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Biomedical subjects

Kiran Bambha

Publications and source records attributed to Kiran Bambha.

7 recordsLinked to original sources
PubMed2006

Hepatic adenomatosis in a young woman with glucose intolerance.

BACKGROUND: A 30-year-old white woman presented to our department in December 2004 for clinical evaluation of episodic, severe, right upper quadrant pain. She was otherwise healthy and her only medication was a daily oral contraceptive pill. Her past medical history was notable for gestational diabetes and fasting hyperglycemia since her pregnancy. Family history was significant for a younger sister with diabetes mellitus, but no known family history of liver disease. INVESTIGATIONS: Physical examination, laboratory investigations, multiphasic CT scan of the abdomen, exploratory laparotomy with biopsies. DIAGNOSIS: Hepatic adenomatosis. MANAGEMENT: Subsegmental hepatic resection followed by interval, long-term follow-up with hepatic imaging.

Adenoma, Liver Cell↗
PubMed2006

MELD-based liver allocation: who is underserved?

Deceased-donor livers are a scarce, lifesaving resource. For patients whose lives depend upon liver transplantation, policies for prioritizing allograft allocation are of ultimate importance. In the current paradigm, donor livers are allocated on the basis of medical urgency. Thus, the onus is on the transplant community to refine the allocation system continuously so that livers are targeted to patients who need them most. The current model for end-stage liver disease (MELD)-based allocation system works well, accurately predicting short-term mortality for the majority (83 to 87%) of waitlisted candidates. However, there are patients with liver diseases whose survival is dependent upon factors other than the severity of the liver disease and who may not manifest derangements in their MELD parameters. Such patients may be underserved by current MELD policies. This article reviews the development of MELD and the MELD-based liver allocation system and addresses issues relevant to whether this system may be improved.

Humans↗
PubMed2005

Employment and health insurance in long-term liver transplant recipients.

This study was conducted to examine factors affecting health insurance and employment status in long-term liver transplant (OLT) recipients. All adult primary OLT recipients surviving at least 1 year were surveyed using existing questionnaires. Out of 217 eligible recipients, 186 (86%) responded. The median age of respondents was 55 years with a median survival after OLT of 3.4 years. The majority (98%) of respondents had health insurance coverage. Thirty-four (18%) reported having lost and/or having been denied health insurance since OLT, and 63 (34%) switched health insurance since OLT. Of the 179 that reported employment status, 98 (55%) were employed, including homemakers and students, while 39 (22%) were retired and 42 (24%) unemployed. The majority (76%) of those unemployed cited poor health as the reason for unemployment, followed by 5 (12%) who feared loss of disability or Medicaid benefits. Fourteen reported to have been denied or terminated from employment because of their transplant. In the regression analysis, employment prior to transplantation (odds ratio (OR)=5.1), age less than 57 (OR=5.1), physical function score>52.4 (OR=3.6) and general health score>33.3 (OR=7.6) were significantly associated with employment. These data may help identify high-risk pre-OLT patients for intervention measures such as work rehabilitation.

Adult↗
PubMed2004

Cost-effectiveness analysis and incremental cost-effectiveness ratios: uses and pitfalls.

Cost-effectiveness analysis is a formal method of comparing alternative medical interventions with regard to their resource utilization (costs) and outcomes (effectiveness). The incremental cost-effectiveness ratio is an informative measure generated from such an analysis and represents the ratio of the difference in cost between two medical interventions to the difference in outcomes between the two interventions. Thus, the incremental cost-effectiveness ratio summarizes the additional cost per unit of health benefit gained in switching from one medical intervention to another. Although incremental cost-effectiveness ratios have limitations, when used in the proper context, these ratios serve as one of the important tools needed to help guide decisions about allocating scarce resources across competing medical programmes.

Cost Allocation↗
PubMed2004

Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements.

We examined whether consideration of repeated model for end-stage liver disease (MELD) measurements for patients listed for liver transplantation improves predictive value beyond current MELD alone. Clinical data were extracted for all adult primary liver transplantation candidates from our institution who were listed with the United Network for Organ Sharing (UNOS) between 1990 and 1999. Serum creatinine, bilirubin, and international normalized ratio (INR) were obtained from an institutional laboratory database. Cox models were constructed using current MELD, change in MELD (Delta), and number of MELD scores to predict survival on the waiting list. Eight hundred and sixty-one patients met inclusion criteria, 639 underwent transplantation, and 80 died while waiting. A one-unit increment in current MELD imparted significant hazard ratios ranging from 1.12 to 1.19 in all models. Delta MELD was predictive of mortality univariately, but less predictive when current MELD was included, and not predictive when considered with both current and number of MELD scores. Overall, current MELD is the single most important determinant of mortality risk on the waiting list. Delta MELD is predictive of death only within 4 d of the event; however, part of this correlates with the dying process itself, thus limiting Delta MELD's utility in survival prediction models.

Adult↗
PubMed2003

Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community.

BACKGROUND & AIMS: The epidemiology of primary sclerosing cholangitis (PSC) in the United States is unknown. We report the incidence, clinical spectrum, and outcomes of PSC in Olmsted County, Minnesota. METHODS: Using the Rochester Epidemiology Project, a medical records linkage system in Olmsted County, Minnesota, we identified county residents with PSC, and the diagnosis was confirmed according to clinical, biochemical, radiographic, and histologic criteria. RESULTS: Twenty-two patients met diagnostic criteria for PSC in 1976-2000. The age-adjusted (to 2000 U.S. whites) incidence of PSC in men was 1.25 per 100,000 person-years (95% CI, 0.70 to 2.06) compared with 0.54 per 100,000 person-years (95% CI, 0.22 to 1.12) in women. The prevalence of PSC in 2000 was 20.9 per 100,000 men (95% CI, 9.5 to 32.4) and only 6.3 per 100,000 women (95% CI, 0.1 to 12.5). Seventy-three percent of cases had inflammatory bowel disease, the majority with ulcerative colitis. Survival among PSC patients was significantly less than expected for the Minnesota white population of similar age and gender (P < 0.001). CONCLUSIONS: These data represent the first population-based estimates of the incidence and prevalence of PSC in the United States. The incidence and prevalence of PSC were approximately one third of those previously described for primary biliary cirrhosis in the same population. Our data suggest that the prevalence of PSC in the United States, with its attendant medical burdens, is significantly greater than previously estimated.

Adult↗