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Lee CM, Wang M, Rajkumar A, Calabrese C, Calabrese L. A scoping review of vasculitis as an immune-related adverse event from checkpoint inhibitor therapy of cancer: Unraveling the complexities at the intersection of immunology and vascular pathology. Semin Arthritis Rheum 2024; 66:152440. [PMID: 38579593 DOI: 10.1016/j.semarthrit.2024.152440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 03/17/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND/PURPOSE Vasculitis as an immune-related adverse event (irAE) from checkpoint inhibitor therapy (ICI) to treat cancer is a rare clinical event, and little is known regarding its nosology, clinical manifestations, or response to treatment and outcomes. METHODS To address these gaps, we used the Preferred Reporting Items for Systemic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to further define this complication. Two independent PUBMED searches in September and November of 2022 revealed 127 publications with 37 excluded from title by relevance, 43 excluded by article type, and 23 excluded due to lack of biopsy results, or biopsy negative for vasculitis. Twenty-nine documented cases from 24 publications were included for final analysis. Basic demographics, ICI details, timing of onset of vasculitis symptoms, irAE treatment and outcomes were collected. The vasculitides were classified using 2022 ACR/EULAR Vasculitis Classification Criteria as well as 2012 Revised Chapel-Hill Nomenclature. Adaptations from Naidoo et al. 2023 [1] consensus definitions for irAEs were used and efforts were made to classify steroid-responsive versus unresponsive irAEs. RESULTS Of the 29 cases reviewed, the average age of patients was 62.1 ± 11.0, composed of 58.6 % (n = 17) male and 41.3 % (n = 12) female. Prominent cancer types were lung cancer (41.4 %; n = 12), melanoma (41.4 %; n = 12), and renal cancer (10.3 %; n = 3), with majority being stage 4 (75.9 %, n = 22) and stage 3 (10.3 %, n = 3). Only 8 cases met the ACR/EULAR criteria, and by Chapel-Hill Nomenclature, approximately a third were small-vessel vasculitis (31.0 %; n = 9) with n = 4 positive for ANCA. Most biopsies were taken from the skin (37.9 %, n = 11) and kidney (24.1 %, n = 7). Patients were either treated with single (65.5 %, n = 19), dual (17.2 %; n = 5), or sequential (17.2 %; n = 5) ICI regimen which included anti-PD-1 therapy in all but one case, with mean of 8.7 ± 10.5 cycles received. Mean time to onset of symptoms from start of ICI was 7.2 ± 7.8 months, with 55.2 % occurring >3 months since the initial immunotherapy. Vasculitis treatment included glucocorticoids in 96 % of cases and immunotherapy was often discontinued (44.8 %; n = 13). Clinical improvement of irAE was documented in 86.2 % (n = 25). Data were missing in terms of fate of ICI (34.5 %; n = 10) and tumor outcomes (41.4 %; n = 12). Cancer progressed in 20.7 % (n = 6), stable in 34.5 % (n = 10) cases, and 6 patients died of all-causes. CONCLUSION Vasculitis as an irAE appears clinically heterogeneous and rare. Among reported cases with adequate documentation, vasculitis is of delayed onset following the initiation of immunotherapy. Outcomes of ICI-vasculitis were generally favorable, responding to glucocorticoids and immunotherapy withdrawal. There is an urgent need for more standardized reporting of rare irAEs such as vasculitis to clarify clinical risks, classification, relationship to immunotherapy and outcomes.
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Affiliation(s)
- Chan-Mi Lee
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Margaret Wang
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Aarthi Rajkumar
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Cassandra Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, United States
| | - Leonard Calabrese
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, United States.
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El Zarif T, Nassar AH, Adib E, Fitzgerald BG, Huang J, Mouhieddine TH, Rubinstein PG, Nonato T, McKay RR, Li M, Mittra A, Owen DH, Baiocchi RA, Lorentsen M, Dittus C, Dizman N, Falohun A, Abdel-Wahab N, Diab A, Bankapur A, Reed A, Kim C, Arora A, Shah NJ, El-Am E, Kozaily E, Abdallah W, Al-Hader A, Abu Ghazal B, Saeed A, Drolen C, Lechner MG, Drakaki A, Baena J, Nebhan CA, Haykal T, Morse MA, Cortellini A, Pinato DJ, Dalla Pria A, Hall E, Bakalov V, Bahary N, Rajkumar A, Mangla A, Shah V, Singh P, Aboubakar Nana F, Lopetegui-Lia N, Dima D, Dobbs RW, Funchain P, Saleem R, Woodford R, Long GV, Menzies AM, Genova C, Barletta G, Puri S, Florou V, Idossa D, Saponara M, Queirolo P, Lamberti G, Addeo A, Bersanelli M, Freeman D, Xie W, Reid EG, Chiao EY, Sharon E, Johnson DB, Ramaswami R, Bower M, Emu B, Marron TU, Choueiri TK, Baden LR, Lurain K, Sonpavde GP, Naqash AR. Safety and Activity of Immune Checkpoint Inhibitors in People Living With HIV and Cancer: A Real-World Report From the Cancer Therapy Using Checkpoint Inhibitors in People Living With HIV-International (CATCH-IT) Consortium. J Clin Oncol 2023; 41:3712-3723. [PMID: 37192435 PMCID: PMC10351941 DOI: 10.1200/jco.22.02459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Compared with people living without HIV (PWOH), people living with HIV (PWH) and cancer have traditionally been excluded from immune checkpoint inhibitor (ICI) trials. Furthermore, there is a paucity of real-world data on the use of ICIs in PWH and cancer. METHODS This retrospective study included PWH treated with anti-PD-1- or anti-PD-L1-based therapies for advanced cancers. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates (ORRs) were measured per RECIST 1.1 or other tumor-specific criteria, whenever feasible. Restricted mean survival time (RMST) was used to compare OS and PFS between matched PWH and PWOH with metastatic NSCLC (mNSCLC). RESULTS Among 390 PWH, median age was 58 years, 85% (n = 331) were males, 36% (n = 138) were Black; 70% (n = 274) received anti-PD-1/anti-PD-L1 monotherapy. Most common cancers were NSCLC (28%, n = 111), hepatocellular carcinoma ([HCC]; 11%, n = 44), and head and neck squamous cell carcinoma (HNSCC; 10%, n = 39). Seventy percent (152/216) had CD4+ T cell counts ≥200 cells/µL, and 94% (179/190) had HIV viral load <400 copies/mL. Twenty percent (79/390) had any grade immune-related adverse events (irAEs) and 7.7% (30/390) had grade ≥3 irAEs. ORRs were 69% (nonmelanoma skin cancer), 31% (NSCLC), 16% (HCC), and 11% (HNSCC). In the matched mNSCLC cohort (61 PWH v 110 PWOH), 20% (12/61) PWH and 22% (24/110) PWOH had irAEs. Adjusted 42-month RMST difference was -0.06 months (95% CI, -5.49 to 5.37; P = .98) for PFS and 2.23 months (95% CI, -4.02 to 8.48; P = .48) for OS. CONCLUSION Among PWH, ICIs demonstrated differential activity across cancer types with no excess toxicity. Safety and activity of ICIs were similar between matched cohorts of PWH and PWOH with mNSCLC.
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Affiliation(s)
| | | | - Elio Adib
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Paul G. Rubinstein
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Taylor Nonato
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Rana R. McKay
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Mingjia Li
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Arjun Mittra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Dwight H. Owen
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert A. Baiocchi
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Michael Lorentsen
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher Dittus
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nazli Dizman
- Yale University School of Medicine, New Haven, CT
| | | | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, TX
- Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Adi Diab
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anand Bankapur
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Alexandra Reed
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Aakriti Arora
- Medstar/Georgetown-Washington Hospital Center, Washington, DC
| | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edward El-Am
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Elie Kozaily
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Wassim Abdallah
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Ahmad Al-Hader
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Claire Drolen
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Javier Baena
- 12 de Octubre University Hospital, Madrid, Spain
| | - Caroline A. Nebhan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Tarek Haykal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Michael A. Morse
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Department of Translational Medicine, Università Del Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Alessia Dalla Pria
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Evan Hall
- University of Washington, Seattle, WA
| | | | | | | | - Ankit Mangla
- Seidman Cancer Center, University Hospitals, Cleveland, OH
| | | | | | | | | | - Danai Dima
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ryan W. Dobbs
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Pauline Funchain
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Rabia Saleem
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, Faculty of Medicine & Health, Charles Perkins Centre, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | - Carlo Genova
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università degli Studi di Genova, Genova, Italy
| | - Giulia Barletta
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sonam Puri
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Vaia Florou
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Dame Idossa
- University of California San Francisco, San Francisco, CA
| | - Maristella Saponara
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Paola Queirolo
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
| | - Alfredo Addeo
- Swiss Cancer Center Leman, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | | | | | | | - Erin G. Reid
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | | | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Bower
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Brinda Emu
- Yale University School of Medicine, New Haven, CT
| | - Thomas U. Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Rajkumar A, Sidebottom AJ. Prospective study of the long-term outcomes and complications after total temporomandibular joint replacement: analysis at 10 years. Int J Oral Maxillofac Surg 2021; 51:665-668. [PMID: 34503888 DOI: 10.1016/j.ijom.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
This prospective analysis was performed to assess the long-term benefits of the TMJ Concepts joint replacement system in the UK. All patients who had replacement temporomandibular joints (TMJ) with at least 10 years of follow-up were included. The most common primary diagnoses were trauma, multiple previous operations, psoriatic arthritis, rheumatoid arthritis, degenerative disease, and ankylosis. A total of 43 patients (62 joints) were followed up for 10 years (mean age 45, range 22-70 years); 39 were female and four were male. The mean number of previous TMJ procedures was 2.5 (range 0-10). Over the 10 years of follow-up, there were significant improvements in pain score (10-point scale; decreased from 7.4 to 1.7), maximum mouth opening (increased from 21.0 mm to 34.7 mm), and dietary score (10-point scale; increased from 4.1 to 9.5). Joints in two patients failed, one secondary to a local dental infection and one due to reankylosis. None failed due to wear of the prosthesis, whether the prosthesis was standard cobalt-chrome or all-titanium. Total TMJ replacement gives good long-term improvements, both lessening pain and improving function, and is an effective form of management for irreparably damaged joints.
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Affiliation(s)
- A Rajkumar
- Department of Oral and Maxillofacial Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
| | - A J Sidebottom
- Department of Oral and Maxillofacial Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK
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Rao S, Rajkumar A, Sundaram S, Joyce ME, Duvuru P. Yet another utility for isocitrate dehydrogenase.1: Can it serve as an immunomarker to assess tumor margins in gliomas? J Cancer Res Ther 2021; 16:1476-1481. [PMID: 33342816 DOI: 10.4103/jcrt.jcrt_22_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Isocitrate dehydrogenase-1 (IDH1) mutation is now an established early event in gliomagenesis. The ability to detect this mutation by several techniques including immunohistochemistry makes it a significant marker for diagnosing and prognosticating gliomas. This study was done to assess the expression of mutant IDH1 in different grades of gliomas and evaluate its utility in differentiating reactive gliosis from glioma and defining surgical margins of these tumors in the operative specimens. Materials and Methods A total of fifty cases including equal number of Grade I, II, III, and IV gliomas and gliosis were included in the study. Formalin-fixed, paraffin-embedded tissue sections from these lesions were immunostained with IDH1 and Ki-67 antibody, and percentage of tumor cells that stained positive with these markers was assessed. Results Grades II, III, and IV showed consistent immunopositivity for IDH1. No immunostaining was noted in Grade I glioma and gliosis. Mean Ki-67 labeling index correlated with grades of gliomas with low activity in Grade I and high activity in Grade IV. Individual tumor cells infiltrating into adjacent normal brain parenchyma also stained positive with IDH1 antibody. Conclusion Immunostaining for IDH1 mutation can be utilized as a reliable marker in the precise diagnosis of diffuse gliomas and also in objective assessment of surgical margins to differentiate gliomas from gliosis.
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Affiliation(s)
- Shaline Rao
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Aarthi Rajkumar
- Department of Internal Medicine, Northeast Ohio Medical University, Canton Medical Education Foundation, Ohio, USA
| | - Sandhya Sundaram
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Prathiba Duvuru
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Radhakrishnan K, Sivapriya V, Rajkumar A, Akramkhan N, Prakasheswar P, Krishnakumar S, Hussain SM. Characterization and distribution of microplastics in estuarine surface sediments, Kayamkulam estuary, southwest coast of India. Mar Pollut Bull 2021; 168:112389. [PMID: 33901903 DOI: 10.1016/j.marpolbul.2021.112389] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
The present study aims to formulate the characterization and distribution of microplastic in the estuarine surface sediments of Kayamkulam estuary, southwest coast of India. The sediments were dominated by fibre and film shaped microplastic substances. The surface sediments were dominated by <1000 μm microplastics. The composition of microplastics in descending order was as follows: polyester > polypropylene > polyethylene. The distribution of microplastics was significantly higher than that observed in the other study regions, except for Pearl river estuary and Guanabara Bay. The distribution of microplastics was chiefly controlled by estuarine inundating water and the distance of the sampling site from the open sea.
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Affiliation(s)
- K Radhakrishnan
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
| | - V Sivapriya
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
| | - A Rajkumar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
| | - N Akramkhan
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
| | - P Prakasheswar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
| | - S Krishnakumar
- Malankara Catholic College, Mariagiri, Kaliakkavilai - 629 153, Kanyakumari District, Tamil Nadu, India.
| | - S M Hussain
- Department of Geology, University of Madras, Guindy Campus, Chennai 600 025, India
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Kassem AN, Park C, Rajkumar A. Acute Liver Failure From Sickle Cell Hepatopathy Treated With Exchange Transfusion. Cureus 2021; 13:e15334. [PMID: 34235013 PMCID: PMC8240763 DOI: 10.7759/cureus.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Sickle cell disease (SCD) is a qualitative hemoglobinopathy that can cause widespread sickling and vaso-occlusive events in all organ systems. Sickle cell hepatopathy is an umbrella term for various acute and chronic pathologies of the liver as a result of sickling in SCD patients. We present below the case of a 49-year-old woman who had an acute liver failure in the setting of a hepatic crisis with recovery after exchange transfusion. Hepatic involvement in SCD may be life-threatening. Understanding the etiology and severity of hepatic involvement by sickling is necessary for appropriate treatment.
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Affiliation(s)
- Ahmad N Kassem
- Internal Medicine, MetroHealth Medical Center, Cleveland, USA
| | - Changsu Park
- Internal Medicine, MetroHealth Medical Center, Cleveland, USA
| | - Aarthi Rajkumar
- Internal Medicine, MetroHealth Medical Center, Cleveland, USA
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Krishnakumar S, Vidyasakar A, Anbalagan S, Godson PS, Kasilingam K, Parthasarathy P, Pradhap D, Saravanan P, Hariharan S, Rajkumar A, Neelavannan K, Magesh NS. Bioavailable trace metals and their ecological risks in the tourist beaches of the Southeast coast of India. Mar Pollut Bull 2020; 160:111562. [PMID: 32853841 DOI: 10.1016/j.marpolbul.2020.111562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/31/2020] [Accepted: 08/09/2020] [Indexed: 05/12/2023]
Abstract
The concentration of Acid Leachable Trace Metals (ALTMs) was assessed in urbanized tourist beaches (96 samples from Marina beach, 34 samples from Edward Elliot's beach, and 28 samples from Silver beach) of southeast coast of India. The concentration of metals accumulated in the beach sediment was less than the Upper Continental Crust (UCC) background reference values. The mean enrichment of ALTMs in the studied urban tourist beaches showed the following descending order: Marina beach - Cr > Pb > Ni > Zn > Cu > Mn > Co; Edward Elliot's beach - Cr > Pb > Ni > Mn > Co > Zn > Cu; Silver beach - Cr > Pb > Ni > Co > Mn > Cu > Zn. The ALTMs such as Fe, Mn, Co, Cu, and Zn were probably derived from natural weathering and mild anthropogenic influences whereas other metals were derived from anthropogenic induced factors.
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Affiliation(s)
- S Krishnakumar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India.
| | - A Vidyasakar
- Department of Geology, Periyar University PG Extension Centre, Dharmapuri 636701, India
| | - S Anbalagan
- Institute for Ocean Management, Anna University, Chennai 600025, India
| | - Prince S Godson
- Department of Environmental Sciences, University of Kerala, Thiruvananthapuram 695581, India
| | - K Kasilingam
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - P Parthasarathy
- Department of Geology, A.V.S College of Arts and Science, Salem 636 106, India
| | - D Pradhap
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - P Saravanan
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - S Hariharan
- Department of Geology, Central University of Karnataka, Kadaganchi, Karnataka 585367, India
| | - A Rajkumar
- Department of Geology, University of Madras, Guindy Campus, Chennai 600025, India
| | - K Neelavannan
- Institute for Ocean Management, Anna University, Chennai 600025, India
| | - N S Magesh
- National Centre for Polar and Ocean Research, Ministry of Earth Sciences, Headland Sada, Vasco-da-Gama, Goa 403 804, India.
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Rajkumar A, Habla F, Fernandes C, Mould S, Sacramento A, Carneiro O, Nóbrega J. Profile Extrusion: Experimental Assessment of a Numerical Code to Model the Temperature Evolution in the Cooling/Calibration Stage. POLYM ENG SCI 2019. [DOI: 10.1002/pen.25240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A. Rajkumar
- IPC/I3N—Institute for Polymers and Composites Campus de Azurém 4800‐058 Guimarães Portugal
- Department of Mechanical EngineeringSt. Xavier's Catholic College of Engineering Nagercoil Tamilnadu India
| | - F. Habla
- Catalysis Research Center and Chemistry DepartmentTechnische Universitat Munchen Lichtenbergstraβe 4 D‐85748 Munchen Germany
| | - C. Fernandes
- IPC/I3N—Institute for Polymers and Composites Campus de Azurém 4800‐058 Guimarães Portugal
| | - S. Mould
- IPC/I3N—Institute for Polymers and Composites Campus de Azurém 4800‐058 Guimarães Portugal
| | - A. Sacramento
- Soprefa—Componentes Industriais SA 4520‐909 Mosteirô Portugal
| | - O.S. Carneiro
- IPC/I3N—Institute for Polymers and Composites Campus de Azurém 4800‐058 Guimarães Portugal
| | - J.M. Nóbrega
- IPC/I3N—Institute for Polymers and Composites Campus de Azurém 4800‐058 Guimarães Portugal
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Triner M, Patel S, Craft R, Rajkumar A, Patel T. 1336. Impact of Procalcitonin-Guided Antibiotic Management in Chronic Obstructive Pulmonary Disease Exacerbation and Community-Acquired Pneumonia. Open Forum Infect Dis 2019. [PMCID: PMC6809209 DOI: 10.1093/ofid/ofz360.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) exacerbation and community-acquired pneumonia (CAP) are major drivers of antibiotic overuse, primarily due to challenges in pathogen identification. Procalcitonin is a serum biomarker that assists in distinguishing bacterial infection from other causes. The purpose of this study was to determine whether the use of a procalcitonin (PCT) guided algorithm in patients diagnosed with COPD exacerbation and/or CAP can reduce antibiotic exposure without negatively impacting clinical outcomes. Methods This was a quasi-experimental study conducted at Mercy Medical Center in Canton, Ohio. The patient data for the retrospective cohort (control group) was collected from the months of September 2017 through January 2018. The prospective phase (PCT group) took place during the months of September 2018 through January 2019. Physicians utilized a procalcitonin guided algorithm to determine appropriate initiation and duration of antibiotic use in patients admitted with a primary diagnosis of COPD exacerbation and/or CAP. The primary outcome was the duration of antibiotic therapy, measured in days. Secondary outcomes included all-cause hospital readmission within 30 days of discharge, respiratory-related hospital readmission within 30 days of discharge, 30-day mortality, hospital length of stay, and adverse events to antibiotics. Results A total of 76 patients were included in the study, 43 in the control group and 33 in the PCT group. Baseline characteristics were similar between groups. The use of a PCT algorithm significantly decreased duration of antibiotics by 2.7 days in comparison to the control group (2.6 [n = 33] vs. 5.3 [n = 43] days; P < 0.001; 95% CI). Secondary safety outcomes between the PCT and control group were similar, including all-cause hospital readmission within 30 days of discharge (30.3% vs. 25.6%; P = 0.648), respiratory-related hospital readmission within 30 days of discharge (80.0% [n = 10] vs. 81.8% [n = 11]; P = 0.731), and 30-day mortality (no incidence in either group). Conclusion The use of a PCT algorithm significantly reduced duration of antibiotics by 2.7 days without negatively impacting clinical outcomes in patients being treated for COPD exacerbation and/or CAP. ![]()
Disclosures All authors: No reported disclosures.
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Teoh B, Waters PS, Peacock O, Smart P, Reid K, Rajkumar A, Heriot AG, Warrier SK. Utilising taTME and robotics to reduce R1 risk in locally advanced rectal cancer with rectovaginal and cervical involvement. Tech Coloproctol 2019; 23:387-390. [PMID: 30778783 DOI: 10.1007/s10151-019-01941-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Affiliation(s)
- B Teoh
- Division of Cancer Surgery, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - P S Waters
- Division of Cancer Surgery, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - O Peacock
- Division of Cancer Surgery, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - P Smart
- Epworth Freemasons Hospital, Melbourne, Australia
| | - K Reid
- Epworth Freemasons Hospital, Melbourne, Australia
| | - A Rajkumar
- Epworth Freemasons Hospital, Melbourne, Australia
| | - A G Heriot
- Division of Cancer Surgery, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Epworth Freemasons Hospital, Melbourne, Australia
| | - S K Warrier
- Division of Cancer Surgery, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Epworth Freemasons Hospital, Melbourne, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
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Abstract
BACKGROUND Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy. Patients typically present with diarrhea and weight loss often prompting exhaustive diagnostic workup. Discontinuation of the drug leads to dramatic recovery and hence, physicians need to be aware of olmesartan associated enteropathy (OAE) in order to avoid unnecessary testing. CASE REPORT A 59-year-old Caucasian male was admitted to the hospital with complaints of intractable diarrhea, vomiting and considerable weight loss. Medical history was notable for hypertension being treated with olmesartan. Workup for all potential infectious causes and celiac disease was negative. Eventually, a colonoscopy was performed due to his persistent symptoms and biopsy revealed lymphocytic colitis. An upper endoscopy was also performed, and histopathology of the duodenum revealed total villous blunting. In light of negative serology for celiac disease and after a detailed review of the patient's medications, the possibility of olmesartan induced enteropathy was considered. Olmesartan was stopped and his symptoms resolved. A follow-up endoscopy done a few months later showed normal small bowel mucosa. CONCLUSIONS This case demonstrates the need for a thorough medication review by healthcare providers especially after a full workup for the patient's symptoms has already been performed. It also reiterates that having an awareness of rare side effects of common medications mitigates the need for extensive diagnostic testing.
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Affiliation(s)
- Sripriya Gonakoti
- Department of Internal Medicine, North East Ohio Medical University, Canton Medical Education Foundation, Canton, OH, USA
| | - Sanjiv Khullar
- Department of Internal Medicine, North East Ohio Medical University, Rootstown, OH, USA
| | - Aarthi Rajkumar
- Department of Internal Medicine, North East Ohio Medical University, Canton Medical Education Foundation, Canton, OH, USA
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Dang V, Rajkumar A. Spinal epidural abscess caused by a community acquired extended spectrum beta lactamase producing Klebsiella pneumonia. IDCases 2018; 13:e00438. [PMID: 30128293 PMCID: PMC6092525 DOI: 10.1016/j.idcr.2018.e00438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022] Open
Abstract
Spinal epidural abscess (SEA) can be a medical and surgical emergency. It is encountered in patients with epidural catheter placement, paraspinal injections, diabetes mellitus, alcoholism, HIV infection, trauma, contiguous bony or soft tissue infection, intravenous drug use, hemodialysis, or overt bacteremia, but may occur spontaneously associated with a presumed silent bacteremia. We report here, a case of extensive SEA due to a community-acquired extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae in a diabetic patient. This case highlights the importance of stringent antimicrobial stewardship and also the need for prompt diagnostic evaluation, and early surgical decompression in order to prevent morbidity and mortality.
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Affiliation(s)
- Vinh Dang
- Department of Internal Medicine, Canton Medical Education Foundation & Aultman Hospital, 2600, 6th street SW, Canton, Ohio 44710, United States
| | - Aarthi Rajkumar
- Department of Internal Medicine, North east Ohio Medical University (NEOMED), Canton Medical Education Foundation, 2600, 6th street SW, Canton, Ohio 44710, United States
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Rajkumar A, Ferrás LL, Fernandes C, Carneiro OS, Sacramento A, Nóbrega JM. An Open-Source Framework for the Computer Aided Design of Complex Profile Extrusion Dies. INT POLYM PROC 2018. [DOI: 10.3139/217.3514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
This work presents a new design procedure for improving the flow distribution in complex profile extrusion dies. The proposed approach is based on open source software and aims to motivate both academics and industrials to consider numerical methodologies in their future developments. A new solver was implemented in OpenFOAM computational library in order to model the steady non-isothermal flow of inelastic fluids. The developed code was verified with the Method of Manufactured Solutions. The capability of the proposed design procedure was experimentally assessed with an industrial case study, and the results obtained suggest that the computational based design aid is an excellent alternative to the usual experimental trial-and-error procedure used in industry.
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Affiliation(s)
- A. Rajkumar
- IPC/i3N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Guimarães , Portugal
| | - L. L. Ferrás
- IPC/i3N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Guimarães , Portugal
| | - C. Fernandes
- IPC/i3N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Guimarães , Portugal
| | - O. S. Carneiro
- IPC/i3N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Guimarães , Portugal
| | - A. Sacramento
- Soprefa – Componentes Industriais SA , Zona Industrial Mosteirô, Santa Maria da Feira , Portugal
| | - J. M. Nóbrega
- IPC/i3N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Guimarães , Portugal
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Rajkumar A, Ferrás L, Fernandes C, Carneiro OS, Nóbrega JM. Guidelines for balancing the flow in extrusion dies: the influence of the material rheology. Journal of Polymer Engineering 2017. [DOI: 10.1515/polyeng-2016-0449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In this work we present improved design guidelines to support the die designer activity, when searching for the flow channel geometry that allows the achievement of a balanced flow distribution, in complex profile extrusion dies. The proposed methodology relies on surrogate models, obtained through a detailed and extensive numerical study, carried out with the open source computational library OpenFOAM®, in which an appropriate numerical solver for the problems under study was implemented. The main contribution of this work is to further enlarge the applicability of the simplified design methodology (Rajkumar A, Ferrás LL, Fernandes C, Carneiro OS, Becker M, Nóbrega JM. Int. Polym. Proc. 2017, 32, 58–71.) previously proposed by this group for similar purposes, by considering the effect of processing parameters and material rheology. The sensitivity analyses performed showed that, among the studied parameters, the power-law exponent was the only one that affected the system behavior. Thus, the previous proposed surrogate models were modified to include the effect of this parameter. Verification studies performed for three geometries and different rheological and process parameters evidenced the effectiveness of the proposed simplified design methodology.
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Affiliation(s)
- A. Rajkumar
- Institute for Polymers and Composites (IPC/i3N) , Department of Polymer Engineering , University of Minho , Campus de Azurem Guimarães 4800-058 , Portugal
| | - L.L. Ferrás
- Institute for Polymers and Composites (IPC/i3N) , Department of Polymer Engineering , University of Minho , Campus de Azurem Guimarães 4800-058 , Portugal
| | - C. Fernandes
- Institute for Polymers and Composites (IPC/i3N) , Department of Polymer Engineering , University of Minho , Campus de Azurem Guimarães 4800-058 , Portugal
| | - Olga S. Carneiro
- Institute for Polymers and Composites (IPC/i3N) , Department of Polymer Engineering , University of Minho , Campus de Azurem Guimarães 4800-058 , Portugal
| | - J. Miguel Nóbrega
- Institute for Polymers and Composites (IPC/i3N) , Department of Polymer Engineering , University of Minho , Campus de Azurem Guimarães 4800-058 , Portugal
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Abstract
BACKGROUND Gallbladder agenesis (GA) is an extremely rare anatomic anomaly with a reported incidence of less than 0.5%. It is usually asymptomatic, but can present with features of biliary colic and cholecystitis. We present here a case of GA in a patient with recurrent biliary colic. CASE REPORT A 24-year-old African American woman presented with recurrent episodes of right upper-quadrant abdominal pain. During her first episode, she was found to have elevated transaminases and clinical features of cholecystitis, but ultrasound did not visualize a gallbladder and she was discharged with a diagnosis of biliary colic. She returned within a week with worsening liver enzymes, severe pain, and vomiting. A hepatobiliary iminodiacetic acid (HIDA) scan was done, which again did not show the gall bladder. On clinical suspicion of acute cholecystitis, she underwent laparoscopic surgery. Intraoperatively, the gall bladder fossa was empty and a diagnosis of gall bladder agenesis was made. She presented a third time with similar complaints and magnetic resonance cholangiopancreatography (MRCP) was done, which showed normal biliary tract anatomy and absent gall bladder. A diagnosis of sphincter of Oddi dysfunction was made and she was discharged on antispasmodics. CONCLUSIONS Diagnosing GA is challenging. The rarity of this entity combined with classic clinical features of cholecystitis and non-visualization of the gall bladder on routine investigation prompts unnecessary surgical intervention. Awareness of this condition, along with use of better imaging modalities like preoperative MRCP, can aide physicians to appropriately manage this uncommon clinical condition.
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Affiliation(s)
- Aarthi Rajkumar
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA.,Department of Internal Medicine, North East Ohio Medical university (NEOMED), Rootstown, OH, USA
| | - Albina Piya
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA
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Rajkumar A, Ferrás LL, Fernandes C, Carneiro OS, Becker M, Nóbrega JM. Design Guidelines to Balance the Flow Distribution in Complex Profile Extrusion Dies. INT POLYM PROC 2017. [DOI: 10.3139/217.3272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
In this work a novel methodology to balance the flow distribution in complex extrusion dies is proposed. For this purpose, the profile cross section geometry is divided into simpler geometries (L and T shaped profiles), which are balanced with a surrogate model obtained by a detailed numerical study. The numerical simulations are performed considering the non-isothermal flow of Bird-Carreau inelastic fluids, and the numerical computations are performed with a solver implemented in OpenFOAM computational library. The proposed methodology is assessed with some case studies.
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Affiliation(s)
- A. Rajkumar
- IPC/I3 N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Campus de Azurém, Guimarães , Portugal
| | - L. L. Ferrás
- IPC/I3 N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Campus de Azurém, Guimarães , Portugal
| | - C. Fernandes
- IPC/I3 N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Campus de Azurém, Guimarães , Portugal
| | - O. S. Carneiro
- IPC/I3 N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Campus de Azurém, Guimarães , Portugal
| | - M. Becker
- DHCAE Tools GmbH , Krefeld , Germany
| | - J. M. Nóbrega
- IPC/I3 N – Institute for Polymers and Composites , Department of Polymer Engineering, University of Minho, Campus de Azurém, Guimarães , Portugal
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Cummings D, Rajkumar A. Increasing opportunities for intubation training for foundation doctors. Br J Anaesth 2016; 117:138. [DOI: 10.1093/bja/aew167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND Synovial lipomatosis is a rare disorder of the synovium, commonly affecting the knee joint, resulting in joint pain, swelling, and effusion. The etiology of this condition still remains unclear. AIM This was a study done to evaluate the disease process in synovial lipomatosis, with respect to the clinical parameters and pathological features. MATERIALS AND METHODS Case files of synovial lipomatosis diagnosed on histopathology between 2007 and 2009 were perused, to study the case history, and tissue sections were reviewed for the histomorphological changes. RESULTS Eight cases of synovial lipomatosis were diagnosed on histopathology from year 2007 to 2009, of which one occurred in the wrist joint and the rest were localized to the knee joint. Age ranged from one year to seventy-three years, with a male preponderance. Pain and swelling were major complaints. Three had a significant past history, one occurring post-trauma, one following chikungunya, and another with septic arthritis. Three of the cases had osteoarthritis. Body mass index was elevated in four cases and one case had protein energy malnutrition. On histopathological examination, all the cases showed villous proliferation of the synovium, with focal and diffuse infiltration by mature adipocytes. Four cases showed focal hyperplasia of the lining epithelium and five cases revealed variable fibrosis. CONCLUSION Synovial lipomatosis may mimic tumorous, lesion-like synovial lipoma or hemangioma and its distinct histomorphology helps in distinguishing it from these lesions. It possibly represents a secondary phenomenon following the degenerative process of articular disease of the joints.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India.
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Abstract
Castleman's disease, a rare condition of uncertain etiology clinically presents in isolated form or as a multicentric disease. The multicentric form can develop malignancies such as Kaposi's sarcoma or lymphomas. We present a case of Castleman's disease with coexisting interfollicular Hodgkin's lymphoma that was confirmed by immunohistochemistry. This case report highlights the fact that an occult lymphoma has to be ruled out in persistent or recurrent Castleman's disease.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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Doraiswami S, Johnson T, Rao S, Rajkumar A, Vijayaraghavan J, Panicker VK. Study of endometrial pathology in abnormal uterine bleeding. J Obstet Gynaecol India 2011; 61:426-30. [PMID: 22851826 DOI: 10.1007/s13224-011-0047-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 06/23/2011] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out-patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times, its interpretation could be quite challenging to the practicing pathologists. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. We also tried to observe the incidence of various pathology in different age groups presenting with abnormal uterine bleeding. MATERIAL AND METHODS This was a study done at Sri Ramachandra Medical College and Research Institute, Chennai, India on 620 patients who presented with AUB from June 2005-June 2006. Out of which 409 cases of isolated endometrial lesions diagnosed on histopathology were selected for the final analyses. A statistical analysis between age of presentation and specific endometrial causes was done using χ(2) test. RESULTS The most common age group presenting with AUB was 41-50 years (33.5%). The commonest pattern in these patients was normal cycling endometrium (28.4%). The commonest pathology irrespective of the age group was disordered proliferative pattern (20.5%). Other causes identified were complications of pregnancy (22.7%), benign endometrial polyp (11.2%), endometrial hyperplasias (6.1%), carcinomas (4.4%) and chronic endometritis (4.2%). Endometrial causes of AUB and age pattern was statistically significant with P value <0.05. CONCLUSION There is an age specific association of endometrial lesions. In perimenopausal women AUB is most commonly dysfunctional in origin and in reproductive age group, one should first rule out complications of pregnancy. The incidence of disordered proliferative pattern was significantly high in this study, suggesting an early presentation of these patients.
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Sundaram S, Prathiba D, Rao S, Rajkumar A, Rajendiran S. Solid variant of papillary carcinoma of nipple: an under recognized entity. INDIAN J PATHOL MICR 2010; 53:537-40. [PMID: 20699520 DOI: 10.4103/0377-4929.68293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Papillary lesions of the breast represent a heterogeneous group with differing biological behavior. Solid papillary carcinomas are uncommon tumors composed of circumscribed large cellular nodules separated by bands of fibrosis. Correct diagnosis is crucial but may be difficult, as many other benign and malignant lesions have similar histological appearances. Immunohistochemistry plays a useful role in their differentiation. We describe one such case of a solid variant of papillary carcinoma of the left nipple in a 75-year-old woman, who had no other palpable mass in rest of the breast tissue. The case is documented for the rarity of its occurrence and significance of recognition of this lesion.
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Affiliation(s)
- Sandhya Sundaram
- Department of Pathology, Sri Ramachandra University, Porur, Chennai 600 116, India
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Abstract
Angiomatous meningioma accounts for 2.1% of all meningiomas. It has features of a typical benign meningioma with many small or large vascular channels which may predominate over its meningothelial elements. We present here a series of three cases of angiomatous meningioma, which posed diagnostic difficulty to clinicians, radiologists, and pathologists. All the three cases showed a tumor entirely composed of thin-walled vascular channels and cells with bland morphology in the background. The diagnosis was confirmed by immunohistochemistry. We present series of three cases to highlight the histomorphological features of this uncommon variant of meningioma that could help in distinguishing it from hemangioblastoma and hemangiopericytoma.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Singh V, Owens D, Rajkumar A, Cheang P, Puttasidiah P. Re: In search of a better clinic letter for general practitioners. Clin Otolaryngol 2008; 33:161. [DOI: 10.1111/j.1749-4486.2008.01606.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prathiba D, Rao S, Rajkumar A, Ehtesham M. Autofluorescence: A screening test for mycotic infection in tissues. INDIAN J PATHOL MICR 2008; 51:215-7. [DOI: 10.4103/0377-4929.41690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Datta NR, Rajkumar A, Basu R. Variations in clinical estimates of tumor volume regression parameters and time factor during external radiotherapy in cancer cervix: does it mimic the linear-quadratic model of cell survival? Indian J Cancer 2005; 42:70-7. [PMID: 16141505 DOI: 10.4103/0019-509x.16695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tumor regression parameters and time factor during external radiotherapy (EXTRT) are of paramount importance. AIMS To quantify the parameters of tumor regression and time factor during EXTRT in cancer cervix. SETTINGS AND DESIGN Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. MATERIALS AND METHODS Seventy-seven patients received 50 Gy of EXTRT followed by intracavitary brachytherapy. Loco-regional regressions were assessed clinically and regression fraction (RF) was represented as RF=c + a 1D + a 2 D2 sub - a 3T, with c, D and T as constant, cumulative EXTRT dose and treatment time respectively. STATISTICAL ANALYSIS USED Step wise linear regression was performed for RF. Scatter plots were fitted using linear-quadratic fit. RESULTS Coefficients of parameters D, D2 sub and T were computed for various dose intervals, namely 0--20 Gy, 0--30 Gy, 0--40 Gy and 0--50 Gy. At 0--20 Gy and 0--30 Gy, only the coefficient of D2 was significant (P 2 sub and T turned significant (P 2 sub and T showed significance, leading to an estimate of 26 Gy for a1/a2 and 0.96 Gy/day for a3/a1. CONCLUSIONS As with alpha/beta and gamma/alpha of post-irradiation cell survival curves, a1/a2 and a3/a1 represents the cumulative effect of various radiobiological factors influencing clinical regression of tumor during the course of EXTRT. The dynamic changes in the coefficients of D, D2 sub and T, indicate their relative importance during various phases of EXTRT.
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Affiliation(s)
- N R Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Venugopal KM, Rajkumar A, Vìjaykant S, Ramanujachari V, Pant GC, Ghanegaonkar PM. Supersonic Jet Interactions in a Plenum Chamber. DEFENCE SCI J 2004. [DOI: 10.14429/dsj.54.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Datta NR, Rajkumar A, Basu R. Tumor regression dynamics with external radiotherapy in cancer cervix and its implications. Indian J Cancer 2004; 41:18-24. [PMID: 15105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND To study the external radiotherapy (EXTRT) regression patterns in cancer of the cervix. AIMS Evaluate EXTRT tumor regression doses (TRD) for 50% (TRD50), 80% response (TRD80), normalized dose response gradient (g50) and slope (slope50) with clinical outcome. SETTINGS AND DESIGN Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. MATERIAL AND METHODS Seventy-seven patients received 50Gy of EXTRT at 2 Gy/fraction followed by 18Gy of high-dose rate intracavitary brachytherapy at 6 Gy/fraction. Loco-regional regressions were assessed clinically at weekly intervals during EXTRT to generate EXTRT dose-response curves. STATISTICAL ANALYSIS USED Student's t test, logistic regression, Kaplan Meier and Cox's proportional hazard model. Scatter plots were fitted using cubic fit. RESULTS Age (P=0.052) and absence or presence of gross residual tumor (AGRT and PGRT respectively) following EXTRT (P<0.001) were the only determinants for complete response (CR) at 1 month following completion of radiotherapy. EXTRT tumor regression sigmoid curves obtained for various patient characteristics differed only for those with AGRT and PGRT with differences in TRD50, (P<0.001); TRD80 (P<0.001) and slope50 (P=0.001). Response status to EXTRT was a prognosticator for loco-regional disease free survival (LDFS) (AGRT vs. PGRT; P=0.046). On multivariate analysis, both TRD50 and TRD80 emerged as significant predictors for tumor status at end of EXTRT while TRD80 was the sole determinant of LDFS. CONCLUSION Extent of tumor regression to EXTRT is an important predictor for treatment outcome in cancer cervix as evident from TRD50 and TRD80 values of EXTRT tumor regression curves.
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Affiliation(s)
- N R Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Datta NR, Rajkumar A, Basu R. Tumor regression dynamics with external radiotherapy in cancer cervix and its implications. Indian J Cancer 2004. [DOI: 10.4103/0019-509x.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Datta NR, Rajkumar A, Basu R. Summated chemotherapy dose-intensity versus loco-regional response in locally advanced breast cancer: its possible implications. Indian J Cancer 2003; 40:127-34. [PMID: 14716108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Summated dose-intensity (SDI) of chemotherapy regimen could influence the outcome in malignancies. AIMS To evaluate the implication of SDI and identify key drugs for loco-regional response in locally advanced breast cancer (LABC). SETTINGS AND DESIGN This retrospective study was based on audit of records of LABC patients who had received neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS Actual unit dose-intensity (UDI) of each drug and corresponding SDI of every doxorubicin (n=116 cycles) or non-doxorubicin (n=110 cycles) based NACT received by 42 patients of LABC were summated. Cumulative dose-intensity (CDI) for individual drugs and cumulative SDI (CSDI) for the entire course of NACT were estimated and correlated with quantum of primary tumor, axillary and supraclavicular nodal responses. STATISTICAL ANALYSIS USED Two-sided chi-square, t-test, step-wise regression was used. RESULTS Dose-response curve between CSDI and corresponding responses for both primary and lymph nodes were sigmoid in shape for both doxorubicin or non-doxorubicin based NACT. Curves were best fitted using a cubic fit for all patients (r2 = 0.82, 0.84 and 0.93 for primary tumor, axillary and supraclavicular lymph nodes respectively). CSDI emerged as an important prognosticators for both primary (P<0.001) and nodal (P<0.001) responses. Individually, CDI of 5-fluorouracil for primary (P<0.001), CDIs of doxorubicin (P<0.001) and methotrexate (P=0.006) for axillary nodes and CDI of cyclophosphamide (P=0.001) for supraclavicular nodes were significant. CONCLUSIONS Loco-regional responses in LABC are dependent on CSDI of NACT regimen. Drugs for high-dose intensification protocols could be identified and chosen based on the impact of CDI of individual drugs in NACT.
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Affiliation(s)
- N R Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Datta NR, Rajkumar A, Basu R. Summated chemotherapy dose-intensity versus loco-regional response in locally advanced breast cancer: Its possible implications. Indian J Cancer 2003. [DOI: 10.4103/0019-509x.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Agarwal KS, Singh SK, Kumar N, Srivastav R, Rajkumar A. A study of current trends in enteric fever. J Commun Dis 1998; 30:171-4. [PMID: 10093424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The results of a study based on 68 cases of blood culture proven enteric fever are presented. Sensitivity to chloramphenicol, ampicillin and cotrimoxazole was found to be 55.88, 54.41, 38.23% respectively. Common clinical features were fever, vomiting, pain abdomen and cough in both the groups. There was no difference in complications in chloramphenicol sensitive against resistant cases. Of the chloramphenicol sensitive cases, 21.05% were resistant to cefotaxime. All cases were sensitive to ciprofloxacin. More than half the cases were sensitive to chloramphenicol and ampicillin.
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Affiliation(s)
- K S Agarwal
- Department of Paediatrics & Microbiology, St. Stephen's Hospital, Delhi
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