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Carande EJ, Salim TS, Chase A, Sekar B, Aldalati O, Hailan A, Khurana A, Smith D, Obaid DR. Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation. Br J Radiol 2023; 96:20230296. [PMID: 37747290 PMCID: PMC10646661 DOI: 10.1259/bjr.20230296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) are common and lead to increased morbidity and mortality. Analysis of plaque at the arterial access site may improve prediction of complications. METHODS We investigated the association between demographic and procedural risk factors for Valve Academic Research Consortium (VARC-3) vascular complications in patients undergoing transfemoral TAVI with use of a vascular closure device (ProGlide® or MANTA®) in this retrospective cohort study. The ability of pre-procedure femoral CT angiography to predict complications was investigated including a novel method of quantifying plaque composition of the common femoral artery using plaque maps created with patient specific X-ray attenuation cut-offs. RESULTS 23 vascular complications occurred in the 299 patients in the study group (7.7%). There were no demographic risk factors associated with vascular complications and no statistical difference between use of closure device (ProGlide® vs MANTA®) and vascular complications. Vascular complications after TAVI were associated with sheath size (OR 1.36, 95% CI 1.08-1.76, P 0.01) and strongly associated with CT-derived necrotic core volume in the common femoral artery of the procedural side (OR 17.49, 95% CI 1.21-226.60, P 0.03). CONCLUSION Plaque map analysis of the common femoral artery by CT angiography reveals patients with greater necrotic core are at increased risk of VARC-3 vascular complications. ADVANCES IN KNOWLEDGE The novel measurement of necrotic core volume in the common femoral artery on the procedural side by CT analysis was associated with post-TAVI vascular complications, which can be used to highlight increased risk.
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Affiliation(s)
- Elliott J. Carande
- Cwm Taff Morgannwg University Health Board, Princess of Wales Hospital, Coity Road, Bridgend, United Kingdom
| | - Tarik S Salim
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Alexander Chase
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Baskar Sekar
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Omar Aldalati
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Ahmed Hailan
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Ayush Khurana
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Dave Smith
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
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2
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Galusko V, Ionescu A, Edwards A, Sekar B, Wong K, Patel K, Lloyd G, Ricci F, Khanji MY. Management of mitral stenosis: a systematic review of clinical practice guidelines and recommendations. European Heart Journal - Quality of Care and Clinical Outcomes 2022; 8:602-618. [PMID: 34878131 DOI: 10.1093/ehjqcco/qcab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022]
Abstract
A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011-5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.
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Affiliation(s)
- Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Adrian Ionescu
- Morriston, UK Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Amy Edwards
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
| | - Baskar Sekar
- Morriston, UK Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Kit Wong
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ketna Patel
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Guy Lloyd
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, G.d'Annunzio University, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35-205 02, Malmö, SE-221 00, Sweden
- Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
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3
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Galusko V, Sekar B, Ricci F, Wong K, Bhattacharyya S, Mullen M, Gallina S, Ionescu A, Khanji MY. Mitral regurgitation management: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes 2022; 8:481-495. [PMID: 34878118 DOI: 10.1093/ehjqcco/qcab082] [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] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022]
Abstract
Multiple guidelines exist for the diagnosis and management of mitral regurgitation (MR), the second most common valvular heart disease in high-income countries, with recommendations that do not always match. We systematically reviewed guidelines on diagnosis and management of MR, highlighting similarities and differences to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (1 June 2010 to 1 September 2021), the Guidelines International Network, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two reviewers independently screened the abstracts and identified articles of interest. Guidelines that were rigorously developed (as assessed with the Appraisal of Guidelines for Research and Evaluation II instrument) were retained for analysis. Five guidelines were retained. There was consensus on a multidisciplinary approach from the heart team and for the definition and grading of severe primary MR. There was general agreement on the thresholds for intervention in symptomatic and asymptomatic primary MR; however, discrepancies were present. There was agreement on optimization of medical therapy in severe secondary MR and intervention in patients symptomatic despite optimal medical therapy, but no consensus on the choice of intervention (surgical repair/replacement vs. transcatheter approach). Cut-offs for high-risk intervention in MR, risk stratification of progressive MR, and guidance on mixed valvular disease were sparse.
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Affiliation(s)
- Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Baskar Sekar
- Department of Cardiology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, G.d'Annunzio University, 66100 Chieti, Italy.,Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35-205, Malmö 22100, Sweden.,Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Kit Wong
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sanjeev Bhattacharyya
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Michael Mullen
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, G.d'Annunzio University, 66100 Chieti, Italy
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Mohammed Yunus Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK.,Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
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4
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Ricci F, Bufano G, Galusko V, Sekar B, Benedetto U, Awad WI, Di Mauro M, Gallina S, Ionescu A, Badano L, Khanji MY. Tricuspid regurgitation management: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes 2022; 8:238-248. [PMID: 34878111 DOI: 10.1093/ehjqcco/qcab081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent condition and an independent risk factor for adverse outcomes. Multiple clinical guidelines exist for the diagnosis and management of TR, but the recommendations may sometimes vary. We systematically reviewed high-quality guidelines with a specific focus on areas of agreement, disagreement, and gaps in evidence. We searched MEDLINE and EMBASE (1 January 2011 to 30 August 2021), the Guidelines International Network International, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed (as assessed by the Appraisal of Guidelines for Research and Evaluation II tool). Three guidelines were finally retained. There was consensus on a TR grading system, recognition of isolated functional TR associated with atrial fibrillation, and indications for valve surgery in symptomatic vs. asymptomatic patients, primary vs. secondary TR, and isolated TR forms. Discrepancies exist in the role of biomarkers, complementary multimodality imaging, exercise echocardiography, and cardiopulmonary exercise testing for risk stratification and clinical decision-making of progressive TR and asymptomatic severe TR, management of atrial functional TR, and choice of transcatheter tricuspid valve intervention (TTVI). Risk-based thresholds for quantitative TR grading, robust risk score models for TR surgery, surveillance intervals, population-based screening programmes, TTVI indications, and consensus on endpoint definitions are lacking.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströmsgata 35-205, 22100 Malmö, Sweden
- Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Gabriella Bufano
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Baskar Sekar
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Michele Di Mauro
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
- Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Mohammed Y Khanji
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, 6229 HX, Maastricht, the Netherlands
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
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5
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Galusko V, Thornton G, Jozsa C, Sekar B, Aktuerk D, Treibel TA, Petersen SE, Ionescu A, Ricci F, Khanji MY. Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes 2022; 8:113-126. [PMID: 35026012 DOI: 10.1093/ehjqcco/qcac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022]
Abstract
Guidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations that do not always match. We systematically reviewed clinical practice guidelines and summarized similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and Embase (1 January 2011 to 1 September 2021), Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.
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Affiliation(s)
- Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - George Thornton
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6DD, UK
| | - Csilla Jozsa
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
| | - Baskar Sekar
- Department of Cardiology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK
| | - Dincer Aktuerk
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6DD, UK
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Adrian Ionescu
- Morriston Hospital, UK Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, 'G.d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, -205 02, Malmö, Sweden
- Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Mohammed Y Khanji
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
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6
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Sekar B, Kurdi H, Smith D. Lockdown cardiomyopathy: from a COVID-19 pandemic to a loneliness pandemic. Br J Cardiol 2021; 28:2. [PMID: 35747487 PMCID: PMC8988221 DOI: 10.5837/bjc.2021.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Social distancing/isolation is vital for infection control but can adversely impact on mental health. As the spread of COVID-19 is contained, mental health issues will surface with particular concerns for elderly, isolated populations. We present a case of Takotsubo cardiomyopathy related to lockdown anxiety.
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Affiliation(s)
- Baskar Sekar
- Cardiology Interventional Fellow Morriston Cardiac Centre, Morriston Hospital, Swansea, SA6 SNL
| | - Hibba Kurdi
- Cardiology Fellow Morriston Cardiac Centre, Morriston Hospital, Swansea, SA6 SNL
| | - David Smith
- Consultant Cardiologist Morriston Cardiac Centre, Morriston Hospital, Swansea, SA6 SNL
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Khanji MY, Ricci F, Galusko V, Sekar B, Chahal CAA, Ceriello L, Gallina S, Kennon S, Awad WI, Ionescu A. Management of aortic stenosis: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes 2021; 7:340-353. [PMID: 33751049 DOI: 10.1093/ehjqcco/qcab016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Multiple guidelines exist for the management of aortic stenosis (AS). We systematically reviewed current guidelines and recommendations, developed by national or international medical organizations, on management of AS to aid clinical decision-making. Publications in MEDLINE and EMBASE between 1 June 2010 and 15 January 2021 were identified. Additionally, the International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations were searched. Two reviewers independently screened titles and abstracts. Two reviewers assessed rigour of guideline development and extracted the recommendations. Of the seven guidelines and recommendations retrieved, five showed considerable rigour of development. Those rigourously developed, agreed on the definition of severe AS and diverse haemodynamic phenotypes, indications and contraindications for intervention in symptomatic severe AS, surveillance intervals in asymptomatic severe AS, and the importance of multidisciplinary teams (MDTs) and shared decision-making. Discrepancies exist in age and surgical risk cut-offs for recommending surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers and complementary multimodality imaging for decision-making in asymptomatic patients and surveillance intervals for non-severe AS. Contemporary guidelines for AS management agree on the importance of MDT involvement and shared decision-making for individualized treatment and unanimously indicate valve replacement in severe, symptomatic AS. Discrepancies exist in thresholds for age and procedural risk used in choosing between SAVR and TAVI, role of biomarkers and complementary imaging modalities to define AS severity and risk of progression in asymptomatic patients.
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Affiliation(s)
- Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK.,Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy.,Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.,Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Baskar Sekar
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
| | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,Department of Cardiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Laura Ceriello
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Wael I Awad
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Heol Maes Eglwys, Swansea SA6 6NL, UK
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Zaidi A, Sekar B, Yousef Z. Broad complex tachycardia in a 46-year-old man. Heart 2021; 106:602-623. [PMID: 32217733 DOI: 10.1136/heartjnl-2019-316397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abbas Zaidi
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Baskar Sekar
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
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Sekar B, Indrapriyadharshini K, Ambika M, Saranyan R, Nirmal M, Manzoor S. Survivin Expression in Metastatic and Nonmetastatic Oral Squamous Cell Carcinoma: A Comparative Study. Journal of Advanced Oral Research 2020. [DOI: 10.1177/2320206820968448] [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: 11/17/2022]
Abstract
Aim: Survivin is a multifunctional protein chiefly involved in apoptosis and cell cycle regulation. Increased expression of survivin in tumors and fetal tissue determines its antiapoptotic activity. The aim of the study is to identify the immunoexpression of survivin in metastatic and nonmetastatic oral squamous cell carcinoma (OSCC) and also to evaluate and compare the expression of survivin in metastatic and nonmetastatic OSCC of buccal mucosa. Materials and Methods: In total, 40 histopathologically proven cases of OSCC, including 20 metastatic and 20 nonmetastatic cases, are selected. Among the 20 metastatic and nonmetastatic cases, 10 well-differentiated and 10 moderately differentiated squamous cell carcinoma cases were included and were subjected to immunohistochemical staining for survivin expression. The results were analyzed by SPSS version 11.5 using chi-square test. Results: The expression of survivin in metastatic and nonmetastatic tumors is 15%–70% and 15%–60%, respectively. When comparing the cases of moderately differentiated squamous cell carcinoma in metastatic and nonmetastatic tumors, 70% cases show moderate staining intensity. Conclusion: The survivin expression was comparatively high in metastatic OSCC. Also based on the aforementioned results, survivin expression was high in increasing grades of OSCC.
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Affiliation(s)
- B. Sekar
- Department of Oral Pathology and Microbiology, Vinayaka Mission’s Sankarachariyar Dental College, VMRF (Deemed to be University), Ariyanoor, Tamil Nadu, India
| | - K. Indrapriyadharshini
- Department of Oral Pathology and Microbiology, Vinayaka Mission’s Sankarachariyar Dental College, VMRF (Deemed to be University), Ariyanoor, Tamil Nadu, India
| | - M. Ambika
- Department of Oral Pathology and Microbiology, Vinayaka Mission’s Sankarachariyar Dental College, VMRF (Deemed to be University), Ariyanoor, Tamil Nadu, India
| | - R. Saranyan
- Department of Periodontics, Vinayaka Mission’s Sankarachariyar Dental College, VMRF (Deemed to be University), Ariyanoor, Tamil Nadu, India
| | - Madhavan Nirmal
- Department of Oral Pathology and Microbiology, Raja Muthiah Dental College, Annamalai University, Chidambaram, Tamil Nadu, India
| | - Sathick Manzoor
- Department of Dental Radiology, MAHSA University, Kuala Lumpur, Malaysia
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Murugesan A, Sekar B, Saranyan R, Manivannan E, Rajmohan M. A Review on Cancer Stem Cells in Vasculogenic Mimicry Formation: A New Dimension for Targeted Therapy. Journal of Advanced Oral Research 2020. [DOI: 10.1177/2320206820960862] [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: 11/17/2022]
Abstract
Aim: Cancer stem cells (CSCs) or tumor-initiating cells have self-renewal and uncontrolled tumor growth capacity that promotes metastasis and recurrence. Challenges in anticancer have found a lateral dimension of treatment against a new pattern of tumor microcirculation, known as vasculogenic mimicry (VM), involved in cancer progression. Increasing evidence suggest that CSCs are involved in the formation of VM. In this review the correlation between CSCs and VM formation is been enlightened. Materials and Methods: The literature search was done in Medline, PubMed, Wiley, Science Direct, and Scopus. The keywords used for database search were cancer stem cells, vasculogenic mimicry, and anticancer therapy. Results: A total of 112 articles appeared from various sources, of which 102 were subjected for screening and 20 were related to the research objective. Conclusion: Based on the literature a positive correlation exists between CSC and VM, which plays a key role in tumor progression, and hence, can serve as a potential target in anticancer therapy.
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Affiliation(s)
- Ambika Murugesan
- Department of Oral Pathology and Oral Microbiology, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - B. Sekar
- Department of Oral Pathology and Oral Microbiology, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - R. Saranyan
- Department of Periodontology, Vinayaka Mission’s Sankarachariyar Dental College, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - E. Manivannan
- Department of Pharmacology, VMKV Medical College, Salem, Tamil Nadu, India
| | - M. Rajmohan
- Department of Oral and Maxillofacial Pathology, KSR Institute of Dental Science and Research, Tiruchengode, Thokkavadi, Tamil Nadu, India
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Kurdi H, Obaid DR, UlHaq Z, Ionescu A, Sekar B. Multiple spontaneous coronary thrombosis causing ST-elevation myocardial infarction in a patient with COVID-19. Br J Hosp Med (Lond) 2020; 81:1-6. [PMID: 32730159 DOI: 10.12968/hmed.2020.0337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hibba Kurdi
- Morriston Cardiology Centre, Morriston Hospital, Swansea, UK
| | - Daniel R Obaid
- Morriston Cardiology Centre, Morriston Hospital, Swansea, UK
| | - Zia UlHaq
- Morriston Cardiology Centre, Morriston Hospital, Swansea, UK
| | - Adrian Ionescu
- Morriston Cardiology Centre, Morriston Hospital, Swansea, UK
| | - Baskar Sekar
- Morriston Cardiology Centre, Morriston Hospital, Swansea, UK
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Premawardhana A, Choudhury A, Sekar B, Hussain H. P2804Initial experience with the novel BioMime Morph 40–60 mm long sirolimus-eluting tapered stent in long coronary lesions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1116] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Aims: Long lesions treated with overlapping stents has been reported to be associated with healing problems and/or adverse events. The novel BioMime Morph is a 40, 50 and 60 mm long sirolimus-eluting cobalt chromium stent (65 μm strut thickness, biodegradable polymer) with a tapered design (0.5 mm taper from proximal to distal end) and is available in the following proximal and distal diameters (2.75–2.2 5mm, 3–2.5 mm and 3.5–3 mm). It can be a novel alternative for treatment of long coronary lesions, overcoming the limitations of overlapping stents.
Methods and results
Methods: Data was evaluated from our centre's prospective BioMime Morph database from August 2016 - January 2019. Primary endpoint was device oriented composite endpoint (DOCE: cardiac death, TV-MI, TLR and TVR). Secondary endpoints were technical (successful Morph implantation) and procedural success (successful procedure with Morph without in-hospital MACE).
Results
103 patients had BioMime Morph stents implanted, with mean follow up of 411 (±214) days and a mean age of 66 (±11) years. Co-morbidities included hypertension (58%), hypercholesterolemia (38%), diabetes mellitus (28%), PVD (2%), CVD (5%), CKD (12%), previous MI (17%), smoking (40%) and positive family history (20%). There was history of previous PCI in 18% and CABG in 4%. Indication for PCI was predominantly ACS (78% including 13% STEMI), 15% were CTOs. 80% of the procedures were performed via radial access using 5–6F sheath in 73%. Vessels treated included LAD (43%), Cx (12%) and RCA (45%). Pre-dilatation was performed in 96% including use of non-complaint balloons in 51%, scoring balloons in 12% and rotablation in 4%. Post-dilatation was performed in 99%. Buddy wire was used in 41% while a guideliner used in 13%. Technical success (secondary endpoint) was achieved in 100 whilst procedural success was achieved in 96% (4 cases of contrast induced nephropathy). Cumulative DOCE (primary endpoint) was % (cardiac death 1%, TV-MI 1%, definitive ST 0%, possible ST 1%, TLR 2% and TVR 2%). OCT follow up at 1 month, 3 month and 6 months in 2 patients showed endothelialisation even at 1 month.
Conclusions
Our initial experience of the use of the novel BioMime Morph tapered DES for treatment of long coronary lesions exhibit promising results in short to medium follow-up. Elution of the drug in 1 month along with biodegradable polymer and ultra thin struts potentially helps early healing and raises the possibility of short DAPT even in these complex long lesions. BioMime Morph stents can potentially be an alternative to overlapping conventional stents for treating long coronary lesions.
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Affiliation(s)
| | - A Choudhury
- University Hospital of Wales, Cardiff, United Kingdom
| | - B Sekar
- University Hospital of Wales, Cardiff, United Kingdom
| | - H Hussain
- University Hospital of Wales, Cardiff, United Kingdom
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Premawardhana D, Sekar B, Ul-Haq MZ, Sheikh A, Gallagher S, Anderson R, Copt S, Ossei-Gerning N, Kinnaird T. Routine iso-osmolar contrast media use and acute kidney injury following percutaneous coronary intervention for ST elevation myocardial infarction. Minerva Cardioangiol 2019; 67:380-391. [PMID: 31527583 DOI: 10.23736/s0026-4725.19.04925-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Temporal changes in contrast-induced acute kidney injury (CI-AKI) incidence following primary percutaneous coronary intervention (PPCI) are poorly defined. Additionally, the benefits of iso-osmolar contrast media (IOCM) compared to low osmolar CM (LOCM) are uncertain. METHODS Using data from a regional PPCI service, temporal changes in baseline risk and annual incidence of CI-AKI were studied. A CM protocol change occurred in 2013 allowing a comparison of the incidence of CI-AKI between LOCM (2012-13) and IOCM (2013-15). RESULTS Between 2012 and 2015, 208 of 1310 patients experienced CI-AKI (15.9%). The Mehran AKI risk score did not change during the study period although there was an increase in the incidence of CI-AKI in later study years (P<0.001 for trend) when IOCM was used. Factors independently associated with CI-AKI were IOCM use (OR=1.96, [95% CI: 1.39-2.75]), age per year (OR=1.02, 95% CI: 1.01-1.04), baseline creatinine per µmol/L (OR=1.006, 95% CI: 1.003-1.01) and contrast volume per milliliter (OR=1.002, 95% CI: 1.001-1.004). The baseline characteristics of patients treated using IOCM (N.=783) vs. LOCM (N.=527) were similar (Mehran Score 6.6 vs. 6.9, P=0.173) but CI-AKI occurred more frequently with IOCM compared to LOCM (19.2% vs. 11.2%, P<0.001). Use of IOCM was independently associated with CI-AKI (OR=1.98, 95% CI: 1.339-2.774, P<0.001) with consistency across all sub-groups of age, gender, baseline creatinine, contrast volume, shock and diabetes. The adjusted in-hospital mortality was increased with IOCM compared to LOCM (OR=3.03, 95% CI: 1.313-6.994, P=0.009). CONCLUSIONS IOCM use was observed to be associated with an increased occurrence of CI-AKI, and an increase in in-hospital mortality after primary PCI.
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Affiliation(s)
| | - Baskar Sekar
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Muhammed Z Ul-Haq
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Azeem Sheikh
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | | | - Nick Ossei-Gerning
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK -
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Priyadharshini KI, Ambika M, Sekar B, Mohanbabu V, Sabarinath B, Pavithra I. Comparison of cheiloscopy, odontometric, and facial index for sex determination in forensic dentistry. J Forensic Dent Sci 2019; 10:88-91. [PMID: 30745784 PMCID: PMC6344791 DOI: 10.4103/jfo.jfds_102_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The “gender determination” which is an important human identification procedure not only helps in establishing the biological profile from skeletal and dental remains but also in facial reconstruction of unidentified victims. Aim: The aim of this study is to analyze predominant types of lip prints (cheiloscopy), accuracy of mandibular canine index (MCI) (odontometric), and facial index in the study population and to identify whether any correlation among the above parameters could help forensic dentistry in solving crimes. Materials and Methods: A pilot study was conducted in 100 individuals, 50 males and 50 females aged between 20 and 25 years. For each individual, the lip prints, MCI, and facial index measurements were recorded on the same day analyzed by two observers. All the analysis was done using SPSS version 14 assessed using t-test and Chi-square test. Results: Type II pattern of lip prints is observed as common pattern among male and female. There is no significant difference in Odontometric analysis. The mean value of facial index analysis in both genders shows highly significant. Conclusion: A large-scale study is required in order to validate our results to arrive at definitive results and value.
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Affiliation(s)
- K Indra Priyadharshini
- Department of Oral and Maxillofacial Pathology, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Ariyanoor, Salem, Tamil Nadu, India
| | - M Ambika
- Department of Oral and Maxillofacial Pathology, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Ariyanoor, Salem, Tamil Nadu, India
| | - B Sekar
- Department of Oral and Maxillofacial Pathology, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Missions Research Foundation (Deemed to be University), Ariyanoor, Salem, Tamil Nadu, India
| | - V Mohanbabu
- Department of Conservative Dentistry, Penang International Dental College, Salem, Tamil Nadu, India
| | - B Sabarinath
- Department of Oral and Maxillofacial Pathology, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Tamil Nadu, India
| | - I Pavithra
- Dental Consultant, Vellore, Tamil Nadu, India
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15
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Sekar B, Saranyan R, Nirmal R, Kumaresan I, Murugesan A, Kamaraj L. Caldesmon Expression in Metastatic and Non-Metastatic Oral Squamous Cell Carcinoma—A Mediator of Epithelial Mesenchymal Transition. J Orofac Sci 2019. [DOI: 10.4103/jofs.jofs_140_19] [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: 11/04/2022] Open
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16
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Sekar B, Wheeler R, Masani N, Gallagher S. Myocardial ischaemia as a result of external coronary compression from infective aortic root aneurysm: atypical presentation of prosthetic valve endocarditis. Echo Res Pract 2018; 5:K35-K40. [PMID: 29643124 PMCID: PMC5948197 DOI: 10.1530/erp-18-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/02/2022] Open
Abstract
This case describes an unusual presentation of prosthetic valve endocarditis (PVE): an acute coronary syndrome. A 67-year-old male presented with cardiac sounding chest pain on a background of a short history of night sweats, weight loss and general malaise. Four months previously, he had undergone bio-prosthetic aortic valve replacement for severe aortic stenosis and single vessel bypass grafting of the obtuse marginal. Whilst having chest pain, his ECG showed infero-lateral ST depression. Early coronary angiography revealed a new right coronary artery (RCA) lesion that was not present prior to his cardiac surgery. Using multi-modality cardiac imaging, the diagnosis of PVE was made. An aortic root abscess was demonstrated that was causing external compression of the RCA.
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Affiliation(s)
- Baskar Sekar
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Richard Wheeler
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Navroz Masani
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sean Gallagher
- Cardiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
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17
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Sekar B, Martins J, Petkar S. Confirmed early myocardial rupture in a patient with pulseless electrical activity (PEA) following late presentation of ST elevation myocardial infarction. Echo Res Pract 2017; 4:I11-I12. [PMID: 28420670 PMCID: PMC5457502 DOI: 10.1530/erp-17-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/18/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Baskar Sekar
- Cardiology Department, Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Joe Martins
- Cardiology Department, Russell's Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Sanjiv Petkar
- Cardiology Department, Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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18
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Suganya K, Prem Kumar A, Sekar B, Sundaran B. Protection of mice against gastric colonization of Helicobacter pylori by therapeutic immunization with systemic whole cell inactivated vaccines. Biologicals 2017; 45:39-46. [DOI: 10.1016/j.biologicals.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022] Open
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19
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Sekar B, Swami G, Ibrahim A, Hanna A, Payne MN, Seale JR, Azzu A. 76-year-old gentlemen with primary cardiac lymphoma presenting as acute coronary syndrome and atrioventricular block. BJR Case Rep 2016; 2:20150466. [PMID: 30459992 PMCID: PMC6243360 DOI: 10.1259/bjrcr.20150466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/05/2022] Open
Abstract
We report the case of an immunocompetent patient who presented with symptoms suggestive of acute coronary syndrome and was found to be in complete heart block. He re-presented within 2 months with worsening breathlessness and investigations confirmed infiltrative cardiac disease. We describe here an uncommon presentation of primary cardiac lymphoma as acute coronary syndrome and atrioventricular block.
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Affiliation(s)
- Baskar Sekar
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Gagan Swami
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Amin Ibrahim
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Azad Hanna
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Mark N Payne
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - James Rc Seale
- Haemotology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Abdul Azzu
- Cardiology Department, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Bangor, UK
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20
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Sekar B, Whyler J, Williams E, Azzu A, Payne M, Hanna A. 49 Rapid Access AF Clinic – A New Service Towards Better Outcome. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Infective endocarditis (IE) is a life-threatening condition with adverse consequences and increased mortality, despite improvements in treatment options. Diagnosed patients usually require a prolonged course of antibiotics, with up to 40-50% requiring surgery during initial hospital admission. We report a case of a 42-year-old intravenous drug user who presented feeling generally unwell, with lethargy, rigours, confusion and a painful swollen right leg. He was subsequently diagnosed with Proteus mirabilis endocarditis (fulfilling modified Duke criteria for possible IE) and deep vein thrombosis (DVT). He was successfully treated with single antibiotic therapy without needing surgical intervention or requiring anticoagulation for his DVT. Proteus endocarditis is extremely uncommon, with a limited number of case reports available in the literature. This case illustrates how blood cultures are invaluable in the diagnosis of IE, especially that due to unusual microorganisms. Our case also highlights how single antibiotic therapy can be effective in treating Proteus endocarditis.
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Affiliation(s)
- Rohan Goel
- Cardiff University, Cardiff, UK Ysbyty Gwynedd, Bangor, UK
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22
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Augustine D, Sekar B, Murali S, Ramesh M, Madhavan RN, Patil SG, Rao RS. Expression of inducible nitric oxide synthase in carcinomas and sarcomas affecting the oral cavity. South Asian J Cancer 2015; 4:78-82. [PMID: 25992347 PMCID: PMC4418088 DOI: 10.4103/2278-330x.155686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Context: Inducible nitric oxide synthase (iNOS) is a cytoplasmic enzyme which plays a crucial role in the pathogenesis of oral carcinomas and sarcomas. Aims: The objective of this study was to analyze the immunohistochemical expression of iNOS in carcinomas and sarcomas affecting the oral cavity in order to understand the possible role of iNOS in their biologic behavior and to correlate iNOS expression with lymph node metastasis in carcinomas and sarcomas. Settings and Design: Patients, who attended the oral diagnosis department of Vinayaka Missions Sankarachariyar Dental College, were screened, for the purpose of the study. Besides these, paraffin-embedded tissue blocks were also retrieved from archives of the Oral and Maxillofacial Pathology Department. A total of 40 cases (20 carcinomas and 20 sarcomas) were selected for the study. Subjects and Methods: A total of 40 cases (20 carcinomas and 20 sarcomas) were selected for the study. Five apparently normal tissues were obtained from the tumor adjacent normal tissue to be used as a control. These were subjected to immunohistochemical staining using antibody to iNOS and evaluated. Statistical Analysis Used: The results were analyzed using the Chi-square test. Results: Among the 20 carcinomas 19 showed a positive immunoreactivity for iNOS and 1 case was negative. Among the 19 immunopositive iNOS cases of carcinomas, 15 cases showed positive lymph node metastasis. Among the sarcomas, positive immunoreactivity for iNOS was seen in 10 hard tissue sarcomas, while the remaining 10 soft tissue sarcomas were negative for iNOS expression. The results were analyzed using the Chi-square test. Conclusions: iNOS is a reliable marker for lymph node metastasis in carcinomas irrespective of the histologic grade. The high expression in carcinomas shows that the carcinomas elaborate more angiogenesis for growth compared with the sarcomas with the exception of hard tissue sarcomas.
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Affiliation(s)
- Dominic Augustine
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, M.S.Ramaiah University of Applied Sciences, M S R Nagar, Bangalore - 560054 Karnataka, India
| | - B Sekar
- Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College & Hospital, Sankari main road, Ariyanoor, Salem - 636308, India
| | - S Murali
- Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College & Hospital, Sankari main road, Ariyanoor, Salem - 636308, India
| | - Maya Ramesh
- Department of Oral and Maxillofacial Pathology, Vinayaka Missions Sankarachariyar Dental College & Hospital, Sankari main road, Ariyanoor, Salem - 636308, India
| | - R Nirmal Madhavan
- Department of Oral and Maxillofacial Pathology, Rajah Muthiah Dental College and Hospital, Annamalai University, Tamilnadu, India
| | - Shankar Gouda Patil
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, M.S.Ramaiah University of Applied Sciences, M S R Nagar, Bangalore - 560054 Karnataka, India
| | - Roopa S Rao
- Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, M.S.Ramaiah University of Applied Sciences, M S R Nagar, Bangalore - 560054 Karnataka, India
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Sekar B, Vohra H, Nishtar S, Ehtisham J. Non-valvular left ventricular papillary fibroelastoma in a patient with recurrent stroke. Echo Res Pract 2015; 2:I7-I8. [PMID: 26693320 PMCID: PMC4676459 DOI: 10.1530/erp-14-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Baskar Sekar
- Kettering General Hospital NHS Trust, Kettering, LE3 9QP, United Kingdom
- Correspondence should be addressed to B Sekar
| | - Hunaid Vohra
- Glenfield Hospital, University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Salman Nishtar
- Kettering General Hospital NHS Trust, Kettering, LE3 9QP, United Kingdom
| | - Javed Ehtisham
- Kettering General Hospital NHS Trust, Kettering, LE3 9QP, United Kingdom
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24
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Yoganna SS, Rajendra Prasad RG, Sekar B. Oral lymphangioma of the buccal mucosa a rare case report. J Pharm Bioallied Sci 2014; 6:S188-91. [PMID: 25210370 PMCID: PMC4157266 DOI: 10.4103/0975-7406.137465] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/03/2013] [Accepted: 01/03/2014] [Indexed: 11/04/2022] Open
Abstract
The lymphangioma are benign hamartomatous tumors of lymphatic vessels that arises from the sequestration of lymphatic that fails to communicate with the lymphatic system. Most common intra oral site being the anterior two-thirds of tongue, usually superficial in location and demonstrates a pebbly surface that resembles a cluster of translucent vesicles, they are typically soft and fluctuant masses. Secondary hemorrhage into the lymphatic spaces may cause some of these vesicles to become purple. They have been known to grow to large size causing difficulties in mastication and speech. A variant of lymphangioma is cystic hygroma grows as lymphatic anomaly found in the neck commonly present with significant airway obstruction. We present a rare case of lymphangioma affecting the buccal mucosa of a 14-year-old male.
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Affiliation(s)
| | | | - B Sekar
- Department of Oral Pathology, VMS Dental College, Salem, India
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25
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Shanthi M, Sekar U, Sowmiya M, Malathi J, Kamalanathan A, Sekar B, Madhavan HN. Clonal diversity of New Delhi metallobetalactamase-1 producing Enterobacteriaceae in a tertiary care centre. Indian J Med Microbiol 2014; 31:237-41. [PMID: 23883709 DOI: 10.4103/0255-0857.115627] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE New Delhi metallobetalactamase-1 (NDM-1) production is a major mechanism of resistance to carbapenems among the Enterobacteriaceae and is a cause for concern in the field of microbial drug resistance. This study was performed to detect NDM-1 in Enterobacteriaceae and to determine the clonal relatedness of NDM-1 producing Escherichia coli and Klebsiella pneumoniae isolated from patients admitted in a tertiary care centre. MATERIALS AND METHODS A total of 111 clinically significant Enterobacteriaceae isolates, resistant to cephalosporin subclass III were screened for carbapenemase production by the modified Hodge test. Minimum inhibitory concentration to imipenem and meropenem was determined and interpreted according to Clinical Laboratory Standards Institute 2011 criteria. Presence of bla NDM-1 was detected by polymerase chain reaction. To ascertain clonal relatedness, random amplification of polymorphic deoxyribonucleic acid (RAPD) was carried out for representative NDM-1 producers. RESULTS bla NDM-1 was detected in 64 study isolates, of which 27 were susceptible to carbapenems. RAPD revealed a high degree of clonal diversity among NDM-1 producers except for a small clustering of isolates in the neonatal intensive care unit. CONCLUSION There is extensive clonal diversity among the NDM-1 producing E. coli and K. pneumoniae. Hence, antibiotic selection pressure rather than horizontal transfer is probably an important operating factor for the emergence of NDM-1. This calls for increased vigilance, continuous surveillance and strict enforcement of antibiotic policy with restricted use of inducer drugs.
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Affiliation(s)
- M Shanthi
- Department of Microbiology, Sri Ramachandra Laboratory Services, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, India
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26
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Maya R, Sekar B, Murali S. Comparative evaluation of expression of proliferating cell nuclear antigen in variants of ameloblastoma and ameloblastic carcinoma. Indian J Dent Res 2013; 23:15-9. [PMID: 22842243 DOI: 10.4103/0970-9290.99031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM To evaluate the use of proliferating cell nuclear antigen index in the different histopathological variants of ameloblastoma, such as the follicular, plexiform, and unicystic types, and in ameloblastic carcinoma by immunohistochemical staining. The proliferating cell nuclear antigen index values of the variants of ameloblastomas and ameloblastic carcinomas are compared in order to determine the biological behavior of these tumors. MATERIALS AND METHODS For the present study, archival tissues that had been diagnosed as ameloblastoma and ameloblastic carcinoma were collected from the department of oral pathology. Specimens were embedded in paraffin wax and were sectioned at a thickness of 5 μm and stained with hematoxylin-eosin for reconfirming the histologic pattern. It was also stained immunohistochemically for anti-proliferating cell nuclear antigen antibody. RESULTS Positive proliferating cell nuclear antigen expression is seen as a light brown, granular stain. The proliferating cell nuclear antigen values of ameloblastic carcinoma were almost five times the value of ameloblastoma. Analysis of variance test, Fischer's exact test/variance ratio test, and Student's t-test were performed and the probability values were determined. SUMMARY AND CONCLUSION This study showed that ameloblastic carcinoma had the maximum proliferative capacity. Among the variants of ameloblastoma, the plexiform variety had the maximum proliferative capacity, followed by the follicular and unicystic varieties. Altogether, these data indicate that proliferating cell nuclear antigen is related to the biological behavior and proliferation of tumor cells in the variants of ameloblastoma and ameloblastic carcinoma.
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Affiliation(s)
- R Maya
- Department of Oral Pathology, VMSDC, Salem, Tamil Nadu, India
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27
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Augustine D, Sekar B, Murali S. Large ameloblastic carcinoma: A rare case with management. Dent Res J (Isfahan) 2013; 10:809-12. [PMID: 24379872 PMCID: PMC3872635] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The ameloblastic carcinoma is a rare malignant counterpart of the ameloblastoma. Ameloblastic carcinoma is a malignant lesion with characteristic histologic features and behavior that dictates a more aggressive surgical approach than that of a simple ameloblastoma. However, reliable evidence of its biologic activity is currently unavailable due to the scarcity of well-documented cases. We present a rare case of a large ameloblastic carcinoma occurring in the mandible of 44-year-old female highlighting its unique histopathologic features and aggressive behavior treated by radical surgery and reconstruction. Involvement of left ramus to right ramus of the mandible makes this case unusual.
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Affiliation(s)
- Dominic Augustine
- Department of Oral Pathology, Bangalore Institute of Dental Sciences and Hospital, Bangalore, Karnataka, India,Address for correspondence: Dr. Dominic Augustine, Department of Oral and Maxillofacial Pathology, Bangalore Institute of Dental Sciences and Hospital, Hosur Main Road, Lakkasandra, Bangalore - 560 029, Karnataka, India. E-mail:
| | - B. Sekar
- Department of Oral Pathology, V.M.S.D.C, Salem, Tamil Nadu, India
| | - S. Murali
- Department of Oral Pathology, V.M.S.D.C, Salem, Tamil Nadu, India
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Critchley WR, Al-Sheklly B, Sekar B, Coppinger T, Waywell C, Leonard CT, Niven R, Williams SG, Shaw SM. Specialist initiation and monitoring of β blockers in patients with chronic heart failure and concomitant obstructive airways disease. Int J Cardiol 2012. [PMID: 23206521 DOI: 10.1016/j.ijcard.2012.11.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arunagiri K, Sekar B, Sangeetha G, John J. Detection and characterization of metallo-beta-lactamases in Pseudomonas aeruginosa by phenotypic and molecular methods from clinical samples in a tertiary care hospital. W INDIAN MED J 2012; 61:778-783. [PMID: 23757897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS The aim of this study was to detect and characterize the presence of metallo-beta-lactamase (MBL) production in multidrug resistant (MDR) P. aeruginosa collected from clinical samples in a tertiary care hospital. METHODS AND MATERIALS A total of 67 non-repetitive isolates of MDR P. aeruginosa recovered from various clinical specimens were screened for MBL production by IPM/MEM-EDTA combined disc test. Polymerase chain reaction was performed on all isolates using bla(IMP) and bla(VIM) consensus primers to characterize them genotypically. RESULTS Among 67 P. aeruginosa isolates, 62.7% (42/67) and 70.1% (47/67) were resistant to imipenem and meropenem respectively and 47 (70.1%) were found to be MBL producers. Among this 47 MBL-producing isolates, 41 (61.1%) strains carried the bla(VIM) gene and 2 (3%) strains carried the bla(IMP) gene. Three strains were phenotypically negative but positive genotypically for bla(VIM) gene. One strain was resistant to both imipenem and meropenem but did not show phenotypic positivity. CONCLUSION This study confirms the dissemination of bla(VIM) genes among MDR Pseudomonas aeruginosa and hence it is indispensible to identify and aptly control the threat of horizontal and vertical transfer.
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Affiliation(s)
- K Arunagiri
- Central Leprosy-Teaching and Research Institute, Chengalpattu, India
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Sekar B, Critchley WR, Williams SG, Shaw SM. Should we consider heart rate reduction in cardiac transplant recipients? Clin Cardiol 2012; 36:68-73. [PMID: 22911227 DOI: 10.1002/clc.22048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 07/13/2012] [Indexed: 12/21/2022] Open
Abstract
Increased resting heart rate is an independent modifiable risk factor for the development of cardiovascular disease. Numerous studies have demonstrated improved clinical outcomes with heart rate reduction in patients with coronary artery disease and heart failure, but its role in transplanted hearts is not yet established. Sinus tachycardia is more common in heart transplant recipients due to graft denervation. Although a large number of studies have recognized increased heart rate as a predictor of native coronary artery atherosclerosis and overall cardiac mortality, contradicting results have been observed in heart transplant recipients. There is no clear consensus about what the normal range of heart rate should be following heart transplantation. The aim of this article was to review the literature to evaluate whether heart rate reduction should be considered in heart transplant recipients.
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Affiliation(s)
- Baskar Sekar
- The Transplant Centre, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, United Kingdom.
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Shanthi M, Sekar U, Arunagiri K, Sekar B. Detection of Amp C genes encoding for beta-lactamases in Escherichia coli and Klebsiella pneumoniae. Indian J Med Microbiol 2012; 30:290-5. [DOI: 10.4103/0255-0857.99489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ravi V, Sekar B, Augustine D, Murali S. Dentigerous cyst involving an inverted mesiodens—a rare report with unusual findings. Indian J Dent 2012. [DOI: 10.1016/s0975-962x(12)60011-2] [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: 11/28/2022] Open
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Abstract
OBJECTIVES Acinetobacter baumannii is a significant pathogen in health care settings. In recent years, an increase in carbapenem resistance among A. baumannii due to Ambler class B metallo-beta-lactamases or class D OXA carbapenamases has been reported. In this study we detected the presence of OXA carbapenamases and coproduction of metallo-beta-lactamases (blaVIM and blaIMP ) by phenotypic and genotypic methods in carbapenem resistant clinical isolates of Acinetobacter baumannii. MATERIALS AND METHODS A total of 116 consecutive, non-duplicate carbapenem resistant A. baumannii isolated from various clinical specimens were included in the study. The modified Hodge test and inhibitor potentiated disk diffusion tests were done for the screening of carbapenamase and metallo-beta-lactamase production, respectively. Polymerase chain reaction (PCR) was performed for the detection of OXA (blaOXA 23 like, blaOXA 24 like, blaOXA-51 like and blaOXA-58 like genes) and metallo-beta-lactamases (blaVIM and blaIMP ) genes. Gene sequencing was performed for representative isolates. RESULTS Among 116 A. baumannii, OXA genes were detected in 106 isolates. BlaOXA 51 like (n = 99) and blaOXA -23 like (n = 95) were the most common and they coexisted in 89 isolates. blaOXA-24 like gene was detected in two isolates of which one also carried blaOXA-51 like and blaOXA-58 like genes. The modified Hodge test was positive in 113 isolates. The metallo-beta-lactamase screening test was positive in 92 isolates. blavim was detected in 54 isolates of which 1 also carried the blaIMP gene. CONCLUSIONS blaOXA-23 like and bla OXA 51 like genes are the most common types of OXA carbapenamases while the blaVIM type is the most common type of metallo-beta-lactamase contributing to carbapenem resistance in clinical isolates of A. baumannii. The coproduction of OXA and metallo-beta-lactamases is not an uncommon phenomenon in A. baumannii.
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Affiliation(s)
- S M Amudhan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Porur, Chennai, India
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Sekar B, Tapp L, Chalil S, Marshall H, Leyva F. Late perforation of a defibrillator lead managed by percutaneous, intravenous extraction. Europace 2009; 11:255-7. [PMID: 19168501 DOI: 10.1093/europace/eun376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the case of a patient with ischaemic cardiomyopathy who underwent cardiac resynchronization therapy with defibrillator back-up. He re-presented 3 weeks later with chest pain, having received two shocks. We describe a case of late perforation with the Riata lead causing inappropriate shocks.
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Affiliation(s)
- Baskar Sekar
- Department of Cardiology, Good Hope Hospital, Sutton Coldfield, UK.
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Sekar B, Selvaraj L, Alexis A, Ravi S, Arunagiri K, Rathinavel L. The utility of IS6110 sequence based polymerase chain reaction in comparison to conventional methods in the diagnosis of extra-pulmonary tuberculosis. Indian J Med Microbiol 2009; 26:352-5. [PMID: 18974489 DOI: 10.4103/0255-0857.43575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IS6110 sequence based polymerase chain reaction (PCR) was compared with conventional bacteriological techniques in the laboratory diagnosis of extra-pulmonary tuberculosis (EPTB). One hundred and ninety one non-repeated clinical samples of EPTB and 17 samples from non-tuberculous cases as controls were included. All the samples were processed for Ziehl-Neelsen staining for acid fast bacilli (AFB) and 143 samples were processed by culture for M. tuberculosis . All the samples were processed for PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of M. tuberculosis complex. Of the total 191 samples processed, 34 (18%) were positive by smear for AFB. Culture for AFB was positive in 31(22%) samples among the 143 samples processed. Either smear or culture for AFB was found positive in 51(27%) samples. Of the total 191 samples processed 120 (63%) were positive by PCR. In 140 samples, wherein both the conventional techniques were found negative, 74 (53%) samples were positive by PCR alone. Among 51 samples positive by conventional techniques, 46 (90%) were found positive by PCR. PCR assay targeting IS6110 is useful in establishing the diagnosis of EPTB, where there is strong clinical suspicion, especially when the conventional techniques are negative.
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Affiliation(s)
- B Sekar
- Laboratory Division, Central Leprosy Teaching and Research Institute, Chengalpattu, Tamilnadu, India.
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Sekar B, Selvaraj L, Alexis A, Ravi S, Arunagiri K, Rathinavel L. THE UTILITY OF IS6110 SEQUENCE BASED POLYMERASE CHAIN REACTION IN COMPARISON TO CONVENTIONAL METHODS IN THE DIAGNOSIS OF EXTRA-PULMONARY TUBERCULOSIS. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01813-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Fifty-four patients with human immunodeficiency virus (HIV) infection were studied to assess the load of oral carriage of Candida spp. The mean oral Candida carriage density (30,305.93 +/- 56,643.93 CFU ml(-1)) in HIV patients was significantly higher than that seen in the control population (93.48 +/- 358.48 CFU ml(-1); P = 0.000). The mean Candida load in HIV patients with oral thrush (46,591.43 +/- 65,002.57 CFU ml(-1)) was significantly higher than in the HIV subjects without oral thrush (306.32 +/- 699.50 CFU ml(-1); P = 0.000). Non-C. albicans Candida species (56%) were more predominant than the C. albicans (44%) isolates. 25S rDNA PCR analysis of C. albicans revealed preponderance of genotype A strains. Interestingly, 42.6% of rinse specimens grew multiple Candida species, with the combination of C. albicans and C. krusei (39.1%) being the most frequent.
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Affiliation(s)
- C P Girish Kumar
- Department of Microbiology, Dr A. L. Mudaliar Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
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Sekar B. Recent advances in immunodiagnosis of leprosy. Indian J Lepr 2007; 79:85-106. [PMID: 18085168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although prevalence of leprosy is considerably reduced, the unabated emergence of about 300,000 cases worldwide indicates that the source of infection and transmission are not being addressed. Early diagnosis and treatment still remain the cornerstone of leprosy control. Many diagnostic issues hinder the correct and timely diagnosis and classification of leprosy. Delayed and missed diagnosis of infectious leprosy patients and the lack of tests to measure asymptomatic M. leprae infection in contacts also hamper the assessment of transmission of M. leprae infection. An important goal would be the development of improved diagnostic tools to diagnose difficult cases and to detect M. leprae infection before clinical manifestation. The search for an ideal immunodiagnostic tool for leprosy had gone through various phases and development over the years, with inherent limitations in the sensitivity and specificity of the immunodiagnostic tests for leprosy. With improvement in technology many modifications of previously used PGL-1 assay in the form of rapid and less expensive techniques, such as dipstick, ELISA, ML flow test, have been introduced. Many new skin test antigens with potential for improving their efficiency, such as MLSA LAM, MLCwA and their fractionates, have been studied. After the completion of genome sequencing of M. leprae in 2000, many genes that were studied in M. tuberculosis and found potential for the immunodiagnosis of tuberculosis, such as CFP-10 and ESAT-6 proteins, have been investigated in M. leprae also. Genes that are unique to M. leprae with no homologous in M. tuberculosis have been explored for novel M. leprae-specific antigens. In order to overcome the problem of cross-reactivity, a number of workers have synthesized overlapping short peptides of different M. leprae recombinant proteins and studied their sequence divergence and attempted to identify M. leprae-specific B- and T-cell epitopes. This review makes an effort to present an overview of all these developments in the field of immunodiagnosis of leprosy.
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Affiliation(s)
- B Sekar
- Central Leprosy Teaching and Research Institute, Chengalpattu, Tamil Nadu
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Vijayaraghavan R, Suribabu CS, Sekar B, Oommen PK, Kavithalakshmi SN, Madhusudhanan N, Panneerselvam C. Protective role of vitamin E on the oxidative stress in Hansen's disease (Leprosy) patients. Eur J Clin Nutr 2005; 59:1121-8. [PMID: 16015260 DOI: 10.1038/sj.ejcn.1602221] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A constellation of reactive oxygen species (ROS) capable of damaging cellular constituents generated in excess during the chronic, inflammatory, neurodegenerative disease process of leprosy. The consequences of this leads to enhanced oxidative stress and lower antioxidant status. Enzymatic antioxidants provide first line defense against ROS. We have measured the levels of oxidative stress indices like lipid peroxidation (LPO), protein carbonyls together with enzymatic antioxidants in the blood samples of control and leprosy patients. Nutritional rehabilitation by way of exogenous supplementation of functionally efficient antioxidants like vitamin E reactivates the enzymatic antioxidant system and guards against the insult caused by ROS during the pathogenesis of the disease and antileprosy chemotherapy. DESIGN Untreated leprosy patients were selected on the basis of clinical examination and skin smear. All diagnosed untreated leprosy patients received multi drug therapy (MDT) consisting of rifampicin, dapsone and clofazimine as recommended by World Health Organization. A small number of untreated cases were selected for co-supplementation of vitamin E along with MDT. Oxidative stress indices, enzymatic and nonenzymatic antioxidant status were assayed in untreated, MDT treated and those supplemented vitamin E along with MDT. STATISTICAL METHODS We have compared the significance in the mean+/-s.d. values of the oxidative stress indices and the levels of antioxidants using one way analysis of variance (ANOVA) between control, untreated, MDT treated and those supplemented vitamin E with MDT and the results were significant at P < 0.05. Statistical analysis of the results suggests that oral administration of vitamin E lowers oxidative stress and augments antioxidant status in affected individuals. RESULTS Enhanced oxidative stress as evidenced by increased LPO and protein carbonyl in leprosy cases lowers the antioxidant status. Treatment with MDT has a limited impact on increased oxidative stress and decreased antioxidant status. Coadministration of vitamin E along with MDT decreases oxidative stress and activate the antioxidant status. DISCUSSION The excess production of ROS as seen in leprosy cases could lead to degeneration of tissues and derangement of internal organs. The possible reason for the decreased antioxidant status in leprosy cases may be increased production of ROS, deranged liver function, and the free radical producing ability of drugs used in MDT of leprosy. Intervention with antioxidant supplementation like vitamin E prevents oxidative stress mediated through ROS and activates the net antioxidant status during the chronic course of the disease and antileprosy chemotherapy.
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Affiliation(s)
- R Vijayaraghavan
- Central Leprosy Teaching and Research Institute, Chengalpattu, Tamilnadu, India.
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Sekar B, Kothandapani G, Prabhakar Rao T, Krishnamurthy P. Evaluation of the modified leprosy elimination campaign in a high leprosy endemic district of Jharkhand. Indian J Lepr 2003; 75:233-42. [PMID: 15267193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
An evaluation of the third Modified Leprosy Eradication Campaign (MLEC) was carried out in Potka block in the high endemic district of East Singhbhum, Jharkhand State, India, by our external evaluation team, from 29 October to 8 November 2001. The searchers in this block detected 389 suspects during the MLEC; of these, 181 (46%) were examined, and 69 (38%) of them were confirmed as cases by the Programme staff. The evaluators examined 189 (48.5%) of the total 389 suspects detected by the searchers, including 31 of the 69 cases confirmed by the Programme staff. Concordance of diagnosis of leprosy cases by the Programme staff and the evaluators was found to be high (90%). However, concordance of the type of leprosy was found to be variable (PB 38%, MB 72%, SSL 100%). Specificity and sensitivity of diagnosis by the Programme staff (as against those by the evaluators) were found to be 85.7% and 79.2% respectively. There was no case of re-registration. The evaluators examined 108 of the suspects detected by the Search Team, but not screened by the Programme staff, and diagnosed 47 cases (44%; PB 20, MB 9, SSL 18) from among them. The evaluators also diagnosed additional 30 new cases (PB 18, MB 5, SSL 7), during their visit. An assessment of knowledge about the disease and treatment among confirmed cases revealed that most of the patients did not know correctly about their disease. All the cases were referred by the searchers. About 45% of cases were aware of the duration for which they needed to take the treatment, 97% of cases showed the blister calendar packs and had taken the supervised dose. Availability of MDT to the patients and drug compliance were found to be adequate. Assessment of the impact of IEC activities on the awareness of leprosy among the community showed that about 50% of those interviewed were aware of the campaign. Most of them had information about the availability of leprosy drugs and knew that treatment was free. A majority of those aware of the disease said that they would refer suspects, if they come across any, to PHC centres for treatment.
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Affiliation(s)
- B Sekar
- Central Leprosy Teaching and Research Institute, Chengalpattu 603 001, Tamil Nadu, India.
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Sekar B, Elangeswaran N, Jayarama E, Rajendran M, Kumar SS, Vijayaraghavan R, Anandan D, Arunagiri K. Drug susceptibility of Mycobacterium leprae: a retrospective analysis of mouse footpad inoculation results from 1983 to 1997. LEPROSY REV 2002; 73:239-44. [PMID: 12449888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
We analysed the results of mouse foot pad (MFP) tests performed between 1983 and 1997 in our laboratory for the cases referred with clinical suspicion of relapse/drug resistance. A total of 214 cases, with clinical suspicion of relapse/drug resistance were investigated for susceptibility to the drugs of MDT by MFP inoculation. Among 96 inoculations that showed conclusive results, 81 (84%) were fully sensitive to dapsone, suggesting that most of the clinically suspected relapse is due to drug susceptible Mycobacterium leprae. Of the remaining 15 strains (16%) found resistant to dapsone, 13 (87%) were of high grade resistance and one strain each of intermediate grade and low grade dapsone resistance, suggesting that most of the dapsone resistance is secondary in nature. No case of rifampicin resistance was found. Only one case of combined dapsone and unconfirmed clofazimine resistance was found. No other combined multidrug resistance was observed in our analysis.
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Affiliation(s)
- B Sekar
- Laboratory Division, Central Leprosy Teaching and Research Institute, Chengalpattu 603001, Tamil Nadu, India.
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Sekar B, Elangeswaran N, Jayarama E, Rajendran M, Kumar SS, Vijayaraghavan R, Anandan D, Arunagiri K. Drug susceptibility of Mycobacterium leprae: a retrospective analysis of mouse footpad inoculation results from 1983 to 1997. LEPROSY REV 2002. [DOI: 10.47276/lr.73.3.239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Verghese SL, Madhavan HN, Sekar B. Isolation and characterisation of nocardia from clinical specimens. J Indian Med Assoc 1996; 94:58-9, 70. [PMID: 8810179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sixteen isolations of nocardia of which 12 were from pulmonary infections, one from wound infection, one from mycetoma and 2 from eye infections were studied from June, 1989 to May, 1990. The importance of Gram's stain findings of primary smear is being highlighted. The nocardia species were identified utilising the morphological characters including acid fastness and cultural and biochemical characters. Notable among the isolates were Nocardia brasiliensis, one each from mycetoma and pulmonary infection, which are rare in South India and Nocardia asteroides from a case of endophthalmitis probably of endogenous origin.
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Sekar B, Jayasheela M, Chattopadhya D, Anandan D, Rathinavel L, Vasanthi B, Subramanian M, Rao PS. Prevalence of HIV infection and high-risk characteristics among leprosy patients of south India; a case-control study. Int J Lepr Other Mycobact Dis 1994; 62:527-31. [PMID: 7868949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
With the observation of the occurrence of the human immunodeficiency virus (HIV) infection among leprosy patients in our pilot study carried out in Tamil Nadu, South India, a case-control study was planned to explore whether HIV infection is a risk factor for leprosy and to understand the characteristics of HIV infection and high-risk behaviors among leprosy patients. We screened 556 patients and 1004 nonleprosy controls (matching 502 cases for age, sex and area of residence) for HIV-1 and HIV-2 antibodies. They also were interviewed for personal information on history of blood transfusion, intravenous drug abuse, high-risk sexual behavior, and sexually transmitted diseases. Of the 1019 total cases screened (of both pilot and extended studies), 5 were found to be position for HIV antibodies (HIV-1 = 4, HIV-2 = 1); of the 1019 nonleprosy controls, 6 were positive for HIV-1 antibodies. An analysis by odds ratio revealed no association between leprosy and HIV infection (OR = 0.824, 95% CI = 0.201-3.593). A strong association was found only between high-risk behavior and HIV infection (OR = 5.186, 95% CI = 1.717-15.667). However, unmarried, unmarried after 30 years of age, exposure to spouses of the leprosy patients, and a history of surgery were all observed to be significantly more common among leprosy patients than the controls.
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Affiliation(s)
- B Sekar
- Laboratory Division, Central Leprosy Teaching and Research Institute, Tamil Nadu, South India
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Sharma R, Krishnamurthy P, Sekar B. Plantar lesions in tuberculoid leprosy: a report of 3 cases. LEPROSY REV 1994; 65:402-4. [PMID: 7861928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Jayasheela M, Sharma RN, Sekar B, Thyagarajan SP. HIV infection amongst leprosy patients in south India. Indian J Lepr 1994; 66:429-33. [PMID: 7714351] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a pilot study, 463 leprosy patients (374 males and 89 females) were investigated for HIV-1 and HIV-2 antibodies by screening tests. Sera positive by the screening tests were subjected to confirmatory tests. Three cases were confirmed to be positive for HIV, two for HIV-1 and one for HIV-2. All the three positive cases were young males, who had visited commercial sex workers. No correlation was found between the type of leprosy and HIV infection. This is the first report of HIV infection amongst leprosy patients from South India.
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Abstract
A total of 26 clinically diagnosed adult patients, with active untreated lepromatous leprosy, with a Bacteriological Index of 4+ or more, were admitted to the hospital of the Central Leprosy Teaching and Research institute, Chengalpattu, India, between 1989 and 1991. After prescribed investigations, the patients were randomly allocated in groups of 3 to 3 treatment regimens, namely: 1, clofazimine 50 mg daily and 300 mg once in 4 weeks + dapsone 100 mg daily (AA); 2, (AA)+ofloxacin 400 mg daily (BB); and 3, (AA)+ofloxacin 800 mg daily (CC). The drugs were administered for 56 days continuously under supervision. Sequential biopsy results on day 0, 7, 14, 28 and 56 in normal mouse footpad revealed no growth by day 28 and 56 in all patients treated with CC and BB regimens, respectively. Calculation of the proportion of viable Mycobacterium leprae through analysis of median infectious dose (ID50) showed significant differences on day 7 in the percentage of kill between the ofloxacin-containing regimens and the other. Moderate to marked clinical improvement has been observed in a significantly higher proportion of patients treated with ofloxacin-containing regimens. All the 3 regimens were well tolerated. No severe complications or side-effects to the drugs were noticed with any of the regimens that required any suspension of treatment or the administration of steroids. Addition of ofloxacin to the standard WHO recommended MDT regimen for multibacillary patients may reduce the present duration of therapy. Ofloxacin may also be considered as an alternative drug in rifampicin-resistant cases or where rifampicin is contraindicated.
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Affiliation(s)
- P S Rao
- Central Leprosy Teaching and Research Institute, Tamil Nadu, India
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Sekar B, Sharma RN, Anandan D, Vasanthi B, Jayasheela M. Indeterminate leprosy: a seroimmunological and histochemical evaluation. LEPROSY REV 1994; 65:167-74. [PMID: 8942147 DOI: 10.5935/0305-7518.19940016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An effort was made to differentiate indeterminate (IND) leprosy from other types of the paucibacillary (PB) group of leprosy and to identify among indeterminate leprosy cases those which may evolve to multibacillary (MB) leprosy, using serological, immunological and histochemical parameters. A total of 92 untreated, histologically classified (TT-19, BT-30, IND-32) patients, including 11 cases diagnosed as nonspecific dermatitis (NSD), which were clinically strongly suspected to be leprotic, were screened for antibodies against PGL-I, 35-kDa and LAM antigens. Lepromin tests and antigen demonstration in tissue by indirect immunoperoxidase staining were also carried out. Though a qualitative analysis did not differentiate, a quantitative analysis in terms of a cumulative index (CI) showed a higher antibody level amongst the indeterminate group of patients than the other groups included in PB leprosy. Also, the lepromin negative indeterminate group patients showed a higher CI than the lepromin positive cases, indicating that perhaps these may be the cases which may develop into MB leprosy. Thus, the semiquantification of antibody levels in the form of a CI may be a useful parameter to predict the possible evolution of a given case of indeterminate leprosy. Interestingly 64% of NSD cases had either antigen or antibody which indicated that they were probably cases of leprosy.
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Affiliation(s)
- B Sekar
- Laboratory Division, Central Leprosy Teaching and Research Institute, Tamil Nadu, S. India
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Sekar B, Sharma RN, Leelabai G, Anandan D, Vasanthi B, Yusuff G, Subramanian M, Jayasheela M. Serological response of leprosy patients to Mycobacterium leprae specific and mycobacteria specific antigens: possibility of using these assays in combinations. LEPROSY REV 1993; 64:15-24. [PMID: 7681925 DOI: 10.5935/0305-7518.19930003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The serological response of 147 leprosy patients to 3 mycobacterial antigens, PGL-I, 35 kDa (Mycobacterium leprae-specific) and LAM (which is a common mycobacterial antigen) were analysed. A stronger serological response was seen amongst the MB patients than the PB patients in all the assays. The 3 antibody levels correlated positively with each other in both MB and PB cases. An overlap of seropositivity was seen between anti-PGL-I and anti-LAM (p > 0.05). A progressive increase in seropositivity and a significant difference of absorbance or titre in antibody levels in all 3 assays over increasing grades of BI were seen in the MB patients (p < 0.05). A significant difference in seropositivity between untreated and treated groups of patients was observed for anti PGL-I (p < 0.05) and antiLAM (p < 0.01) antibodies. The sensitivity, specificity and efficiency of antiPGL-I (50%; 99%; 70%), antiLAM (43%; 95%; 64%) and anti35 kDa (66%; 100%; 80%) assays taken individually were less than that of combinations of antiPGL-I/anti-35 kDa (74%; 99%; 84%) or antiPGL-I/anti-35 kDa/antiLAM (80%; 94%; 86%). The difference in the efficiency of both sets of combination of assays were not statistically significant (p > 0.05).
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Affiliation(s)
- B Sekar
- Laboratory Division, Central Leprosy Teaching and Research Institute, Tamil Nadu, India
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Sekar B, Anandan D. Evaluation of Mycobacterium leprae particle agglutination test, using eluates of filter paper blood spots. LEPROSY REV 1992; 63:117-24. [PMID: 1640778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A comparison of the ELISA test with the newly-developed MLPA test was carried out, using eluates of blood spots from filter paper for the detection of the anti-PGL-I antibody. A very good positive correlation was observed between these two tests. The concordance rate was found to be 92.6%, ranging from 71.4% to 100%. This nonconcordance was not found when freshly-collected samples were used. The MLPA test is simple and reliable. The use of eluates from blood spots collected on filter paper further simplifies the test in the collection and transportation of blood samples. This accurate and rapid method makes the MLPA test logistically feasible for large-scale screening. With our modification of MLPA with eluates more samples can be screened with the kit than with sera.
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Affiliation(s)
- B Sekar
- Division of Laboratories, Central Leprosy Teaching & Research Institute, Chengalpattu, Tamil Nadu, India
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