dhanush Shimoga, Asad Jehangir, Dariush Shahsavari, Yun Yan, Tennekoon Buddhika Karunaratne, Amol Sharma Department of Medicine, Augusta University, Augusta, GA, USACorrespondence: Amol Sharma, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA, Email amosharma@augusta.eduAbstract: Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction (DGBI). IBS significantly impacts the quality of life of patients. Since its pathogenesis is unclear and can be multifactorial, it highlights the need for new and improved pharmaceutical drugs that not only improve bowel symptoms, but also address global IBS symptoms, such as abdominal pain. Tenapanor, a recently Food & Drug Administration (FDA)-approved medication for IBS with constipation (IBS-C), is a small molecule inhibitor of the sodium/hydrogen exchanger isoform 3 (NHE3) that inhibits the absorption of sodium and phosphate in the gastrointestinal tract, resulting in fluid retention and softer stool. Furthermore, tenapanor reduces intestinal permeability to improve visceral hypersensitivity and abdominal pain. Due to its recent approval, tenapanor was not included in the recent IBS guidelines, however, it may be considered for IBS-C patients failing first-line treatment of soluble fiber. In this review article, we aim to provide in-depth information to the reader regarding the design of tenapanor, its development through Phase I, II and III randomized clinical trials, and its role in the treatment of IBS-C.Keywords: irritable bowel syndrome, irritable bowel syndrome with constipation, IBS, IBS-C, constipation, tenapanor

Published
2023

37. Clinical manifestation and outcomes of multi-drug resistant (MDR) Raoultella terrigena infection – A case series at Indus Health Network, Karachi, Pakistan

Author

Pushpa Bhawan Mal, Samreen Sarfaraz, Fivzia Herekar, and Rakhshinda Ambreen

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

Background and objectives: There is paucity of literature available on Raoultella terrigena infection. Microbiological identification of Raoultella terrigena is difficult and isolates are frequently misidentified as Klebsiella species. This series of 3 cases with Raoultella terrigena septicemia provides a description of the pitfalls and challenges in the diagnosis and management of the highly resistant strains isolated and to the best of our knowledge, is the first report from Pakistan. Methods: The medical records of 3 cases of R. terrigena reported in the hospital over two months were reviewed retrospectively to record all relevant clinical information. Organism was identified by using Analytical profile index (API) 20 E with 90–95% successful identification and the sensitivity testing was performed by disc diffusion method. Results: This organism caused fulminant sepsis in case 2 resulting in mortality and complicated urinary tract infection in the third, while in case 1 it preceded the fatal candidemia. All three patients were females who had multiple co-morbid and had a history of protracted hospital stay and antibiotic usage elsewhere before being shifted to our hospital. The isolates were resistant to all beta lactams and were even colistin resistant in two patients, creating challenges and suboptimal response for effective antibiotic therapy. Conclusions: The purpose of this case series is to highlight the highly drug resistant profile of this organism and the fulminant infection it can cause, which if spreads in our hospitals due to breaches in infection control practices, can pose risk as a deadly and untreatable nosocomial infection. Keywords: Raoultella terrigena, Extensively drug resistant, Nosocomial infection

Published
2019
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38. Implementing an early childhood development intervention with routine immunization visits in India: a feasibility trial

Author

Reshma Shah, Veena Herekar, Deepa Metgud, Hajwa Kim, Marc Atkins, and Sangappa Dhaded

Subjects
Child, Preschool, Vaccination, Pediatrics, Perinatology and Child Health, COVID-19, Feasibility Studies, Humans, India, Infant, Prospective Studies, Child, Article
Abstract

Integrating an early childhood development (ECD) intervention within routine healthcare visits offers an important opportunity for a population-level approach to support ECD in low- and middle-income countries (LMICs) where 250 million children under the age of 5 years fail to reach their full developmental potential. This paper reports on the feasibility of integrating an adapted healthcare-based ECD intervention (Sit Down and Play) in primary health centers (PHCs) serving low-income rural communities in Karnataka, India, and its potential to support research-informed components needed to improve ECD (e.g., opportunities for learning). Using a prospective cluster nonrandomized pilot and feasibility trial, caregivers with infants 6-10 weeks of age were recruited from 2 PHCs: one which delivered the intervention at two subsequent immunization visits (n = 25) and the other as care as usual (n = 28). Feasibility was assessed using the following indicators: implementation, practicality, acceptability, demand, and limited efficacy. Quality of home stimulation and opportunities for learning were explored with key items from the UNICEF Multiple Cluster Index Surveys with generalized estimating equation models. While outcome measures were to be obtained from all participants 3-month post-enrollment, due to COVID19 restrictions, there was variability in timing of follow-up interviews; however, outcome data from all participants were obtained and no significant group differences existed in contact time. Results suggest the feasibility of delivery of SDP during routine immunization visits, high satisfaction with adapted content, and utility of developed training and fidelity measures. Though not powered for hypothesis testing, our exploratory analyses reveal the intervention group demonstrated greater improvements on quality of home stimulation over time than the control group.Our findings suggest integrating an ECD intervention with routine healthcare visits is a feasible and promising strategy for supporting ECD in India. Further studies are needed to determine the effectiveness of SDP on children's development.ClinicalTrials.gov Identifier: NCT04167254.• Interventions are increasingly being developed to target responsive caregiving and opportunities for learning because of their potential to support early childhood development (ECD) in low- and middle-income countries where 250 million children under the age of 5 years fail to reach their full developmental potential. • A critical issue in ECD intervention research is the gap between what is known to be effective treatment to protect healthy brain development and what is provided to millions of caregivers during routine care who live in low-income communities.• We adapted a brief, ECD intervention for use with routine healthcare visits in India as a population-level strategy to support ECD in LMICs. • Our results demonstrate feasibility, acceptability, and improvements in key parenting behaviors that promote ECD.

Published
2022
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41. Feeding practices and growth patterns of moderately low birthweight infants in resource-limited settings: results from a multisite, longitudinal observational study

Author

Vesel, Linda, primary, Bellad, Roopa M, additional, Manji, Karim, additional, Saidi, Friday, additional, Velasquez, Esther, additional, Sudfeld, Christopher R, additional, Miller, Katharine, additional, Bakari, Mohamed, additional, Lugangira, Kristina, additional, Kisenge, Rodrick, additional, Salim, Nahya, additional, Somji, Sarah, additional, Hoffman, Irving, additional, Msimuko, Kingsly, additional, Mvalo, Tisungane, additional, Nyirenda, Fadire, additional, Phiri, Melda, additional, Das, Leena, additional, Dhaded, Sangappa, additional, Goudar, Shivaprasad S, additional, Herekar, Veena, additional, Kumar, Yogesh, additional, Koujalagi, M B, additional, Guruprasad, Gowdar, additional, Panda, Sanghamitra, additional, Shamanur, Latha G, additional, Somannavar, Manjunath, additional, Vernekar, Sunil S, additional, Misra, Sujata, additional, Adair, Linda, additional, Bell, Griffith, additional, Caruso, Bethany A, additional, Duggan, Christopher, additional, Fleming, Katelyn, additional, Israel-Ballard, Kiersten, additional, Fishman, Eliza, additional, Lee, Anne C C, additional, Lipsitz, Stuart, additional, Mansen, Kimberly L, additional, Martin, Stephanie L, additional, Mokhtar, Rana R, additional, North, Krysten, additional, Pote, Arthur, additional, Spigel, Lauren, additional, Tuller, Danielle E, additional, Young, Melissa, additional, and Semrau, Katherine E A, additional

Published
2023
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45. Blue autofluorescence markers of reactivation of choroidal neovascularization in age-related macular degeneration

Author

Herekar, Sujay, Roy, Rupak, and Saurabh, Kumar

Subjects
Neovascularization -- Physiological aspects, Fluorescence -- Physiological aspects, Macular degeneration -- Physiological aspects, Health
Abstract

Byline: Sujay. Herekar, Rupak. Roy, Kumar. Saurabh Spectral-domain optical coherence tomography (SDOCT) image of scarred type 1 choroidal neovascularisation (CNV) showed degenerative intraretinal cysts and flattening hyperreflective double-layer sign [Figure [...]

Published
2021

46. Translumbosacral Anorectal Magnetic Stimulation Test for Fecal Incontinence

Author

Enoe Jimenez, Yun Yan, Amol Sharma, Anam Herekar, Amit Hudgi, Qiaochu Gu, and Satish S.C. Rao

Subjects
Adult, Male, medicine.medical_specialty, Constipation, Lumbosacral Plexus, Anal Canal, Rectum, Gastroenterology, Article, Cohort Studies, Lumbar, Neuritis, Internal medicine, Prevalence, medicine, Humans, Fecal incontinence, Evoked potential, Electrodes, Aged, Aged, 80 and over, business.industry, Magnetic Phenomena, Lumbosacral Region, Anal Region, General Medicine, Middle Aged, Evoked Potentials, Motor, Neurophysiological Monitoring, Sacral plexus, medicine.anatomical_structure, Case-Control Studies, Female, medicine.symptom, business, Fecal Incontinence, Lumbosacral joint
Abstract

Neuropathy may cause fecal incontinence and mixed fecal incontinence/constipation, but its prevalence is unclear, partly due to the lack of comprehensive testing of spino-anorectal innervation.This study aimed to develop and determine the clinical usefulness of a novel test, translumbosacral anorectal magnetic stimulation for fecal incontinence.This observational cohort study was conducted from 2012 to 2018.This study was performed at a tertiary referral center.Patients with fecal incontinence, patients with mixed fecal incontinence/constipation, and healthy controls were included.A translumbosacral anorectal magnetic stimulation test was performed by using an anorectal probe with 4 ring electrodes and magnetic coil, and by stimulating bilateral lumbar and sacral plexuses, uses and recording 8 motor-evoked potentials at anal and rectal sites.The prevalence of lumbar and/or sacral neuropathy was examined. Secondary outcomes were correlation of neuropathy with anorectal sensorimotor function(s) and morphological changes.We evaluated 220 patients: 144 with fecal incontinence, 76 with mixed fecal incontinence/constipation, and 31 healthy controls. All 8 lumbar and sacral motor-evoked potential latencies were significantly prolonged (p0.01) in fecal incontinence and mixed fecal incontinence/constipation groups compared with controls. Neuropathy was patchy and involved 4.0 (3.0) (median (interquartile range)) sites. Lumbar neuropathy was seen in 29% to 65% of the patients in the fecal incontinence group and 22% to 61% of the patients in the mixed fecal incontinence/constipation group, and sacral neuropathy was seen in 24% to 64% and 29% to 61% of these patients. Anal neuropathy was significantly more (p0.001) prevalent than rectal neuropathy in both groups. There was no correlation between motor-evoked potential latencies and anal sphincter pressures, rectal sensation, or anal sphincter defects.No comparative analysis with electromyography was performed.Lumbar or sacral plexus neuropathy was detected in 40% to 75% of patients with fecal incontinence with a 2-fold greater prevalence at the anal region than the rectum. Lumbosacral neuropathy appears to be an independent mechanism in the pathogenesis of fecal incontinence, unassociated with other sensorimotor dysfunctions. Translumbosacral anorectal magnetic stimulation has a high yield and is a safe and clinically useful neurophysiological test. See Video Abstract at http://links.lww.com/DCR/B728.ANTECEDENTES:La neuropatía puede causar incontinencia fecal y una combinación de incontinencia fe-cal/estreñimiento, pero su prevalencia no está clara, en parte debido a la falta de pruebas comple-tas de inervación espino-anorrectal.OBJETIVO:Desarrollar y determinar la utilidad clínica de una nueva prueba, estimulación magnética trans-lumbosacral anorrectal para la incontinencia fecal.DISEÑO:Estudio de cohorte observacional del 2012 al 2018.ENTORNO CLINICO:Centro de referencia terciario.PACIENTES:Pacientes con incontinencia fecal, combinación de incontinencia fecal/estreñimiento y controles sanos.INTERVENCIONES:Se realizó una prueba de estimulación magnética translumbosacral anorrectal utilizando una sonda anorrectal con 4 electrodos anulares y bobina magnética, y estimulando los plexos lumbares y sacros bilaterales y registrando ocho potenciales evocados motores las regiones anal y rectal.PRINCIPALES MEDIDAS DE RESULTADO:Se examinó la prevalencia de neuropatía lumbar y/o sacra. Los resultados secundarios fueron la correlación de la neuropatía con las funciones sensitivomotoras anorrectales y cambios morfológi-cos.RESULTADOS:Evaluamos 220 pacientes, 144 con incontinencia fecal, 76 con combinación de incontinencia fe-cal/estreñimiento y 31 sujetos sanos. Las ocho latencias de los potenciales evocadas motoras lum-bares y sacras se prolongaron significativamente (p0,01) en la incontinencia fecal y el grupo mixto en comparación con los controles. La neuropatía fue irregular y afectaba 4,0 (3,0) (mediana (rango intercuartílico) sitios. Se observó neuropatía lumbar en 29-65% en la incontinencia fecal y 22-61% en el grupo mixto, y neuropatía sacra en 24-64% y 29-61 % de pacientes respectivamen-te. La neuropatía anal fue significativamente más prevalente (p0,001) que la rectal en ambos grupos. No hubo correlación entre las latencias de los potenciales evocadas motoras y las presio-nes del esfínter anal, la sensación rectal o los defectos del esfínter anal.LIMITACIONES:Sin análisis comparativo con electromiografía.CONCLUSIÓNES:Se detectó neuropatía del plexo lumbar o sacro en el 40-75% de los pacientes con incontinencia fecal con una prevalencia dos veces mayor en la región anal que en el recto. La neuropatía lumbo-sacra parece ser un mecanismo independiente en la patogenia de la incontinencia fecal, no asocia-do con otras disfunciones sensitivomotoras. La estimulación magnética translumbosacral anorrec-tal tiene un alto rendimiento, es una prueba neurofisiológica segura y clínicamente útil. Consulte Video Resumen en http://links.lww.com/DCR/B728.

Published
2021
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