Arvind B Bambhroliya
University of Texas at Austin
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Publication
Featured researches published by Arvind B Bambhroliya.
International Journal of Stroke | 2013
Preeti Sahota; Farhaan Vahidy; Claude Nguyen; Thanh Tung Bui; Bing Yang; Kaushik Parsha; Jennifer Garrett; Arvind B Bambhroliya; Andrew D. Barreto; James C. Grotta; Jaroslaw Aronowski; Mohammad H. Rahbar; Sean I. Savitz
Background In animal models, the spleen contracts after acute ischemic stroke, followed by release of inflammatory cells leading to secondary brain injury. Aims We aim to characterize splenic responses in patients with acute ischemic stroke. Methods In this prospective observational study, we measured daily spleen sizes with abdominal ultrasound in 30 patients with suspected acute ischemic stroke. Splenic ultrasounds were also performed in 20 healthy individuals. Results A generalized estimating equation, longitudinal regression model for adjusted spleen measurements showed the difference between baseline spleen volume (within six-hours of stroke onset) and the volume at the last measured time point (up to seven-days) to be statistically significant (volume difference of 51·9 cm3, P = 0·04). Healthy controls had significantly smaller day-to-day variations; the maximum observed difference in mean spleen volume between any two time points was 9·5 cm3, with the average change over the period of observation being 1·24 cm3. A statistically significant negative association was also observed between the pattern of change of total white blood cell count and spleen volume (P = 0·01). An analysis of individual cases demonstrated possible associations between daily spleen volume changes and clinical course. Conclusions We hypothesize that the spleen may initially contract after ischemic stroke followed by a re-expansion and that it contributes to ischemic brain injury mediated via cellular components. Characterization of the splenic response after stroke and its contribution to cerebral ischemic injury has the potential to provide new opportunities for the development of novel stroke therapies.
Stroke | 2016
Farhaan Vahidy; Mohammad H. Rahbar; Hongjian Zhu; Paul J. Rowan; Arvind B Bambhroliya; Sean I. Savitz
Background and Purpose— Bone marrow–derived mononuclear cells (BMMNCs) offer the promise of augmenting poststroke recovery. There is mounting evidence of safety and efficacy of BMMNCs from preclinical studies of ischemic stroke; however, their pooled effects have not been described. Methods— Using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we conducted a systematic review of preclinical literature for intravenous use of BMMNCs followed by meta-analyses of histological and behavioral outcomes. Studies were selected based on predefined criteria. Data were abstracted by 2 independent investigators. After quality assessment, the pooled effects were generated using mixed-effect models. Impact of possible biases on estimated effect size was evaluated. Results— Standardized mean difference and 95% confidence interval for reduction in lesion volume was significantly beneficial for BMMNC treatment (standardized mean difference: −3.3; 95% confidence interval, −4.3 to −2.3). n=113 each for BMMNC and controls. BMMNC-treated animals (n=161) also had improved function measured by cylinder test (standardized mean difference: −2.4; 95% confidence interval, −3.1 to −1.6), as compared with controls (n=205). A trend for benefit was observed for adhesive removal test and neurological deficit score. Study quality score (median: 6; Q1–Q3: 5–7) was correlated with year of publication. There was funnel plot asymmetry; however, the pooled effects were robust to the correction of this bias and remained significant in favor of BMMNC treatment. Conclusions— BMMNCs demonstrate beneficial effects across histological and behavioral outcomes in animal ischemic stroke models. Although study quality has improved over time, considerable degree of heterogeneity calls for standardization in the conduct and reporting of experimentation.
Journal of Cerebral Blood Flow and Metabolism | 2016
Farhaan Vahidy; Kaushik Parsha; Mohammad H. Rahbar; MinJae Lee; Thanh Tung Bui; Claude Nguyen; Andrew D. Barreto; Arvind B Bambhroliya; Preeti Sahota; Bing Yang; Jaroslaw Aronowski; Sean I. Savitz
Animal models provide evidence of spleen mediated post-stroke activation of the peripheral immune system. Translation of these findings to stroke patients requires estimation of pre-stroke spleen volume along with quantification of its day-to-day variation. We enrolled a cohort of 158 healthy volunteers and measured their spleen volume over the course of five consecutive days. We also enrolled a concurrent cohort of 158 stroke patients, measured initial spleen volume within 24u2009h of stroke symptom onset followed by daily assessments. Blood samples for cytokine analysis were collected from a subset of patients. Using data from healthy volunteers, we fit longitudinal quantile regression models to construct gender and body surface area based normograms of spleen volume. We quantified day-to-day variation and defined splenic contraction. Based on our criteria, approximately 40% of stroke patients experienced substantial post-stroke reduction in splenic volume. African Americans, older patients, and patients with past history of stroke have significantly higher odds of post-stroke splenic contraction. All measured cytokine levels were elevated in patients with splenic contraction, with significant differences for interferon gamma, interleukin 6, 10, 12, and 13. Our work provides reference standards for further work, validation of pre-clinical findings, and characterization of patients with post-stroke splenic contraction.
Neurology | 2014
Farhaan Vahidy; William J Hicks; Indrani Acosta; Hen Hallevi; Hui Peng; Renganayaki Pandurengan; Nicole R. Gonzales; Andrew D. Barreto; Sheryl Martin-Schild; Tzu Ching Wu; Mohammad H. Rahbar; Arvind B Bambhroliya; James C. Grotta; Sean I. Savitz
Objective: The purpose of this study was to assess the incidence of deterioration, fluctuation, and associated risk of poor outcome in patients with subcortical stroke (SCS). Methods: We conducted a prospective observational study, enrolling patients admitted with SCS based on their clinical examination and imaging studies. An NIH Stroke Scale evaluation was performed daily and whenever deterioration in examination was detected. Neurologic deterioration was defined as a motor score increase of at least 1 on the NIH Stroke Scale. Modified Rankin Scale scores at discharge were used to assess outcome. Results: Among 90 enrolled patients, 37 (41%) deteriorated, 75% of them in the first 24 hours after enrollment. Administration of tissue plasminogen activator was significantly associated with deterioration (hazard ratio 2.25; 95% confidence interval [CI]: 1.13–4.49) even after controlling for the association of deterioration with the early poststroke period. Deterioration conferred an increased risk of poor outcome (modified Rankin Scale scores 3–6) at discharge (relative risk: 1.80; 95% CI: 1.71–1.93). Reversion back to predeterioration deficits occurred in 38% of patients, and was associated with reduced risk of poor outcome at discharge (relative risk: 0.12; 95% CI: 0.02–0.83). Treatment with tissue plasminogen activator conferred better chances of spontaneous recovery to predeterioration deficits after initial deterioration (hazard ratio: 4.36; 95% CI: 1.36–14.01). Conclusion: More than 40% of patients with SCS deteriorate neurologically. Deterioration tends to occur early after stroke, spontaneously reverses in approximately one-third of cases, and poses an increased risk of poor outcome. Therapies are needed to prevent, arrest, or reverse deterioration in patients with SCS.
Journal of Environmental and Public Health | 2012
Arvind B Bambhroliya; Keith D. Burau; Ken Sexton
Objective. The objectives of the study were to detect high-risk areas and to examine how racial and ethnic status affect the geographic distribution of female breast cancer mortality in Texas. Analyses were based on county-level data for the years from 2000 to 2008. Materials and Methods. Breast cancer mortality data were obtained from the Texas Cancer Registry, and the Spatial Scan Statistics method was used to run Purely Spatial Analyses using the Discrete Poisson, Bernoulli, and Multinomial models. Results and Conclusions. Highest rates of female breast cancer mortality in Texas have shifted over time from southeastern areas towards northern and eastern areas, and breast cancer mortality at the county level is distributed heterogeneously based on racial/ethnic status. Non-Hispanic blacks were at highest risk in the northeastern region and lowest risk in the southern region, while Hispanics were at highest risk in the southern region along the border with Mexico and lowest risk in the northeastern region.
Stroke | 2017
Amanda L. Jagolino-Cole; Shima Bozorgui; Christy Ankrom; Arvind B Bambhroliya; Tiffany Cossey; Alyssa Trevino; Sean I. Savitz; Tzu Ching Wu; Farhaan Vahidy
Background and Purpose— Formal telestroke training for neurovascular fellows (NVFs) is necessary because of growing use of telestroke technologies in the management of acute ischemic stroke; yet, educational approaches and training benchmarks are not formalized. Time between telestroke consultant page and tissue-type plasminogen activator administration (page-to-needle time, PTNT) can provide an objective measure of proficiency. We compared PTNT between NVFs and neurovascular attendings (NVAs) and evaluated changes in PTNT with experience. Methods— We identified suspected acute ischemic stroke patients in our telestroke registry from July 2013 to December 2015 who received tissue-type plasminogen activator. Using multivariable quantile regression, we estimated the difference and 95% confidence interval in median PTNT between NVFs and NVAs. We also report the coefficient of change in PTNT over increasing number of telestroke consults. Results— NVFs evaluated 53.7% of 618 tissue-type plasminogen activator cases over telestroke. NVAs had significantly shorter PTNT compared with NVFs, with a difference in median PTNT of −9 minutes (95% confidence interval, −12.3 to −5.7). This difference persisted when adjusted for relative tissue-type plasminogen activator contraindications. For each additional telestroke consult, PTNT decreased by 0.07 minutes for NVFs or NVAs (P=0.02 and <0.01, respectively). Conclusions— PTNT improves by ≈1 minute for every 14 consults for both NVFs and NVAs. Our findings support the importance of integrating telestroke training into supervised neurovascular fellowships to increase proficiency prior to independent practice and suggest that PTNT can be a benchmark for tracking proficiency.
Stroke | 2018
Kristen B Slaughter; Ellie G Meyer; Jennifer R Meeks; Arvind B Bambhroliya; Ritvij Bowry; Wamda O Ahmed; Gretchel A Gealogo; Steven Warach; Jon E. Tyson; Charles C. Miller; Louise D. McCullough; Tzu-Ching Wu; Charles E. Begley; Sean I. Savitz; Farhaan Vahidy
Introduction: Value-based care and patient-perceived outcomes are increasingly important. Standard Gamble (SG) derived utilities directly measure patients’ preferences for health states and form the basis of health economic analyses. We describe distribution of and factors associated with SG utilities (SGU) in a cohort of intracerebral hemorrhage (ICH) patients, and explore changes in SGU over 90 days post-discharge. Methods: Our study is a multisite cohort aiming to evaluate the comparative effectiveness of ICH patient management at various levels of care across Texas. Consented patients undergo assessments including SG in-hospital, and 30 and 90 days post-discharge. The SG assesses patients’ risk-taking behavior toward achieving a perfect health status, and outputs utility on a scale of 0 - 1 (Figure 1). Median and interquartile range (IQR) are reported for inpatient and day-90 SGU. Quantile regression was used to evaluate factors associated with SGU. Difference in median (DIM) and 95% confidence interv...
Stroke | 2018
Nicole A Wysocki; Arvind B Bambhroliya; Shima Bozorgui; Christy Ankrom; Alyssa Trevino; Rene Malazarte; Tiffany Cossey; Amanda L. Jagolino-Cole; Sean I. Savitz; Tsu-Ching Wu; Anjail Sharrief
Introduction: Telemedicine (TM) is increasingly utilized for tPA delivery. The destination of the patient after tPA, whether to stay at the presenting hospital or transfer to a hub stroke center, i...
Stroke | 2018
Arvind B Bambhroliya; Ellie G Meyer; Jennifer R Meeks; Kristen B Slaughter; Ritvij Bowry; Wamda O Ahmed; Gretchel A Gealogo; Steven Warach; Louise D. McCullough; Tzu-Ching Wu; Charles E. Begley; Jon E. Tyson; Charles C. Miller; Sean I. Savitz; Farhaan Vahidy
Introduction: Readmission (RA) after stroke is an established quality of care metric and is tied to reimbursements. Administrative databases lack stroke-specific severity indicators and information...
Stroke | 2018
Arvind B Bambhroliya; Ellie G Meyer; Jennifer R Meeks; Kristen B Slaughter; Ritvij Bowry; Wamda O Ahmed; Gretchel A Gealogo; Steven Warach; Jon E. Tyson; Charles C. Miller; Charles E. Begley; Sean I. Savitz; Farhaan Vahidy
Introduction: Assessments of health-related quality of life (QoL) are increasingly important for stroke patients; however, such data are lacking for patients with intracerebral hemorrhage (ICH). Us...