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Article: Prolonged Use of Tirofiban Infusion Without Percutaneous Coronary Intervention To Achieve Optimal Results in a COVID-19 Positive Patient With Inferior ST Segment Elevated Myocardial Infarction (STEMI) Secondary to Thromboembolism: A Case Report.

Khan, Zahid / Patel, Niket

2022 Volume 14, Issue 10, Page(s) e30287

Abstract: Severe acute respiratory syndrome‑coronavirus‑2 (SARS‑CoV‑2), responsible for COVID-19, is mainly a respiratory illness, but it can affect other organs also such as heart, kidneys, and liver. Myocardial injury from COVID-19 has been reported in ... ...

Abstract	Severe acute respiratory syndrome‑coronavirus‑2 (SARS‑CoV‑2), responsible for COVID-19, is mainly a respiratory illness, but it can affect other organs also such as heart, kidneys, and liver. Myocardial injury from COVID-19 has been reported in hospitalized patients ranging from pericarditis and myocarditis to acute coronary syndrome (ACS). COVID-19 is highly hypercoagulable state and is associated with both central and peripheral thromboembolism. COVID 19 patients with ACS may not present with classical features of chest pain and electrocardiogram (ECG) is the most important initial investigation in these patients to assess for any ST or T waves changes. COVID-19 patients with cardiac involvement are the most vulnerable group of patients and have increased morbidity and mortality risk. COVID-19 infections can affect the cardiovascular system in patients with or without history of coronary artery disease (CAD), but the risk of type 1 or 2 myocardial infarction (MI), myocardial injury, ST segment elevation, myocarditis, heart failure, cardiogenic shock, and life threatening arrhythmias are more common in the former group. We present a case of 55-year-old patient who presented to our cardiac center with ST elevated myocardial infarction and high blood sugar level. Patient was recently diagnosed with type 2 diabetes mellitus (T2DM) but was not commenced on medications. Echocardiogram showed mildly impaired left ventricular systolic function (LVSF) with inferior wall hypokinesia, and ECG showed inferior leads ST elevation. Coronary angiogram showed severe mid-vessel lesion and occluded posterior left ventricular branch (PLV). Multiple attempts at aspirating the thrombus resulted in thrombolysis in MI grade 2 (TIMI 2) flow in the vessel and patient was commenced on a tirofiban infusion for 72 hours.
Language	English
Publishing date	2022-10-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.30287
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Acquired angioedema late in the course of nivolumab treatment.

Habibi, Shaghayegh / Patel, Niket / Plaxe, Steven C / Dasanu, Constantin A

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners

2023 , Page(s) 10781552231170555

Abstract: Introduction: Although programmed cell death-1 inhibitors have become the mainstay of treatment for many cancers, their use can at times be accompanied by unusual side effects.: Case report: We describe herein a 43-year-old patient with Lynch ... ...

Abstract	Introduction: Although programmed cell death-1 inhibitors have become the mainstay of treatment for many cancers, their use can at times be accompanied by unusual side effects. Case report: We describe herein a 43-year-old patient with Lynch syndrome and colon cancer who developed facial swelling 18 months after starting nivolumab therapy. Our patient also experienced a grade 1 maculopapular rash due to this agent. Naranjo nomogram assessment showed a probable causality between nivolumab and angioedema (score of 8). Management & outcome: Given the modest intensity of symptoms and the excellent response of metastatic colon cancer to nivolumab, this agent was continued without interruptions. She was prescribed prednisone 20 mg orally daily as needed to be taken if the swelling progressed, or if respiratory symptoms developed. The patient experienced another two similar episodes over the next months; however, they were self-limiting and did not require steroids. Subsequently, she had no further similar symptoms. Discussion: Rare reports of angioedema associated with immune checkpoint inhibitor (ICI) treatment have previously been described. The exact mechanism of these phenomena is unknown, but bradykinin release leading to increased vascular permeability might be involved. Clinicians, pharmacists, and patients should be aware of this rare side effect of ICIs as it can be life-threatening when involving the respiratory tract and causing impending airway obstruction.
Language	English
Publishing date	2023-04-17
Publishing country	England
Document type	Journal Article
ZDB-ID	1330764-2
ISSN	1477-092X ; 1078-1552
ISSN (online)	1477-092X
ISSN	1078-1552
DOI	10.1177/10781552231170555
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Article: Atypical Carcinoid Syndrome in a Patient Presenting With Pericarditis and Supraventricular Tachycardia: A Case Report.

Khan, Zahid / Besis, George / Patel, Niket

Cureus

2022 Volume 14, Issue 10, Page(s) e30052

Abstract: Atypical carcinoids are more uncommon than typical carcinoids, and carcinoid syndrome in general is quite rare. Mediastinal atypical carcinoid is a rare neuroendocrine tumor (NET) that spreads aggressively and rapidly. Morphologically, neuroendocrine ... ...

Abstract	Atypical carcinoids are more uncommon than typical carcinoids, and carcinoid syndrome in general is quite rare. Mediastinal atypical carcinoid is a rare neuroendocrine tumor (NET) that spreads aggressively and rapidly. Morphologically, neuroendocrine tumors are classified into typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma, and the latter two are high-grade tumors. The incidence of atypical carcinoid is rare, and the prognosis is poor, which makes larger trials difficult. It may affect the liver, lungs, or mediastinum with or without metastasis. We present a case of a 47-year-old male patient who presented with chest pain and was found to be in supraventricular tachycardia (SVT) on initial presentation to the hospital. A repeat electrocardiogram (ECG) showed widespread ST-segment elevation. A bedside echocardiogram showed a moderate pericardial effusion, and the patient underwent a coronary angiogram, which showed normal coronary arteries. A computed tomography pulmonary angiogram (CTPA) showed a right mediastinal mass, and the patient was referred to oncology following a discussion in a multidisciplinary team (MDT) meeting. He was commenced on neoadjuvant chemotherapy and has been followed up since in the outpatient clinic. This case is unique due to the initial presentation of supraventricular tachycardia and pericardial effusion.
Language	English
Publishing date	2022-10-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.30052
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Book ; Online: Bridging the Gap

Patel, Niket / Salamanca, Luis / Barba, Luis

Addressing Discrepancies in Diffusion Model Training for Classifier-Free Guidance

2023

Abstract: Diffusion models have emerged as a pivotal advancement in generative models, setting new standards to the quality of the generated instances. In the current paper we aim to underscore a discrepancy between conventional training methods and the desired ... ...

Abstract	Diffusion models have emerged as a pivotal advancement in generative models, setting new standards to the quality of the generated instances. In the current paper we aim to underscore a discrepancy between conventional training methods and the desired conditional sampling behavior of these models. While the prevalent classifier-free guidance technique works well, it's not without flaws. At higher values for the guidance scale parameter $w$, we often get out of distribution samples and mode collapse, whereas at lower values for $w$ we may not get the desired specificity. To address these challenges, we introduce an updated loss function that better aligns training objectives with sampling behaviors. Experimental validation with FID scores on CIFAR-10 elucidates our method's ability to produce higher quality samples with fewer sampling timesteps, and be more robust to the choice of guidance scale $w$. We also experiment with fine-tuning Stable Diffusion on the proposed loss, to provide early evidence that large diffusion models may also benefit from this refined loss function. Comment: Accepted at NeurIPS Diffusion Workshop 2023
Keywords	Computer Science - Machine Learning ; Computer Science - Artificial Intelligence ; Computer Science - Computer Vision and Pattern Recognition
Publishing date	2023-11-01
Publishing country	us
Document type	Book ; Online
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Article: Clinical Outcomes in Patients Receiving Originator Follitropin Alfa and Follitropin Alfa Biosimilars in Real-world Clinical Practice: A Retrospective Study.

Patel, Nayana Hitesh / Patel, Niket H / Patel, Molina Niket / Bhadarka, Harsha K / Vyas, Kairavi Sunilkumar

Journal of human reproductive sciences

2023 Volume 16, Issue 2, Page(s) 148–155

Abstract: Background: Biosimilar drugs have broadened the treatment options in assisted reproductive technology (ART). Real-world data comparing clinical outcomes of originator follitropin alfa (Gonal-f: Aims: To compare the ART outcomes in patients receiving ... ...

Abstract	Background: Biosimilar drugs have broadened the treatment options in assisted reproductive technology (ART). Real-world data comparing clinical outcomes of originator follitropin alfa (Gonal-f Aims: To compare the ART outcomes in patients receiving originator follitropin (Gonal-f Settings and design: Medical records of 364 infertile women who underwent ART between 2016 and 2020 at Akanksha Hospital and Research Institute, Gujrat, India, were retrospectively analysed. Materials and methods: Participants were divided into two cohorts based on treatment (Gonal-f Statistical analysis used: Descriptive statistics and Chi-square test were used for analysis. Results: The number of oocytes retrieved from Gonal-f Conclusions: Gonal-f
Language	English
Publishing date	2023-06-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2418984-4
ISSN	1998-4766 ; 0974-1208
ISSN (online)	1998-4766
ISSN	0974-1208
DOI	10.4103/jhrs.jhrs_37_23
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Article: Drug-free

Patel, Niket H / Bhadarka, Harsha K / Patel, Nayana H / Patel, Molina Niket

Journal of human reproductive sciences

2021 Volume 14, Issue 4, Page(s) 443–445

Abstract: Primary Ovarian Insufficiency (POI) or Diminished Ovarian Reserve (DOR) are the two conditions that affects women leading to infertility due to the lack of follicular growth and ovulation. Egg / Oocyte donation remains an option for these patients. ... ...

Abstract	Primary Ovarian Insufficiency (POI) or Diminished Ovarian Reserve (DOR) are the two conditions that affects women leading to infertility due to the lack of follicular growth and ovulation. Egg / Oocyte donation remains an option for these patients. However, with the development in Reproductive medicine various novel technologies like Ovarian Cryopreservation, Fragmentation,
Language	English
Publishing date	2021-12-31
Publishing country	India
Document type	Case Reports
ZDB-ID	2418984-4
ISSN	1998-4766 ; 0974-1208
ISSN (online)	1998-4766
ISSN	0974-1208
DOI	10.4103/jhrs.jhrs_56_21
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Article ; Online: Distinct gut and vaginal microbiota profile in women with recurrent implantation failure and unexplained infertility.

Patel, Nayna / Patel, Nidhi / Pal, Sejal / Nathani, Neelam / Pandit, Ramesh / Patel, Molina / Patel, Niket / Joshi, Chaitanya / Parekh, Bhavin

BMC women's health

2022 Volume 22, Issue 1, Page(s) 113

Abstract: Background: Female reproductive tract dysbiosis impacts implantation. However, whether gut dysbiosis influences implantation failure and whether it accompanies reproductive tract dysbiosis remains scantly explored. Herein, we examined the gut-vaginal ... ...

Abstract	Background: Female reproductive tract dysbiosis impacts implantation. However, whether gut dysbiosis influences implantation failure and whether it accompanies reproductive tract dysbiosis remains scantly explored. Herein, we examined the gut-vaginal microbiota axis in infertile women. Methods: We recruited 11 fertile women as the controls, and a cohort of 20 infertile women, 10 of whom had recurrent implantation failure (RIF), and another 10 had unexplained infertility (UE). Using amplicon sequencing, which employs PCR to create sequences of DNA called amplicon, we compared the diversity, structure, and composition of faecal and vaginal bacteria of the controls with that of the infertile cohort. Of note, we could only sequence 8 vaginal samples in each group (n = 24/31). Result: Compared with the controls, α-diversity and β-diversity of the gut bacteria among the infertile groups differed significantly (p < 0.05). Taxa analysis revealed enrichment of Gram-positive bacteria in the RIF group, whereas Gram-negative bacteria were relatively abundant in the UE group. Strikingly, mucus-producing genera declined in the infertile cohort (p < 0.05). Hungatella, associated with trimethylamine N-oxide (TMAO) production, were enriched in the infertile cohort (p < 0.05). Vaginal microbiota was dominated by the genus Lactobacillus, with Lactobacillus iners AB-1 being the most abundant species across the groups. Compared with the infertile cohort, overgrowth of anaerobic bacteria, associated with vaginal dysbiosis, such as Leptotrichia and Snethia, occurred in the controls. Conclusion: The gut microbiota had little influence on the vaginal microbiota. Gut dysbiosis and vaginal eubiosis occurred in the infertile women, whereas the opposite trend occurred in the controls.
MeSH term(s)	Dysbiosis/complications ; Dysbiosis/microbiology ; Female ; Humans ; Infertility, Female ; Microbiota ; RNA, Ribosomal, 16S/genetics ; Vagina/microbiology
Chemical Substances	RNA, Ribosomal, 16S
Language	English
Publishing date	2022-04-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-022-01681-6
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Article ; Online: Obstructive left main stem coronary disease: is it time to recommend coronary stenting?

De Maria, Giovanni Luigi / Patel, Niket / Banning, Adrian P

Heart (British Cardiac Society)

2017 Volume 104, Issue 7, Page(s) 614–620

MeSH term(s)	Clinical Decision-Making ; Clinical Trials as Topic ; Coronary Angiography/methods ; Coronary Artery Disease/complications ; Coronary Occlusion/diagnosis ; Coronary Occlusion/etiology ; Coronary Occlusion/therapy ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/pathology ; Humans ; Patient Care Management/methods ; Patient Care Management/trends ; Percutaneous Coronary Intervention/instrumentation ; Percutaneous Coronary Intervention/methods ; Percutaneous Coronary Intervention/trends ; Prognosis ; Stents
Language	English
Publishing date	2017-10-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2016-310880
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Article ; Online: Production of low-expressing recombinant cationic biopolymers with high purity.

Chen, Xuguang / Nomani, Alireza / Patel, Niket / Hatefi, Arash

Protein expression and purification

2017 Volume 134, Page(s) 11–17

Abstract: The growing complexity of recombinant biopolymers for delivery of bioactive agents requires the ability to control the biomaterial structure with high degree of precision. Genetic engineering techniques have provided this opportunity to synthesize ... ...

Abstract	The growing complexity of recombinant biopolymers for delivery of bioactive agents requires the ability to control the biomaterial structure with high degree of precision. Genetic engineering techniques have provided this opportunity to synthesize biomaterials in an organism such as E. coli with full control over their lengths and sequences. One class of such biopolymers is recombinant cationic biopolymers with applications in gene delivery, regenerative medicine and variety of other biomedical applications. Unfortunately, due to their highly cationic nature and complex structure, their production in E. coli expression system is marred by low expression yield which in turn complicates the possibility of obtaining pure biopolymer. SlyD and ArnA endogenous E. coli proteins are considered the major culprits that copurify with the low-expressing biopolymers during the metal affinity chromatography. Here, we compared the impact of different parameters such as the choice of expression hosts as well as metal affinity columns in order to identify the most effective approach in obtaining highly pure recombinant cationic biopolymers with acceptable yield. The results of this study showed that by using E. coli BL21(DE3) LOBSTR strain and in combination with our developed stringent expression and Ni-NTA purification protocols highly pure products in one purification step (>99% purity) can be obtained. This approach could be applied to the production of other complex and potentially toxic biopolymers with wide range of applications in biomedicine.
MeSH term(s)	Carboxy-Lyases/biosynthesis ; Carboxy-Lyases/chemistry ; Carboxy-Lyases/genetics ; Carboxy-Lyases/isolation & purification ; Cations/chemistry ; Cations/isolation & purification ; Escherichia coli/chemistry ; Escherichia coli/genetics ; Escherichia coli/metabolism ; Escherichia coli Proteins/biosynthesis ; Escherichia coli Proteins/chemistry ; Escherichia coli Proteins/genetics ; Escherichia coli Proteins/isolation & purification ; Gene Expression ; Peptidylprolyl Isomerase/biosynthesis ; Peptidylprolyl Isomerase/chemistry ; Peptidylprolyl Isomerase/genetics ; Peptidylprolyl Isomerase/isolation & purification
Chemical Substances	Cations ; Escherichia coli Proteins ; SlyD protein, E coli ; Carboxy-Lyases (EC 4.1.1.-) ; UDPglucuronate decarboxylase (EC 4.1.1.35) ; Peptidylprolyl Isomerase (EC 5.2.1.8)
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1055455-5
ISSN	1096-0279 ; 1046-5928
ISSN (online)	1096-0279
ISSN	1046-5928
DOI	10.1016/j.pep.2017.03.012
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Article: Birth of a healthy infant after bone marrow-derived cell therapy.

Patel, Nayana H / Jadeja, Yuvraj D / Patel, Niket H / Patel, Molina N / Bhadarka, Harsha K / Chudasama, Piyush N / Thakkar, Harmi R

Clinical and experimental reproductive medicine

2021 Volume 48, Issue 3, Page(s) 268–272

Abstract: Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live ...

Abstract	Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband's semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.
Language	English
Publishing date	2021-08-26
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2653899-4
ISSN	2233-8241 ; 2233-8233
ISSN (online)	2233-8241
ISSN	2233-8233
DOI	10.5653/cerm.2020.04252
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