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Shetty A, Saab EG, Choi G. Social Impact of Hepatic Encephalopathy. Clin Liver Dis 2024; 28:273-285. [PMID: 38548439 DOI: 10.1016/j.cld.2024.01.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Hepatic encephalopathy is a medical condition that stems from liver dysfunction, leading to the accumulation of toxins in the bloodstream. This can result in cognitive impairments, mood changes, and motor dysfunction. Its social impact includes challenges in employment, relationships, and daily functioning for affected individuals. Stigma and misunderstanding around the condition can further exacerbate the difficulties faced by both patients and their caregivers. Efforts to raise awareness, improve medical management, and provide support systems can help mitigate the social impact of hepatic encephalopathy.
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Affiliation(s)
- Akshay Shetty
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Elena G Saab
- School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Gina Choi
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
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Faksova K, Walsh D, Jiang Y, Griffin J, Phillips A, Gentile A, Kwong JC, Macartney K, Naus M, Grange Z, Escolano S, Sepulveda G, Shetty A, Pillsbury A, Sullivan C, Naveed Z, Janjua NZ, Giglio N, Perälä J, Nasreen S, Gidding H, Hovi P, Vo T, Cui F, Deng L, Cullen L, Artama M, Lu H, Clothier HJ, Batty K, Paynter J, Petousis-Harris H, Buttery J, Black S, Hviid A. COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals. Vaccine 2024; 42:2200-2211. [PMID: 38350768 DOI: 10.1016/j.vaccine.2024.01.100] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified.
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Affiliation(s)
- K Faksova
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - D Walsh
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - J Griffin
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - A Phillips
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - A Gentile
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J C Kwong
- ICES, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - K Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - M Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Z Grange
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - S Escolano
- Université Paris-Saclay, UVSQ, Inserm, CESP, High Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, France
| | - G Sepulveda
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Shetty
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - A Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - C Sullivan
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - Z Naveed
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Giglio
- Department of Epidemiology, Ricardo Gutierrez Children Hospital, Buenos Aires University, Argentina
| | - J Perälä
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Nasreen
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - H Gidding
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia; The University of Sydney, Australia
| | - P Hovi
- Department of Public Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - T Vo
- Faculty of Social Sciences, Tampere University, Finland
| | - F Cui
- School of Public Health, Peking University, China
| | - L Deng
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - L Cullen
- Public Health Scotland, Glasgow, Scotland, United Kingdom
| | - M Artama
- Faculty of Social Sciences, Tampere University, Finland
| | - H Lu
- Department of Statistics, University of Auckland, New Zealand; Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand
| | - H J Clothier
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - K Batty
- Auckland UniServices Limited at University of Auckland, New Zealand
| | - J Paynter
- School of Population Health, University of Auckland, New Zealand
| | - H Petousis-Harris
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - J Buttery
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; Murdoch Children's Research Institute, Parkville, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - S Black
- Global Vaccine Data Network, Global Coordinating Centre, Auckland, New Zealand; School of Population Health, University of Auckland, New Zealand
| | - A Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Arman SS, Shetty A, Ahmed N, Singarapu R, Priya B, Iyengar A. Versatility of Titanium Mesh in Comminuted Maxillofacial Fractures. A Retrospective Study. J Maxillofac Oral Surg 2024; 23:387-393. [PMID: 38601232 PMCID: PMC11001821 DOI: 10.1007/s12663-022-01745-y] [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: 01/27/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Titanium mesh provides three-dimensional stability, it is easier and quick in placement, highly malleable and adaptable hence, proved to be worth in restoring the function and form in cases of comminuted maxillofacial fractures. Materials and Methods A total of 12 patients were included in this retrospective study at Department of Oral and maxillofacial surgery, Sri Rajiv Gandhi College of Dental Science and Hospital, from December 2015 to June 2020. Out of 12 patients, 7 reported with frontal bone fracture and 5 reported with mandibular fracture. Patients were followed up for upto 18 months to evaluate efficacy of titanium mesh on postoperative long-term healing, aesthetic outcomes and return to normal function were evaluated. Results The results have shown that titanium mesh has low complication rates and the ability to maintain occlusion and chewing postoperatively. Union occurred without complication in 90% of fractures, and patients treated for frontal bone fracture had excellent cosmetic results. Conclusion The semi rigid nature of the titanium mesh fixation allows micro movement at the healing bone ends, reduces stress shielding effect which may improve functional bone healing. Bony continuity of the mandible can be restored providing three-dimensional morphology and stability. The versatile placement of screws is the principal advantage.
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Affiliation(s)
- Syeda Sana Arman
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
- No 25, 4th cross, Umarbagh layout, JP nagar, Bangalore, 560078 India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Nida Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Ravalika Singarapu
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Bhanu Priya
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
| | - Aditya Iyengar
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore, Karnataka 560032 India
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Shetty A, Saab S. Commentary on New Fatty Liver Nomenclature: Steatotic Liver Disease. J Clin Gastroenterol 2024; 58:109. [PMID: 38019052 DOI: 10.1097/mcg.0000000000001941] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/20/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Akshay Shetty
- Departments of Medicine and Surgery, University of California at Los Angeles, Los Angeles, CA
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Shetty A, Ibrahim B, Eskander B, Saab S. Management of Patients After Treatment of Severe Alcohol-associated Hepatitis. J Clin Gastroenterol 2023; 57:991-1000. [PMID: 37428091 DOI: 10.1097/mcg.0000000000001882] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Alcohol-associated liver disease is the leading indication for hospitalization among patients with chronic liver disease. Rates of hospitalization for alcohol-associated hepatitis have been rising over the last 2 decades. Patients with alcohol-associated hepatitis carry significant morbidity and mortality, but there is a lack of standardized postdischarge management strategies to care for this challenging group of patients. Patients warrant management of not only their liver disease but also their alcohol use disorder. In this review, we will discuss outpatient management strategies for patients who were recently hospitalized and discharged for alcohol-associated hepatitis. We will discuss short management of their liver disease, long-term follow-up, and review-available treatment options for alcohol use disorder and challenges associated with pursuing treatment for alcohol use disorder.
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Affiliation(s)
- Akshay Shetty
- Departments of Medicine
- Surgery, University of California at Los Angeles, Los Angeles, CA
| | | | - Benjamin Eskander
- Departments of Medicine
- Surgery, University of California at Los Angeles, Los Angeles, CA
| | - Sammy Saab
- Departments of Medicine
- Surgery, University of California at Los Angeles, Los Angeles, CA
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6
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Hoang T, Sutera P, Nguyen T, Chang JH, Jagtap S, Song Y, Shetty A, Chowdhury DD, Chan A, Carrieri FAA, Song D, DeWeese TL, Lafargue A, Van der Eecken K, Bunz F, Ost P, Tran PT, Deek MP. The Impact of TP53 Mutations and Use of the TP53-Mutation-Reactivating Agent APR-246 on Metastatic Castrate-Sensitive Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e443. [PMID: 37785435 DOI: 10.1016/j.ijrobp.2023.06.1621] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) TP53 mutations appear to be enriched over the spectrum of metastatic castration-sensitive prostate cancer (mCSPC) and are associated with worse survival outcomes. We chose to further explore the impact of dominant negative (DN) TP53 mutations on mCSPC progression and pro-metastatic behaviors in addition to studying the ability of APR-246, a small molecule targeting TP53 mutants, to blunt pro-metastatic behaviors. MATERIALS/METHODS We retrospectively analyzed 531 mCSPC patients who underwent next-generation sequencing. Patients were stratified by metastasis timing (synchronous if metastasis present at diagnosis or metachronous if arising after definitive treatment of localized disease) and the number of metastatic lesions (oligometastatic ≤5 or polymetastatic >5 lesions). Tumors were classified based on TP53 mutation status (missense, truncating, or wild-type [WT]) and dominant negativity, which was defined as the production of a mutant protein that reduces the residual WT protein's transcriptional activity according to the World Health Organization TP53 database. Clinical outcomes were radiographic progression-free survival (rPFS) and overall survival (OS), evaluated with Kaplan-Meier and multivariable Cox regression. To verify the impact of TP53 mutation on metastasis, we created isogenic 22Rv1 prostate cancer cell lines that carried either TP53 WT or TP53 R175H and tested this mutation for migration, invasion, and anchorage-independent growth. APR-246 (25-80 µM) was tested for anti-metastatic properties in vitro and anti-tumor growth in 22Rv1 xenografted nude mice. RESULTS In our cohort, 155 (29.2%) had a TP53 mutation, which mostly occurred in the DNA-binding domain (85.16%). DN TP53 mutations were associated with more aggressive disease states: DN TP53 mutations were enriched in patients with synchronous (vs. metachronous: 20.7% vs. 6.3%, p < 0.01) and polymetastatic disease (vs. oligometastatic: 14.4% vs. 7.9%, p < 0.01). On multivariable analysis, DN TP53 mutations were correlated with shorter rPFS (HR = 1.97, 95% CI: 1.31-2.98, p < 0.01) and OS (HR = 2.05, 95% CI: 1.14-3.68, p = 0.02) compared to those with TP53 WT. In vitro, 22Rv1 cells with DN TP53 R175H mutation had increased abilities to migrate, invade, and form colonies compared to TP53 WT. APR-246 treatment of TP53 R175H mutants blunted the pro-metastatic effects of the cell line in vitro (p < 0.01 for all assays by unpaired t-test). Interestingly, APR-246 also inhibited xenograft tumor growth of 22Rv1 TP53 R175H mutants (p < 0.0001 by two-way ANOVA). CONCLUSION DN TP53 mutations were associated with poorer survival outcomes for mCSPC patients. DN TP53 mutations also promoted prostate cancer pro-metastatic behaviors in vitro, which was effectively counteracted by APR-246, making it a promising treatment option that should be explored further in early-phase clinical studies.
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Affiliation(s)
- T Hoang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - P Sutera
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - T Nguyen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J H Chang
- University of Maryland, Baltimore, MD
| | - S Jagtap
- University of Maryland, Baltimore, MD
| | - Y Song
- University of Maryland, Baltimore, MD
| | - A Shetty
- University of Maryland, Baltimore, MD
| | | | - A Chan
- University of Maryland, Baltimore, MD
| | | | - D Song
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - T L DeWeese
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - A Lafargue
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - F Bunz
- Johns Hopkins Medicine, Baltimore, MD, United States
| | - P Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - P T Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - M P Deek
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
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7
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Sutera P, Shetty A, Hakansson A, Van der Eecken K, Song Y, Liu Y, Fonteyne V, Verbeke S, Song D, Ross AE, Feng FY, Gillessen S, Attard G, James N, Lotan TL, Davicioni E, Sweeney C, Tran PT, Deek MP, Ost P. Transcriptomic Heterogeneity of Metastatic Disease Timing within Metastatic Castration-Sensitive Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e261-e262. [PMID: 37785002 DOI: 10.1016/j.ijrobp.2023.06.1217] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Metastatic castration-sensitive prostate cancer (mCSPC) is commonly partitioned into high- and low-volume subgroups which have demonstrated differential biology, prognosis, and response to therapy. Timing of metastasis has similarly demonstrated differences in clinical outcomes, however less is known about any potential underlying biologic differences between these disease states. Herein we aim to compare transcriptomic differences between synchronous and metachronous mCSPC and identify any differential responses to therapy. MATERIALS/METHODS We performed an international multi-institutional retrospective review of men with mCSPC who completed RNA expression profiling evaluation of their primary tumor. Patients were stratified according to disease timing (synchronous vs metachronous). The primary endpoint was to identify differences in transcriptomic profiles between disease time. Median genomic scores between groups were compared with Mann-Whitney U test. Secondary analyses included determining clinical and transcriptomic variables associated with overall survival (OS) from time of metastasis. Survival analysis was performed with the Kaplan-Meier Method and Multivariable Cox regression. RESULTS A total of 252 patients were included with a median follow-up of 39.6 months. Patients with synchronous disease experienced worse 5-yr OS (39% vs 79%, p<0.01) and demonstrated lower median Androgen Receptor Activity (AR-A) (11.78 vs 12.64, p<0.01) and Hallmark Androgen Response (HAR) (3.15 vs 3.32; p<0.01). Multivariable cox-regression identified only high-volume disease (HR = 4.97, 95% CI 2.71-9.10; p<0.01) and HAR score (HR = 0.51, 95% CI 0.28-0.88; p = 0.02 significantly associated with OS. Finally, patients with synchronous (HR = 0.47, 95% CI 0.30-0.72; <0.01) but not metachronous (HR = 1.37, 95% CI 0.50-3.92; p = 0.56) disease were found to have better OS with Androgen Receptor (AR) + non-AR combination therapy as compared to monotherapy (p value for interaction = 0.05). CONCLUSION We have demonstrated a potential biologic difference between metastatic timing of mCSPC. Specifically, for patients with low volume disease, those with metachronous low volume disease have a more hormone dependent transcriptional profile and exhibit a better prognosis than synchronous low volume disease.
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Affiliation(s)
- P Sutera
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shetty
- University of Maryland, Baltimore, MD
| | | | - K Van der Eecken
- Department of Pathology and Human Structure and Repair, University of Ghent, Ghent, Belgium
| | - Y Song
- University of Maryland, Baltimore, MD
| | - Y Liu
- Decipher/Veractye, San Francisco, CA
| | - V Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - S Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Ghent, Belgium
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - S Gillessen
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G Attard
- The Institute of Cancer Research, London, United Kingdom
| | - N James
- The Royal Marsden Hospital NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - T L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - C Sweeney
- University of Adelaide, Adelaide, Australia
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - M P Deek
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - P Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Sutera P, Shetty A, Song Y, Hodges T, Hoang T, Rana ZH, Pienta K, Feng FY, Song D, DeWeese TL, Gillessen S, James N, Attard G, Deek MP, Tran PT. Identification of a Predictive Genomic Biomarker for Prostate Directed Therapy in Synchronous Low-Volume Metastatic Castration Sensitive Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e441-e442. [PMID: 37785432 DOI: 10.1016/j.ijrobp.2023.06.1619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Standard of care management for metastatic castration sensitive prostate cancer (mCSPC) includes androgen deprivation therapy (ADT) with docetaxel or second-generation anti-androgen therapy. Recently, randomized data has demonstrated radiotherapy to the prostate is associated with an improvement in overall survival among patients with low-volume metastatic disease. Tumor genomics represents an additional dimension to understand the clinical trajectory of patients with mCSPC. Herein we aim to evaluate a high-risk genomic signature for its ability to predict response to prostate directed therapy (PDT). MATERIALS/METHODS We performed a single institution retrospective review of men with low-volume mCSPC who underwent next-generation sequencing of their tumor. Patients were classified according to the presence of high-risk (HiRi) mutation including pathogenic mutations in either TP53, ATM, BRCA1/2, or Rb1. Our primary endpoint was to determine the effect of PDT on overall survival (OS) in patients with and without a HiRi mutation. Survival analysis was performed with the Kaplan-Meier method compared with log-rank test and multivariable cox regression. Interaction between HiRi mutation and PDT was evaluated. RESULTS A total of 101 patients with synchronous low-volume CSPC were included in our analysis with a median follow-up of 44 months. Approximately half of patients were found to have a HiRi pathogenic mutation (48.5%) with TP53 mutations accounting for 75.5% of HiRi mutations. On multivariable cox regression PDT was associated with improvement in OS (HR = 0.37, 95% CI 0.16-0.88; p = 0.03). When stratified by presence of HiRi mutation, PDT was not associated with any clinical outcome. Patients with HiRi mutations demonstrated a median OS of 73 vs 66.8 months (p = 0.28) for no PDT and PDT, respectively. Conversely, patients without a HiRi mutation demonstrated a significant improvement in median OS of 60 vs 105.3 months (p<0.01) for no PDT and PDT, respectively. The p-value for interaction for OS between PDT and HiRi mutation was statistically significant (p<0.01). CONCLUSION Here we have identified a high-risk genomic biomarker that appears predictive for response to PDT in men with synchronous low-volume mCSPC. Further work validating these results with prospective randomized data is warranted.
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Affiliation(s)
- P Sutera
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - A Shetty
- University of Maryland, Baltimore, MD
| | - Y Song
- University of Maryland, Baltimore, MD
| | - T Hodges
- University of Maryland, Baltimore, MD
| | - T Hoang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Z H Rana
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD
| | - K Pienta
- Department of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - D Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T L DeWeese
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
| | - S Gillessen
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - N James
- The Royal Marsden Hospital NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - G Attard
- The Institute of Cancer Research, London, United Kingdom
| | - M P Deek
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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Deek MP, Shetty A, Song Y, Efstathiou JA, Feng FY, Shipley WU, Simko J, Mouw KW, Miyamoto DT, Pollack A, Michaelson D, Zietman AL, Coen JJ, Dahl DM, Jani A, Souhami L, Chang BK, Lee RJ, Rodgers J, Tran PT. Prognostic Significance of Pretreatment Immune Cell Infiltration in Muscle Invasive Bladder Cancer Treated with Definitive Chemoradiation: Analysis of NRG RTOG 0524 and 0712. Int J Radiat Oncol Biol Phys 2023; 117:S22-S23. [PMID: 37784456 DOI: 10.1016/j.ijrobp.2023.06.278] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Chemoradiation therapy (CRT) is an organ conserving approach in the treatment of locally advanced bladder cancer. Chemoradiation is thought to potentially result in immunogenic stimulation, and bladder cancer is often a tumor with high immune cell infiltration. Thus, we aimed to profile the tumor immune microenvironment of bladder cancer and identify prognostic immune biomarkers for CRT response by profiling tumor samples from NRG/RTOG 0524 and 0712, two prospective trials of CRT in muscle invasive bladder cancer (MIBC). MATERIALS/METHODS Pretreatment tissue samples from both trials were profiled using Cofactor Genomics ImmunoPrism, an RNA sequencing assay that uses gene expression profiles to quantify immune cell populations in the tumor microenvironment (TME). Differential gene expression was estimated for different immune cell type proportions across samples. Kaplan-Meier survival analysis and log rank tests were performed to evaluate differences in overall survival (OS) stratified by genes influenced by immune cell proportions or genes associated with immune response signatures. RESULTS A total of 70 samples (43 from RTOG 0524 and 27 from RTOG 0712) underwent analysis using the ImmunoPrism assay. Immune cell proportions were as follows: CD8 T cells: median 1.2%, CD4 T cells: median 0.8%, Treg cells: median 9.2%, CD19 B cells: median 5.1%, M2 macrophages: median 0.8%, M1 macrophages: median 0%. Unbiased clustering based on gene expression profiles driven by immune cell proportions demonstrated two groups: cluster 1 with a low percentage of immune cells and shorter OS (median 31 months) and cluster 2 with a high percentage of immune cells and longer OS (median 101 months, p = 0.036). Higher expression of genes associated with T cell infiltration (CD8A and ICOS) was associated with improved OS (104 vs 35 months, p = 0.028, HR = 0.48 (0.25 - 0.94), p = 0.031) as was higher expression of IDO1, which is associated with the interferon gamma pathway (104 vs 35 months, p = 0.042, HR = 0.49 (0.24 - 0.99), p = 0.046). CONCLUSION Bladder tumors have a wide range of immune cell infiltration in the TME. Increased immune cell proportions are prognostic for OS following CRT, as well as a higher expression of genes associated with T cell infiltration interferon gamma signaling. These findings have implications for the integration of immunotherapy in the definitive management of MIBC; and can be explored further in the ongoing NRG/SWOG 1806 trial.
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Affiliation(s)
- M P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - A Shetty
- University of Maryland, Baltimore, MD
| | - Y Song
- University of Maryland, Baltimore, MD
| | - J A Efstathiou
- Department of Radiation Oncology, Harvard School of Medicine, Boston, MA
| | - F Y Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - W U Shipley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - K W Mouw
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - D T Miyamoto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - A Pollack
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - D Michaelson
- Massachusetts General Hospital/ Harvard Medical School, Boston, MA
| | - A L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J J Coen
- Massachusetts General Hospital, Boston, MA
| | - D M Dahl
- Massachusetts General Hospital/ Harvard Medical School, Boston, MA
| | - A Jani
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - L Souhami
- Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - B K Chang
- Radiation Medicine Associates, Oklahoma City, OK
| | - R J Lee
- Intermountain Medical Center, Murray, UT
| | - J Rodgers
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
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10
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Kaldas FM, Horwitz JK, Noguchi D, Korayem IM, Markovic D, Ebaid S, Agopian VG, Yersiz H, Saab S, Han SB, El Kabany MM, Choi G, Shetty A, Singh J, Wray C, Barjaktarvic I, Farmer DG, Busuttil RW. The Evolution of Redo Liver Transplantation Over 35 Years: Analysis of 654 Consecutive Adult Liver Retransplants at a Single Center. Ann Surg 2023; 278:441-451. [PMID: 37389564 DOI: 10.1097/sla.0000000000005962] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To examine liver retransplantation (ReLT) over 35 years at a single center. BACKGROUND Despite the durability of liver transplantation (LT), graft failure affects up to 40% of LT recipients. METHODS All adult ReLTs from 1984 to 2021 were analyzed. Comparisons were made between ReLTs in the pre versus post-model for end-stage liver disease (MELD) eras and between ReLTs and primary-LTs in the modern era. Multivariate analysis was used for prognostic modeling. RESULTS Six hundred fifty-four ReLTs were performed in 590 recipients. There were 372 pre-MELD ReLTs and 282 post-MELD ReLTs. Of the ReLT recipients, 89% had one previous LT, whereas 11% had ≥2. Primary nonfunction was the most common indication in the pre-MELD era (33%) versus recurrent disease (24%) in the post-MELD era. Post-MELD ReLT recipients were older (53 vs 48, P = 0.001), had higher MELD scores (35 vs 31, P = 0.01), and had more comorbidities. However, post-MELD ReLT patients had superior 1, 5, and 10-year survival compared with pre-MELD ReLT (75%, 60%, and 43% vs 53%, 43%, and 35%, respectively, P < 0.001) and lower in-hospital mortality and rejection rates. Notably, in the post-MELD era, the MELD score did not affect survival. We identified the following risk factors for early mortality (≤12 months after ReLT): coronary artery disease, obesity, ventilatory support, older recipient age, and longer pre-ReLT hospital stay. CONCLUSIONS This represents the largest single-center ReLT report to date. Despite the increased acuity and complexity of ReLT patients, post-MELD era outcomes have improved. With careful patient selection, these results support the efficacy and survival benefit of ReLT in an acuity-based allocation environment.
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Affiliation(s)
- Fady M Kaldas
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Julian K Horwitz
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daisuke Noguchi
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Islam M Korayem
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daniela Markovic
- Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Samer Ebaid
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vatche G Agopian
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Hasan Yersiz
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sammy Saab
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven B Han
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mohamad M El Kabany
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gina Choi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Akshay Shetty
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jasleen Singh
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christopher Wray
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Igor Barjaktarvic
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Douglas G Farmer
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ronald W Busuttil
- Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA
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11
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Ajmal BM, Kushalappa PBD, Ahamed SAS, Kaur M, Shetty A, Minz M, Saleem CM, Raheel SA. Evaluation and Comparison of Impact Strength and Transverse Strength of Heat Polymerized Polymethylmethacrylate (PMMA) Denture Base Resin Repaired Using Heat Polymerizied PMMA Denture Base Resin, Auto-Polymerized PMMA Resin and A New Light Polymerizied Denture Resin: An In Vitro Study. J Pharm Bioallied Sci 2023; 15:S706-S710. [PMID: 37654365 PMCID: PMC10466562 DOI: 10.4103/jpbs.jpbs_101_23] [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: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 09/02/2023] Open
Abstract
Context Repaired denture prosthesisdemands adequate transverse and impact strength. A new repairdenture base resin- "Lukafix" require to fulfil these criteria. Aims This study evaluates and compares the transverse and impact strength of heat polymerizing, auto polymerizing and LUKAfix denture resin. Methods and Material 20 specimens were control(without repair), and other were test specimens which were fractured and repaired with heat polymerized PMMA resin, chemically polymerized PMMA resin and LUKAfix light polymerizing denture resin. Each group wasdivided in two subgroups. Subgroup A was subjected to transverse strength test and subgroup B to impact strength test. Statistical Analysis Used One way ANOVA was used to identify the mean difference among the four groups. Post-Hoc-Bonferroni was done to observe the difference between the groups. Results Maximum transverse strength was observed in specimens repaired with heat polymerized (48.33 ± 9.19) and least in LUKAfix denture resin (6.56 ± 1.15). Also, impact strength was maximum for heat polymerized (3.64 ± 0.41) followed by LUKAfix denture resin (2.34 ± 0.44). Conclusions Repair with LUKAfix denture resin resulted inferior transverse and impact strength as compared to heat polymerized PMMA resin.
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Affiliation(s)
- B Mohammed Ajmal
- Department of Prosthodontics, KGF College of Dental Sciences, Kolar, Karnataka, India
| | - PB Dhyan Kushalappa
- Department of Dentistry, Kodagu Institute of Medical Sciences and Teaching Hospital, Madekeri, Karnataka, India
| | - Saadath Afzaa S. Ahamed
- Department of Prosthodontics Crown Bridge and Implantology, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, India
| | - Manpreet Kaur
- Department of Dentistry, Kodagu District Hospital, Madikeri, Karnataka, India
| | - Akshay Shetty
- Department of Prosthodontics, KGF College of Dental Sciences, Kolar, Karnataka, India
| | - Manisha Minz
- Department of Prosthodontics, Government Dental College, Raipur, Chhattisgarh, India
| | - C Mohammed Saleem
- Department of Prosthodontics, KGF College of Dental Sciences, Kolar, Karnataka, India
| | - Syed A. Raheel
- Department of Oral Medicine and Radiology, KGF College of Dental Sciences, Kolar, Karnataka, India
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12
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Shetty A, De La Torre S, Ibrahim B, Hong A, Meza J, Saab S. Role of Biomarkers to Assess the Use of Alcohol. J Clin Gastroenterol 2023; 57:537-545. [PMID: 37039472 DOI: 10.1097/mcg.0000000000001852] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.
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Affiliation(s)
| | | | | | | | - Julio Meza
- Family Medicine, University of California at Los Angeles, Los Angeles, CA
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13
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Hemavathi U, Aymen S, Shetty A, Cherian R, Garg S, Jeevan BS. Comparative Evaluation of Efficacy of EMLA Versus Ice as Topical Anesthetic in Prior to Needle Prick in Palatine Nerve Blocks—A Randomized Split Mouth Study EMLA Versus Ice as Topical Anesthetic in Dental Nerve Blocks. J Maxillofac Oral Surg 2023; 22:352-358. [PMID: 37122805 PMCID: PMC10130254 DOI: 10.1007/s12663-023-01905-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Background and Objectives The study aims to evaluate the pain efficacy of EMLA versus ice in palatine nerve blocks undergoing extraction. Materials and Methods A prospective randomized study, single-blind, split-mouth study carried out on a total of 20 healthy individuals needing extraction of bilateral maxillary teeth under local anesthesia referred to our department in the university from March 2021 to April 2022. Patients were randomly categorized into two groups: Group E (5% EMLA) and Group I (ice application), with 20 operative sites, respectively. In the study, the VAS-pain and satisfaction score and SEM score were analyzed. Statistical analysis was done using SPSS version 20.0 software using the Mann-Whitney U test. Results Study results showed that 13 patients were men and 7 were women whose ages ranged from 46 ± 18 years. Statistical analysis of pain on the VAS scale showed that the mean score for Group E and Group I were 2.3 ± 0.47 and 3.2 ± 0.41(mean ± SD), respectively, which was statistically significant (P < 0.001). On the statistical analysis of the SEM scale for Group E and Group I, the mean score was 1.00 ± 0.00 and 1.25 ± 0.44426 (mean ± SD), respectively, which was statistically significant (P < 0.018). Conclusion EMLA and ice were both good topical anesthetics each with advantages and disadvantages in clinical use. Each clinician needs to weigh the pros and cons of the different available methods and expenses to determine what type of anesthetic to use for each particular case during treatment.
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Affiliation(s)
- U. Hemavathi
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
| | - Saniya Aymen
- Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
| | - Roshan Cherian
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
| | - Shriya Garg
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
| | - B. S. Jeevan
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India
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14
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Shah A, Shetty A, Victor D, Kodali S. Klebsiella pneumoniae Infection as a Mimicker of Multiple Metastatic Lesions. Cureus 2022; 14:e32669. [PMID: 36686095 PMCID: PMC9850263 DOI: 10.7759/cureus.32669] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
We describe the case of a 42-year-old man with cirrhosis who presented with fever and imaging concerning for metastatic disease from suspected renal cell carcinoma. He had a right renal mass with multiple pulmonary masses and underwent a lung biopsy and oncology consultation. Blood cultures revealed Klebsiella pneumoniae, and all the lesions disappeared after intravenous (IV) antibiotics. Our case attempts to increase awareness of this unique presentation of invasive Klebsiella infections and discusses host factors that can predispose to this condition.
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Affiliation(s)
- Ayushi Shah
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Akshay Shetty
- Hepatology and Transplant Medicine, Houston Methodist Hospital, Houston, USA
| | - David Victor
- Hepatology and Transplant Medicine, Houston Methodist Hospital, Houston, USA
| | - Sudha Kodali
- Hepatology and Transplant Medicine, Houston Methodist Hospital, Houston, USA
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Aich S, Singarapu R, Shetty A, Rathna K, Purvey PK, Shaju A. Evaluation of Sagittal Curving Osteotomy vs Conventional Advancement Genioplasty in Retrogenia Patients: a Randomized Control Trial. J Maxillofac Oral Surg 2022; 21:1244-1258. [PMID: 36896052 PMCID: PMC9989048 DOI: 10.1007/s12663-021-01578-1] [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: 09/05/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
Background and Objectives With increasing aesthetic awareness, in addition to the forehead, nose, and cheekbone prominence, the chin nowadays is seen as one of the most important parts of the facial skeleton. Position of the chin has a strong influence on the assessment of the facial harmony; its different types and forms dominate the appearance. Furthermore, the expression of the chin is equated with character traits, and thus, it is an important component of the profile forms. Genioplasty is a routine procedure for the correction of aesthetic and functional deformity of the chin region. It is therefore one of the contour-enhancing surgical methods. The purpose of the present study is to study the versatility of sagittal curving osteotomy for advancement genioplasty as an alternative to conventional technique. Materials and Methods A total of 24 subjects were enrolled for the study who were randomly distributed into two groups: group 1(n-12) comprising of patients in whom sagittal curving osteotomy was done and group 2 (n- 12) comprising of patients in whom conventional osteotomy was done. Neurosensory disturbances and hard and soft tissue relapse were compared between the two groups. Results On comparison of all the variables, it was found that the conventional osteotomy technique had more hard tissue relapse and more neurosensory disturbance as compared to sagittal curving osteotomy technique. Conclusion Results of this study suggest that the use of sagittal curving osteotomy may be helpful in reducing postoperative neurosensory disturbances and relapses following genioplasty. Hence, it is recommended that sagittal curving osteotomy can be used as an alternative osteotomy technique for advancement genioplasty.
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Affiliation(s)
- Shikhar Aich
- Sri Rajiv Gandhi College of Dental Science, Bengaluru, India
| | | | - Akshay Shetty
- Sri Rajiv Gandhi College of Dental Science, Bengaluru, India
| | - Kumari Rathna
- Sri Rajiv Gandhi College of Dental Science, Bengaluru, India
| | | | - Akash Shaju
- Sri Rajiv Gandhi College of Dental Science, Bengaluru, India
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17
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Sanz Cortes M, Corroenne R, Sangi-Haghpeykar H, Orman G, Shetty A, Castillo J, Castillo H, Johnson RM, Shamshirsaz A, Belfort MA, Whitehead W, Meoded A. Association between ambulatory skills and diffusion tensor imaging of corpus callosal white matter in infants with spina bifida. Ultrasound Obstet Gynecol 2022; 60:657-665. [PMID: 35638229 DOI: 10.1002/uog.24958] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess brain white matter using diffusion tensor imaging (DTI) at 1 year of age in infants diagnosed with open neural tube defect (ONTD) and explore the association of DTI parameters with ambulatory skills at 30 months of age. METHODS Magnetic resonance imaging (MRI) was performed at an average of 12 months of age and included an echo planar axial DTI sequence with diffusion gradients along 20 non-collinear directions. TORTOISE software was used to correct DTI raw data for motion artifacts, and DtiStudio, DiffeoMap and RoiEditor were used for further postprocessing. DTI data were analyzed in terms of fractional anisotropy (FA), trace, radial diffusivity and axial diffusivity. These parameters reflect the integrity and maturation of white-matter motor pathways. At 30 months of age, ambulation status was evaluated by a developmental pediatrician, and infants were classified as ambulatory if they were able to walk independently with or without orthoses or as non-ambulatory if they could not. Linear mixed-effects method was used to examine the association between study outcomes and study group. Possible confounders were sought, and analyses were adjusted for age at MRI scan and ventricular size by including them in the regression model as covariates. RESULTS Twenty patients with ONTD were included in this study, including three cases that underwent postnatal repair and 17 cases that underwent prenatal repair. There were five ambulatory and 15 non-ambulatory infants evaluated at a mean age of 31.5 ± 5.7 months. MRI was performed at 50.3 (2-132.4) weeks postpartum. When DTI analysis results were compared between ambulatory and non-ambulatory infants, significant differences were observed in the corpus callosum (CC). Compared with non-ambulatory infants, ambulatory infants had increased FA in the splenium (0.62 (0.48-0.75) vs 0.41 (0.34-0.49); P = 0.01, adjusted P = 0.02), genu (0.64 (0.47-0.80) vs 0.47 (0.35-0.61); P = 0.03, adjusted P = 0.004) and body (0.55 (0.45-0.65) vs 0.40 (0.35-0.46), P = 0.01, adjusted P = 0.01). Reduced trace was observed in the CC of ambulatory children at the level of the splenium (0.0027 (0.0018-0.0037) vs 0.0039 (0.0034-0.0044) mm2 /s; P = 0.04, adjusted P = 0.03) and genu (0.0029 (0.0020-0.0038) vs 0.0039 (0.0033-0.0045) mm2 /s; P = 0.04, adjusted P = 0.01). In addition, radial diffusivity was reduced in the CC of the ambulatory children at the level of the splenium (0.00057 (0.00025-0.00089) vs 0.0010 (0.00084-0.00120) mm2 /s; P = 0.02, adjusted P = 0.02) and the genu (0.00058 (0.00028-0.00088) vs 0.0010 (0.00085-0.00118) mm2 /s; P = 0.02, adjusted P = 0.02). There were no differences in axial diffusivity between ambulatory and non-ambulatory children. CONCLUSION This study demonstrates a significant association between white matter integrity of connecting fibers of the corpus callosum, as assessed by DTI, and ambulatory skills at 30 months of age in infants with ONTD. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - R Corroenne
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - G Orman
- Department of Pediatric Radiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - A Shetty
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - J Castillo
- Department of Pediatrics, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - H Castillo
- Department of Pediatrics, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - R M Johnson
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - W Whitehead
- Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - A Meoded
- Department of Pediatric Radiology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
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Ahmed Z, Shetty A, Victor DW, Kodali S. Viral hepatitis: A narrative review of hepatitis A–E. World J Meta-Anal 2022; 10:99-121. [DOI: 10.13105/wjma.v10.i3.99] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/27/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis continues to be a major health concern leading to hepatic decompensation ranging from acute hepatitis to cirrhosis and hepatocellular carcinoma. The hepatic and extrahepatic manifestations are not only debilitating but also associated with a significant economic burden. Over the last two decades, the field of virology has made significant breakthroughs leading to a better understanding of the pathophysiology of viral hepatitis, which in turn has led to new therapeutic options. The advent of direct-acting antiviral agents changed the landscape of hepatitis C virus (HCV) therapy, and new drugs are in the pipeline for chronic hepatitis B virus (HBV) treatment. There has also been a significant emphasis on screening and surveillance programs, widespread availability of vaccines, and linkage of care. Despite these efforts, significant gaps persist in care, and there is a pressing need for increased collaboration and teamwork across the globe to achieve a reduction of disease burden and elimination of HBV and HCV.
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Affiliation(s)
- Zunirah Ahmed
- Division of Gastroenterology and Hepatology, Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Akshay Shetty
- Department of Gastroenterology and Hepatology, University of California, Los Angeles, CA 90095, United States
| | - David W Victor
- Department of Hepatology, J C Walter Jr Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston, TX 77030, United States
| | - Sudha Kodali
- Department of Hepatology, J C Walter Jr Transplant Center, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Weill Cornell Medical College, Houston, TX 77030, United States
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G.K V, Reader, Ahmed N, Shetty A, Vaibhav N, Imran M, Umeshappa H. Complications of Conventional Sinus Augmentation Techniques Versus Modified Osteotome Techniques in Dental Implant Surgery: A 3-Year Retrospective Clinical Study. J Maxillofac Oral Surg 2022; 22:287-295. [PMID: 37122803 PMCID: PMC10130269 DOI: 10.1007/s12663-022-01733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Sinus Augmentation has proven to be a predictable and popular approach to overcome bone volume deficiency in the posterior maxilla for patients seeking dental implants. The most common surgical methods utilized for maxillary sinus augmentations are the lateral window approach and crestal osteotome technique, which may cause many complications like sinus membrane tear, bleeding, sinusitis, etc. the purpose of this study is to compare complications rates of different sinus lift techniques in dental implant surgery. Aims and Objective To assess the intraoperative and postoperative complications between the conventional direct or indirect method with alternative sinus lift techniques using Modified Crestal and Lateral (CAS & LAS KIT) ®method (Osstem/Hiossen). Materials and Methods This is a retrospective study where in all the sinus lift cases done during 3year duration in the center data was collected and analyzed a total of 61 sinus lift procedure was done and all the data is tabulated and analyzed. Results Results show of the total 61 cases 25 (40%) male patients and 36(59%)female patients traditional techniques like summers osteotome and conventional direct or indirect method had 7 cases (33.3%-37.5%) complication rates compared to Modified Lateral osteotome had 2 complications (14.2%) & Modified Crestal osteotome had only 3 case(3.7%) infections, wound dehiscence, membrane tear etc. Conclusion Modified Crestal & Lateral Osteotome (CAS KIT & LAS KIT) ® technique does reduce the incidence of complications like sinus membrane tear compared to conventional Direct and Indirect techniques, because of stopper system used in hydraulic lift and the special design of drill head of these instruments.
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Ahmad MI, Khan MU, Kodali S, Shetty A, Bell SM, Victor D. Hepatocellular Carcinoma Due to Nonalcoholic Fatty Liver Disease: Current Concepts and Future Challenges. J Hepatocell Carcinoma 2022; 9:477-496. [PMID: 35673598 PMCID: PMC9167599 DOI: 10.2147/jhc.s344559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 02/10/2022] [Accepted: 05/14/2022] [Indexed: 12/24/2022] Open
Abstract
Obesity has been labeled as the global pandemic of the 21st century, resulting from a sedentary lifestyle and caloric excess. Nonalcoholic fatty liver disease (NAFLD), characterized by excessive hepatic steatosis, is strongly associated with obesity and metabolic syndrome and is estimated to be present in one-quarter of the world population, making it the most common cause of the chronic liver disease (CLD). NAFLD spectrum varies from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. The burden of NAFLD has been predicted to increase in the coming decades resulting in increased rates of decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver-related deaths. In the current review, we describe the pathophysiology of NAFLD and NASH, risk factors associated with disease progression, related complications, and mortality. Later, we have discussed the changing epidemiology of HCC, with NAFLD emerging as the most common cause of CLD and HCC. We have also addressed the risk factors of HCC development in the NAFLD population (including demographic, metabolic, genetic, dietary, and lifestyle factors), presentation of NAFLD-associated HCC, its prognosis, and the issue of HCC development in non-cirrhotic NAFLD. Lastly, the problems related to HCC screening in the NAFLD population, the remaining challenges, and future directions, especially the need to identify the high-risk individuals, will be discussed. We will conclude the review by summarizing the clinical evidence for treating fibrosis and preventing HCC in those at risk with NAFLD-associated HCC.
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Affiliation(s)
- Muhammad Imran Ahmad
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital Houston, Houston, TX, USA
| | - Muhammad Umair Khan
- Department of Gastroenterology and Hepatology, Hamad Medical Corporation, Doha, Qatar
- ECPE- Executive and Continuing Professional Education, Harvard T.H Chan School of Public Health, Boston, MA, 02115-5810, USA
| | - Sudha Kodali
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital Houston, Houston, TX, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - Akshay Shetty
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital Houston, Houston, TX, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - S Michelle Bell
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - David Victor
- Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital Houston, Houston, TX, USA
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
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Macher J, Brahmbhatt A, Shetty A, Chughtai K, Baah N, Dogra V. Abstract No. 398 Concomitant pelvic pain diagnoses do not affect outcomes in pelvic congestion syndrome. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.479] [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] Open
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22
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Archana T, Vinod Kumar A, Shetty A, Ahmed N, Veerabasvaiah BT, Ahmed F. Cone-beam computed tomography (CBCT) analysis of maxillary sinus septa in Indians. Bioinformation 2022; 18:251-254. [PMID: 36518147 PMCID: PMC9722424 DOI: 10.6026/97320630018251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/03/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 10/28/2023] Open
Abstract
It is of interest to assess the presence of maxillary sinus septae in patients undergoing implant treatment using Cone Beam Computed Tomography (CBCT).This retrospective study evaluated CBCT scans of 99 patients who opted for implant placement. A total of 198 sinuses were analyzed. The cases were divided into two group's namely edentulous group and non-edentulous groups. The location of septa was divided for analysis into 3 regions namely, the anterior (1st and 2nd premolar), middle (1st and 2nd molar) and posterior (behind 2nd molar) regions. Out of 198 sinuses assessed 15 sinuses had septa. It was more common in males. Mean height of septa was 7.7mm. It was more commonly seen in the middle region (1st and 2nd molar). All of the septa were partial in nature. Septa were common on the right side. It was absent in the edentulous group. To conclude this study showed low prevalence of septa in patients who were assessed as a part of pre-operative planning for implant placement. Modified sinus lift procedures were completed for placement of bone grafts in patients with septa,. This reduced the chances of membrane perforation and increases the chances of better outcomes. CBCT with its low cost and high resolution is useful for assessing the sinus.
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Affiliation(s)
- T.Sukumar Archana
- Department of Oral and Maxillofacial surgery, AECS Maaruti College of Dental Sciences and Research Renter, Bannerghata road, Bangalore 560076
| | | | - Akshay Shetty
- Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore 560032
| | - Nida Ahmed
- Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore 560032
| | - Bhavana T Veerabasvaiah
- Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences & Hospital, Cholanagar, Bangalore 560032
| | - Fazeel Ahmed
- Healing Care medical center, Kulhudhuffushi Island, Maldives
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23
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Waghela R, Ansari U, Kodali S, Shetty A, Victor D. Primary Hepatic Neuroendocrine Tumor With Ectopic Adrenocorticotropic Hormone Production. Cureus 2022; 14:e22771. [PMID: 35371881 PMCID: PMC8974531 DOI: 10.7759/cureus.22771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/22/2022] Open
Abstract
This report describes the case of a 63-year-old female with a metastatic neuroendocrine tumor (NET). Imaging studies revealed a primary hepatic NET (PHNET) originating in the porta hepatis and associated with extensive hepatic metastasis. This represents an extremely rare presentation of PHNET associated with ectopic adrenocorticotropic hormone (ACTH) production and hypercortisolism. As such, it is a unique presentation of an otherwise rare pathology and hence we believe it contributes to the literature on PHNETs by supplementing it with information on an uncommon variation of an infrequent pathology.
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McMillan RR, Javle M, Kodali S, Saharia A, Mobley C, Heyne K, Hobeika MJ, Lunsford KE, Victor DW, Shetty A, McFadden RS, Abdelrahim M, Kaseb A, Divatia M, Yu N, Nolte Fong J, Moore LW, Nguyen DT, Graviss EA, Gaber AO, Vauthey JN, Ghobrial RM. Survival following liver transplantation for locally advanced, unresectable intrahepatic cholangiocarcinoma. Am J Transplant 2022; 22:823-832. [PMID: 34856069 DOI: 10.1111/ajt.16906] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 05/16/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 01/25/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) has previously been considered a contraindication to liver transplantation (LT). However, recent series showed favorable outcomes for LT after neoadjuvant therapy. Our center developed a protocol for neoadjuvant therapy and LT for patients with locally advanced, unresectable iCCA in 2010. Patients undergoing LT were required to demonstrate disease stability for 6 months on neoadjuvant therapy with no extrahepatic disease. During the study period, 32 patients were listed for LT and 18 patients underwent LT. For transplanted patients, the median number of iCCA tumors was 2, and the median cumulative tumor diameter was 10.4 cm. Patients receiving LT had an overall survival at 1-, 3-, and 5-years of 100%, 71%, and 57%. Recurrences occurred in seven patients and were treated with systemic therapy and resection. The study population had a higher than expected proportion of patients with genetic alterations in fibroblast growth factor receptor (FGFR) and DNA damage repair pathways. These data support LT as a treatment for highly selected patients with locally advanced, unresectable iCCA. Further studies to identify criteria for LT in iCCA and factors predicting survival are warranted.
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Affiliation(s)
- Robert R McMillan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Milind Javle
- Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Sudha Kodali
- Department of Medicine, Hepatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Ashish Saharia
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Constance Mobley
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Kirk Heyne
- Department of Medicine, Cancer Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Mark J Hobeika
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Keri E Lunsford
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David W Victor
- Department of Medicine, Hepatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Akshay Shetty
- Department of Medicine, Hepatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Robert S McFadden
- Department of Medicine, Hepatology, Houston Methodist Hospital, Houston, Texas, USA
| | - Maen Abdelrahim
- Department of Medicine, Cancer Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Ahmed Kaseb
- Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Mukul Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Nam Yu
- Houston Radiology Associates, Houston, Texas, USA
| | - Joy Nolte Fong
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, Division of Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - R Mark Ghobrial
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Shetty A, Aggarwal S, Patel S, Sharma S, Jindal K, Prakash M. Early versus delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma- a prospective study. Injury 2022; 53:529-533. [PMID: 34635338 DOI: 10.1016/j.injury.2021.09.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/04/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Delayed presentation of pelvic-acetabular fractures is a common scenario in developing countries and there is usually a delay of more than 24 h in their presentation. OBJECTIVES We aim to comparatively analyse early(<24 h) versus delayed (>24 h) thromboprophylaxis with low molecular weight heparin (LMWH) in prevention of deep venous thrombosis (DVT) in Pelvic Acetabular fractures. METHODS Patients of pelvic-acetabular fractures who presented during 1 year of study period were divided into 2 groups after exclusion of patients with contraindications for thromboprophylaxis. Group A included patients who received LMWH prophylaxis within 24 h of injury. Group B included patients who received LMWH prophylaxis after 24 h of injury. All patients underwent CT venography at day 14 and were followed up with doppler ultrasound on 4th and 8th week. RESULTS 110 patients with pelvic-acetabular fractures were included after exclusion of 61 patients. 4 out of 29 patients in group A (13.8%) and 12 out of 81 patients (14.8%) in group B developed DVT. There was no significant difference in incidence of DVT between Group A and B (P value-0.893). CONCLUSION There was no difference between early and delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma.
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Affiliation(s)
- Akshay Shetty
- Senior Resident, Department of Orthopaedics, PGIMER, Chandigarh, INDIA
| | - Sameer Aggarwal
- Professor, Department of Orthopaedics, PGIMER, Chandigarh, INDIA
| | - Sandeep Patel
- Assistant Professor, Department of Orthopaedics, PGIMER, Chandigarh, INDIA.
| | - Siddharth Sharma
- Assistant Professor, Department of Orthopaedics, PGIMER, Chandigarh, INDIA
| | - Karan Jindal
- Senior Resident, Department of Orthopaedics, PGIMER, Chandigarh, INDIA
| | - Mahesh Prakash
- Professor, Department of Radiodiagnosis, PGIMER, Chandigarh, INDIA
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Shetty A, Kodali S. Long-Term Management of the Successful Adult Liver Transplant: A Patient-Friendly Summary of the 2012 AASLD and AST Practice Guideline. Clin Liver Dis (Hoboken) 2022; 19:83-88. [PMID: 35355845 PMCID: PMC8958238 DOI: 10.1002/cld.1179] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Audio Recording.
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Affiliation(s)
- Akshay Shetty
- Department of MedicineSherrie and Alan Conover Center for Liver Disease and TransplantationHouston Methodist HospitalHoustonTX
| | - Sudha Kodali
- Department of MedicineSherrie and Alan Conover Center for Liver Disease and TransplantationHouston Methodist HospitalHoustonTX
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Blumenschein G, Eggert T, Shetty A, Janát-Amsbury M, Kouros-Mehr H, Bhatia A, Gupta V, Tiso S, Salvati M, Boyer M. P11.02 Targeting the Tumor Neovasculature in Lung Cancer: A Phase I Study of AMG 160 in Subjects With Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.321] [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: 11/25/2022]
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Archana TS, Shetty A, Imran M, Ahmed N, Kumar P, Shruthi TM. A Rare Entity of Undifferentiated Pleomorphic Sarcoma of the Mandible - A Case Report. Ann Maxillofac Surg 2021; 11:156-159. [PMID: 34522674 PMCID: PMC8407644 DOI: 10.4103/ams.ams_334_20] [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] [Received: 08/07/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
The Rationale: Undifferentiated pleomorphic sarcoma originally known as malignant fibrous histiocytoma was declassified by the World Health Organization in 2002 as a formal diagnostic entity and renamed as an undifferentiated pleomorphic sarcoma. It accounts for <1% of malignant tumours of the long bone. Patient Concerns: A 33-year-old male patient reported with swelling and pain in the lower left posterior jaw region for 3 months with a history of fall on the floor 3 months back. Diagnosis: On examination, diffuse solitary swelling was present on the left lower third of the face and was diagnosed radiographically and histopathologically as undifferentiated pleomorphic sarcoma of the mandible. Treatment and Outcomes: Selective neck dissection, followed by reconstruction with fibula osteomyocutaneous flap and then referred for adjuvant radiotherapy. Take-away Lessons: Vimentin staining plays a substantial role in the diagnosis of undifferentiated pleomorphic sarcoma. A long-term follow-up after treatment is required to increase the chances of disease-free survival for the patients.
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Affiliation(s)
- T S Archana
- Department of Oral and Maxillofacial Surgery, AECS Maaruti College of Dental Sciences and Research Center, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Mohammed Imran
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Nida Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar
- Consultant Maxillofacial Surgeon, Vagus Superspeciality Hospital, Bengaluru, Karnataka, India
| | - T M Shruthi
- Consultant Maxillofacial Surgeon, People Tree Hospital, Bengaluru, Karnataka, India
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Umeshappa H, Shetty A, Kavatagi K, Vivek GK, Vaibhav N, Mohammed I. Microbiological profile of aerobic and anaerobic bacteria and its clinical significance in antibiotic sensitivity of odontogenic space infection: A prospective study of 5 years. Natl J Maxillofac Surg 2021; 12:372-379. [PMID: 35153434 PMCID: PMC8820308 DOI: 10.4103/njms.njms_1_20] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/21/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction: Odontogenic infections are mixed aerobic-anaerobic microbial flora. Infections caused by anaerobic bacteria are serious and life-threatening. The microbial specificity in odontogenic infections is technique sensitive depending on the sampling and culturing of specimens. Materials and Methods: A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 5 years by surgical intervention and intravenous antibiotics. This study evaluates the pathogenic potential and virulence factors of aerobes and anaerobes as well as its synergistic interrelations with other infectious flora, by culturing of specimens and testing antibiotic sensitivity in standard microbiological methodology in correlation with patient demographic factors. Results: Of the 100 patients of odontogenic space infection, males were more affected, between third and fourth decades. Caries is the most common etiology with involvement of mandibular molars. Submandibular and buccal space is commonly involved. The most common microorganisms isolated being Staphylococcus aureus and Streptococcus viridans are facultative anaerobes which belong to aerobes and Peptostreptococcus predominated among obligate anaerobes. The empirical antibiotic regimen followed is amoxicillin plus clavulanic acid with Metronidazole, followed by surgical treatment. Clindamycin was preferred as the second line of choice in patients resistance to penicillin drugs with comparable efficacy in it. Conclusion: Our study expanded the knowledge base of the microbial flora associated with odontogenic infections, with special reference to anaerobes. Successful management of odontogenic space infection lies in decompression, removal of etiological factors, and also in selecting appropriate antimicrobial therapy depending on microbial flora isolated, for recovery of patients and preventing complications associated with fascial space infection.
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Affiliation(s)
- Hemavathi Umeshappa
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
| | - Kiran Kavatagi
- Department of Microbiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - G K Vivek
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
| | - N Vaibhav
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
| | - Imran Mohammed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bengaluru, Karnataka, India
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Dowlati A, Byers L, Johnson M, Aljumaily R, Prenen H, Zhang A, Minocha M, Shetty A, Hashemi Sadraei N. 1668TiP Phase Ib study of AMG 757, a half-life extended bispecific T-cell engager immuno-oncology therapy, combined with AMG 404, an anti-PD-1 antibody, in patients with small cell lung cancer (SCLC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.252] [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: 10/20/2022] Open
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31
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Shetty A, Giron F, Divatia MK, Ahmad MI, Kodali S, Victor D. Nonalcoholic Fatty Liver Disease after Liver Transplant. J Clin Transl Hepatol 2021; 9:428-435. [PMID: 34221929 PMCID: PMC8237139 DOI: 10.14218/jcth.2020.00072] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 12/18/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the world. The rising prevalence of nonalcoholic steatohepatitis (NASH) has led to a 170% increase in NASH cirrhosis as the listing indication for liver transplantation from 2004 to 2013. As of 2018, NASH has overtaken hepatitis C as an indication for liver transplantation in the USA. After liver transplantation, the allograft often develops recurrent NAFLD among patients with known NASH cirrhosis. In addition to recurrent disease, de novo NAFLD has been reported in patients with other indications for liver transplantation. In this review, we will discuss the risk factors associated with recurrent and de novo NAFLD, natural course of the disease, and management strategies after liver transplantation.
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Affiliation(s)
- Akshay Shetty
- Department of Medicine, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - Fanny Giron
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Mukul K. Divatia
- Department of Pathology and Genomic Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Muhammad I. Ahmad
- Department of Medicine, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - Sudha Kodali
- Department of Medicine, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
| | - David Victor
- Department of Medicine, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, TX, USA
- Correspondence to: David Victor, Department of Medicine, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist Hospital, Outpatient Center 22 Floor, Houston, TX 77030, USA. ORCID: https://orcid.org/0000-0003-1414-3128. Tel: +1-713-790-3089, E-mail:
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32
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Kodali S, Shetty A, Shekhar S, Victor DW, Ghobrial RM. Management of Intrahepatic Cholangiocarcinoma. J Clin Med 2021; 10:jcm10112368. [PMID: 34072277 PMCID: PMC8198953 DOI: 10.3390/jcm10112368] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/10/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
Cholangiocarcinoma is a tumor that arises as a result of differentiation of the cholangiocytes and can develop from anywhere in the biliary tree. Subtypes of cholangiocarcinoma are differentiated based on their location in the biliary tree. If diagnosed early these can be resected, but most cases of intrahepatic cholangiocarcinoma present late in the disease course where surgical resection is not an option. In these patients who are poor candidates for resection, a combination of chemotherapy, locoregional therapies like ablation, transarterial chemo and radioembolization, and in very advanced and metastatic disease, external radiation are the available options. These modalities can improve overall disease-free and progression-free survival chances. In this review, we will discuss the risk factors and clinical presentation of intrahepatic cholangiocarcinoma, diagnosis, available therapeutic options, and future directions for management options.
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Affiliation(s)
- Sudha Kodali
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX 77030, USA; (S.K.); (A.S.); (R.M.G.)
- Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Akshay Shetty
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX 77030, USA; (S.K.); (A.S.); (R.M.G.)
- Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Soumya Shekhar
- Texas A&M College of Medicine, Houston Campus, Houston, TX 77030, USA;
| | - David W. Victor
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX 77030, USA; (S.K.); (A.S.); (R.M.G.)
- Houston Methodist Research Institute, Houston, TX 77030, USA
- Correspondence:
| | - Rafik M. Ghobrial
- Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX 77030, USA; (S.K.); (A.S.); (R.M.G.)
- Houston Methodist Research Institute, Houston, TX 77030, USA
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Bm A, Rao S, Shetty S, Shetty A, Shetty S, Kim S, Mohana Kumar B. Comparative characterization of mesenchymal progenitor cells from osteoarthritic and rheumatoid arthritic human articular cartilage. Cytotherapy 2021. [DOI: 10.1016/s1465324921003467] [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: 10/21/2022]
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34
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Shetty A, Brahmbhatt A, Patel A, Baah N. Abstract No. 125 Endovascular versus percutaneous treatment of pancreatic pseudoaneurysms. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.131] [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: 10/21/2022] Open
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35
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Paz-Ares L, Owonikoko T, Johnson M, Govindan R, Izumi H, Lai V, Borghaei H, Boyer M, Boosman R, Hummel HD, Blackhall F, Dowlati A, Zhang Y, Mukherjee S, Sable B, Pati A, Shetty A, Sadraei NH, Champiat S. 48MO Phase I study of AMG 757, a delta-like ligand 3 (DLL3) targeting, half-life extended bispecific T-cell engager immuno-oncology therapy, in small cell lung cancer (SCLC). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01890-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Shetty A, Janda M, Fry K, Brown S, Yau B, Schuckmann LV, Thomas S, Rayner JE, Spelman L, Wagner G, Jenkins H, Lun K, Parbery J, Soyer HP, Neale RE, Green AC, Whiteman DC, Olsen CM, Khosrotehrani K. Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study. J Eur Acad Dermatol Venereol 2020; 35:1094-1098. [PMID: 33274462 DOI: 10.1111/jdv.17062] [Citation(s) in RCA: 2] [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] [Received: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Screening for skin cancer can be cost-effective if focused on high-risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimize advice and management. However, few have been validated in a clinical setting over the past few years. OBJECTIVES To assess the clinical utility of risk assessment tools to identify individuals with prevalent skin cancers in a volunteer-based screening clinic. METHODS Participants were adults presenting for a skin check at a volunteer-based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers [KCs; basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] and classified each participant into one of five risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied, and all cancers were histopathologically confirmed. RESULTS Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty-two BCCs, 19 SCCs and eight melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from <1% in the lowest to 24% in the highest risk category (P < 0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low-risk and high-risk groups. CONCLUSION The risk prediction model for keratinocyte cancers can reliably identify individuals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger sample exposed to a wider range of environmental risk factors.
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Affiliation(s)
- A Shetty
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - M Janda
- Centre of Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - K Fry
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - S Brown
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - B Yau
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - L Von Schuckmann
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - S Thomas
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - J E Rayner
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - L Spelman
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - G Wagner
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - H Jenkins
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - K Lun
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - J Parbery
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - H P Soyer
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - R E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C M Olsen
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - K Khosrotehrani
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
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37
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Lambe G, Kapadia F, Rodrigues C, Khodaiji S, Mansukhani D, Shetty A. Evaluation of association between immune modulation and incidence of CMV reactivation in Sepsis-induced immunosuppression. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.721] [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: 10/22/2022] Open
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38
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Ajbani K, Kazi M, Agrawal U, Sunavala A, Soman R, Shetty A, Rodrigues C. Evaluation of the performance of CSF pyrosequencing in the diagnosis of TB meningitis. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1185] [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: 10/22/2022] Open
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39
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Gurava Reddy AV, Manohar M, Shetty A, Sankineani SR, Ashok Kumar PS, Bose VC, Pichai S, Patil S, Mukartihal R, Dhanasekhara Raja P, Rajkumar N, Rajasekharan S. A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial. Musculoskelet Surg 2020; 104:267-271. [PMID: 31236778 DOI: 10.1007/s12306-019-00616-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.
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Affiliation(s)
- A V Gurava Reddy
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - M Manohar
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - A Shetty
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S R Sankineani
- Department of Orthopaedics and Traumatology, Sunshine Hospital, Secunderabad, 500003, India.
- South India Arthroplasty Academy (SIAA), Secunderabad, India.
| | - P S Ashok Kumar
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - V C Bose
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Pichai
- Department of Orthopaedics, Asian Joint Reconstruction Institute, Chennai, 600026, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Patil
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - R Mukartihal
- Department of Orthopaedics, Sparsh Hospital, Bangalore, 560022, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - P Dhanasekhara Raja
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - N Rajkumar
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
| | - S Rajasekharan
- Department of Orthopaedics, Ganga Hospital, Coimbatore, 641043, India
- South India Arthroplasty Academy (SIAA), Secunderabad, India
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Saini UC, Neradi D, Kumar D, Bacchal V, Sodavarapu P, Shetty A. Letter to the Editor Regarding "Lateral Approach and Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis.". Bull Emerg Trauma 2020; 8:207-208. [PMID: 32944584 PMCID: PMC7468219 DOI: 10.30476/beat.2020.86013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Uttam Chand Saini
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Deepak Neradi
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Deepak Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vikas Bacchal
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Praveen Sodavarapu
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Akshay Shetty
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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41
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Shruthi TM, Shetty A, Imran M, Akash KS, Ahmed F, Ahmed N. Removal of Displaced Maxillary Third Molar Using Modified Gillie's Temporal Approach. Ann Maxillofac Surg 2020; 10:210-212. [PMID: 32855943 PMCID: PMC7433979 DOI: 10.4103/ams.ams_254_19] [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] [Received: 11/22/2019] [Revised: 01/12/2020] [Accepted: 03/16/2020] [Indexed: 12/01/2022] Open
Abstract
Tooth impaction is a pathological situation where a tooth is unable to achieve its normal functional position within the expected time span. The removal may be associated with intra-operative or post-operative complications. The Le Fort I osteotomy is a procedure used by maxillofacial surgeons to correct a wide range of dentofacial deformities. Due to its versatility and simplicity, it has gained popularity for a wide range of uses. This case report describes the location and surgical removal of a right maxillary third molar which was accidentally displaced into the infratemporal fossa in a 26-year-old female while performing Le Fort I osteotomy. The patient underwent a second surgery for the retrieval of tooth using modified Gillie's temporal approach. The important role of the cone beam computed tomography in determining the localization of the displaced tooth is demonstrated.
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Affiliation(s)
- T M Shruthi
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Mohammed Imran
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - K S Akash
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Fazeel Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Nida Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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Vivek GK, Vaibhav N, Shetty A, Mohammad I, Ahmed N, Umeshappa H. Efficacy of Various Routes of Dexamethasone Administration in Reducing Postoperative Sequelae Following Impacted Third Molar Surgery. Ann Maxillofac Surg 2020; 10:61-65. [PMID: 32855917 PMCID: PMC7433949 DOI: 10.4103/ams.ams_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/13/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/08/2022] Open
Abstract
Aim: To compare the efficacy of intravenous (IV), intramassetric (IM) submucosal (SM) routes & oral routes of dexamethasone administration post impacted third molar removal surgery. Type of Study: Prospective randomized comparative clinical study. Materials and Method: This prospective comparative study included 60 patients with Class II and position B type of impaction (according to Pell and Gregory's classification). Patients were randomly divided into 4 groups. Group A, B, C & D patients received 8mg dexamethasone immediately post-surgical tooth removal via the IV, SM and IM route & oral respectively. Assessment of swelling, mouth opening and pain was done at intervals of 1st, 3rd and 7th post-op days. Results: The average age of the patients was 27 years. The mean time taken was 20 mins 40 seconds. The IV group showed minimal swelling and better pain control on the 3rd post op day (statistically significant). All 4 routes showed comparable mouth opening results. Conclusion: IV administration of dexamethasone post third molar surgery has been the traditional way because of its faster onset of action and increased efficacy; IM and SM routes are also comparably effective although oral route had the best patient acceptance.
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Affiliation(s)
- G K Vivek
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - N Vaibhav
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Imran Mohammad
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Nida Ahmed
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
| | - Hemavathi Umeshappa
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India
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Hooda A, Dhillon MS, Neradi D, Kumar D, Vatsya P, Shetty A. Orthopedic Residency in a Tertiary Care Hospital of India: Positives, Negatives and Perspectives for Change. Indian J Orthop 2020; 55:209-216. [PMID: 34122772 PMCID: PMC8149530 DOI: 10.1007/s43465-020-00221-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Orthopaedic residency training is a 3-year period of preparation that converts a raw medical student into a proficient orthopaedic surgeon. Due to wide variations at different centers in India, the program in a tertiary hospital is presented, in an attempt to improve the overall levels of training. MATERIALS AND METHODS PGIMER has produced many good surgeons who are well settled across the country and the world. A survey of the postgraduates of the last 30 years was done to highlight the perceptions about the program. An overview of the program was also added to the narrative to highlight the positive aspects of the training. RESULTS 132 Orthopaedic passed-out residents from PGIMER could be contacted. 97% of them rated their residency experience as excellent or good, and stated that they would recommend this program to new residents. Key points highlighted by them were the readiness of trainees for any surgical contingency after graduation, continuation of the mindset for research, and their prompt acceptability into their subsequent places of work due to their place of graduation. DISCUSSION Converting an orthopaedic resident into a competent surgeon involves knowledge upgrades and impartation of skills; these are not limited to the theory of orthopaedics, but involve the thought processes and the planning as a surgeon, the attitude towards patient management, and a continuously inquisitive scientific mind. The shortcomings and strengths of the residency program in PGIMER are discussed; international standard methodology limited to this institute like formal log books, mentorship program, hands-on skill development through courses, etc. is something that is recommended to be mandatory in all residency programs. CONCLUSION The PGIMER Orthopaedic residency program could act as a basic model for other Indian medical schools, with any appropriate modifications. Standardization of Orthopaedic residency programs could allow upgrading to International levels.
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Affiliation(s)
- Aman Hooda
- Department of Orthopedics, PGIMER, Chandigarh, India
| | | | - Deepak Neradi
- Department of Orthopedics, PGIMER, Chandigarh, India
| | - Deepak Kumar
- Department of Orthopedics, PGIMER, Chandigarh, India
| | | | - Akshay Shetty
- Department of Orthopedics, PGIMER, Chandigarh, India
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Kale SG, Shetty A, Moin A, Archana TS, Kumar P, Bagga V. Comparative Evaluation of Preemptive Analgesia of Dextromethorphan and Ibuprofen in Third Molar Surgeries. Ann Maxillofac Surg 2020; 10:312-319. [PMID: 33708573 PMCID: PMC7944010 DOI: 10.4103/ams.ams_252_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction: Postoperative pain following third molar removal is one of the most common and unpleasant complications encountered in routine surgical practice. Various methods have been advocated to minimize the postoperative pain: preemptive analgesia is one of those found to be effective. Objective: The aim of this study was to compare the preemptive analgesic efficacy of Dextromethorphan (DM) and Ibuprofen in the third molar surgeries. Material and Methods: Thirty-six patients reporting to our institution were included in the study. Patients were randomized into three groups of 12 patients each to receive either DM 30 mg, ibuprofen 100 mg, or placebo in the form of multivitamin syrup, 90 min before the procedure. The difficulty of removal of the teeth was assessed using Campbell difficulty score. The study objectives were to evaluate the time elapsed since surgery after which the patient took their first dose of aceclofenac, to evaluate the postoperative pain using visual analog scale score, and to record the number of aceclofenac tablets consumed postoperatively. Results: The results of the study revealed that preemptive DM was significantly better than ibuprofen and placebo in the duration of time that elapsed before the patients consumed their first analgesic postoperatively. Preemptive DM also reduced the total number of aceclofenac tablets consumed on the day of surgery and on the 1st postoperative day, but the difference was not statistically significant. Between the two drugs, DM is better suited for providing preemptive analgesia. No side effects at a dose of 30 mg of DM were noted in any of the patients. Conclusion: DM premedication is a viable preemptive analgesic in reducing postoperative pain.
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Affiliation(s)
- Saurabh Gajanan Kale
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Ayesha Moin
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - T S Archana
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Praveen Kumar
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
| | - Vivek Bagga
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India
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Nguyen H, Alawieh A, Bastian D, Kuril S, Dai M, Daenthanasanmak A, Zhang M, Iamsawat S, Schutt SD, Wu Y, Sleiman MM, Shetty A, Atkinson C, Sun S, Varela JC, Tomlinson S, Yu XZ. Targeting the Complement Alternative Pathway Permits Graft Versus Leukemia Activity while Preventing Graft Versus Host Disease. Clin Cancer Res 2020; 26:3481-3490. [PMID: 31919135 PMCID: PMC7334060 DOI: 10.1158/1078-0432.ccr-19-1717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/03/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Application of allogeneic hematopoietic cell transplantation (allo-HCT) for patients with hematologic disorders is limited by the development of GVHD. Separation of GVHD and graft-versus-leukemia (GVL) remains a great challenge in the field. We investigated the contribution of individual pathways involved in the complement cascade in GVH and GVL responses to identify specific targets by which to separate these two processes. EXPERIMENTAL DESIGN We used multiple preclinical murine and human-to-mouse xenograft models involving allo-HCT recipients lacking components of the alternative pathway (AP) or classical pathway (CP)/lectin pathway (LP) to dissect the role of each individual pathway in GVHD pathogenesis and the GVL effect. For translational purposes, we used the AP-specific complement inhibitor, CR2-fH, which localizes in injured target organs to allow specific blockade of complement activation at sites of inflammation. RESULTS Complement deposition was evident in intestines of mice and patients with GVHD. In a preclinical setting, ablation of the AP, but not the CP/LP, significantly improved GVHD outcomes. Complement activation through the AP in host hematopoietic cells, and specifically dendritic cells (DC), was required for GVHD progression. AP deficiency in recipients decreased donor T-cell migration and Th1/Th2 differentiation, while increasing the generation of regulatory T cells. This was because of decreased activation and stimulatory activity of recipient DCs in GVHD target organs. Treatment with CR2-fH effectively prevented GVHD while preserving GVL activity. CONCLUSIONS This study highlights the AP as a new therapeutic target to prevent GVHD and tumor relapse after allo-HCT. Targeting the AP by CR2-fH represents a promising therapeutic approach for GVHD treatment.
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Affiliation(s)
- Hung Nguyen
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ali Alawieh
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
- Medical Scientist Training Program, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - David Bastian
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Sandeepkumar Kuril
- Department of Pediatric, Medical University of South Carolina, Charleston, South Carolina
| | - Min Dai
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Anusara Daenthanasanmak
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Mengmeng Zhang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Supinya Iamsawat
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Steven D Schutt
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Yongxia Wu
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - M Mahdi Sleiman
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Akshay Shetty
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shaoli Sun
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina
| | - Juan Carlos Varela
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
| | - Stephen Tomlinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, South Carolina
| | - Xue-Zhong Yu
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina.
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Kumar S, Shetty A, Rathod P. Letter to the Editor concerning "Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients" by Yang JH, et al. (Eur Spine J; [2020] 29:761-769). Eur Spine J 2020; 30:1791. [PMID: 32519029 DOI: 10.1007/s00586-020-06487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/26/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sunil Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Akshay Shetty
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratik Rathod
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Vaibhav N, Ghosh A, Kamath S, Vivek GK, Shetty A, Raut R. Maxillofacial Injuries as an Occupational Hazard of Farming in Rural and Semi-urban Population: A 3-Year Retrospective Epidemiological Study. J Maxillofac Oral Surg 2020; 20:5-12. [PMID: 33584036 DOI: 10.1007/s12663-020-01354-7] [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: 09/21/2018] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of the retrospective study is to conduct an epidemiological evaluation of farm-based/farm-related maxillofacial injuries to assess the pattern and severity of maxillofacial injuries sustained and to formulate prevention strategies. Materials & Method In this analytical retrospective study, records/case sheets of patients presenting with trauma sustained in farm-based settings in a government hospital catering to rural and semi-urban population from January 2014 to Dec 2017 were analyzed to assess the incidence, pattern, etiology and trauma configurations of maxillofacial injuries sustained. Results Out of a total of 11,736 trauma cases, 2484 patients suffered injuries in farm-based settings. Out of these, 334 patients had maxillofacial injuries. Mandibular condylar fracture along with parasymphysis fracture was the most common fracture configuration. Injuries while working with non-motorized machinery followed by working around farm livestock were the most common etiological factors in farm-related trauma. Conclusion Maxillofacial injuries account for a significant percentage of injuries suffered in a farm-related environment. Through this study, we have identified the patterns of maxillofacial injuries occurring in such an environment, and the data thus obtained can be used to develop various ergonomic and safety interventions in terms of machinery design and handling along with implementation of training programs and enforcing strict safety guidelines to minimize maxillofacial trauma in farm-based settings.
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Affiliation(s)
- N Vaibhav
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bangalore, India
| | - Abhishek Ghosh
- Department of Oral and Maxillofacial Surgery, Maitri Dental College, Anjora, Bhilai India
- Bhilai, Durg India
| | - Shashidhara Kamath
- Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College, Hassan, India
| | - G K Vivek
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bangalore, India
| | - Akshay Shetty
- Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bangalore, India
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Affiliation(s)
- A. Shetty
- Dallas Nephrology Associates Dallas, TX, USA
| | - J.V. Hawkins
- National Heart, Lung and Blood Institute National Institutes of Health, Bethesda, MD, USA
| | - A. Gupta
- Division of Nephrology University of California Irvine, California, USA, and Rockwell Medical, Inc, Wixom, MI, USA
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Sanz Cortes M, Torres P, Yepez M, Guimaraes C, Zarutskie A, Shetty A, Hsiao A, Pyarali M, Davila I, Espinoza J, Shamshirsaz AA, Nassr A, Whitehead W, Lee W, Belfort MA. Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy-assisted fetoscopic or open approach. Ultrasound Obstet Gynecol 2020; 55:87-95. [PMID: 31219638 DOI: 10.1002/uog.20373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/23/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair. METHODS This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, at 21.4-25.9 weeks' gestation. Fetoscopic repair was performed under CO2 insufflation, according to our protocol. Diffusion-weighted magnetic resonance imaging (MRI) was performed before surgery in 30 cases (14 fetoscopic and 16 open), at 6 weeks postsurgery in 48 cases (24 fetoscopic and 24 open) and within the first year after birth in 23 infants (five fetoscopic and 18 open). Apparent diffusion coefficient (ADC) values from the basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of the three timepoints (presurgery, 6 weeks postsurgery and postnatally) and the percentage change in the ADC values between the timepoints were compared between the fetoscopic-repair and open-repair groups. ADC values at 6 weeks after surgery in the two prenatally repaired groups were compared with those in a control group of eight healthy fetuses that underwent MRI at a similar gestational age (GA). Comparison of ADC values was performed using the Student's t-test for independent samples (or Mann-Whitney U-test if non-normally distributed) and multivariate general linear model analysis, adjusting for GA or age at MRI and mean ventricular width. RESULTS There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed. CONCLUSIONS Fetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO2 insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - P Torres
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M Yepez
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - C Guimaraes
- Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - A Zarutskie
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Shetty
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Hsiao
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M Pyarali
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - I Davila
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - A Nassr
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - W Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - W Lee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Riddle PJ, Shetty A, Brock AS. Confirmatory Visualization of an Aorto-enteric Fistula With Esophagogastroduodenoscopy. Clin Gastroenterol Hepatol 2019; 17:e157. [PMID: 30196161 DOI: 10.1016/j.cgh.2018.08.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Philip J Riddle
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Akshay Shetty
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew S Brock
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
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