1
|
Mirza A, Watt R, Heilmann A, Stennett M, Singh A. Social Disadvantage and Multimorbidity Including Oral Conditions in the United States. J Dent Res 2024; 103:477-483. [PMID: 38504091 PMCID: PMC11047010 DOI: 10.1177/00220345241228834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Existing studies on multimorbidity have largely excluded oral diseases in multimorbidity prevalence estimates. The reason behind this is somewhat unclear, as chronic oral conditions are highly prevalent, affecting over half the global population. To address this gap, we examined the relationship between social disadvantage and multimorbidity, stratifying by the inclusion and exclusion of oral conditions. For participants aged 30 y and over (n = 3,693), cross-sectional analysis was carried out using the US National Health and Nutrition Survey (2013-2014). Multimorbidity was defined as having 2 or more chronic conditions. Five medical conditions were examined: diabetes, asthma, arthritis, cardiovascular disease, and depression, as well as 4 oral health conditions: caries, periodontal disease, number of teeth, and edentulousness. Education and income poverty ratio were selected as measures of social disadvantage. Multimorbidity prevalence estimates according to social disadvantage were analyzed on an absolute and relative scale using inverse probability treatment weighting (IPTW), adjusting for age, sex, and ethnicity. The inclusion of oral health conditions in the assessment of multimorbidity increased the overall prevalence of multimorbidity from 20.8% to 53.4%. Findings from IPTW analysis demonstrated clear social gradients for multimorbidity estimates stratified by the exclusion of oral conditions. Upon inclusion of oral conditions, the prevalence of multimorbidity was higher across all social groups for both education and income. Stratifying by the inclusion of oral conditions, the mean probability of multimorbidity was 27% (95% confidence interval [CI], 23%-30%) higher in the low-education group compared to the high-education group. Similarly, the mean probability of multimorbidity was 44% (95% CI, 40%-48%) higher in the low-income group. On a relative scale, low education was associated with a 1.52 times (95% CI, 1.44-1.61) higher prevalence of multimorbidity compared to high education. Low income was associated with a 2.18 (95% CI, 1.99-2.39) higher prevalence of multimorbidity. This novel study strongly supports the impact of chronic oral conditions on multimorbidity prevalence estimates.
Collapse
Affiliation(s)
- A. Mirza
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A. Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - M. Stennett
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A. Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Mirza A, Mirza JB, Zappia LC, Thomas TL. Ulnar-Sided Wrist Pain: A Diagnostic Evaluation Guide From 30-Plus Years of Experience. Cureus 2024; 16:e53332. [PMID: 38435942 PMCID: PMC10907076 DOI: 10.7759/cureus.53332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION While multiple ulnar-sided wrist pain (USWP) diagnostic evaluation guides have been presented, none have included original clinical data or statistical analysis. The purpose of this study is to provide a diagnostic evaluation guide derived from original clinical data and analysis to help clinicians arrive at a differential diagnosis for USWP. METHODS Using a computer search of patients presenting with sprains, instability, and laxity of the wrist, 385 patient charts were identified. Patient demographics, mechanism of injury, subjective complaints, physical findings, and diagnostic test findings were reviewed. Statistical analysis was performed to determine sensitivity and specificity of diagnostic methods on their ability to identify lunotriquetral ligament tears, triangular fibrocartilage complex (TFCC) tears, and ulnar impaction syndrome. Diagnostic arthroscopy was used as the reference standard. RESULTS Ninety-three patients, comprising 101 cases of USWP, were included in the study. The onset of injury was traumatic in 83 out of 101 cases with motor vehicle accidents (N=46) being the most common, followed by overuse (N=18), and a fall onto an outstretched hand (N=16). The ulnocarpal tenderness test exhibited sensitivity/specificity of 72%/33%; lunotriquetral ligament laxity test of 42%/62%; bone scan of 80%/33%; radiocarpal arthrogram of 90%/98% for TFCC tears and 50%/91% for lunotriquetral ligament tears; midcarpal arthrogram of 82%/86% for lunotriquetral ligament tears. The mean ulnar variance on standard posteroanterior view radiograph was 0.95 mm, increasing to 2.67 mm on gripping posteroanterior view. CONCLUSION Physicians should suspect a lunotriquetral ligament and/or TFCC tear with the acute onset of USWP following a loaded dorsiflexed mechanism of injury. Ulnocarpal tenderness tests and pre-operative ulnar variance measures are effective for increasing suspicion of USW pathology. Bone scans are helpful in diagnosing ulnar impaction syndrome in conjunction with radiographic findings. A combination of midcarpal arthrogram for lunotriquetral ligament tears and radiocarpal arthrogram for TFCC tears should be employed.
Collapse
Affiliation(s)
- Ather Mirza
- Orthopedics, North Shore Surgi-Center, Smithtown, USA
| | - Justin B Mirza
- Orthopedics, North Shore Surgi-Center, Smithtown, USA
- Orthopedics, Stony Brook University Hospital, Stony Brook, USA
- Orthopedics, St. Catherine of Sienna Hospital, Smithtown, USA
| | - Luke C Zappia
- Orthopedics, North Shore Surgi-Center, Smithtown, USA
- Orthopedics, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Terence L Thomas
- Orthopedic Surgery, Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
3
|
Abstract
BACKGROUND Open trigger finger release (OTFR) and endoscopic trigger finger release (ETFR) are effective methods in treating stenosing tenosynovitis. However, a paucity of literature exists comparing the techniques. This study describes and compares postoperative complications following OTFR and ETFR at a single institution. METHODS Patients undergoing trigger finger release between 2018 and 2020 within a single institution were identified. Electronic medical records were reviewed for patient demographics, surgical history, surgical characteristics, and clinical outcomes. Major and minor postoperative complications were assessed. Secondary outcome measures included tourniquet time and procedure time. Statistical analysis evaluated associations between postoperative complications, surgical technique, patient demographics, and surgical characteristics. RESULTS In total, 57 patients (80 digits) were included in the study: 42 digits treated with OTFR and 38 digits treated with ETFR. Mean follow-up time was 57.6 ± 69.0 days (range, 7-307 days) for ETFR and 34.2 ± 26.3 days (range, 6-120 days) for OTFR. Overall, major, and minor complication rates for the cohort were 8.8%, 1.8% and 7.0%, respectively. There were no major complications following ETFR and 1 following OTFR (4%), the isolated case being postoperative Chronic regional pain syndrome. Minor complication rates were similar following OTFR (8%) and ETFR (6%). Persistent digit stiffness and swelling were found to be the most prevalent minor complications (n = 2, respectively), followed by wound dehiscence (n = 1). Female patients were significantly more likely to experience postoperative complications. CONCLUSIONS Major complications following trigger finger release are unlikely; however, minor complications are prominent. Patients treated with OTFR and ETFR showed similar postoperative complication rates. Continued investigations into the benefits of ETFR are warranted.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Justin Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | | | | | | |
Collapse
|
4
|
Mirza A, Mirza JB, Zappia LC, Thomas TL, Corabi J, Dusckas Z, Lubahn JD. Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach. Hand (N Y) 2023:15589447231174041. [PMID: 37243476 DOI: 10.1177/15589447231174041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist. METHODS We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture. CONCLUSIONS We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Justin B Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Luke C Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | | | | | - Zachary Dusckas
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - John D Lubahn
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
- Hand, Microsurgery & Reconstructive Orthopaedics, LLP, Erie, PA, USA
| |
Collapse
|
5
|
Mikheev A, Adawi M, Mirza A, Bechtel A. Prolonged fever and inflammation in a young child in the midst of the pandemic – it’s not always MIS-C. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00717-6] [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: 01/28/2023]
|
6
|
Mirza A, Mirza J, Zappia L, Thomas TL, Corabi J, Talay R. Single-Portal Antegrade Endoscopic Trigger Finger Release: Cadaveric and Clinical Outcomes. Hand (N Y) 2023:15589447221150512. [PMID: 36726337 DOI: 10.1177/15589447221150512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study aimed to examine the relationship between anatomical surface landmarks in fresh frozen cadavers as related to in vivo endoscopic trigger finger release (ETFR) and present clinical outcomes after a single-portal antegrade ETFR technique. METHODS Endoscopic trigger finger release was performed on 40 cadaveric digits. Each digit was dissected and the following measurements were recorded: distance from palmar digital crease and A1 pulley, length of the A1 pulley, percentage of A1 pulley released, and injury to vulnerable anatomy. A retrospective chart review was performed on 48 patients (62 digits) treated with ETFR. Outcome measures included grip and pinch strength, range of motion, Disability of Arm, Shoulder, and Hand (DASH) questionnaires, and Visual Analog Scale (VAS) pain scores. RESULTS Release of the A1 pulley was achieved in 33 of the 40 cadaveric digits (83%) with an A2 pulley laceration rate of 25%. No flexor tendon or neurovascular injuries occurred. Gross grasp, lateral pinch, 3-jaw chuck, and precision pinch strength had 85%, 90%, 82%, and 90% recovery, respectively. At the final follow-up, average metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint range of motion were within the normal limits. Mean VAS scores decreased from 5.7 preoperatively to 1.0 postoperatively and mean DASH score at the final follow-up was 4.8. CONCLUSIONS With the use of anatomical surface landmarks, ETFR may be performed in an efficient and reproducible manner. Patients treated with ETFR had low complication rates, good functional recovery, and improved pain at short-term follow-up. Further study of long-term outcomes and cost-effectiveness of ETFR is warranted.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
| | - Justin Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
- Stony Brook University, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Luke Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | - Terence L Thomas
- Mirza Orthopedics, Smithtown, NY, USA
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | |
Collapse
|
7
|
Mirza A, Win Naing Z, Khonsari P, Khan H, Rezai P, Abbas AK, Nisar M. POS1421 AROMATASE INHIBITORS AND SKELETAL HEALTH – NATURAL HISTORY AND INTERVENTIONAL EPIDEMIOLOGY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBreast cancer remains the most common cancer diagnosed in women worldwide. Aromatase inhibitors (AI) are employed for hormone sensitive disease in mainly postmenopausal women. AI related bone loss (AIBL) is a known complication; although data regarding the natural history in the real-world, long-term outcomes and the role of bone active therapy in fracture prevention is sparse.ObjectivesOur aim was to determine the real-world impact of AIBL and whether bone sparing therapy utilising standard risk stratification model is sufficient for fracture prevention.MethodsWe undertook a longitudinal study of patients prescribed AI for breast cancer over a seven-year period at our university teaching hospital. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management. DEXA scans performed prior to initiation of AI were compared with subsequent imaging over a mean follow up of 3 years. Outcome data for cancer and all fractures was collected. Statistical analysis was done to investigate significant relationships amongst the variables of interest.Results1001 women were identified during the study period. The mean age of the cohort was 64 years (range 29-93). 929 (93%) were Caucasian, 57 (6%) were Asian and 15 (1%) were Afro-Caribbean. 723 women (72%) were diagnosed with invasive ductal carcinoma and 863 women (86%) were postmenopausal. At diagnosis, 428 women (43%) had node positive disease and 35 women (4%) had metastases. 91 women (9%) had sustained fractures prior to their breast cancer diagnosis.All women had a baseline DEXA: 496 (49.6%) had osteopenia, 151 (15%) had osteoporosis and 354 (35.4%) had a normal result. 478 (48%) of women had a repeat scan available. Overall, there was a decline (from a mean of 0.888 g/cm2 to 0.858 g/cm2, p<0.0001) in left neck of femur (LNOF) bone mineral density (BMD) over time (mean of 3 years, with a range of 1-6).334 (33%) were prescribed bone active therapy with 276 women (83%) given oral bisphosphonates. This group had an improvement in BMD by 0.4% (LNOF mean BMD of 0.785 g/cm2 at baseline compared to LNOF mean BMD of 0.788 at repeat DEXA, p=0.82).Women who were not offered any treatment (n=667, 66%), showed a significant decline in bone density with the decline being -5%. (LNOF mean BMD of 0.939 g/cm2 at baseline compared to LNOF mean BMD of 0.888 g/cm2 at repeat DEXA, p< 0.0001).The rate of fractures remained the same between the treatment (19 fractures, 5.67%) and non-treatment group (38 fractures, 5.70%)ConclusionOur study provides long term data for AIBL and confirms a significant decline in BMD over seven years. It confirms that bone sparing therapy is effective in reducing the pace of decline in BMD. However standard risk stratification model such as FRAX based intervention thresholds in mainly those with WHO defined osteoporosis (T ≤-2.5) is ineffective in fracture prevention in keeping with prior literature. Since our study period overlaps with publication of newer guidelines recommending different T score-based risk model, further studies are required to confirm their utility.References[1]https://www.wcrf.org/dietandcancer/worldwide-cancer-data/. Date accessed: 26.01.2022[2]R. Coleman, J.J. Body, M. Aapro, et al., Bone health in cancer patients: ESMO clinical practice guidelines, Ann. Oncol. 25 (Suppl 3) (2014) iii124–iii137.[3]E. Amir, B. Seruga, S. Niraula, et al., Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis, J. Natl. Cancer Inst. 103 (2011) 1299–1309.Disclosure of InterestsNone declared
Collapse
|
8
|
Mirza A, Win Naing Z, Khonsari P, Khan H, Rezai P, Abbas AK, Nisar M. OP0244 AROMATASE INHIBITORS AND FRACTURE PREVENTION – DO NEW GUIDELINES WORK IN REAL WORLD? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background2,261,419 women were diagnosed with breast cancer worldwide in 2020. For postmenopausal women with hormone sensitive disease, aromatase inhibitors (AI) are recommended for their mortality benefit. However, AI bone loss (AIBL) is a recognised adverse event with resultant increase in fracture risk. In 2017, a consensus statement of 7 international bone and cancer societies was published proposing an algorithm based on clinical risk factors and different bone mineral density (BMD) threshold for bone active therapeutic intervention.ObjectivesTo determine the real-world impact of the 2017 consensus guidelines on AIBL and whether bone sparing therapy utilising proposed risk stratification model is effective in fracture prevention.MethodsOver a 7-year study period, 1001 women were prescribed AI at our university teaching hospital. The new guidelines were adopted in July 2017. We split the participants in two groups: 361 (36%) women had commenced their AI prior to the adoption of guidelines and 640 (64%) were in the post implementation group.First group were offered bone active treatment based on NOS 2009 guidelines whereas the second group followed the 2017 consensus guidelines. Women with osteoporosis were all offered treatment, however the difference in guideline is pertinent to osteopenia and we compared the results of that group.Results1001 women were included. Mean age was 64 years (range 29-93). 929 (93%) were Caucasian, 57 (6%) were Asian and 15 (1%) were Afro-Caribbean. 723 women (72%) had invasive ductal carcinoma and 863 women (86%) were postmenopausal. At diagnosis, 428 women (43%) had node positive disease and 35 women (4%) had metastases. 91 women (9%) had sustained fractures prior to their cancer diagnosis.276 women (28%) were offered oral bisphosphonates based on DEXA result, with 58 (6%) offered parenteral therapy.First group: 361 women had a baseline DEXA with a mean left neck of femur (LNOF) BMD of 0.888 g/cm2 (range 0.552-1.222). 143 (40%) women had a normal DEXA, 174 (48%) had osteopenia and 44 (12%) had osteoporosis.Of the women with osteopenia, 44 (25%) women were offered treatment and 33 women had a repeat DEXA after a mean of 4 years. In the treatment group, LNOF mean BMD remained relatively unchanged from 0.814 g/cm2 to 0.812 g/cm2 at the repeat DEXA (p= 0.94).Of the 174 women with osteopenia, 22 (13%) women had a fracture.Second group: 640 women had a baseline DEXA with a mean LNOF BMD of 0.888 g/cm2 (range 0.512-1.390). 216 (33%) women were normal, 322(50%) had osteopenia and 107 (17%) had osteoporosis.Of the women with osteopenia, 127 (39%) women were offered treatment and 56 women had a repeat DEXA after a mean of 3 years. In the treatment group, LNOF mean BMD remained relatively unchanged from 0.822 g/cm2 to 0.829 g/cm2 at the repeat DEXA (p= 0.6169).Of the 322 women with osteopenia, 8 (2.5%) women had a fracture.ConclusionOur study provides real world evidence of the success of 2017 consensus statement in lowering fracture risk. Though there has been data for positive impact on BMD decline with this approach, evidence for fracture prevention has been limited. This study showcases the success of lowering bone active therapy threshold employing alternative risk modelling strategy for women with breast cancer commenced on AI. A significant reduction in fractures pre (13%) and post guidelines change (2.5%) was demonstrated (absolute risk reduction of 10.5%) which has implications for healthcare systems worldwide as we have demonstrated this approach can reduce morbidity.References[1]https://www.wcrf.org/dietandcancer/worldwide-cancer-data/. Accessed: 26.01.2022.[2]Reid DM, Doughty J, Eastell R, et al. Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer Treat Rev. 2008;34 Suppl 1:S3-S18.[3]Hadji P, Aapro MS, Body JJ, et al. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol. 2017;7:1-12.Disclosure of InterestsNone declared
Collapse
|
9
|
Mirza A, Mirza JB, Klingbeil L, Pavlik JF, Muratori J, Thomas T. A Modified Suture Suspension Arthroplasty Technique for the Treatment of Basal Joint Arthritis: Short- to Intermediate-Term Outcomes. Hand (N Y) 2021; 16:797-803. [PMID: 31916458 PMCID: PMC8647329 DOI: 10.1177/1558944719886669] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: To present a retrospective study on the outcomes of a modified version of suture suspension arthroplasty with trapeziectomy on patients with thumb basal joint arthritis and to evaluate the relationship between the degree of subsidence and functional outcome. Methods: We performed a chart review on 67 patients (75 thumbs) who were surgically treated for thumb carpometacarpal osteoarthritis with trapeziectomy and suture suspension arthroplasty from May 2010 to May 2016. Outcome measures included Disabilities of the Arm, Shoulder and Hand (DASH), grip strength, lateral/precision pinch strength, range of motion, and return to work/resumption of usual activities. Radiographic images were used to measure first metacarpal subsidence into the trapezial space. Results: Clinical outcomes were satisfactory, showing an initial postoperative DASH score of 45.94, which decreased to 27.93 at 6 months postoperatively and to 19.69 at 1 year postoperatively. Radiographic images revealed a mean first metacarpal subsidence of 39% compared with the preoperative images. Grip and pinch strengths showed steady improvement from initial postoperative to final follow-up visits, resulting in 90% recovery of gross grasp, 77% recovery of lateral pinch, and 79% recovery of precision pinch compared with the contralateral side. Conclusions: Our study has found that suture suspension arthroplasty with trapeziectomy is an effective treatment for thumb basal joint arthritis. Suture suspension arthroplasty allows for short immobilization time, avoids tendon sacrifice, avoids anchor use, and leaves a cosmetically appealing scar. Furthermore, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Mirza Orthopedics, Smithtown, NY, USA,Ather Mirza, Mirza Orthopedics, 290 East Main Street, Suite 200, Smithtown, NY 11787, USA.
| | - Justin B. Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Mirza Orthopedics, Smithtown, NY, USA
| | | | | | | | | |
Collapse
|
10
|
Ali RF, Offeddu V, Siddiqi DA, Mirza A, Naz N, Abdullah S, Lim JM, Kembhavi G, Tam CC, Chandir S. Adolescent girls’ recommendations for designing Human Papillomavirus Vaccination Program in Pakistan. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.550] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In Pakistan, cervical cancer is the third most frequent cancer among women. Most cases are caused by sexually-acquired infection with human papillomaviruses (HPV). Vaccination of adolescent girls against HPV significantly reduces the incidence of cervical cancer. HPV vaccination is available in Pakistan, but plans to develop a HPV vaccination program are currently at a very early stage. We conducted a formative study to explore adolescent girls' perspectives on HPV and cervical cancer, and collected their recommendations for implementing an HPV vaccination program. We conducted qualitative focus group discussions (FGDs), with unmarried adolescent girls aged 16-19 years, residing in Karachi. We conducted four FGDs with 12 participants each. The topic guide assessed i) girls' knowledge of cervical cancer and HPV vaccination, ii) vaccination decision-making dynamics within families, and iii) factors girls would consider essential for the successful implementation of HPV vaccination program. Overall, participants displayed a positive attitude towards the HPV vaccine. However, many basic concepts related to female reproductive health were unfamiliar to them. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as the definitive decision-making authority on vaccination. Girls gave critical input for the development of a HPV vaccination program. Eligible girls should be recruited through individual household visits and the vaccine should be administered at community-based camps, which would ensure both good accessibility and a large outreach. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. Adolescents demonstrated great capacity and shared recommendations for a future program's acceptability. Integrating their perspectives will be essential to design an effective program in local context.
Key messages
Adolescent girls’ perspectives should be incorporated to develop context-specific recommendations for the implementation of a HPV vaccination program. Community-based camps and household visits by adolescent girls to recruit the target population could potentially increase program penetration among communities.
Collapse
Affiliation(s)
- RF Ali
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - V Offeddu
- MCH, IRD-Global, Singapore, Singapore
| | | | - A Mirza
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - N Naz
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - S Abdullah
- MCH, Interactive Research & Development, Karachi, Pakistan
| | - JM Lim
- National University of Singapore, Singapore, Singapore
| | - G Kembhavi
- National University of Singapore, Singapore, Singapore
| | - CC Tam
- National University of Singapore, Singapore, Singapore
| | - S Chandir
- MCH, IRD-Global, Singapore, Singapore
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Mirza A, Nisar MK. POS0227 SHOULD ALL PATIENTS TRIAL SUBCUTANEOUS METHOTREXATE PRIOR TO COMMENCING BIOLOGIC THERAPY – A REAL WORLD STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Methotrexate (MTX) is the bed rock of inflammatory arthritis management. However intolerance is a major limiting factor for drug optimisation and retention. There is data to suggest that subcutaneous (SC) MTX is tolerated better and is now being recommended in several guidelines including ACR’s. It is less clear though whether this strategy is effective in those where oral preparation is inefficacious and its potential to avoid escalation to biologic therapy.Objectives:Our aim was to analyse the reasons for switching to SC formulation in a real world setting, clinical outcomes achieved and proportion requiring biologic prescription.Methods:We undertook a retrospective survey of all patients prescribed SC MTX in a large university teaching hospital between 1983 and Apr 2019. We had access to full patient records including details on co-morbidities, drugs and disease management. We analysed demographics, reasons for SC MTX initiation, clinical outcomes and impact on biologic prescription.Results:352 patients were identified during the study period. The mean age of the cohort was 54 yrs (3-87). 192 (70%) were women. 260 (74%) were Caucasian, 64 (18%) Asian, 21 (6%) Afro-Caribbean and remaining of other ethnicity. Two most common diagnoses were RA [n=243 (69%)] and pSpA [n=66 (18%)]. Average disease duration was 74 months (11-324) with mean of three comorbidities (0-11).284 (80%) had switched from oral to SC MTX. 137 (49%) stopped oral MTX due to side effects. Mean duration of oral MTX prior to switching was 26 months (0.25-167). Follow up period for SC MTX ranged from two to 132 months (mean 29) until the data cut-off date of Apr 2019. 103 (29%) patients progressed to biologic therapy.Amongst RA patients, DAS28 improved from mean 4.16 (0.63-8.06) to 2.83 (0.14-7.32) following the switch. pSpA cohort’s mean TJC and SJC improved from mean seven (0-42) and two (0-26) to two (0-25) and one (0-6) respectively.Conclusion:Our study confirms that SC MTX is an effective solution irrespective of whether oral MTX is inefficacious or intolerable. This applies to people with both RA and pSpA. In accordance with prior published data, our findings support the utility of SC MTX for those intolerant of enteral option. Additionally, it shows that even in instances where oral MTX was ineffective, a switch to SC formulation achieved low disease activity despite multi-morbidity, long disease course and protracted oral MTX exposure. This intervention also prevented over two-thirds of patients progressing to biologic therapy with significant financial savings. SC MTX therefore remains a durable strategy with excellent disease outcomes and confers substantial economic benefits to healthcare.Disclosure of Interests:None declared
Collapse
|
12
|
Siddiqi DA, Mirza A, Abdullah S, Dharma VK, Shah MT, Akhter MA, Habib A, Khan AJ, Chandir S. Real-time immunization trends in under-2 children in Pakistan: insights from big data analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.367] [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: 11/14/2022] Open
Abstract
Abstract
Background
Despite the provision of free-of-cost vaccines in Pakistan, fully immunized child (FIC) coverage in Sindh province remains low at 49%. In 2012, we developed and piloted the Zindagi Mehfooz (Safe Life; ZM) Digital Immunization Registry, an Android-based platform that enables vaccinators to enroll and track child level immunization data of children in the catchment population. In 2017, ZM was scaled-up across Sindh province and is currently being used by 2,284 vaccinators across 1,526 facilities serving >48 million (m) population.
Methods
All children under-2 years of age visiting EPI centers are enrolled. At enrollment, caregiver and child bio-data and child immunization history are recorded, and the child is provided with a unique Quick Response (QR) code for identification. For follow-up immunization visits, 3 SMS reminders are sent to caregivers, and upon immunization, child history is retrieved by scanning the QR code and vaccination record updated. ZM allows real-time access to data and generation of monitoring reports. Data from ZM was used to calculate coverage rates, timeliness, and trends for immunization coverage in Sindh.
Results
From Oct'17 to Dec'19, more than 2.4m children and 0.8m women were enrolled in the Registry, while >17m immunizations were administered. The FIC coverage in 12-23 months old children has increased from 49% (at baseline) to 57% for children enrolled in ZM. Additionally, pentavalent-3 coverage increased from 59% to 68%.
Discussion
ZM demonstrates the potential of DIRs to improve immunization outcomes within low-resource settings by enabling better child tracking and a higher retention rate. Additionally, the big dataset provides the opportunity to identify real-time trends and provides actionable data for evidence-based decision making.
Key messages
ZM Immunization Registry has strengthened the current EPI program through increased FIC coverage and timeliness through better tracking of children and increased retention. Big Data from ZM can be used to analyze immunization trends of global relevance, and guide strategic policy decisions for improving immunization coverage and equity, based on actionable data insights.
Collapse
Affiliation(s)
| | - A Mirza
- IRD Pakistan, Karachi, Pakistan
| | | | - V K Dharma
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | | | - M A Akhter
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | - A Habib
- Interactive Health Solutions, Karachi, Pakistan
| | - A J Khan
- IRD Global, Singapore, Singapore
- Harvard Medical School, Boston, USA
| | - S Chandir
- IRD Global, Perry Hall, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
13
|
Siddique M, Abdullah S, Siddiqi DA, Mirza A, Dharma VK, Shah MT, Akhter MA, Khan AJ, Chandir S. Using mobile immunization vans to cover under-served populations in hard-to-reach areas. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.975] [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: 11/13/2022] Open
Abstract
Abstract
Background
In Pakistan, only 66% of children receive their basic vaccinations. However, the figure masks significant inequalities in vaccine coverage between urban and rural residences, slums and areas distantly located from EPI centers. Frequent outbreaks of vaccine-preventable diseases such as polio and measles, in urban cities like Karachi, signal the need for expanding vaccine services to underserved areas. In Apr'19, we introduced the Mobile Immunization Van initiative in Karachi in collaboration with EPI Sindh. Currently, two vans are deployed in hard-to-reach areas and slums to immunize under-2 children for routine vaccines.
Methods
Before the van visit, mobilization efforts are conducted in targeted areas to encourage caretakers to bring their child for vaccination. On the day of visit, the van is parked at a central location, and announcements are played on a loudspeaker to attract caregivers. All vaccinations are administered in the van, and entries are recorded in Government's Digital Immunization Registry along with GIS coordinates of immunized children. The data is then automatically transferred on to a web-dashboard for analysis and tracking.
Results
From Apr'19 to Jan'20, the vans have vaccinated 2,867 children, out of which 50% had never been immunized prior to the van visit. Of those who received their follow-up vaccines from the van, 80% were at least 4 weeks beyond from their vaccine due date. GIS analysis of van data confirmed that immunizations were conducted in slums, and areas distantly located from EPI centers. Moreover, compared to government outreach activity, proportion of BCG, Penta3 and Measles1 administrations in slums was higher through the vans by 5%, 6%, and 4% respectively.
Conclusions
The vans provide an opportunity for immunizing never-vaccinated children and children defaulting on their vaccine schedule, from the most vulnerable geographies, while simultaneously enrolling them in the Government's EPI Program for effective tracking.
Key messages
The mobile vans help achieve universal immunization coverage through provision of vaccine services in slum and rural hard-to-reach areas with limited access to government-provided services. The mobile vans help vaccinate and capture never-immunized children into the Government’s EPI records, reducing the number of children missed through routine services.
Collapse
Affiliation(s)
| | | | | | - A Mirza
- IRD Pakistan, Karachi, Pakistan
| | - V K Dharma
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | | | - M A Akhter
- Indus Health Network, Karachi, Pakistan
- IRD Pakistan, Karachi, Pakistan
| | - A J Khan
- IRD Global, Singapore, Singapore
- Harvard Medical School, Boston, USA
| | - S Chandir
- IRD Global, Perry Hall, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
14
|
Mirza A, Mirza JB, Thomas TL. Premeasured Intramedullary Nails for the Treatment of Metacarpal Fractures: Novel Instrumentation and Technique. Journal of Hand Surgery Global Online 2020; 2:250-255. [PMID: 35415502 PMCID: PMC8991423 DOI: 10.1016/j.jhsg.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/26/2020] [Indexed: 11/24/2022] Open
Abstract
With nearly 36% of hand fractures occurring at the metacarpal, a variety of treatment interventions have been developed. Although many nondisplaced metacarpal fractures can be treated with conservative management, displaced, unstable, open, and extra-articular fractures require surgical attention. Compared with open reduction with plate fixation, closed reduction with intramedullary fixation has shown advantages of a simplified technique, minimal soft tissue dissection, and reduced tendon irritation and scar formation. The current study reports on the improved surgical technique associated with the use of novel instrumentation for the closed reduction and intramedullary fixation of extra-articular metacarpal fractures. The design and surgical technique of the premeasured Secure Intramedullary Nail improves fracture fixation, minimizing rotation and backing out, while reducing concerns for soft tissue irritation complications at the base of the metacarpal. Our reported case series suggests procedural efficiency, a low complication rate, and fast recovery for those with indicated extra-articular fractures.
Collapse
|
15
|
Mirza A, Mirza JB, Thomas TL. Classification and Treatment of Ulnar Nerve Subluxation Following Endoscopic Cubital Tunnel Release. Journal of Hand Surgery Global Online 2020; 2:232-239. [PMID: 35415505 PMCID: PMC8991866 DOI: 10.1016/j.jhsg.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/06/2020] [Indexed: 11/09/2022] Open
Abstract
Purpose Endoscopic cubital tunnel release (ECuTR) is an effective procedure to alleviate cubital tunnel syndrome. To improve patient outcomes and lessen concerns regarding ulnar nerve subluxation (UNS) after ECuTR, the current study proposes an intraoperative UNS classification system and subsequent treatment protocol. We present a preliminary report of patients treated under these guidelines. Methods We retrospectively reviewed 87 patients (100 ECuTRs). Nerve mobility was classified during surgery, in which grade 1 = no movement or partial subluxation; deep retrocondylar groove and/or no generalized hypermobility (no further intervention); grade 2 = partial subluxation; shallow retrocondylar groove and/or inherent generalized hypermobility (required medial epicondylectomy); and grade 3 = complete anterior dislocation (required medial epicondylectomy or anterior transposition). Clinical outcomes at final follow-up (mean ± SD, 34 ± 20.3 weeks; range, 5–89 weeks) were collected and included Disabilities of the Arm, Shoulder, and Hand questionnaires, visual analog scale pain score, grip and pinch strength, 2-point discrimination, and range of motion. Results We report 37 patients (42 cases), grade 1 (n = 30), grade 2 (n = 1), and grade 3 (n = 11). Gross grip strength, lateral, 3-jaw chuck, and precision pinch strength recovered 87%, 90%, 105%, and 87%, respectively. Wrist and elbow range of motion returned to normal limits, 2-point discrimination improved to normal scores at final follow-up, Disabilities of the Arm, Shoulder, and Hand scores were reduced from 59.8 before to 29.9 after surgery, and visual analog scale pain score improved from 7.2 before to 2.5 after surgery (P < .001). Conclusions To our knowledge, this is the first study to classify UNS after ECuTR and describe a guideline for ensuing treatment. Our preliminary report of patients shows satisfactory outcomes, which suggests that our intraoperative UNS classification system has promise in preventing adverse complications of ulnar nerve hypermobility after ECuTR. Type of study/level of evidence Therapeutic IV.
Collapse
|
16
|
Tolah A, Masaudi SAL, El-Kafrawy S, Mirza A, Harakeh S, Hassan A, Alzahrani A, Alsaaidi G, Alagaili A, Hashem A, Azhar E. Cross-sectional prevalence study of MERS-CoV in local and imported dromedary camels in Saudi Arabia, 2016-2018. J Infect Public Health 2020. [PMCID: PMC7129807 DOI: 10.1016/j.jiph.2020.01.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
17
|
Bhargavan RV, Mirza A, Cherian K, Krishna J, Augustine P. Level III dissection in locally advanced breast cancer following neoadjuvant chemotherapy: a retrospective study. Ann R Coll Surg Engl 2019; 102:214-219. [PMID: 31755729 DOI: 10.1308/rcsann.2019.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/06/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common female cancer in India, and 30-60% of patients present with locally advanced breast cancer. Level III clearance is routinely performed in India in locally advanced breast cancer following neoadjuvant chemotherapy, even in clinical complete response. We analysed our data of patients with locally advanced breast cancer post-neoadjuvant chemotherapy who have undergone level III clearance to identify any subgroup in which level III dissection can be avoided. MATERIAL AND METHODS This is a retrospective study of female patients with locally advanced breast cancer who received neoadjuvant chemotherapy and underwent breast surgery including level III nodal clearance between June 2016 and May 2018. Data collected included age, menopausal status, TNM stage at presentation, grade, estrogen, progesterone, human epidermal growth factor receptor 2 status, response to treatment, post-chemotherapy stage and final histopathology. Uni- and multivariate analysis was undertaken. RESULTS Data from 200 patients was analysed. The level III positivity rate was 15.5%. The clinical complete response rate was 43%, of which 41% had pathological complete response. A significant association was present between level III node positivity and pathological T stage (p=0.03). No association was seen between level III positivity and any other studied variables. In the subset of patients with cT3N1 and cT2N2, level III positivity was seen in only 3/49 (6.1%) and 1/31 (3%), respectively. CONCLUSION Level III positivity rate is high and so cannot be avoided in locally advanced breast cancer following neoadjuvant chemotherapy. None of the preoperative factors predict for level III positivity. Level III positivity in cT3N1 and cT2N2 is low and these subgroups require further studies.
Collapse
Affiliation(s)
- R V Bhargavan
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - A Mirza
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K Cherian
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - J Krishna
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - P Augustine
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| |
Collapse
|
18
|
Blacksburg S, Carpenter T, Demircioglu G, Mirza A, Coakley M, Mieles M, Murray A, Witten M, Mendez C, Katz A, Haas J. Comparison of 5-Year Outcomes of Stereotactic Body Radiotherapy for African American and white Men Treated for Low Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1874] [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: 10/26/2022]
|
19
|
Blacksburg S, Demircioglu G, Carpenter T, Mirza A, Witten M, Mendez C, Katz A, Haas J. Demographic and Pharmaceutical Predictors of Unfavorable Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1877] [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: 10/26/2022]
|
20
|
Blacksburg S, Powers A, Carpenter T, Demircioglu G, Mirza A, Witten M, Haas J. An Eighteen-Year Longitudinal Analysis of Accepted Prostate Cancer Presentations at the Annual ASTRO Meeting (2000-2017): Historical Trends In SBRT Technique Composition. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2195] [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: 10/26/2022]
|
21
|
Demircioglu G, Haas J, Mirza A, Witten M, Carpenter T, Mendez C, Coakley M, Mieles M, Murray A, Blacksburg S. Assessing the Impact of Increased Dose Rate Output on Bladder and Rectal Quality of Life in Men Treated with Definitive SBRT for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.951] [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: 10/26/2022]
|
22
|
Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019. [PMID: 30832732 DOI: 10.1186/s40425-018-0493-9.pmid:30832732;pmcid:pmc6399967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
Collapse
MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
Collapse
Affiliation(s)
- E Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - D S Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Q Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M D To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Binnewies
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - M L Broz
- Department of Pathology, UCSF, San Francisco, CA, USA
| | - H Mori
- Center for Comparative Medicine UC Davis, Davis, CA, USA
| | - D Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - M Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - R Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - O Li
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - T Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - B Liang
- Xoma Corporation, Berkeley, CA, USA
| | - J Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - F Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B C Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - A Mirza
- Department of Medicine, UCSF, San Francisco, CA, USA
| | - S A Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M D Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Dermatology, UCSF, San Francisco, CA, USA
| | - M F Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- Department of Pathology, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - A Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA, USA
| | - R J Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Department of Anatomy, UCSF, San Francisco, CA, USA.
| |
Collapse
|
23
|
Dodagatta-Marri E, Meyer DS, Reeves MQ, Paniagua R, To MD, Binnewies M, Broz ML, Mori H, Wu D, Adoumie M, Del Rosario R, Li O, Buchmann T, Liang B, Malato J, Arce Vargus F, Sheppard D, Hann BC, Mirza A, Quezada SA, Rosenblum MD, Krummel MF, Balmain A, Akhurst RJ. α-PD-1 therapy elevates Treg/Th balance and increases tumor cell pSmad3 that are both targeted by α-TGFβ antibody to promote durable rejection and immunity in squamous cell carcinomas. J Immunother Cancer 2019; 7:62. [PMID: 30832732 PMCID: PMC6399967 DOI: 10.1186/s40425-018-0493-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Checkpoint blockade immunotherapy has improved metastatic cancer patient survival, but response rates remain low. There is an unmet need to identify mechanisms and tools to circumvent resistance. In human patients, responses to checkpoint blockade therapy correlate with tumor mutation load, and intrinsic resistance associates with pre-treatment signatures of epithelial mesenchymal transition (EMT), immunosuppression, macrophage chemotaxis and TGFβ signaling. METHODS To facilitate studies on mechanisms of squamous cell carcinoma (SCC) evasion of checkpoint blockade immunotherapy, we sought to develop a novel panel of murine syngeneic SCC lines reflecting the heterogeneity of human cancer and its responses to immunotherapy. We characterized six Kras-driven cutaneous SCC lines with a range of mutation loads. Following implantation into syngeneic FVB mice, we examined multiple tumor responses to α-PD-1, α-TGFβ or combinatorial therapy, including tumor growth rate and regression, tumor immune cell composition, acquired tumor immunity, and the role of cytotoxic T cells and Tregs in immunotherapy responses. RESULTS We show that α-PD-1 therapy is ineffective in establishing complete regression (CR) of tumors in all six SCC lines, but causes partial tumor growth inhibition of two lines with the highest mutations loads, CCK168 and CCK169. α-TGFβ monotherapy results in 20% CR and 10% CR of established CCK168 and CCK169 tumors respectively, together with acquisition of long-term anti-tumor immunity. α-PD-1 synergizes with α-TGFβ, increasing CR rates to 60% (CCK168) and 20% (CCK169). α-PD-1 therapy enhances CD4 + Treg/CD4 + Th ratios and increases tumor cell pSmad3 expression in CCK168 SCCs, whereas α-TGFβ antibody administration attenuates these effects. We show that α-TGFβ acts in part through suppressing immunosuppressive Tregs induced by α-PD-1, that limit the anti-tumor activity of α-PD-1 monotherapy. Additionally, in vitro and in vivo, α-TGFβ acts directly on the tumor cell to attenuate EMT, to activate a program of gene expression that stimulates immuno-surveillance, including up regulation of genes encoding the tumor cell antigen presentation machinery. CONCLUSIONS We show that α-PD-1 not only initiates a tumor rejection program, but can induce a competing TGFβ-driven immuno-suppressive program. We identify new opportunities for α-PD-1/α-TGFβ combinatorial treatment of SCCs especially those with a high mutation load, high CD4+ T cell content and pSmad3 signaling. Our data form the basis for clinical trial of α-TGFβ/α-PD-1 combination therapy (NCT02947165).
Collapse
MESH Headings
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers
- CD4 Lymphocyte Count
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/metabolism
- Cell Line, Tumor
- Drug Synergism
- Epithelial-Mesenchymal Transition
- Humans
- Immunohistochemistry
- Lymphocyte Count
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/metabolism
- Signal Transduction/drug effects
- Smad3 Protein/metabolism
- T-Lymphocytes, Helper-Inducer/drug effects
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Transforming Growth Factor beta/antagonists & inhibitors
Collapse
Affiliation(s)
- E. Dodagatta-Marri
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - D. S. Meyer
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Q. Reeves
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Paniagua
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. D. To
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Binnewies
- Department of Pathology, UCSF, San Francisco, CA USA
| | - M. L. Broz
- Department of Pathology, UCSF, San Francisco, CA USA
| | - H. Mori
- Center for Comparative Medicine UC Davis, Davis, CA USA
| | - D. Wu
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - M. Adoumie
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - R. Del Rosario
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - O. Li
- Department of Medicine, UCSF, San Francisco, CA USA
| | - T. Buchmann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - B. Liang
- Xoma Corporation, Berkeley, CA USA
| | - J. Malato
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - F. Arce Vargus
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | | | - B. C. Hann
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
| | - A. Mirza
- Department of Medicine, UCSF, San Francisco, CA USA
| | - S. A. Quezada
- Cancer Immunology Unit, Immune Regulation and Tumour Immunotherapy Lab, University College London, London, UK
| | - M. D. Rosenblum
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Dermatology, UCSF, San Francisco, CA USA
| | - M. F. Krummel
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- Department of Pathology, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
| | - A. Balmain
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA USA
| | - R. J. Akhurst
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA USA
- UCSF Parker Institute for Cancer Immunotherapy, San Francisco, CA USA
- Department of Anatomy, UCSF, San Francisco, CA USA
| |
Collapse
|
24
|
Abdulwahid D, Abutaleb K, Mirza A. Single centre real life experience with first line pembrolizumab in advanced NSCLC in the North West Coast (Lans and South Cumbria). Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30149-7] [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]
|
25
|
Blacksburg S, Carpenter T, Demircioglu G, Mirza A, Witten M, Sheu R, Mendez C, Morgenstern J, Pappas D, Garbus J, Haas J. Robotic-Based SBRT for Prostate Cancer is Well Tolerated in Patients with a History of Inflammatory Bowel Disease. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.375] [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]
|
26
|
Blacksburg S, Sheu R, Demircioglu G, Mirza A, Carpenter T, Morgenstern J, Witten M, Mendez C, Endres P, Katz A, Haas J. PSA Nadir 2 Years after Definitive SBRT for Prostate Cancer: Predictors of Absolute PSA Decline. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.381] [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: 11/15/2022]
|
27
|
Demircioglu G, Mirza A, Fernandez S, Morgenstern J, Murray A, Haas J, Oliveri M, Aime S, Blacksburg S. Addressing Billing Errors: Results of a Prospective Quality Assurance Initiative to Optimize the Accuracy of Radiation Oncology Patient Charges. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Blacksburg S, Sheu R, Carpenter T, Demircioglu G, Mirza A, Morgenstern J, Witten M, Mendez C, Endres P, Pappas D, Garbus J, Haas J. Characterizing Rectal Dosimetry in Patients Who Have Received Definitive SBRT for Prostate Cancer: The 7-year Freedom from Proctitis in a Large Patient Cohort. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.379] [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: 11/15/2022]
|
29
|
Blacksburg S, Sheu R, Carpenter T, Demircioglu G, Morgenstern J, Mirza A, Witten M, Endres P, Haas J. Dosimetric Predictors For Attaining Rectal V3600cGy <1cc During SBRT for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.175] [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: 11/16/2022]
|
30
|
Whitson R, Mirza A, Yao C, McKeller S, Hollmig S, Aasi S, Sarin K, Tang J, Oro A. 210 MRTF inhibition displays promising therapeutic potential in human BCC patient explants. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.215] [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: 10/17/2022]
|
31
|
Kim G, Kwon G, Bailey-Healy I, Mirza A, Whitson R, Oro A, Tang J. 456 Pilot study of topical itraconazole for the treatment of basal cell carcinomas in gorlin syndrome patients. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.463] [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: 10/17/2022]
|
32
|
Mirza A, McKeller S, Oro A. 179 Drug resistance in basal cell carcinoma identifies the inner nuclear membrane as a critical GLI1 regulatory checkpoint. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.184] [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: 11/16/2022]
|
33
|
Ibrahim E, Biswas A, Mirza A, Sivaramalingam M. PO-0698: Severe and late dysphagia after head and neck cancer IMRT without residual disease. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31008-9] [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: 10/14/2022]
|
34
|
Mirza A, Mirza J, Healy C, Mathew V, Lee B. Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures. Hand (N Y) 2018; 13:184-189. [PMID: 28719990 PMCID: PMC5950961 DOI: 10.1177/1558944717695747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of the article was to evaluate clinical and radiographic outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation. METHODS A total of 55 patients with unstable metacarpal fractures between 2003 and 2010 were treated with IMN fixation and followed for a minimum of 1 year. The outcomes were assessed via a radiological study of longitudinal and angular collapse, Disabilities of the Arm, Shoulder, and Hand (DASH) score, total active range of motion (ROM) of the wrist, and grip strength testing. RESULTS In the 55 patients, metacarpal fractures were healed by clinical and radiographic assessment at an average of 12.7 weeks. IMNs were removed in all cases at an average of 13.9 weeks. Patients regained full finger ROM at the final follow-up and were capable of 72.4% of motion at 2 weeks postoperatively. The mean DASH score at the final follow-up was 6.5. Complications included 3 cases of extensor tendon irritation that resolved without functional impairment and 2 cases of "backing out" that required reoperation to replace the pin. In one case, a bony exostosis formed on the affected metacarpal that led to tendon irritation and required operative excision. CONCLUSIONS We found that this technique allowed for the stabilization of fractures, early ROM, resumption of usual activities, reduced immobilization, and minimal complications. A removable orthosis, instead of a cast, allowed for earlier mobilization of the wrist, metacarpophalangeal, and proximal interphalangeal joints.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Ather Mirza, North Shore Surgi-Center, 987 West Jericho Turnpike, Smithtown, NY 11787, USA.
| | | | - Chris Healy
- North Shore University Plainview Hospital, NY, USA
| | | | - Brian Lee
- North Shore Surgi-Center, Smithtown, NY, USA
| |
Collapse
|
35
|
Jao J, Yu W, Patel K, Miller TL, Karalius B, Geffner ME, DiMeglio LA, Mirza A, Chen JS, Silio M, McFarland EJ, Van Dyke RB, Jacobson D. Improvement in lipids after switch to boosted atazanavir or darunavir in children/adolescents with perinatally acquired HIV on older protease inhibitors: results from the Pediatric HIV/AIDS Cohort Study. HIV Med 2017; 19:175-183. [PMID: 29159965 DOI: 10.1111/hiv.12566] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/22/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Dyslipidaemia is common in perinatally HIV-infected (PHIV) youth receiving protease inhibitors (PIs). Few studies have evaluated longitudinal lipid changes in PHIV youth after switch to newer PIs. METHODS We compared longitudinal changes in fasting lipids [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and TC:HDL-C ratio] in PHIV youth enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) study who switched to atazanavir/ritonavir (ATV/r)- or darunavir/ritonavir (DRV/r)-based antiretroviral therapy (ART) from an older PI-based ART and those remaining on an older PI. Generalized estimating equation models were fitted to assess the association of a switch to ATV/r- or DRV/r-based ART with the rate of change in lipids, adjusted for potential confounders. RESULTS From 2007 to 2014, 47 PHIV children/adolescents switched to ATV/r or DRV/r, while 120 remained on an older PI [primarily lopinavir/r (72%) and nelfinavir (24%)]. Baseline age ranged from 7 to 21 years. After adjustment for age, Tanner stage, race/ethnicity, and HIV RNA level, a switch to ATV/r or DRV/r was associated with a more rapid annual rate of decline in the ratio of TC:HDL-C. (β = -0.12; P = 0.039) than remaining on an older PI. On average, TC declined by 4.57 mg/dL/year (P = 0.057) more in the switch group. A switch to ATV/r or DRV/r was not associated with the rate of HDL-C, LDL-C, or TG change. CONCLUSIONS A switch to ATV/r or DRV/r may result in more rapid reduction in TC and the TC:HDL-C ratio in PHIV youth, potentially impacting long-term cardiovascular disease risk.
Collapse
Affiliation(s)
- J Jao
- Department of Obstetrics, Gynecology and Reproductive Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Yu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - K Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - T L Miller
- Department of Pediatrics, University of Miami, Miami, FL, USA
| | - B Karalius
- Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M E Geffner
- Keck School of Medicine of USC, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - L A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Mirza
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA
| | - J S Chen
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA
| | - M Silio
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - E J McFarland
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - R B Van Dyke
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - D Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
36
|
Blacksburg S, Mirza A, Katz A, Carpenter T, Witten M, Haas J. Testicular Dose as a Function of Robotic Non-coplanar Planimetry: Computing the Effect of Limiting Transtesticular Beam Pathway for Prostate Cancer SBRT. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1116] [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: 10/18/2022]
|
37
|
Blacksburg S, Mirza A, Carpenter T, Ebling D, Catell D, Witten M, Haas J. Chart Rounds at a High Volume Hospital Program: Quantifying Discussion Time as a Function of Patient and Treatment Parameters. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1537] [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: 10/18/2022]
|
38
|
Blacksburg S, Mirza A, Murray A, Maher N, Mieles M, Scalia K, Carpenter T, Witten M, Katz A, Haas J. Fiducials as Surrogate for Prostate Motion During Robotic SBRT for Prostate Cancer: Predictors of Migration and Interfraction Discursion. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1117] [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]
|
39
|
King A, Troakes C, Aizpurua M, Mirza A, Hodges A, Al-Sarraj S, Exley C. Unusual neuropathological features and increased brain aluminium in a resident of Camelford, UK. Neuropathol Appl Neurobiol 2017; 43:537-541. [PMID: 28603852 DOI: 10.1111/nan.12417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 12/20/2022]
Affiliation(s)
- A King
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - C Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - M Aizpurua
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - A Mirza
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Keele, Staffordshire, UK
| | - A Hodges
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - S Al-Sarraj
- Department Of Clinical Neuropathology, King's College Hospital, London, UK.,London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - C Exley
- The Birchall Centre, Lennard-Jones Laboratories, Keele University, Keele, Staffordshire, UK
| |
Collapse
|
40
|
Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017; 7:26-31. [PMID: 28775940 DOI: 10.5588/pha.16.0125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. Objective: To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. Design: This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Results: Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Conclusion: Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.
Collapse
Affiliation(s)
- Y Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M A Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E Heldal
- Independent TB Consultant, Oslo, Norway
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| |
Collapse
|
41
|
Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017. [DOI: 10.5588/pha.16.0125%0asetting] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- Y. Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. A. Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R. Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E. Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E. Heldal
- Independent TB Consultant, Oslo, Norway
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union South-East Asia Office, New Delhi, India
| |
Collapse
|
42
|
Whitson R, Lee A, Urman N, Li J, Mirza A, Brown A, Yao C, Shankar G, Fry M, Atwood S, Epstein E, Tang J, Oro A. 081 Resistant basal cell carcinomas require SRF/MRTF to maintain hedgehog pathway activation and tumor growth. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
43
|
Zia S, Mirza A, Ozbek U, Sheu R, Ghafar R, Posner M, Misiukiewicz K, Genden E, Gupta V, Bakst R. Clinical and Treatment Predictors of Weight Loss in Patients With Head and Neck Malignancies Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
44
|
Mirza A, Galloway S. Laparoscopy, computerised tomography and fluorodeoxyglucose positron emission tomography in the management of gastric and gastro-oesophageal junction cancers. Surg Endosc 2015; 30:2690-6. [PMID: 26487234 DOI: 10.1007/s00464-015-4590-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/12/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The staging laparoscopy has been used in the management of gastrointestinal cancers. The aim of this study was to evaluate the role of staging laparoscopy, in comparison with computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) imaging in staging patients with gastro-oesophageal junction (GOJ) and gastric cancers. METHODS The data were collected for patients between 1996 and 2013 undergoing investigation and treatment for GOJ and gastric cancers at a single institute. The pre-operative data (staging data), intraoperative details, post-operative course and follow-up were analysed for individual cases. RESULTS Staging laparoscopy altered management plan in 64 (17 %) of 387 patients with negative staging CT and FDG-PET scan. Twenty-seven (7 %) patients with GOJ cancer (types I, II and III) were identified with pathological intraperitoneal nodes, 15 (4 %) gastric cancer with metastatic intraperitoneal deposits and liver metastases and 3 % gastric cancers with positive ascitic fluid for cancer cells. Ten (3 %) of patients were downstaged and were offered curative resection. Patients with metastatic disease were referred for palliative chemotherapy. The overall sensitivity of staging laparoscopy in diagnosing intraabdominal pathology was 86 % in comparison with CT (81 %) and FDG-PET (78 %). CONCLUSIONS The diagnostic laparoscopy is useful for detecting and confirming nodal involvement and distant metastatic disease not evident on the staging CT scan and FDG-PET. This could potentially alter treatment and prognosis in patients with upper gastrointestinal cancer. The diagnostic laparoscopy should be performed as part of investigation and treatment planning for patients suffering from GOJ and gastric cancers. This can help to avoid surgery in patients with advanced disease.
Collapse
Affiliation(s)
- A Mirza
- Department of Oesophago-Gastric Surgery, The University Hospital of South Manchester, Manchester, UK. .,Department of General Surgery, The University Hospital of South Manchester, SouthMoor Road, Manchester, M23 2RW, UK.
| | - S Galloway
- Department of Oesophago-Gastric Surgery, The University Hospital of South Manchester, Manchester, UK
| |
Collapse
|
45
|
Raza F, Oliveros E, Mirza A, Forfia P, Schwartz D, Dries D, Tsai E, Punnoose L, Shiose A, Toyoda Y, Alvarez R, Bove A, Hamad E. Simple RVOT Doppler Measurements in Addition to Hemodynamic Variables Can Help Identify Need for RVAD at Time of LVAD Placement. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.636] [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] Open
|
46
|
Mirza A, Foster L, Valentine H, Welch I, West CM, Pritchard S. Investigation of the epithelial to mesenchymal transition markers S100A4, vimentin and Snail1 in gastroesophageal junction tumors. Dis Esophagus 2014; 27:485-92. [PMID: 23082947 DOI: 10.1111/j.1442-2050.2012.01435.x] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial to mesenchymal transition (EMT) promotes tumor progression and invasion. As no study has focused on gastroesophageal junction (GEJ) tumors, the expression of three EMT-related proteins (S100A4, vimentin, and Snail1) was investigated with the aim of assessing their pathologic and prognostic significance. Resection specimens were obtained from 104 patients who underwent surgery for GEJ adenocarcinoma, without preoperative chemotherapy. Three tissue cores were obtained from each of the tumor body (TB), luminal surface (LS), and invasive edge (IE) to produce tissue microarrays, and immunohistochemical staining was performed. The microarrays were scored independently by two observers. The demographic and histopathologic details of the patients were collected. Overall positive expression was observed in 88 (S100A4, 85%), 16 (vimentin, 14%), and 92 (Snail1, 89%) tumors. Staining for S100 A4 was positive in 79 (76%) of TB, 69 (66%) of IE, and 69 (66%) of LS specimens. Staining for vimentin was positive in 7 (6%) of TB, 11 (11%) of IE, and 5 (5%) of LS specimens. Staining for Snail1 was positive in 83 (80%) of TB, 51 (49%) of IE, and 78 (75%) of LS specimens. Positive staining of TB for S100A4 (P = 0.04) and Snail1 at IE (P = 0.01) was associated with involvement of circumferential resection margins. Positive staining for S100A4 in the TB (P = 0.02) and LS (P = 0.01) was associated with poor 5-year overall survival. Vimentin had no statistically significant relationships with pathologic factors or outcome. The acquisition of mesenchymal protein S100A4 is associated with a poor prognosis in patients with GEJ tumors who undergo potentially curative surgery, and LS samples can be used to obtain prognostic information. Increased EMT-related protein expression (S100A4, Snail1) is associated with the involvement of circumferential resection margin.
Collapse
Affiliation(s)
- A Mirza
- Department of Gastrointestinal Surgery, University Hospital of South Manchester, Manchester, UK; Department of Histopathology, University Hospital of South Manchester, Manchester, UK
| | | | | | | | | | | |
Collapse
|
47
|
Mirza A, Mirza JB, Lee BK, Adhya S, Litwa J, Lorenzana DJ. An anatomical basis for endoscopic cubital tunnel release and associated clinical outcomes. J Hand Surg Am 2014; 39:1363-9. [PMID: 24881897 DOI: 10.1016/j.jhsa.2014.04.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the ulnar nerve in fresh-frozen cadavers as related to endoscopic release of the cubital tunnel and to present a retrospective review of patients treated with decompression via endoscopic visualization. METHODS To further our understanding of relevant anatomy, we dissected 26 cadaver limbs. We paid special attention to fascial membranes as potential sites of constriction as well as the position of nerves, vessels, and aberrant anatomy. These findings facilitated our understanding of the extent of release in 80 patients (92 cases) with endoscopic cubital tunnel simple decompression. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score, Gabel and Amadio score, and grip and pinch strengths. RESULTS We noted fascial bands proximal to the medial epicondyle in 12 of 26 cadaver specimens, 2 of which could be the so-called arcade of Struthers. We observed a high degree of variability in the anatomy of the flexor pronator aponeurosis distal to the medial epicondyle. Where present (n = 10), medial antebrachial cutaneous nerve branches crossed the ulnar nerve at an average distance of 2.9 cm from the medial epicondyle (range, 1.0-4.5 cm). Aberrant structures were noted in 8 of the 26 specimens, including an anconeus epitrochlearis muscle in 2 specimens, a basilic vein crossing the ulnar nerve in 4 specimens, and an accessory origin of the medial head of the triceps from the medial intermuscular septum in 2 specimens. In the clinical portion of this study, the average Disabilities of the Arm, Shoulder, and Hand score before surgery was 49 (n = 34) and after surgery was 25 (n = 56). The Gabel and Amadio outcome scores were 24 excellent, 40 good, 25 fair, and 3 poor (n = 92). Average follow-up was 8.2 months (range, 0.1-35 mo). CONCLUSIONS Cadaveric dissections shed light on vulnerable anatomical structures during release, including branches of the medial antebrachial cutaneous nerve, ulnar nerve, brachial artery, fascial bands, and basilic vein. The high degree of anatomical variability in this study highlights the advantage of endoscopic visualization in allowing surgeons to minimize surgical trauma. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Justin B Mirza
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian K Lee
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shawn Adhya
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joshua Litwa
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel J Lorenzana
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| |
Collapse
|
48
|
Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. In reply. J Hand Surg Am 2013; 38:2519. [PMID: 24275057 DOI: 10.1016/j.jhsa.2013.09.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ather Mirza
- Department of Hand and Microsurgery, St. Catherine of Siena Medical Center; and the North Shore Surgi-Center, Smithtown, NY
| | | | | | | | | | | |
Collapse
|
49
|
Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy. J Hand Surg Am 2013; 38:1492-7. [PMID: 23849735 DOI: 10.1016/j.jhsa.2013.05.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 05/18/2013] [Accepted: 05/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate outcomes in a single-surgeon series of ulnar shortening osteotomy for the treatment of traumatic isolated tears to the lunotriquetral interosseous ligament (LTIL). METHODS This study includes 53 consecutive cases of posttraumatic isolated LTIL tears treated with ulnar shortening osteotomy with minimum 1-year follow-up (range, 1.0-10.6 y). We confirmed all LTIL tears via arthroscopy before performing a precision 2.5-mm oblique osteotomy using a modified Rayhack technique. We assessed outcomes using grip strength measurements and Chun and Palmer's modified Gartland Werley wrist scoring system, which includes subjective and objective outcome measures. RESULTS Preoperatively, 45 cases were graded as fair (28%; n = 15) or poor (57%; n = 30) on the modified Gartland Werley score. There were insufficient data to calculate grades in 8 cases (15%). At final follow-up, most patients exhibited excellent (51%; n = 27) or good (32%; n = 17) scores, some scored fair (17%; n = 9), and none scored as poor. All subjective and objective variables significantly improved over a mean follow-up of 36 months (range, 12-127 mo). Mean grip strength increased from a value of 23 kg before surgery to 33 kg over the same period, a 41% increase. All patients achieved clinical and radiographic union by 10 months. Osteotomy plates were removed routinely in most cases (89%; n = 47) at a mean of 17 months. CONCLUSIONS Ulnar shortening osteotomy reduced symptoms of posttraumatic isolated LTIL tears in this single-surgeon series. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Ather Mirza
- Department of Hand and Microsurgery, St. Catherine of Siena Medical Center, Smithtown, NY 11787, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Vermes E, Sirinelli A, Marliere J, Mirza A, Aupart M. Impact of Sex Mismatch on Overall and Cardiac Survivals in Male Heart Recipients: A 21-Year French Experience. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.668] [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: 10/27/2022] Open
|