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Dhamija K, Manjappaiah MG, Kandavel T, Mahadevan A, Netravathi M. Are monoclonals the only panacea for treatment of aquaporin-4 positive NMOSD? Experience from a low-&middle-income (LMIC) region. Clin Neurol Neurosurg 2024; 239:108212. [PMID: 38460428 DOI: 10.1016/j.clineuro.2024.108212] [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: 04/10/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE A plethora of monoclonals have ushered up for NMOSD treatment. However, their limited availability and cost concerns poses a challenge for usage in developing nations. We compared relapse rates and disabilities among aquaporin-4 positive(AQP4+ve) patients on conventional immunosuppressants and rituximab in a tertiary referral center in southern India. METHODS This was a chart review of AQP4+ve patients registered under national demyelination registry maintained at institute. AQP4+ve patients were included if they were on azathioprine, MMF, methotrexate for six months; cyclophosphamide for three months and rituximab for one month. RESULTS 207 records were screened, 154 fulfilled inclusion criteria. Drugs used were azathioprine (70), MMF (34) and rituximab (33). All three drugs were non-inferior to each other in terms of ARR reduction. Median EDSS at last follow-up was significantly lower for azathioprine(2;IQR:0-5) and rituximab(2;IQR:0.5-5) than MMF(3.5;IQR:2-5.6), however azathioprine was associated with highest switch rate(34.3%) and was the only drug which required change because of intolerance. Failure rate was least for rituximab(27.3%).Patients on azathioprine and MMF required higher mean duration of concurrent steroids(7.8±7.7 and 4.56±2.17 months respectively) when compared to rituximab(2.77±1.38) and had more relapses due to steroid withdrawal. CONCLUSION Initial treatment with azathioprine, MMF and rituximab is comparable in terms of ARR reduction. Findings suggest that choice may be guided by adverse event profile of drug, rather than efficacy per se. Concurrent treatment duration with steroids should also guide clinical decision. Switch to second immunomodulation in event of initial failure adds to efficacy benefit, irrespective of the drug chosen.
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Affiliation(s)
- Kamakshi Dhamija
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | - Thennarasu Kandavel
- Department of Biostatistics National Institute of Mental Health & Neurosciences, Bangalore, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India.
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Rush A, Weil C, Siminoff L, Griffin C, Paul CL, Mahadevan A, Sutherland G. The Experts Speak: Challenges in Banking Brain Tissue for Research. Biopreserv Biobank 2024; 22:179-184. [PMID: 38621226 DOI: 10.1089/bio.2024.29135.ajr] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- A Rush
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - C Weil
- Independent Consultant, Human Research Protections and Bioethics, Bethesda, USA
| | - L Siminoff
- College of Public Health, Department of Social and Behavioral Sciences, Temple University, Pennsylvania, USA
| | - C Griffin
- College of Health, Medicine and Wellbeing University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Mark Hughes Foundation Centre for Brain Cancer Research, The University of Newcastle, Newcastle, Australia
| | - C L Paul
- College of Health, Medicine and Wellbeing University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Mark Hughes Foundation Centre for Brain Cancer Research, The University of Newcastle, Newcastle, Australia
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - G Sutherland
- Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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John DV, Sreenivas N, Deora H, Purushottam M, Debnath M, Mahadevan A, Patil SA. Cerebrospinal fluid inflammatory cytokine profiles of patients with neurotropic parasitic infections. Trop Biomed 2023; 40:406-415. [PMID: 38308827 DOI: 10.47665/tb.40.4.005] [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: 02/05/2024]
Abstract
The pathogenesis of chronic parasitic central nervous system (CNS) infections, including granulomatous amoebic meningoencephalitis (GAE), cerebral toxoplasmosis (CT), and neurocysticercosis (NCC), is primarily due to an inflammatory host reaction to the parasite. Inflammatory cytokines produced by invading T cells, monocytes, and CNS resident cells lead to neuroinflammation which underlie the immunopathology of these infections. Immune molecules, especially cytokines, can therefore emerge as potential biomarker(s) of CNS parasitic infections. In this study, cerebral spinal fluid (CSF) samples from suspected patients with parasitic infections were screened for pathogenic free-living amoebae by culture (n=2506) and PCR (n=275). Six proinflammatory cytokines in smear and culture-negative CSF samples from patients with GAE (n = 2), NCC (n = 7), and CT (n = 23) as well as control (n = 7) patients were measured using the Multiplex Suspension assay. None of the CSF samples tested was positive for neurotropic free-living amoebae by culture and only two samples showed Acanthamoeba 18S rRNA by PCR. Of the six cytokines measured, only IL-6 and IL-8 were significantly increased in all three infection groups compared to the control group. In addition, TNFa levels were higher in the GAE and NCC groups and IL-17 in the GAE group compared to controls. The levels of IL-1b and IFNg were very low in all the infection groups and the control group. There was a correlation between CSF cellularity and increased levels of IL-6, IL-8, and TNFa in 11 patients. Thus, quantifying inflammatory cytokine levels in CSF might help with understanding the level of neuroinflammation in patients with neurotropic parasitic diseases. Further studies with clinico-microbiological correlation in the form of reduction of cytokine levels with treatment and the correlation with neurological deficits are needed.
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Affiliation(s)
- D V John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - N Sreenivas
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - H Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M Purushottam
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S A Patil
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Mahale R, Shashi S, Mahadevan A, Singh R, Potluri V, Padmanabha H, Mailankody P, Pavagada MS. Spastic Ataxia with Sensory Neuropathy Sans Cerebral Leukodystrophy in Probable Adult Polyglucosan Body Disease. Ann Indian Acad Neurol 2023; 26:1030-1032. [PMID: 38229650 PMCID: PMC10789398 DOI: 10.4103/aian.aian_725_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sridhar Shashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Raviprakash Singh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Vivek Potluri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mathuranath S. Pavagada
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Milano MT, Mavroidis P, Ryckman J, Yorke ED, Doucette CW, Mahadevan A, Kapitanova I, Kong FM, Marks LB, Grimm J. Radiation-Induced Brachial Plexopathy (RIBP) after Stereotactic Body Radiotherapy (SBRT): Pooled Analyses of Risks. Int J Radiat Oncol Biol Phys 2023; 117:e42. [PMID: 37785381 DOI: 10.1016/j.ijrobp.2023.06.740] [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) RIBP, with symptomatic upper extremity motor or sensory deficits, is a risk after SBRT. We herein model dosimetric factors associated with risks of RIBP of the inferior aspect of the brachial plexus following SBRT for apical lung tumors. MATERIALS/METHODS Literature searches (PubMed & Embase databases) were performed to identify reports published from 2000-2021, using search criteria of ["brachial plex*" and stereotactic]. From a PRISMA systematic review, studies were identified that included individual patient data on: (1) RIBP endpoints after SBRT for apical lung tumors; and (2) brachial plexus Dmax, or maximum point doses (i.e., D0.035cc or D0.03cc). These data were amenable to normal tissue complication probability (NTCP) modelling. Doses were converted using the linear-quadratic model with an alpha-beta ratio of 3 Gy. For the probit models, the parameter values were determined using the maximum likelihood method and the 95% confidence intervals (CI) were determined using the profile likelihood method. The ability of the NTCP models to distinguish patients with and without RIBP was evaluated using the area under the curve (AUC). RESULTS Two probit NTCP models were derived: one from 3 studies (185 patients with 192 targets and 11 events) and another from 4 studies (221 patients with 229 targets and 18 events). NTCP models (summarized in table) suggest ≈10% risks associated with brachial plexus maximum dose (Dmax) of ∼32-34 Gy in 3 fractions and ∼40-43 Gy in 5 fractions, with a clear dose response. These dose-responses with SBRT (with steep dose gradients beyond the target volume and thus only partial-irradiation of the brachial plexus) are far less steep than those reported following conventionally-fractionated or moderately-hypofractionated radiotherapy used for breast, lung and head and neck cancers (that tend to use radiotherapy fields that circumferentially irradiate the brachial plexus). CONCLUSION A dose-response for risk of RIBP after SBRT is observed relative to brachial plexus Dmax. The less-steep dose-response compared to that seen from conventionally-fractionated or moderately-hypofractionated radiotherapy (with large irradiated plexus volumes) suggest a possible volume dependence of RIBP risks. Future work should focus on understanding possible volume effects.
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Affiliation(s)
- M T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - P Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - J Ryckman
- Department of Radiation Oncology, West Virginia University Medicine, Camden Clark Medical Center, Parkersburg, WV
| | - E D Yorke
- Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C W Doucette
- University of Rochester Medical Center, Rochester, NY
| | | | | | - F M Kong
- The University of Hong Kong, Hong Kong, China
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - J Grimm
- Geisinger Cancer Institute, Danville, PA
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Hurwitz JC, Santos V, Akerman M, Mendez C, Sanchez A, Corcoran A, Katz A, Lepor H, Taneja S, Carpenter TJ, Evans AJ, Mahadevan A, Haas JA, Lischalk JW. Multifocal MRI-Directed Simultaneous Integrated Boost (SIB) in the Treatment of Prostate Cancer with Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2023; 117:e395. [PMID: 37785324 DOI: 10.1016/j.ijrobp.2023.06.1521] [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) Conventionally fractionated MRI-directed radiation boosts in the treatment of prostate cancer have been shown to improve oncologic outcomes in the FLAME trial. Moreover, recent data has demonstrated local recurrences following SBRT predominately occur at the site of the dominant intraprostatic lesion. Modern protocols including HYPO-Flame have demonstrated early safety profiles of a 5-fraction intraprostatic SBRT boost. This study aims to determine if multifocal SIB treatment is associated with additional acute toxicity relative to unifocal boosts. MATERIALS/METHODS In this single-center retrospective analysis, we identified all patients who underwent SBRT with a SIB using a robotic radiosurgical platform. Fiducial markers and hydrogel rectal spacers were placed prior to simulation. All patients underwent treatment planning MRI with documented PI-RADS 3-5 lesions targeted for SIB delineation. Patients were treated to a prescription dose of 3500 to 3625 cGy in 5 fractions, or 1800 to 2100 cGy in 3 fractions in concert with pelvic nodal irradiation. The SIB prescription dose ranged from 4000 to 4200 cGy and 2100 to 2300 cGy for the 5- and 3-fraction regimens, respectively. Acute toxicity was defined as that occurring within 60 days of treatment completion using the CTCAE v. 5.0. RESULTS A total of 35 patients with a median age of 70 underwent SBRT SIB from 5/2022 to 1/2023 with the following risk distribution: low (3%), intermediate (66%), high (28%), and regional (3%). Most patients received rectal spacers (77%) and neoadjuvant ADT (71%) prior to treatment. The majority of patients underwent 5-fraction SBRT (74%) with the remainder receiving SBRT as a boost. Approximately half (51%) of the cohort was treated with a multifocal SIB to multiple PI-RADS lesions. Mean SIB dose was 4105 and 2377 cGy in 5- and 3-fractions, respectively. With a median follow up of 33 days, we identified no grade 3+ acute toxicities. Crude rate of grade 2 GU and GI toxicity was 51% and 6%, respectively, on par with prior unifocal publications. There was no difference in median SIB volume between uni- and multifocal boosts (1.47 vs. 1.72 cc, p = 0.57), nor was SIB volume associated with an increased risk of grade 2 GU toxicity (p = 0.28). Dominant lesion location was not associated with increased grade 2 GU toxicity (p = 0.29). No grade 2 GI toxicities occurred in the multifocal group. Finally, univariate analysis did not identify multifocal boost as a risk of grade 2 GU toxicity (35%) relative to unifocal (67%) boost (p = 0.09). CONCLUSION In the first analysis of its kind in the literature, we demonstrate that multifocal MRI-directed intraprostatic SBRT SIB yields no acute high-grade toxicity and is not associated with a higher risk of low-grade GU and GI toxicity relative to unifocal boost. Longer follow is necessary to determine risk of late toxicity and oncologic efficacy.
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Affiliation(s)
- J C Hurwitz
- Department of Radiation Oncology, New York University Long Island School of Medicine, Mineola, NY
| | - V Santos
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
| | - M Akerman
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY
| | - C Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
| | - A Sanchez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
| | - A Corcoran
- Department of Urology, New York University Langone Hospital - Long Island, Mineola, NY
| | - A Katz
- Department of Urology, New York University Langone Hospital - Long Island, Mineola, NY
| | - H Lepor
- NYU Langone Medical Center, Manhattan, NY
| | - S Taneja
- Department of Urology, Perlmutter Cancer Center at New York University Grossman School of Medicine, New York, NY
| | - T J Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
| | - A J Evans
- Department of Radiation Oncology, NYU Langone Health and Perlmutter Cancer Center, New York, NY
| | | | - J A Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
| | - J W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, Mineola, NY
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Tan VS, Correa RJM, Warner A, Ali M, Muacevic A, Ponsky L, Ellis RJ, Lo SS, Onishi H, Swaminath A, Kwon YS, Morgan SC, Cury F, Teh BS, Mahadevan A, Kaplan ID, Chu W, Hannan R, Staehler M, Grubb W, Louie AV, Siva S. 5-Year Renal Function Outcomes after SABR for Primary Renal Cell Carcinoma: A Report from the International Radiosurgery Oncology Consortium of the Kidney (IROCK). Int J Radiat Oncol Biol Phys 2023; 117:S84. [PMID: 37784588 DOI: 10.1016/j.ijrobp.2023.06.405] [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) Renal cell carcinoma (RCC) presents uncommonly in patients with a congenital solitary kidney or prior contralateral nephrectomy. The objective of this study was to compare renal function outcomes of stereotactic ablative body radiotherapy (SABR) in patients with solitary vs. bilateral kidneys. MATERIALS/METHODS Patients with primary RCC with ≥2 years of follow-up at 12 participating International Radiosurgery Consortium for Kidney (IROCK) institutions were included. Patients with upper tract urothelial carcinoma or metastatic disease were excluded. Renal function was measured by estimated glomerular filtration rate (eGFR). For patients where eGFR was not recorded, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate eGFR based on known creatinine. Baseline characteristics and renal function outcomes were compared between solitary vs. bilateral kidneys. Multivariable logistic regression was used to identify factors predictive of eGFR decline ≥ 15 mL/min and any eGFR increase evaluated at 1-year post-SABR. RESULTS One hundred and ninety patients with solitary (n = 56) or bilateral kidneys (n = 134) underwent SABR and were followed for a median of 5.0 years (IQR: 3.4-6.8). Pre-SABR eGFR (mean ± SD) was similar in patients with solitary (61.1 ± 23.2 mL/min) vs. bilateral kidneys (58.0 ± 22.3 mL/min, p = 0.324). Mean tumor size was 3.70 ± 1.40 cm in solitary and 4.35 ± 2.50 cm in bilateral kidneys (p = 0.026). After SABR, an initial compensatory increase in eGFR was observed in both cohorts (22.7% solitary and 17.7% bilateral at 1 year). This compensatory increase persisted in patients with bilateral but not a solitary kidney (10.3% vs. 0% at 3-years and 21.1% vs. 0% at 5-years, respectively). At 5-years post-SABR, eGFR decreased by -14.5 ± 7.6 in solitary and -13.3 ± 15.9 mL/min in bilateral kidneys (p = 0.665). At all timepoints assessed, there were no significant differences in eGFR decline between solitary vs. bilateral cohorts (all p > 0.05). There were also no significant differences in post-SABR end-stage renal disease (7.1% vs. 6.7%) or dialysis (3.6% vs. 3.7%) in solitary vs. bilateral, respectively. Multivariable analysis demonstrated that increasing tumor size (OR per 1 cm: 1.57; 95% CI: 1.14-2.16, p = 0.006) and baseline eGFR (OR per 10 mL/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) was more likely to be associated with eGFR decline ≥ 15 mL/min. There was no significant association between solitary vs. bilateral kidney and eGFR decline (OR: 1.22; 95% CI: 0.45-3.34, p = 0.693). CONCLUSION There was no observed difference between renal function outcomes in patients with a solitary vs. bilateral kidneys. While larger tumor size may increase the risk of eGFR decline post-SABR, treatment of a solitary kidney does not appear to increase the risk of renal dysfunction long-term.
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Affiliation(s)
- V S Tan
- London Regional Cancer Program, London, ON, Canada
| | - R J M Correa
- London Regional Cancer Program, London, ON, Canada
| | - A Warner
- London Regional Cancer Program, London, ON, Canada
| | - M Ali
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - A Muacevic
- University of Munich Hospitals, Munich, Germany
| | - L Ponsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - S S Lo
- University of Washington School of Medicine, Seattle, WA
| | - H Onishi
- University of Yamanashi, Chuo, Japan
| | - A Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Y S Kwon
- University of Texas Southwestern Medical Center, Dallas, TX
| | - S C Morgan
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - F Cury
- McGill University Health Centre, Montreal, QC, Canada
| | - B S Teh
- Houston Methodist Hospital, Houston, TX
| | - A Mahadevan
- NYU Langone Health Laura and Isaac Perlmutter Cancer Center, New York, NY
| | - I D Kaplan
- Beth Israel Deaconess Medical Center, Boston, MA
| | - W Chu
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R Hannan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - M Staehler
- University of Munich Hospitals, Munich, Germany
| | - W Grubb
- Augusta University, Augusta, GA
| | - A V Louie
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Jha S, Hema AV, Padmanabha H, Mahadevan A, Mailankody P, Mathuranath PS, Mahale RR. ANCA-associated Vasculitic Neuropathy Following Anti-SARS-CoV-2 Vaccination: An Epiphenomenon or Causal Association? Ann Indian Acad Neurol 2023; 26:187-189. [PMID: 37179680 PMCID: PMC10171003 DOI: 10.4103/aian.aian_848_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023] Open
Affiliation(s)
- Shreyashi Jha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - A. V. Hema
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - P. S. Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rohan R. Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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John DV, Aryalakshmi B, Deora H, Purushottam M, Raju R, Mahadevan A, Rao MB, Patil SA. Identification of microbial agents in culture-negative brain abscess samples by 16S/18S rRNA gene PCR and sequencing. Trop Biomed 2022; 39:489-498. [PMID: 36602206 DOI: 10.47665/tb.39.4.002] [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: 12/30/2022]
Abstract
Despite clinical suspicion of an infection, brain abscess samples are often culture-negative in routine microbiological testing. Direct PCR of such samples enables the identification of microbes that may be fastidious, non-viable, or unculturable. Brain abscess samples (n = 217) from neurosurgical patients were subjected to broad range 16S rRNA gene PCR and sequencing for bacteria. All these samples and seven formalin-fixed paraffin-embedded tissue (FFPE) samples were subjected to species-specific 18S rRNA PCR for neurotropic free-living amoeba that harbour pathogenic bacteria. The concordance between smear and/or culture and PCR was 69%. One-third of the samples were smear- and culture-negative for bacterial agents. However, 88% of these culture-negative samples showed the presence of bacterial 16S rRNA by PCR. Sanger sequencing of 27 selected samples showed anaerobic/fastidious gram negative bacteria (GNB, 38%), facultative Streptococci (35%), and aerobic GNB (27%). Targeted metagenomics sequencing of three samples showed multiple bacterial species, including anaerobic and non-culturable bacteria. One FFPE tissue revealed the presence of Acanthamoeba 18S rRNA. None of the frozen brain abscess samples tested was positive for 18S rRNA of Acanthamoeba or Balamuthia mandrillaris. The microbial 16/18S rRNA PCR and sequencing outperformed culture in detecting anaerobes, facultative Streptococci and FLA in brain abscess samples. Genetic analyses of 16S/18S sequences, either through Sanger or metagenomic sequencing, will be an essential diagnostic technology to be included for diagnosing culture-negative brain abscess samples. Characterizing the microbiome of culture-negative brain abscess samples by molecular methods could enable detection and/or treatment of the source of infection.
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Affiliation(s)
- D V John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B Aryalakshmi
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - H Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M Purushottam
- Molecular Genetics Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - R Raju
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M B Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S A Patil
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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LeCompte M, Chen X, Tseng C, Campbell M, Balagamwala E, Hanan J, Byun D, Silverman J, Foote M, Gatt N, Mahadevan A, Grimm J, Redmond K. Impact of Dosimetric Factors on Local Failure in Patients with Spine Metastasis after Stereotactic Body Radiotherapy: A Multi-Institutional Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.869] [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: 10/31/2022]
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Vasudevan RS, Nedjat-Haiem MA, Mahadevan A, Herbert MS, Lander L, Warsi T, Shaikh U, Harding C, Savoia MC. Assessing Changes in Stethoscope Hygiene During COVID-19: A Multicentre Cross-Sectional Study. J Hosp Infect 2022; 127:1-6. [PMID: 35671861 PMCID: PMC9167726 DOI: 10.1016/j.jhin.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Background The COVID-19 (SARS-CoV-2) pandemic has increased infection control vigilance across several modes of patient contact. However, it is unknown whether hygiene pertaining to stethoscopes, which carry the potential for pathogenic contamination, has also shifted accordingly. Aim To characterize pandemic-related changes in stethoscope hygiene. Methods We surveyed healthcare providers at three major medical centres. Questions quantitatively (Likert scale and frequency) assessed stethoscope hygiene beliefs and practices with two components: before and during COVID-19. Participants were grouped based on performance of optimal stethoscope hygiene (after every patient) before and during COVID-19. Groups were compared using χ2 and analysis of variance (ANOVA). Findings Of the 515 (10%) who completed the survey, 55 were excluded (N = 460). Optimal hygiene increased from 27.4% to 55.0% (P < 0.001). There were significant increases in Likert scores for all questions pertaining to knowledge of stethoscope contamination (P < 0.001). Belief in stethoscope contamination increased (P < 0.001) despite no change in perceived hygiene education. Resident physicians were less likely compared with attending physicians and nurses to have adopted optimal hygiene during COVID-19 (P < 0.001). Conclusion Despite a positive shift in stethoscope hygiene during COVID-19, optimal hygiene was still only performed by around half of providers. Educational interventions, particularly targeting early-career providers, are encouraged.
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Affiliation(s)
- R S Vasudevan
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.
| | - M A Nedjat-Haiem
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - A Mahadevan
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M S Herbert
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - L Lander
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - T Warsi
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - U Shaikh
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - C Harding
- University of California Irvine School of Medicine, Irvine, CA, USA
| | - M C Savoia
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA
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Raju R, Khurana S, Mahadevan A, John DV. Central nervous system infections caused by pathogenic free-living amoebae: An Indian perspective. Trop Biomed 2022; 39:265-280. [PMID: 35838101 DOI: 10.47665/tb.39.2.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pathogenic free-living amoebae (FLA), namely Acanthamoeba sp., Naegleria fowleri and Balamuthia mandrillaris are distributed worldwide. These neurotropic amoebae can cause fatal central nervous system (CNS) infections in humans. This review deals with the demographic characteristics, symptoms, diagnosis, and treatment outcomes of patients with CNS infections caused by FLA documented in India. There have been 42, 25, and 4 case reports of Acanthamoeba granulomatous amoebic encephalitis (GAE), N. fowleri primary amoebic meningoencephalitis (PAM), and B. mandrillaris meningoencephalitis (BAE), respectively. Overall, 17% of Acanthamoeba GAE patients and one of the four BAE patients had some form of immunosuppression, and more than half of the N. fowleri PAM cases had history of exposure to freshwater. Acanthamoeba GAE, PAM, and BAE were most commonly seen in males. Fever, headache, vomiting, seizures, and altered sensorium appear to be common symptoms in these patients. Some patients showed multiple lesions with edema, exudates or hydrocephalus in their brain CT/MRI. The cerebrospinal fluid (CSF) of these patients showed elevated protein and WBC levels. Direct microscopy of CSF was positive for amoebic trophozoites in 69% of Acanthamoeba GAE and 96% of PAM patients. One-fourth of the Acanthamoeba GAE and all the BAE patients were diagnosed only by histopathology following autopsy/biopsy samples. Twenty-one Acanthamoeba GAE survivors were treated with cotrimoxazole, rifampicin, and ketoconazole/amphotericin B, and all eleven PAM survivors were treated with amphotericin B alongside other drugs. A thorough search for these organisms in CNS samples is necessary to develop optimum treatment strategies.
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Affiliation(s)
- R Raju
- KIDWAI Memorial Institute of Oncology Research & Training Centre, Bangalore, India
| | - S Khurana
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - D V John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Ajmal Ahamed S, Mohamed Riyaz S, Mahadevan A, Mohamed Hathim J, Bakrutheen M, Willjuice Iruthayarajan M. Impact of Moisture on AC Breakdown Voltage of Crude, Refined and Transesterified Groundnut Oil-based Liquid Insulations. Arab J Sci Eng 2021. [DOI: 10.1007/s13369-021-05543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Mahale R, Farsana MK, Mahadevan A, Mukherjee J, Lakshmi V, Sandeep M, Padmanabha H, Mailankody P, Pavagada M. Stroke-like episodes with cerebellar ataxia as presenting manifestation of adult-onset anti-N-methyl D-aspartate receptor encephalitis: an unusual presentation. Acta Neurol Belg 2021; 121:1093-1095. [PMID: 34216377 DOI: 10.1007/s13760-021-01735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | | | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Joydeep Mukherjee
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Vathsala Lakshmi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - M Sandeep
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Mathuranath Pavagada
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
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15
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Ashok VR, Nagabushana D, Yashwanth G, Mahadevan A, Netravathi M. A Rare Case of Wobbly, Psychotic Patient with Frozen Eyes - Anti-AMPA Receptor Encephalitis. Neurol India 2021; 69:149-152. [PMID: 33642288 DOI: 10.4103/0028-3886.310087] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Anti α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis is a rare autoimmune encephalitis. They present with memory, confusion or behavioral changes. Objective The aim of this study was to describe unusual clinical features in a patient with AMPAR-associated encephalitis. Case A 42-year-old female presented to us with bulbar and gait disturbances of three weeks duration and behavioral changes for ten days. She was found to have memory impairment along with psychosis. She had left eye ptosis, restricted eye movements, sluggish deep tendon reflexes, and bilateral cerebellar signs. Her serum and CSF (cerebrospinal fluid) AMPAR2 antibodies were strongly positive; CT (computed tomography) chest showed evidence of Thymoma. She was treated with steroids with significant improvement initially but expired within 3 months of diagnosis. Conclusion This is the first report of AMPAR associated encephalitis from India presenting with unique clinical features affecting both the CNS (central nervous system)--(psychosis, ataxia, cognition) and PNS--peripheral nervous system involvement (ptosis, restricted eye movements, bulbar disturbances).
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Affiliation(s)
- V R Ashok
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - D Nagabushana
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - G Yashwanth
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - A Mahadevan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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16
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Alite F, Shaikh M, Greenberg M, Christie D, Rostock R, Malik U, Mahadevan A. Influence of Dexamethasone Premedication on Acute Lung Toxicity in Lung SBRT. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1811] [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: 11/26/2022]
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17
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Saini J, Kumar Gupta P, Awasthi A, Pandey C, Singh A, Patir R, Ahlawat S, Sadashiva N, Mahadevan A, Kumar Gupta R. Multiparametric imaging-based differentiation of lymphoma and glioblastoma: using T1-perfusion, diffusion, and susceptibility-weighted MRI. Clin Radiol 2018; 73:986.e7-986.e15. [DOI: 10.1016/j.crad.2018.07.107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/31/2018] [Indexed: 01/19/2023]
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18
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Correa R, Siva S, Staehler M, Warner A, Gandhidasan S, Ponsky L, Ellis R, Kaplan I, Mahadevan A, Chu W, Swaminath A, Onishi H, Teh B, Lo S, Muacevic A, Louie A. Renal SABR in Patients with a Solitary Kidney: An Individual-Patient Pooled Analysis from the International Radiosurgery Oncology Consortium for Kidney (IROCK). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.275] [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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19
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Abstract
Introduction Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.
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Affiliation(s)
| | - Venkata Raviteja Karru
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M A Mukheem Mudabbir
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subashree Ramakrishnan
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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20
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Thotakura AK, Patibandla MR, Panigrahi MK, Mahadevan A. Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie 2017; 63:453-457. [PMID: 29122303 DOI: 10.1016/j.neuchi.2017.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/11/2017] [Revised: 06/09/2017] [Accepted: 06/25/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine if the consistency of pituitary adenomas can be predicted based on a preoperative MRI study and to assess the surgical outcome of firm pituitary adenomas. MATERIALS AND METHODS One hundred consecutive patients with pituitary adenomas and suprasellar extension were operated by a transsphenoidal approach from July 2003 to December 2006. In addition to the neurological examination, the patients were evaluated by ophthalmological, endocrinological and radiological workups. The signal intensity of the lesion on T2WI and other dimensions of the tumors were included in the MRI study. RESULTS There were 52 male and 48 female patients with a mean age of 42.47 years. The mean diameter of the tumor was 32.97mm and the mean SSE was 14.95mm. Six out of 100 patients had firm adenomas peroperatively. Only one of the six patients had isointense SI on T2 WI. Of these 6 patients, total excision was performed in 1 patient, subtotal in 3 patients and partial excision in 2 patients. Among the six patients with firm adenomas, 4 had preoperative hypopituitarism (P<0.001). There was a statistically significant correlation between consistency and the postoperative permanent hypopituitarism (P<0.001). The average follow up was 43.5 months. The literature is reviewed and various aspects of pituitary adenoma consistency are discussed. CONCLUSIONS With the present study, the consistency of pituitary adenomas cannot be reliably predicted based on a preoperative MRI study. Patients with firm adenomas likely to have more incidence of preoperative hypopituitarism and postoperative permanent hypopituitarism.
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Affiliation(s)
- A K Thotakura
- Department of neurosurgery, NRI academy of sciences, Chinakakani, 522503 Guntur, Andhra Pradesh, India.
| | - M R Patibandla
- Department of neurosurgery, university of Virginia, Charlottesville, VA, USA
| | - M K Panigrahi
- Department of neurosurgery, Krishna institute of medical sciences, Secunderabad, India
| | - A Mahadevan
- Department of neuropathology, NIMHANS, Bangalore, Karnataka, India
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21
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Siva S, Muacevic A, Staehler M, Warner A, Gandhidasan S, Ponsky L, Ellis R, Kaplan I, Mahadevan A, Chu W, Onishi H, Lo S, Teh B, Swaminath A, Correa R, Louie A. Individual Patient Data Meta-analysis of SBRT Kidney: A Report From the International Radiosurgery Oncology Consortium for Kidney (IROCK). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Lahiri Mukhopadhyay S, Mahadevan A, Bahubali VH, Dawn Bharath R, Prabhuraj AR, Maji S, Siddaiah N. A rare case of multiple brain abscess and probably disseminated phaeohyphomycosis due to Cladophialophora bantiana in an immunosuppressed individual from India. J Mycol Med 2017; 27:391-395. [PMID: 28478966 DOI: 10.1016/j.mycmed.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/01/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
Cladophialophora bantiana, a dematiaceous neurotropic mold causes rare and lethal brain abscess, commonly in immunocompetent hosts. We report a rare and probably a case of disseminated infection with this black mold in an immunosuppressed individual from India. A 55-year-old diabetic male presented with severe headache, blurred-vision, behavioural abnormalities, eye-pain and ear-discharge. He was undergoing treatment for hypertension, prostatomegaly and obstructive pulmonary disease. He was on steroids for the past six years for uveitis. Haematology reports indicated elevated WBC and platelet count. He was negative for HIV, hepatitis, autoimmune antibodies and tumour markers. CD4 count was within normal limits. Brain magnetic resonance imaging revealed multiple ring-enhancing lesions and oedema in the left tempero-parietal region. Chest X-ray showed irregular consolidations in right paracardiac region and confluence in both lungs. Positron Emission Tomography of whole body revealed multiple lesions in brain, lungs, lymph nodes and C3-vertebrae. Histopathology of the lung lesion showed non-tuberculous infectious pathology and brain lesions showed necrosis with occurrence of pigmented hyphal fungi. The pus aspirated during surgical excision of brain lesions grew black mold, identified as C. bantiana. Although patient was started on intravenous Voriconazole, he succumbed to the infection after 7 days. The lesion was initially suspected to be of tuberculous etiology, and the lesions in lungs were also suggestive of malignancy, which was however ruled out by histopathological examination. Such diagnostic dilemmas are common in the infection caused by Cladophialophora, which can cause treatment delay and death. Early diagnosis is therefore mandatory for the rapid treatment and survival of patients.
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Affiliation(s)
- S Lahiri Mukhopadhyay
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - A Mahadevan
- Department of neuropathology, NIMHANS, Bangalore, India
| | - V H Bahubali
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - R Dawn Bharath
- Department of neuroimaging & interventional radiology, NIMHANS, Bangalore, India
| | - A R Prabhuraj
- Department of neurosurgery, NIMHANS, Bangalore, India
| | - S Maji
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India
| | - N Siddaiah
- Department of neuromicrobiology, National institute of mental health and neuro sciences (NIMHANS), Bangalore, India.
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Garcia-Molina G, Baehr K, Steele B, Tsoneva T, Pfundtner S, Mahadevan A, Papas N, Riedner B, Tononi G, White D. 0285 CHARACTERIZATION OF SLEEP NEED DISSIPATION USING EEG BASED SLOW-WAVE ACTIVITY ANALYSIS IN TWO AGE GROUPS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Long BL, Li H, Mahadevan A, Tang T, Balotin K, Grandel N, Soto J, Wong SY, Abrego A, Li S, Qutub AA. GAIN: A graphical method to automatically analyze individual neurite outgrowth. J Neurosci Methods 2017; 283:62-71. [PMID: 28336360 DOI: 10.1016/j.jneumeth.2017.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/13/2017] [Revised: 03/18/2017] [Accepted: 03/18/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neurite outgrowth is a metric widely used to assess the success of in vitro neural stem cell differentiation or neuron reprogramming protocols and to evaluate high-content screening assays for neural regenerative drug discovery. However, neurite measurements are tedious to perform manually, and there is a paucity of freely available, fully automated software to determine neurite measurements and neuron counting. To provide such a tool to the neurobiology, stem cell, cell engineering, and neuroregenerative communities, we developed an algorithm for performing high-throughput neurite analysis in immunofluorescent images. NEW METHOD Given an input of paired neuronal nuclear and cytoskeletal microscopy images, the GAIN algorithm calculates neurite length statistics linked to individual cells or clusters of cells. It also provides an estimate of the number of nuclei in clusters of overlapping cells, thereby increasing the accuracy of neurite length statistics for higher confluency cultures. GAIN combines image processing for neuronal cell bodies and neurites with an algorithm for resolving neurite junctions. RESULTS GAIN produces a table of neurite lengths from cell body to neurite tip per cell cluster in an image along with a count of cells per cluster. COMPARISON WITH EXISTING METHODS GAIN's performance compares favorably with the popular ImageJ plugin NeuriteTracer for counting neurons, and provides the added benefit of assigning neurites to their respective cell bodies. CONCLUSIONS In summary, GAIN provides a new tool to improve the robust assessment of neural cells by image-based analysis.
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Affiliation(s)
- B L Long
- Department of Bioengineering, Rice University, Houston, TX 77030 USA.
| | - H Li
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - A Mahadevan
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - T Tang
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - K Balotin
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - N Grandel
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - J Soto
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - S Y Wong
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - A Abrego
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
| | - S Li
- Department of Bioengineering, University of California, Los Angeles, CA 90095 USA
| | - A A Qutub
- Department of Bioengineering, Rice University, Houston, TX 77030 USA
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25
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Benachinmardi KK, Rajalakshmi P, Veenakumari HB, Bharath RD, Vikas V, Mahadevan A, Nagarathna S. Successful treatment of primary cerebral mucormycosis: Role of microbiologist. Indian J Med Microbiol 2016; 34:550-553. [PMID: 27934843 DOI: 10.4103/0255-0857.195373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fungal brain abscess is rare with a rapidly progressive disease with fulminant course and invariably fatal outcome, unless diagnosed early and treated rapidly. We report a 56-year-old woman diagnosed to have fungal abscess who recovered completely following amphotericin B treatment. She presented with weakness of the right hand, deviation of mouth to left and aphasia for 2 days. Computed tomography of the brain revealed a left frontal capsuloganglionic hypodense lesion. Stereotactic biopsy was performed, and microbiological confirmation of non-septate fungal hyphae from pus from aspirate within 2 h helped initiate timely and appropriate treatment leading to cure. Histopathology and culture later confirmed mucormycosis.
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Affiliation(s)
- K K Benachinmardi
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - P Rajalakshmi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - H B Veenakumari
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R D Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V Vikas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - S Nagarathna
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Affiliation(s)
- D P Misra
- From the Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - K G Chengappa
- From the Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - V K Jain
- From the Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - V S Negi
- From the Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
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27
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Kovtun K, Moser J, Callery M, Kent T, Tseng J, Miksad R, Bullock A, Schlechter B, Mahadevan A. Neoadjuvant Therapy for Borderline Resectable and Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1090] [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]
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Griffith OL, Griffith M, Krysiak K, Magrini V, Ramu A, Skidmore ZL, Kunisaki J, Austin R, McGrath S, Zhang J, Demeter R, Graves T, Eldred JM, Walker J, Larson DE, Maher CA, Lin Y, Chapman W, Mahadevan A, Miksad R, Nasser I, Hanto DW, Mardis ER. A genomic case study of mixed fibrolamellar hepatocellular carcinoma. Ann Oncol 2016; 27:1148-1154. [PMID: 27029710 PMCID: PMC4880064 DOI: 10.1093/annonc/mdw135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 01/05/2015] [Accepted: 03/07/2016] [Indexed: 12/28/2022] Open
Abstract
We report the first comprehensive genomic analysis of a case of mixed conventional and fibrolamellar HCC (mFL-HCC). This study confirms the expression of DNAJB1:PRKACA, a fusion previously associated with pure FL-HCC but not conventional HCC, in mFL-HCC. These results indicate the DNAJB1:PRKACA fusion has diagnostic utility for both pure and mixed FL-HCC. Background Mixed fibrolamellar hepatocellular carcinoma (mFL-HCC) is a rare liver tumor defined by the presence of both pure FL-HCC and conventional HCC components, represents up to 25% of cases of FL-HCC, and has been associated with worse prognosis. Recent genomic characterization of pure FL-HCC identified a highly recurrent transcript fusion (DNAJB1:PRKACA) not found in conventional HCC. Patients and Methods We performed exome and transcriptome sequencing of a case of mFL-HCC. A novel BAC-capture approach was developed to identify a 400 kb deletion as the underlying genomic mechanism for a DNAJB1:PRKACA fusion in this case. A sensitive Nanostring Elements assay was used to screen for this transcript fusion in a second case of mFL-HCC, 112 additional HCC samples and 44 adjacent non-tumor liver samples. Results We report the first comprehensive genomic analysis of a case of mFL-HCC. No common HCC-associated mutations were identified. The very low mutation rate of this case, large number of mostly single-copy, long-range copy number variants, and high expression of ERBB2 were more consistent with previous reports of pure FL-HCC than conventional HCC. In particular, the DNAJB1:PRKACA fusion transcript specifically associated with pure FL-HCC was detected at very high expression levels. Subsequent analysis revealed the presence of this fusion in all primary and metastatic samples, including those with mixed or conventional HCC pathology. A second case of mFL-HCC confirmed our finding that the fusion was detectable in conventional components. An expanded screen identified a third case of fusion-positive HCC, which upon review, also had both conventional and fibrolamellar features. This screen confirmed the absence of the fusion in all conventional HCC and adjacent non-tumor liver samples. Conclusion These results indicate that mFL-HCC is similar to pure FL-HCC at the genomic level and the DNAJB1:PRKACA fusion can be used as a diagnostic tool for both pure and mFL-HCC.
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Affiliation(s)
- O L Griffith
- McDonnell Genome Institute; Department of Medicine; Siteman Cancer Center; Department of Genetics.
| | - M Griffith
- McDonnell Genome Institute; Siteman Cancer Center; Department of Genetics
| | | | - V Magrini
- McDonnell Genome Institute; Department of Genetics
| | - A Ramu
- McDonnell Genome Institute
| | | | | | | | | | | | | | | | | | | | - D E Larson
- McDonnell Genome Institute; Department of Genetics
| | - C A Maher
- McDonnell Genome Institute; Department of Medicine; Siteman Cancer Center
| | - Y Lin
- Department of Surgery, Washington University School of Medicine, St Louis
| | - W Chapman
- Department of Surgery, Washington University School of Medicine, St Louis
| | | | | | - I Nasser
- Pathology, Harvard Medical School, Boston
| | - D W Hanto
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, USA
| | - E R Mardis
- McDonnell Genome Institute; Department of Medicine; Siteman Cancer Center; Department of Genetics
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Das B, Goyal MK, Bhatkar SR, Vinny PW, Modi M, Lal V, Gayathri N, Mahadevan A, Radotra BD. Hereditary inclusion body myopathy: A myopathy with unique topography of weakness, yet frequently misdiagnosed: Case series and review of literature. Ann Indian Acad Neurol 2016; 19:119-22. [PMID: 27011643 PMCID: PMC4782528 DOI: 10.4103/0972-2327.167709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 02/02/2023] Open
Abstract
Background: Hereditary inclusion body myopathy (HIBM) continues to be underrecognized clinically despite a characteristic topography of weakness with total sparing of quadriceps muscles and patient being wheelchair bound. We report seven patients of HIBM from four families in North India. Methods and Results: Seven patients from four different families were diagnosed to have HIBM. There was no consanguinity in any of the families. While one patient had two affected siblings, another had one affected siblings and the family history was noncontributory in two patients. Two of the siblings were available for examination and confirmed clinically to be suffering from HIBM. Among the seven patients, only one was still ambulatory at the time of diagnosis. Discussion: This is the first case report of occurrence of HIBM in North Indian population. Despite its unique clinical presentation, HIBM is frequently misdiagnosed resulting in unnecessary diagnostic and therapeutic interventions. A high index of suspicion of this rare myopathy along with proper clinical examination may go a long way in accurate prognostication and management of these patients.
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Affiliation(s)
- Biplab Das
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanat Ramchandra Bhatkar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulikottil Wilson Vinny
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N Gayathri
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Bishan Dass Radotra
- Department of Hisopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pradeep K, Sinha S, Mahadevan A, Saini J, Arivazhagan A, Bharath R, Bindu P, Jamuna R, Rao M, Govekar S, Ravikumar B, Chandramouli B, Satishchandra P. Clinical, electrophysiological, imaging, pathological and therapeutic observations among 18 patients with Rasmussen’s encephalitis. J Clin Neurosci 2016; 25:96-104. [DOI: 10.1016/j.jocn.2015.05.062] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 11/28/2022]
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Lai G, Mahadevan A, Hackney D, Warnke PC, Nigim F, Kasper E, Wong ET, Carter BS, Chen CC. Diagnostic Accuracy of PET, SPECT, and Arterial Spin-Labeling in Differentiating Tumor Recurrence from Necrosis in Cerebral Metastasis after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2015; 36:2250-5. [PMID: 26427832 DOI: 10.3174/ajnr.a4475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic assessment of cerebral metastasis after stereotactic radiosurgery remains a major challenge in neuro-oncology. It is often difficult to distinguish tumor progression from radiation necrosis in this setting using conventional MR imaging. The objective of this study was to compare the diagnostic sensitivity and specificity of different functional imaging modalities for detecting tumor recurrence after stereotactic radiosurgery. MATERIALS AND METHODS We retrospectively reviewed patients treated between 2007 and 2010 and identified 14 patients with cerebral metastasis who had clinical or radiographic progression following stereotactic radiosurgery and were imaged with arterial spin-labeling, FDG-PET, and thallium SPECT before stereotactic biopsy. Diagnostic accuracy, specificity, sensitivity, positive predictive value, and negative predictive value were calculated for each imaging technique by using the pathologic diagnosis as the criterion standard. RESULTS Six patients (42%) had tumor progression, while 8 (58%) developed radiation necrosis. FDG-PET and arterial spin-labeling were equally sensitive in detecting tumor progression (83%). However, the specificity of arterial spin-labeling was superior to that of the other modalities (100%, 75%, and 50%, respectively). A combination of modalities did not augment the sensitivity, specificity, positive predictive value, or negative predictive value of arterial spin-labeling. CONCLUSIONS In our series, arterial spin-labeling positivity was closely associated with the pathologic diagnosis of tumor progression after stereotactic radiosurgery. Validation of this finding in a large series is warranted.
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Affiliation(s)
- G Lai
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | | | | | - P C Warnke
- Division of Neurosurgery (P.C.W.), University of Chicago, Chicago, Illinois
| | - F Nigim
- Division of Neurosurgery (F.N., E.K.)
| | - E Kasper
- Division of Neurosurgery (F.N., E.K.)
| | - E T Wong
- Department of Neurology (E.T.W.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - B S Carter
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | - C C Chen
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
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Siva S, Ellis R, Ponsky L, Teh B, Mahadevan A, Muacevic A, Onishi H, Wersall P, Nomiya T, Lo S. A Multinational Report on Technical Factors of Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dagoglu R, Catalano P, Mahadevan A, Martin N, Hong T, Wo J, Nedea E, Kimmelman A, Mamon H. Lymph Node Retrieval Following Neoadjuvant Therapy in Patients With Rectal Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.987] [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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34
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Lo S, Ellis R, Ponsky L, Teh B, Mahadevan A, Muacevic A, Onishi H, Wersall P, Nomiya T, Siva S. A Multinational Report on Factors of Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma: Patient Selection and Follow-up. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1076] [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: 11/17/2022]
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Sengupta S, Rojas R, Mahadevan A, Kasper E, Jeyapalan S. CPT-11/bevacizumab for the treatment of refractory brain metastases in patients with HER2-neu-positive breast cancer. Oxf Med Case Reports 2015; 2015:254-7. [PMID: 26634139 PMCID: PMC4664841 DOI: 10.1093/omcr/omv010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 11/14/2022] Open
Abstract
Nervous system relapse of patients with advanced HER2-neu-positive breast cancer is an increasing problem, with one-third of women developing brain metastases. Standard therapies using steroids, surgery and radiotherapy do not provide a lasting response. We evaluated CPT-11 and bevacizumab, which can both cross the blood-brain barrier, as combination therapy to treat HER2-neu-positive breast cancer with brain metastases.
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Affiliation(s)
- S Sengupta
- Department of Neurology , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - R Rojas
- Department of Neuroradiology , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - A Mahadevan
- Department of Radiation Oncology , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - E Kasper
- Department of Neurosurgery , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - S Jeyapalan
- Department of Neurology, Tuft Medical School, Tufts Medical Center, Boston, MA
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Sathishkumar M, Pavagadhi S, Mahadevan A, Balasubramanian R. Biosynthesis of gold nanoparticles and related cytotoxicity evaluation using A549 cells. Ecotoxicol Environ Saf 2015; 114:232-240. [PMID: 24835429 DOI: 10.1016/j.ecoenv.2014.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/20/2013] [Revised: 03/16/2014] [Accepted: 03/18/2014] [Indexed: 06/03/2023]
Abstract
Biosynthesis of gold nanoparticles (AuNPs) has become an attractive area of research as it is environmentally benign. The toxicity of AuNPs synthesized by chemical routes has been widely studied. However, little is known about the toxicity associated with the biological synthesis of AuNPs. The present study was carried out to synthesize AuNPs using star anise (Illicium verum; a commercially available spice in abundance)and evaluate its toxicity using human epithelial lung cells (A549) in comparison with AuNPs synthesized by the traditional chemical methods (using sodium citrate and sodium borohydride). Apart from cell viability, markers of oxidative stress (reduced glutathione) and cell death (caspases) were also evaluated to understand the mechanisms of toxicity. Cell viability was observed to be 65.7 percent and 72.3 percent in cells exposed to chemically synthesized AuNPs at the highest dose (200nM) as compared to 80.2 percent for biologically synthesized AuNPs. Protective coating/capping of AuNPs by various polyphenolic compounds present in star anise extract appears to be a major contributor to lower toxicity observed in biologically synthesized AuNPs.
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Affiliation(s)
- M Sathishkumar
- Singapore-Delft Water Alliance, National University of Singapore, Singapore
| | - S Pavagadhi
- Singapore-Delft Water Alliance, National University of Singapore, Singapore; Department of Civil and Environmental Engineering, National University of Singapore
| | - A Mahadevan
- Singapore-Delft Water Alliance, National University of Singapore, Singapore; Department of Civil and Environmental Engineering, National University of Singapore
| | - R Balasubramanian
- Singapore-Delft Water Alliance, National University of Singapore, Singapore; Department of Civil and Environmental Engineering, National University of Singapore.
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Netravathi M, Kamble N, Saini J, Mahadevan A, Yadav R, Nalini A, Pal PK, Satishchandra P. Clinical and imaging characteristics of 16 patients with autoimmune neuronal synaptic encephalitis. Neurol India 2015; 63:687-96. [DOI: 10.4103/0028-3886.166532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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Ippen FM, Pfannl R, Rojas R, Mahadevan A, Kasper E. ED-09 * TANCYTIC EPENDYMOMA: PRESENTATION OF A RARE CYSTIC DISEASE VARIANT AND REVIEW OF LITERATURE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou253.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nagappa M, Netravathi M, Taly A, Sinha S, Bindu P, Mahadevan A. Long-term efficacy and limitations of cyclophosphamide in myasthenia gravis. J Clin Neurosci 2014; 21:1909-14. [DOI: 10.1016/j.jocn.2014.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/01/2014] [Accepted: 03/05/2014] [Indexed: 12/29/2022]
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Pradeep K, Sinha S, Saini J, Mahadevan A, Arivazhagan A, Bharath RD, Bindu PS, Jamuna R, Rao MB, Chandramouli BA, Shankar SK, Satishchandra P. Evolution of MRI changes in Rasmussen's encephalitis. Acta Neurol Scand 2014; 130:253-9. [PMID: 24341778 DOI: 10.1111/ane.12212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We studied the MRI findings in 16 patients with Rasmussen's encephalitis (RE), further analysed serial MRI changes in 11 of them and correlated it with clinical features. METHODOLOGY The diagnosis of RE was based on the European consensus statement (Brain, 128, 2005, 454). Details related to demographical, clinical, MRI observations were analysed. RESULTS Forty MRIs of brain of 16 patients were reviewed. Eleven patients had undergone serial brain MRIs ranging from two to five occasions. All the patients had unihemispheric focal cortical atrophy, predominantly in the perisylvian region (n = 13). Other features were white matter signal changes (n = 14), and ipsilateral caudate (n = 6) and putamen (n = 4) atrophy. Signal alterations in putamen and caudate were noted in four each. In all the 11 patients with serial MRI, there was progression of cerebral atrophy and a trend towards increase in MRI staging. The MRI signal changes remained same in five patients, resolved in three patients, differential change in two patients and increased in one patient. Diffusion-weighted imaging showed facilitated diffusion (n = 5), and MR spectroscopy showed reduced N-acetyl-aspartate and elevated lactate (n = 2). CONCLUSIONS Pattern recognition of MRI findings and the changes in serial MRI might serve as a surrogate marker of disease viz. unihemispheric progressive focal cortical atrophy and signal changes predominantly in the perisylvian distribution and caudate followed by putamen involvement. This might assist in understanding and monitoring of the disease progression.
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Affiliation(s)
- K. Pradeep
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - S. Sinha
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - J. Saini
- Department of Neuroimaging and Interventional Radiology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - A. Mahadevan
- Department of Neuropathology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - A. Arivazhagan
- Department of Neurosurgery; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - R. D. Bharath
- Department of Neuroimaging and Interventional Radiology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - P. S. Bindu
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - R. Jamuna
- Department of Psychology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - M. B. Rao
- Department of Neurosurgery; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - B. A. Chandramouli
- Department of Neurosurgery; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - S. K. Shankar
- Department of Neuropathology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
| | - P. Satishchandra
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore India
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Walentiny D, Vann R, Mahadevan A, Kottani R, Gujjar R, Wiley J. Novel 3-substituted rimonabant analogues lack Δ(9) -tetrahydrocannabinol-like abuse-related behavioural effects in mice. Br J Pharmacol 2014; 169:10-20. [PMID: 23297801 DOI: 10.1111/bph.12099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/08/2012] [Accepted: 12/16/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous structure-activity relationship studies with analogues of the CB1 receptor antagonist rimonabant have demonstrated that a subset of these analogues with 3-substituent replacements of rimonabant's pyrazole core displayed cannabimimetic profiles seemingly independent of CB1 receptors. We sought to further evaluate these analogues in several behavioural models sensitive to detecting THC-like abuse liability. EXPERIMENTAL APPROACH Selected analogues were tested in a battery of tests in mice to replicate previous findings. Cross-generalization tests were conducted in mice trained to discriminate either THC or O-6629 from vehicle. Rimonabant and its analogues were also evaluated in substitution and challenge tests. Finally, development of cross-tolerance between THC and O-6211 in the mouse test battery was assessed. KEY RESULTS O-6629 and O-6658 produced dose-dependent acute cannabimimetic activity in mice, but neither substituted for nor antagonized THC's discriminative stimulus. Cross-substitution was observed with O-6658 in mice discriminating O-6629, whereas rimonabant neither substituted for nor attenuated the O-6629 discriminative stimulus. THC and morphine did not generate O-6629-like responding. Cross-tolerance did not develop in mice repeatedly treated with THC when tested with O-6211 in the mouse test battery. CONCLUSIONS AND IMPLICATIONS While some overlap exists between the pharmacological profiles of THC and these 3-substituent rimonabant analogues, the effects are mediated by distinct neural targets. Notably, these analogues are unlikely to possess marijuana-like abuse liability in humans, but general abuse liability has not yet been determined. Efforts to determine the mechanism(s) of action of this seemingly unique class of compounds are underway.
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Affiliation(s)
- Dm Walentiny
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298-0613, USA.
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Manoj N, Arivazhagan A, Mahadevan A, Bhat DI, Arvinda HR, Devi BI, Sampath S, Chandramouli BA. Authors reply. Neurol India 2014; 62:343. [PMID: 25181762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Report of a case of young immunocompetent male adult with autopsy proven acanthamoeba meningoencephalitis. The patient presented with a protracted febrile illness of 3 months duration with features of meningoencephalitis, this was followed by rapid deterioration while on anti tuberculous therapy and steroids and ended fatally. His magnetic resonance imaging showed features of hemorrhagic meningoencephalitis and magnetic resonance spectroscopy showed choline peak. Autopsy revealed necrotizing meningoencephalitis and intraocular colonization due to acanthamoeba.
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Affiliation(s)
- S R Chandra
- Professor of Neurology, Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sikandar Adwani
- Senior Resident Neurology, Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Anitha Mahadevan
- Additional Professor Neuropathology, Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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Manoj N, Arivazhagan A, Bhat DI, Arvinda HR, Mahadevan A, Santosh V, Devi BI, Sampath S, Chandramouli BA. Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review. J Neurosci Rural Pract 2014; 5:32-9. [PMID: 24741247 PMCID: PMC3985354 DOI: 10.4103/0976-3147.127869] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children. MATERIALS AND METHODS The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed. RESULTS Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series. CONCLUSION Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
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Affiliation(s)
- N Manoj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - D I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - V Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - S Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B A Chandramouli
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Adachi JI, Totake K, Shirahata M, Mishima K, Suzuki T, Yanagisawa T, Fukuoka K, Nishikawa R, Arimappamagan A, Manoj N, Mahadevan A, Bhat D, Arvinda H, Indiradevi B, Somanna S, Chandramouli B, Petterson SA, Hermansen SK, Dahlrot RH, Hansen S, Kristensen BW, Carvalho F, Jalali S, Singh S, Croul S, Aldape K, Zadeh G, Choi J, Park SH, Khang SK, Suh YL, Kim SP, Lee YS, Kim SH, Coberly S, Samayoa K, Liu Y, Kiaei P, Hill J, Patterson S, Damore M, Dahiya S, Emnett R, Phillips J, Haydon D, Leonard J, Perry A, Gutmann D, Epari S, Ahmed S, Gurav M, Raikar S, Moiyadi A, Shetty P, Gupta T, Jalali R, Georges J, Zehri A, Carlson E, Martirosyan N, Elhadi A, Nichols J, Ighaffari L, Eschbacher J, Feuerstein B, Anderson T, Preul M, Jensen K, Nakaji P, Girardi H, Monville F, Carpentier S, Giry M, Voss J, Jenkins R, Boisselier B, Frayssinet V, Poggionovo C, Catteau A, Mokhtari K, Sanson M, Peyro-Saint-Paul H, Giannini C, Hide T, Nakamura H, Makino K, Yano S, Anai S, Shinojima N, Kuroda JI, Takezaki T, Kuratsu JI, Higuchi F, Matsuda H, Iwata K, Ueki K, Kim P, Kong J, Cooper L, Wang F, Gao J, Teodoro G, Scarpace L, Mikkelsen T, Schniederjan M, Moreno C, Saltz J, Brat D, Cho U, Hong YK, Lee YS, Lober R, Lu L, Gephart MH, Fisher P, Miyazaki M, Nishihara H, Itoh T, Kato M, Fujimoto S, Kimura T, Tanino M, Tanaka S, Nguyen N, Moes G, Villano JL, Nishihara H, Kanno H, Kato Y, Tanaka S, Ohnishi T, Harada H, Ohue S, Kouno S, Inoue A, Yamashita D, Okamoto S, Nitta M, Muragaki Y, Maruyama T, Sawada T, Komori T, Saito T, Okada Y, Omay SB, Gunel JM, Clark VE, Li J, Omay EZE, Serin A, Kolb LE, Hebert RM, Bilguvar K, Ozduman K, Pamir MN, Kilic T, Baehring J, Piepmeier JM, Brennan CW, Huse J, Gutin PH, Yasuno K, Vortmeyer A, Gunel M, Perry A, Pugh S, Rogers CL, Brachman D, McMillan W, Jenrette J, Barani I, Shrieve D, Sloan A, Mehta M, Prabowo A, Iyer A, Veersema T, Anink J, Meeteren ASV, Spliet W, van Rijen P, Ferrier T, Capper D, Thom M, Aronica E, Chharchhodawala T, Sable M, Sharma MC, Sarkar C, Suri V, Singh M, Santosh V, Thota B, Srividya M, Sravani K, Shwetha S, Arivazhagan A, Thennarasu K, Chandramouli B, Hegde A, Kondaiah P, Somasundaram K, Rao M, Santosh V, Kumar VP, Thota B, Shastry A, Arivazhagan A, Thennarasu K, Kondaiah P, Shastry A, Narayan R, Thota B, Somanna S, Thennarasu K, Arivazhagan A, Santosh V, Shastry A, Naz S, Thota B, Thennarasu K, Arivazhagan A, Somanna S, Santosh V, Kondaiah P, Venneti S, Garimella M, Sullivan L, Martinez D, Huse J, Heguy A, Santi M, Thompson C, Judkins A, Voronovich Z, Chen L, Clark K, Walsh M, Mannas J, Horbinski C, Wiestler B, Capper D, Holland-Letz T, Korshunov A, von Deimling A, Pfister SM, Platten M, Weller M, Wick W, Zieman G, Dardis C, Ashby L, Eschbacher J. PATHOLOGY. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahadevan A, Curry M, Lake-Bakaar B, Evenson A, Bullock A, Buchbinder E, Miksad R. Stereotactic Body Radiation Therapy for Unresectable Large and Multiple Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.839] [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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Harish G, Venkateshappa C, Mahadevan A, Pruthi N, Bharath MMS, Shankar SK. Mitochondrial function in human brains is affected by pre- and post mortem factors. Neuropathol Appl Neurobiol 2013; 39:298-315. [PMID: 22639898 DOI: 10.1111/j.1365-2990.2012.01285.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM Mitochondrial function and the ensuing ATP synthesis are central to the functioning of the brain and contribute to neuronal physiology. Most studies on neurodegenerative diseases have highlighted that mitochondrial dysfunction is an important event contributing to pathology. However, studies on the human brain mitochondria in various neurodegenerative disorders heavily rely on post mortem samples. As post mortem tissues are influenced by pre- and post mortem factors, we investigated the effect of these variables on mitochondrial function. METHODS We examined whether the mitochondrial function (represented by mitochondrial enzymes and antioxidant activities) in post mortem human brains (n=45) was affected by increased storage time (11.8-104.1 months), age of the donor (2 days to 80 years), post mortem interval (2.5-26 h), gender difference and agonal state [based on Glasgow Coma Scale: range=3-15] in the frontal cortex, as a prototype. RESULTS We observed that the activities of citrate synthase, succinate dehydrogenase and mitochondrial reductase (MTT) were significantly affected only by gender difference (citrate synthase: P=0.005; succinate dehydrogenase: P=0.01; mitochondrial reductase: P=0.006), being higher in females, but not by any other factor. Mitochondrial complex I activity was significantly inhibited by increasing age (r=-0.40; P=0.05). On the other hand, the mitochondrial antioxidant enzyme glutathione reductase decreased with severe agonal state (P=0.003), while the activity of glutathione-S-transferase declined with increased storage time (P=0.005) and severe agonal state (P=0.02). CONCLUSION Our data highlight the influence of pre- and post mortem factors on preservation of mitochondrial function with implications for studies on brain pathology employing stored human samples.
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Affiliation(s)
- G Harish
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Nagappa M, Taly AB, Sinha S, Bharath RD, Mahadevan A, Bindu PS, Saini JS, Prasad C, Shankar SK. Tumefactive demyelination: clinical, imaging and follow-up observations in thirty-nine patients. Acta Neurol Scand 2013; 128:39-47. [PMID: 23277913 DOI: 10.1111/ane.12071] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE We describe the clinical, neuroimaging and pathological features and therapeutic outcome in a large cohort of 39 patients with tumefactive demyelination. MATERIALS AND METHODS A retrospective audit of 39 patients with 'tumefactive demyelination' was performed. The demographic, clinical, MR imaging and pathological details were reviewed. RESULTS The clinical course was monophasic (n = 22) or relapsing-remitting (n = 17). Common neurological manifestations at presentation included hemiparesis - 27; ataxia - 11; vomiting - 10; headache -9; ophthalmoplegia - 7; seizure - 5; impaired vision - 4; aphasia - 4; visual field defects - 3; papilloedema - 5; extrapyramidal - 5; intellectual decline - 5; behavioural disturbances - 3; altered sensorium - 5. MRI revealed fronto-parietal lesions, which were isolated in 14 (36%) patients. Moderate perilesional oedema and/or mass effect was noted in 12 (30.8%) patients. Post-contrast MR sequences revealed partial ring enhancement in 15, complete ring in seven, patchy enhancement in six, uniform enhancement in two and lack of enhancement in nine cases. Clinical and MR characteristics did not help distinguish between monophasic and relapsing-remitting subgroups. In the monophasic group, 53.8% had complete recovery, while 38.5% had partial improvement (follow-up duration, 8.31 ± 9.3 months). In the relapsing-remitting subgroup, the median time to relapse was 4 months (n = 12, follow-up, 37.8 ± 39.4 months). Patients with monophasic course or single relapse received steroids. Patients with more than one relapse received cyclophosphamide (2), mycophenolate (1), azathioprine (1) or methotrexate (1). CONCLUSIONS A high proportion of cases of tumefactive demyelination follow a relapsing course, thus necessitating a long-term follow-up. MRI, although helpful in diagnosis, does not predict monophasic or relapsing-remitting course. Guidelines for the management of acute episodes and prevention of relapses are required.
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Affiliation(s)
- M. Nagappa
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - A. B. Taly
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - S. Sinha
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - R. D. Bharath
- Department of Neuroimaging and Interventional Radiology (NIIR); National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - A. Mahadevan
- Department of Neuropathology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - P. S. Bindu
- Department of Neurology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - J. S. Saini
- Department of Neuroimaging and Interventional Radiology (NIIR); National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - C. Prasad
- Department of Neuroimaging and Interventional Radiology (NIIR); National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
| | - S. K. Shankar
- Department of Neuropathology; National Institute of Mental Health and NeuroSciences (NIMHANS); Bangalore; India
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Nagappa M, Taly AB, Sinha S, Gayathri N, Bindu PS, Mahadevan A, Yasha T. Efficacy and limitations of pulse cyclophosphamide therapy in polymyositis and dermatomyositis. J Clin Neuromuscul Dis 2013; 14:161-168. [PMID: 23703010 DOI: 10.1097/cnd.0b013e31828ee913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 06/02/2023]
Abstract
OBJECTIVES To assess the therapeutic response of intravenous (IV) pulse cyclophosphamide therapy in polymyositis and dermatomyositis. METHODS Data of 9 patients (M:F = 2:7) who received IV pulse cyclophosphamide therapy were retrospectively analyzed. RESULTS The mean symptom duration was 11.33 ± 10.6 months (range, 2-34 months). The cohort comprised (1) primary idiopathic polymyositis (n = 1), (2) primary idiopathic dermatomyositis (n = 1), (3) childhood type associated with vasculitis (n = 1), and (4) associated with collagen vascular disease (n = 6). All patients improved and became clinically asymptomatic after a mean period of 12.33 ± 6.5 months (range, 4-24 months); 5 remained asymptomatic at the end of a median follow-up period of 22 months. All patients received concomitant steroid therapy, and in 6, steroids could be tapered after the initiation of IV pulse cyclophosphamide therapy. CONCLUSIONS In this cohort of polymyositis/dermatomyositis, treatment with IV pulse cyclophosphamide was associated with improvement; the therapeutic response was sustained in majority of the patients.
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Affiliation(s)
- M Nagappa
- Department of Neurology, NIMHANS, Bangalore, India
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