Himala Kashmiri

Children's Hospital of Orange County

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Mark Daniels

Children's Hospital of Orange County

Arti Bhan

Henry Ford Health System

Amrit Bhangoo

Children's Hospital of Orange County

Nelly Mauras

Nemours Children's Health System

Bruce A. Buckingham

Stanford University

Sarit Polsky

University of Colorado Anschutz Medical Campus

Gregory P. Forlenza

University of Colorado Anschutz Medical Campus

Robin Goland

Columbia University

M. Sue Kirkman

University of North Carolina at Chapel Hill

Nikta Forghani

Children's Hospital of Orange County

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University of Colorado Anschutz Medical Campus

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Jaeb Center for Health Research

Massachusetts General Hospital

Children's Hospital of Orange County

Boston University

The University of Texas Southwestern Medical Center

University of Colorado Denver

The University of Texas Health Science Center at San Antonio

Harvard University

University of Washington

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The Insulin-Only Bionic Pancreas Improves Glycemic Control in Non-Hispanic White and Minority Adults and Children With Type 1 Diabetes

Diabetes Care (2023)

Luz E. Castellanos Steven Russell Edward R. Damiano Roy W. Beck Viral N. Shah

OBJECTIVE We evaluated the performance of the iLet bionic pancreas (BP) in non-Hispanic White individuals (here referred to as “Whites”) and in Black, Hispanic, and other individuals (here collectively referred to as “Minorities”). RESEARCH DESIGN AND METHODS A multicenter, randomized controlled trial evaluated glycemic management with the BP versus standard of care (SC) in 161 adult and 165 pediatric participants with type 1 diabetes over 13 weeks. RESULTS In Whites (n = 240), the mean baseline-adjusted difference in 13-week HbA1c between the BP and SC groups was −0.45% (95% CI −0.61 to −0.29 [−4.9 mmol/mol; −6.6 to −3.1]; P < 0.001), while this difference among Minorities (n = 84) was −0.53% (−0.83 to −0.24 [−6.0 mmol/mol; −9.2 to −2.8]; P < 0.001). In Whites, the mean baseline-adjusted difference in time in range between the BP and SC groups was 10% (95% CI 7–12; P < 0.001) and in Minorities was 14% (10–18; P < 0.001). CONCLUSIONS The BP improves glycemic control in both Whites and Minorities and offers promise in decreasing health care disparities.

10.2337/dc22-1478

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Citations (5)

Diazoxide-Responsive Hypoglycemia in a Child Receiving Dasatinib for Treatment of B-Cell Acute Lymphoblastic Leukemia

JCEM Case Reports (2024)

M. Berra Juliana Biro Himala Kashmiri Michael J. Daniels

Tyrosine kinase inhibitors (TKIs) are being used more regularly in treatment regimens for pediatric cancers. They have distinct side effect profiles, including endocrinopathies. Here we present a 2-year-old boy with Philadelphia chromosome-like (Ph-like) B-cell acute lymphoblastic leukemia (ALL) who developed refractory hypoglycemia after using dasatinib. His evaluation was suggestive of hyperinsulinism, and his symptoms were ultimately controlled with diazoxide. There have not been any published data exploring the relationship between TKIs and glycemic profiles in pediatric patients. In adults, there is research indicating that patients using TKIs could experience both hyperglycemia and hypoglycemia. The pathophysiology of these side effects is not well described, nor are the risk factors for development. More research is needed to understand these relationships in general, but particularly in the pediatric population.

Diazoxide

10.1210/jcemcr/luae219

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Citations (1)

Atypical Presentation of Hypothermia Induced Diabetes Insipidus: a Case Report

53rd ESPE Meeting (2014)

Ellen Klocker Himala Kashmiri

Presentation (obstetrics)

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Recurrent ventral curvature after corporoplasty with tunica vaginalis flap

Journal of Pediatric Urology (2022)

Kathy H. Huen Amanda Macaraeg Carol A. Davis-Dao Himala Kashmiri Sarah H. Williamson

Optimal means to correct ventral curvature (VC) is debated. Our preferred technique for curvature greater than 45° is corporoplasty using tunica vaginalis flap (TVF). We describe our complications with TVF for ventral lengthening.Forty-four boys who underwent ventral lengthening with a corporoplasty with TVF were identified in a prospective database for proximal hypospadias repair by a single surgeon from 2008 to 2021. Corporotomy was performed by incising the tunica albuginea of the corpora cavernosa transversely at the point of maximum curvature. Harvested TVF was tailored to the size of the corporotomy and anastomosed to the edges of the tunica albuginea and on laid to the corporal defect with the mesothelial side of the TVF abutting the erectile tissue.Median age at surgery was 1.0 years (IQR 0.72-1.82). Median follow-up time was 4.9 years (IQR 2.6-8.0). Thirteen patients (27%) were older than 10 years of age at last follow up (median 13.3, range 10-20). Twenty-two boys (50%) received preoperative testosterone. The most common location of the meatus after degloving was penoscrotal (41%). Median VC after degloving was 90° (IQR 80-100). The urethral plate was transected in 43/44 (98%) of boys, improving median VC to 60° (IQR 40-60). After corporotomy, the median longitudinal distracted distance was 15 mm (IQR 12-17). Urethral reconstruction was most commonly achieved with the transverse island preputial flap technique or its modifications (39/44; 89%). Erections were reported in 42 boys (95%). None developed corporal diverticula, and two patients (4.5%) had ascended testis associated with TVF harvest. Seven percent of boys had recurrent ventral curvature (RVC; 3/44). Median RVC was 30° (IQR 30-45). One patient had RVC at the penoscrotal junction (not at site of prior corporoplasty) identified 11 years post operatively at age 15, and underwent dorsal plication. The other 2 patients were diagnosed less than 1 year post operatively. Both patients received testosterone due to small glans size, had double-face tubularized transverse island preputial flap as urethral and ventral skin coverage, and had endocrine and genetic consultation. Both had scarring of the preputial flap and of the corporoplasty. Scar excision and superficial transverse incisions on the tunica albuginea corrected RVC.The five-year outcome of ventral penile lengthening using TVF for corporoplasty is favorable with 7% of boys with RVC, and 4.5% with ascended testes associated with TVF harvest. None developed corporal diverticula.

Degloving

Tunica albuginea (penis)

Tunica vaginalis

Tunica

Preputial gland

10.1016/j.jpurol.2022.10.009

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Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes

New England Journal of Medicine (2022)

Steven Russell Roy W. Beck Edward R. Damiano Firas H. El-Khatib Katrina J. Ruedy

Currently available semiautomated insulin-delivery systems require individualized insulin regimens for the initialization of therapy and meal doses based on carbohydrate counting for routine operation. In contrast, the bionic pancreas is initialized only on the basis of body weight, makes all dose decisions and delivers insulin autonomously, and uses meal announcements without carbohydrate counting.

Artificial Pancreas

Initialization

Insulin delivery

10.1056/nejmoa2205225

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Citations (107)

Initial outcomes at a nascent tertiary pediatric thyroid surgical center

International Journal of Pediatric Otorhinolaryngology (2021)

David M. Bruss Alexander Kovacs Himala Kashmiri Kevin C. Huoh

Hypoparathyroidism

Neck dissection

10.1016/j.ijporl.2021.110639

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Citations (2)

Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes

Carolina Digital Repository (University of North Carolina at Chapel Hill) (2022)

R. Speakman J Beck R.W Damiano E.R El-Khatib F.H Ruedy K.J

10.17615/kj0v-z880

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Preferences of Type 1 Diabetic Patients on Devices for Islet Transplantation

Cell Transplantation (2020)

M. Rezaa Mohammadi Farideh Dehkordi‐Vakil Joni Ricks‐Oddie Robert Mansfield Himala Kashmiri

Transplantation of pancreatic islets within a biomaterial device is currently under investigation in clinical trials for the treatment of patients with type 1 diabetes (T1D). Patients’ preferences on such implants could guide the designs of next-generation implantable devices; however, such information is not currently available. We surveyed the preferences of 482 patients with T1D on the size, shape, visibility, and transplantation site of islet containing implants. More than 83% of participants were willing to receive autologous stem cells, and there was no significant association between implant fabricated by one’s own stem cell with gender ( χ 2 (1, n = 468) = 0.28; P = 0.6) or with age ( χ 2 (4, n = 468) = 2.92; P = 0.6). Preferred location for islet transplantation within devices was under the skin (52.7%). 48.3% preferred microscopic disks, and 32.3% preferred a thin device (like a credit card). Moreover, 58.4% preferred the implant to be as small as possible, 25.4% did not care about visibility, and 16.2% preferred their implants not to be visible. Among female participants, 81% cared about the implant visibility, whereas this number was 64% for male respondents ( χ 2 test (1, n = 468) = 16.34; P < 0.0001). 22% of those younger than 50 years of age and 30% of those older than 50 did not care about the visibility of implant ( χ 2 test (4, n = 468) = 23.69; P < 0.0001). These results suggest that subcutaneous sites and micron-sized devices are preferred choices among patients with T1D who participated in our survey.

Visibility

10.1177/0963689720952343

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Citations (6)

Longitudinal Changes in Continuous Glucose Monitoring Use Among Individuals With Type 1 Diabetes: International Comparison in the German and Austrian DPV and U.S. T1D Exchange Registries

Diabetes Care (2019)

Kellee M. Miller Julia M. Hermann Nicole C. Foster Sabine E. Hofer Michael R. Rickels

Continuous glucose monitoring (CGM) has been demonstrated in randomized trials to improve glucose control in patients with type 1 diabetes (1), but until recently only a minority of participants in the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry and the U.S.-based T1D Exchange (T1DX) registry were using CGM (2,3). Over the past decade, both the accuracy and usability of CGM devices have improved considerably with expanded cost coverage of CGM by government statutory and private insurance. Some CGM devices are regulatory body approved for determining insulin dose in most circumstances, thereby reducing the number of fingersticks needed to monitor blood glucose. To assess change in CGM use over time across the age spectrum, we analyzed data from the T1DX and DPV registries for the years 2011, 2013, 2015, and 2017. CGM use (including both real-time and intermittent scanning CGM) at each data collection time point were obtained from clinic medical records. The number of participants with available data on CGM usage varied slightly depending on the calendar year for both registries. In DPV, the cohort size ranged from 17,632 to 21,707 for youth (aged 2 to <18 years) and from 7,651 to 8,390 for adults aged (≥18 years). In T1DX, cohort size ranged from 8,334 to 9,184 …

Medical record

10.2337/dc19-1214

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Citations (80)

Temporal induction of immunoregulatory processes coincides with age-dependent resistance to viral-induced type 1 diabetes

Genes and Immunity (2013)

Y-G Chen J P Mordes Elizabeth P. Blankenhorn Himala Kashmiri Mary L. Kaldunski

Transcription

Congenic

10.1038/gene.2013.31

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Citations (11)