Publications by authors named "Shakthi Unnithan"

Objective: To compare levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac strain, and clinical outcomes in patients at risk of preeclampsia randomized to continuation of low-dose aspirin (LDA) versus placebo for 6 weeks postpartum.

Study Design: This double-blinded randomized-controlled trial included patients at risk of preeclampsia randomized in a 1:1 fashion to LDA (81 mg) versus placebo for 6 weeks postpartum. The primary outcome was NT-proBNP levels at the postpartum visit.

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Introduction/aims: Patients with myasthenia gravis (MG) often receive immunosuppressive treatments. While approved COVID-19 vaccines effectively prevent severe infections, the impact of vaccination among immunocompromised MG patients remains unclear. This study explored vaccination status, adverse events, and post-vaccination outcomes among MG patients.

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Background: Poststroke cognitive impairment is associated with disability and decreased quality of life. We assessed whether individual or collective magnetic resonance imaging (MRI) biomarkers can aid in predicting cognitive impairment after lacunar infarction (LACI).

Methods: We conducted a retrospective analysis of data from the American Stroke Association Bugher Small Vessel Study, which included 134 patients within 2 years of an acute LACI, enrolled between 2007 and 2012 at 4 North Carolina hospitals.

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Anemia is observed in 30% of pregnancies with pyelonephritis, yet little is known about the underlying etiology. Erythropoietin (EPO) is renally produced in response to hypoxic and inflammatory conditions. Changes in serum EPO have been demonstrated in infectious conditions in the nonpregnant population.

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Objective: To estimate the effect of Medicaid expansion on uninsurance rates and catastrophic charges from emergency surgical management of ectopic pregnancy and ovarian torsion using difference-in-difference analysis and to evaluate for racial and ethnic disparities.

Methods: We conducted a retrospective cohort analysis using 2012-2018 State Inpatient Data and State Ambulatory Surgery and Services Databases in four states: Kentucky and Maryland (expansion) and Florida and North Carolina (nonexpansion). Patients undergoing surgical management of ovarian torsion or ectopic pregnancy were included.

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Objective: To evaluate whether transcutaneous electric nerve stimulation (TENS) decreases pain at the time of outpatient endometrial biopsy.

Methods: We conducted a randomized, double-blind trial of active TENS compared with placebo TENS at the time of endometrial biopsy. The primary outcome was pain measured on a 0- to 100-mm visual analog scale immediately after biopsy, with secondary outcomes including satisfaction and tolerability of TENS and pain scores at other procedural time points.

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Introduction: Migraine is an established risk factor for cerebral ischemic stroke, with an especially robust association in patients with migraine with aura. However, it is not known if migraine is a risk factor for retinal stroke (central or branch retinal artery occlusion; CRAO or BRAO).

Methods: We performed a retrospective, observational, cohort study using population-based data from the State Inpatient Databases and State Emergency Department Databases from New York (2006-2015), California (2003-2011), and Florida (2006-2015) to determine the association between hospital-documented migraine and retinal stroke.

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Objective: To evaluate cumulative live birth after preimplantation genetic testing for aneuploidy (PGT-A) with next generation sequencing (NGS) compared with morphology alone among patients aged 21-40 years undergoing single blastocyst transfer.

Design: Retrospective cohort study.

Subjects: Patients aged 21-40 years undergoing first autologous retrieval cycles resulting in ≥5 fertilized oocytes, with subsequent single blastocyst transfer in Society for Assisted Reproductive Technology clinics from 2016-2019.

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Background: Pre-eclampsia is a leading cause of maternal morbidity and mortality in the United States. Emerging data suggests that postpartum pre-eclampsia may be associated with a higher incidence of maternal morbidity compared to hypertensive disorders of pregnancy (HDP) diagnosed antenatally. Understanding postpartum maternal risk across facilities with a spectrum of obstetric services is critical with the rising rates of pre-eclampsia in all healthcare settings.

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Article Synopsis
  • The study aimed to assess the effects of the ARRIVE trial and COVID-19 on differences in labor induction, pregnancy-related hypertension, and cesarean delivery between non-Hispanic Black and White first-time pregnant women.
  • Researchers analyzed U.S. birth data over three time periods: before the ARRIVE trial, after the trial, and during the COVID-19 pandemic, focusing on low-risk pregnancies at or beyond 39 weeks gestation.
  • Findings showed that while labor induction rates increased for both racial groups post-ARRIVE, only non-Hispanic White women saw an increase post-COVID-19; non-Hispanic Black women consistently faced higher rates of hypertension and cesarean deliveries throughout the study periods.
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Objectives: We sought to examine the frequency of depression after small vessel-type stroke (SVS) and associated risk factors.

Materials And Methods: We conducted a retrospective analysis of a prospective cohort of patients enrolled in the American Stroke Association-Bugher SVS Study, which included 200 participants within 2-years of SVS and 79 controls without a history of stroke from 2007 to 2012 at four sites. The primary outcome was PHQ-8, with scores ≥10 consistent with post-stroke depression (PSD).

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An effective HIV-1 vaccine remains a critical unmet need for ending the AIDS epidemic. Vaccine trials conducted to date have suggested the need to increase the durability and functionality of vaccine-elicited antibodies to improve efficacy. We hypothesized that a conjugate vaccine based on the learned response to immunization with hepatitis B virus could be utilized to expand T cell help and improve antibody production against HIV-1.

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Objective: To investigate the efficacy of cryocompression therapy to prevent chemotherapy-induced peripheral neuropathy.

Methods: This single-institution, randomized, self-controlled trial of cryocompression enrolled gynecologic cancer patients planned for five to six cycles neurotoxic chemotherapy. Exclusion criteria were prior neurotoxic chemotherapy or baseline peripheral neuropathy.

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Background: To standardize research terminology and to reduce unanticipated placenta accreta spectrum, the European Working Group for Abnormally Invasive Placenta developed a consensus checklist for reporting suspected placenta accreta spectrum observed during an antenatal ultrasound. The diagnostic accuracy of the European Working Group for Abnormally Invasive Placenta checklist has not been assessed.

Objective: This study aimed to test the performance of the European Working Group for Abnormally Invasive Placenta sonographic checklist in predicting histologic placenta accreta spectrum.

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Background: Carotid stenosis is thought to be the primary risk factor for central retinal artery occlusion (CRAO); however, it is not known whether atrial fibrillation (AF)-a cardiac arrhythmia that underlies over 25% of cerebral ischemic strokes-predisposes patients to CRAO.

Methods: A retrospective, observational, cohort study was performed using data from the State Inpatient Databases and State Emergency Department Databases from New York (2006-2015), California (2003-2011), and Florida (2005-2015) to determine the association between AF and CRAO. The primary exposure was hospital-documented AF.

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Research Question: What is the utilization of direct-to-consumer fertility tests (DTCFT) among fertility patients? How does the perceived utility of DTCFT differ between patients and reproductive endocrinologists (REI)?

Design: Infertility patients visiting the Duke Fertility Center between December 2020 and December 2021 were sent an electronic invitation to participate in a patient survey. Members of the Society of Reproductive Endocrinology and Infertility were also sent e-mail invitations to participate in the REI survey. DTCFT were defined as tests not ordered by a physician or performed at a physician's office, including calendar methods of ovulation prediction, urinary ovulation prediction kits, basal body temperature (BBT) monitoring, hormone analysis, ovarian reserve testing and semen analysis.

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Article Synopsis
  • Writer's cramp (WC) dystonia is a rare condition that affects writing postures, and effective research requires specific measures to differentiate affected individuals from healthy controls.
  • This study evaluated 21 individuals with WC and 22 healthy volunteers using automated measures during a sentence-copying task, examining their ability to accurately identify WC and their reliability over time.
  • Results showed that measures like word legibility and peak accelerations effectively distinguished WC patients from controls with high sensitivity and specificity, making them useful in future clinical research on this rare disorder.
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Background: Pathogenic leucine-rich repeat kinase 2 LRRK2 mutations may increase LRRK2 kinase activity and Rab substrate phosphorylation. Genetic association studies link variation in LRRK2 to idiopathic Parkinson disease (iPD) risk.

Objectives: Through measurements of the LRRK2 kinase substrate pT73-Rab10 in urinary extracellular vesicles, this study seeks to understand how LRRK2 kinase activity might change with iPD progression.

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