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Cypel MC, Berezovsky A, Fernandes AG, Watanabe SS, Kimie Higashi Mitsuhiro MR, Ferraz NN, Sacai PY, Furtado JM, Morales PH, Muñoz S, Cohen JM, Belfort R, Salomão SR. Regional Disparities in Prevalence and Causes of Visual Impairment and Blindness, Cataract Surgical Coverage and Ocular Findings in Adults 50 Years and Older in Brazil: A Comparative Analysis between Two Population-Based Cross-Sectional Surveys Performed Within a 10-Year Interval. Semin Ophthalmol 2023; 38:656-664. [PMID: 37154578 DOI: 10.1080/08820538.2023.2209164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate disparities in the prevalence and causes of visual impairment and blindness, cataract surgical coverage, and ocular findings in older adults from two Brazilian geo-socio-demographic areas, São Paulo and Parintins cities. METHODS Data from two population-based studies including participants 50 years and older from the cities of São Paulo (São Paulo Eye Study - SPES, 2004) and Parintins (Brazilian Amazon Region Eye Survey - BARES, 2014) were aggregated. RESULTS A total of 5318 participants (3677 from SPES;1641 from BARES) were included. The prevalence of severe visual impairment (SVI) and blindness were, respectively, 0.74% (0.46-1.02) and 0.77% (0.48-1.05) in SPES and 1.72% (1.09-2.35) and 3.44% (2.55-4.33) in BARES. SVI and blindness were associated with BARES study [OR = 2.27 (1.30-3.95); p = .004 - SVI] [OR:4.07 (2.51-6.60); p < .001- blindness]; and older age [OR = 10.93 (4.20-28.45); p < .001 - SPES; OR = 17.96 (8.75-36.83); p < .001 - BARES] while higher education level was a protective factor [OR = 0.21 (0.05-0.95) - SPES; p = .042; OR = 0.21 (0.05-0.91); p = .037 - BARES]. Cataract was the main cause of bilateral severe visual impairment (25.93% in SPES and 64.29% in BARES) and bilateral blindness (21.43% in SPES and 35.71% in BARES). Cataract surgical coverage was significantly lower in BARES (36.32%) compared to SPES (57.75%). CONCLUSION The prevalence of SVI and blindness was three times higher in older adults from the Brazilian Amazon compared to those living in São Paulo city, despite a 10-year interval between the two studies. These disparities should be mitigated by initiatives to promote access to eye care services targeting underprivileged and remote Brazilian areas.
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Affiliation(s)
- Marcela Colussi Cypel
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Adriana Berezovsky
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sung Song Watanabe
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Nivea Nunes Ferraz
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Paula Yuri Sacai
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - João Marcello Furtado
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, Brazil
| | - Paulo Henrique Morales
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Sergio Muñoz
- Department of Public Health-CIGES, Universidad de La Frontera, Temuco, Chile
| | - Jacob Moysés Cohen
- Divisão de Oftalmologia, Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal do Amazonas (UFAM), Manaus, Brazil
| | - Rubens Belfort
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Instituto da Visão, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), São Paulo, Brazil
| | - Solange Rios Salomão
- Núcleo de Epidemiologia Ocular, Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
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Dotto PG, Salomão SR, Fernandes AG, Mitsuhiro MRKH, Ferraz NN, Furtado JM, Watanabe SS, Cypel M, Sacai PY, Cunha CC, Vasconcelos GC, Morales PH, Cohen MJ, Cohen JM, Campos M, Muñoz S, Belfort R, Berezovsky A. Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults. Eur J Ophthalmol 2023:11206721231154433. [PMID: 36726300 DOI: 10.1177/11206721231154433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). METHODS BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. RESULTS A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 μm (median = 521; range = 304-665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65-74 years had CCT 7 μm thinner than those aged 45-54 years (p = 0.044), individuals aged 75 years and older had CCT 15 μm thinner than those aged 45-54 years (p = 0.001), and eyes with severe pterygium had CCT 33 μm thinner than eyes without pterygium (p < 0.001). CONCLUSIONS The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.
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Affiliation(s)
- Pedro Gabriel Dotto
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Solange Rios Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcia Regina Kimie Higashi Mitsuhiro
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - João Marcello Furtado
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, 544243Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Sung Song Watanabe
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcela Cypel
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Paula Yuri Sacai
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Cristina Coimbra Cunha
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,37871Faculdade de Medicina da Universidade Federal do Pará - UFPA, Belém, PA, Brasil
| | - Galton Carvalho Vasconcelos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Oftalmologia e Otorrinolaringologia, 28114Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil
| | - Paulo Henrique Morales
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Marcos Jacob Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Jacob Moysés Cohen
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Divisão de Oftalmologia, Departamento de Cirurgia, 67892Faculdade de Medicina da Universidade Federal do Amazonas - UFAM, Manaus, AM, Brasil
| | - Mauro Campos
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Sergio Muñoz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil.,Departamento de Salud Publica, 469458Universidad de La Frontera, Temuco, Chile
| | - Rubens Belfort
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
| | - Adriana Berezovsky
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
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Duret A, Olgemoeller F, Ferreras-Antolin L, Whittaker E, Cohen JM. Paediatric TB care in the United Kingdom. Int J Tuberc Lung Dis 2022; 26:814-819. [PMID: 35996289 DOI: 10.5588/ijtld.21.0581] [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: 11/10/2022] Open
Abstract
BACKGROUND: Care of patients with paediatric TB is delivered in a variety of settings by different clinicians in the United Kingdom. Paediatric practices vary in size. Guidelines on managing children with TB differ in recommendations. These factors contribute to variations in practice.OBJECTIVE: To describe practice among UK professionals caring for children exposed to or infected with TB, and their investigation and treatment.METHODS: From 81 NHS (National Health Service) clinical services, 114 individuals responded to a web-based questionnaire.RESULTS: We describe variation in several areas of practice, with important differences between smaller and larger centres. Most respondents go beyond National Institute for Health & Care Excellence guidance and screen child contacts of extrapulmonary TB. Most respondents would presume pulmonary TB exposed children aged under 2 years to be infected. They would not rely on immunological investigations to rule out infection. There was wide variety in approaches to microbiological diagnosis, and in the use of laboratory investigations to monitor treatment. Many respondents felt unclear on how to manage newborns exposed to TB, or children exposed to multidrug-resistant TB.CONCLUSION: These findings support the case for further developing regional networks providing evidence and consensus-based care for children with TB.
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Affiliation(s)
- A Duret
- Paediatric Infectious Diseases Department, Imperial Healthcare NHS Trust, London, UK
| | - F Olgemoeller
- Department of Paediatric Immunology & Infectious Diseases, Evelina London Children´s Hospital, London, UK
| | - L Ferreras-Antolin
- Paediatric Infectious Diseases Department, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - E Whittaker
- Paediatric Infectious Diseases Department, Imperial Healthcare NHS Trust, London, UK, Paediatric Infectious Diseases Department, Imperial College London, London, UK
| | - J M Cohen
- Department of Paediatric Immunology & Infectious Diseases, Evelina London Children´s Hospital, London, UK, University College London Great Ormond Street Institute of Child Health, London, UK
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Affiliation(s)
- A C Leasure
- Yale University School of Medicine, New Haven, CT, USA
| | - S E Cowper
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - J McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - J M Cohen
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, USA
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Cohen JM, Kridin K, Perez-Chada LM, Merola JF, Cohen AD. Hidradenitis suppurativa and sleep disorders: a population-based study. J Eur Acad Dermatol Venereol 2021; 35:e520-e522. [PMID: 33893667 DOI: 10.1111/jdv.17293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Affiliation(s)
- J M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - K Kridin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - L M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A D Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Watanabe SES, Berezovsky A, Furtado JM, Kimie Higashi Mitsuhiro MR, Cypel M, Cohen MJ, Cohen JM, Cunha CC, Sacai PY, Ferraz NN, Vasconcelos GC, Morales PH, Campos M, Fernandes AG, Muñoz S, Belfort R, Salomão SR. Population-Based Cataract Surgery Complications and Their Impact on Visual Status in the Brazilian Amazon Region. Am J Ophthalmol 2019; 208:295-304. [PMID: 31377288 DOI: 10.1016/j.ajo.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region. DESIGN Population-based cross-sectional study. METHODS Individuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression. RESULTS A total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC <20/63 to 20/200 in 14.4%, APC <20/200 to 20/400 in 2.6%, and APC <20/400 in 17.8%. Low surgical coverage was found with 57.9% of those with visual impairment due to cataract not being treated surgically. CONCLUSIONS Although a reasonable prevalence of cataract surgery was found, a high complication rate, poor visual outcomes, and low cataract surgery coverage indicated that actions to improve quality and appropriate postsurgical management should be planned and implemented by public health authorities.
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Laiacona D, Cohen JM, Coulon K, Lipsky ZW, Maiorana C, Boltyanskiy R, Dufresne ER, German GK. Non-invasive in vivo quantification of human skin tension lines. Acta Biomater 2019; 88:141-148. [PMID: 30735808 DOI: 10.1016/j.actbio.2019.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/23/2019] [Accepted: 02/04/2019] [Indexed: 01/26/2023]
Abstract
Human skin is a composite tissue that exhibits anisotropic mechanical properties. This anisotropy arises primarily from the alignment of collagen and elastin fibers in the dermis, which causes the skin to exhibit greater tension in one direction, making it appear stiffer. A diverse number of skin tension guidelines have been developed to assist surgeons in making incisions that produce the least conspicuous scars. However, skin anisotropy is believed to vary from subject to subject, and no single guideline is universally recognized as the best to implement for surgical applications. To date, no system exists that can rapidly and non-invasively measure lines of skin tension in vivo. In this article, we evaluate the ability of a new aspiration system to measure the anisotropy of human skin. The device painlessly applies a radial stress of 17 kPa to a region of skin, and captures radially asymmetric skin deformations via a dermal camera. These deformations are used to quantify orientations of strain extrema and the direction of greatest skin stiffness. The ratio of these asymmetric strains varies between 1 and -0.75. A simple 2D transverse isotropic model captures this behavior for multiple anatomical sites. Clinical trials reveal that skin tension line orientations are comparable with existing skin tension maps and generally agree across subjects, however orientations statistically differ between individuals. As such, existing guidelines appear to provide only approximate estimates of skin tension orientation. STATEMENT OF SIGNIFICANCE: Skin tension lines (STL) in human skin arise primarily from collagen fiber alignment in the dermis. These lines are used by surgeons to guide incisions that produce the least conspicuous scars. While numerous anatomical STL maps exist, no single guideline is universally recognized as the most reliable. Moreover, manual methods of quantifying STL are imprecise. For the first time, we have developed a device capable of rapidly and non-invasively measuring STL orientations in vivo, using a single test. Our results are used to establish a simple constitutive model of mechanical skin anisotropy. Clinical trials further reveal STL orientations are comparable with existing maps, but statistically differ between individuals. Existing guidelines therefore appear to provide only approximate estimates of STL orientation.
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Affiliation(s)
- D Laiacona
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - J M Cohen
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - K Coulon
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - Z W Lipsky
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - C Maiorana
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA
| | - R Boltyanskiy
- Department of Physics, Yale University, CT 06520, USA; Department of Radiology & Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, NY 10065, USA
| | - E R Dufresne
- Department of Materials, Swiss Federal Institute of Technology Zürich, 8093 Zürich, Switzerland
| | - G K German
- Department of Biomedical Engineering, Binghamton University, NY 13902, USA.
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8
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Cunha CC, Berezovsky A, Furtado JM, Ferraz NN, Fernandes AG, Muñoz S, Watanabe SS, Sacai PY, Cypel M, Mitsuhiro MH, Morales PH, Vasconcelos GC, Cohen MJ, Campos M, Cohen JM, Belfort R, Salomão SR. Presbyopia and Ocular Conditions Causing Near Vision Impairment in Older Adults From the Brazilian Amazon Region. Am J Ophthalmol 2018; 196:72-81. [PMID: 30118685 DOI: 10.1016/j.ajo.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 05/24/2018] [Revised: 07/25/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. DESIGN Population-based cross-sectional study. METHODS Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. RESULTS A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. CONCLUSIONS A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.
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Affiliation(s)
- Cristina Coimbra Cunha
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Adriana Berezovsky
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - João Marcello Furtado
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Nívea Nunes Ferraz
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Arthur Gustavo Fernandes
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Sergio Muñoz
- Universidad de La Frontera, Departamento de Salud Publica, Temuco, Chile
| | - Sung Song Watanabe
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Paula Yuri Sacai
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Marcela Cypel
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Márcia Higashi Mitsuhiro
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Paulo Henrique Morales
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Galton Carvalho Vasconcelos
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Marcos Jacob Cohen
- Universidade Federal do Amazonas (UFAM), Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Manaus, Brazil
| | - Mauro Campos
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Jacob Moysés Cohen
- Universidade Federal do Amazonas (UFAM), Faculdade de Medicina, Departamento de Cirurgia, Divisão de Oftalmologia, Manaus, Brazil
| | - Rubens Belfort
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil
| | - Solange Rios Salomão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Oftalmologia e Ciências Visuais, São Paulo, Brazil.
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Mosnier A, Daviaud I, Casalegno JS, Ruetsch M, Burugorri C, Nauleau E, Bui TT, Fleury H, Lina B, van der Werf S, Cohen JM. Influenza B burden during seasonal influenza epidemics in France. Med Mal Infect 2017; 47:11-17. [PMID: 28062245 DOI: 10.1016/j.medmal.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 11/29/2016] [Indexed: 11/15/2022]
Abstract
CONTEXT Seasonal flu outbreaks are linked to the circulation of influenza virus type A or B. Special attention has always been paid to influenza A epidemics; but recently, several studies have investigated the impact of influenza B virus epidemics, particularly as, since the 1980s, two antigenically different influenza B lineages co-circulate, raising the issue of vaccine matching. OBJECTIVES We present the results of influenza B burden during nine influenza seasons (2003-2013) and vaccine matching of the circulating lineages. PATIENTS AND METHODS Clinical and virological influenza surveillance data, collected by the Regional Groups for Influenza Surveillance Network in France, allows for studying the burden of influenza in the practice of the population of ambulatory care physicians. RESULTS AND CONCLUSION Our analysis is based on 37,801 samples, of which 12,036 were virologically confirmed influenza cases (31.8%), including 3576 cases of influenza B (29.7% of influenza cases). Influenza B viruses significantly circulated during six seasons. For each season, the influenza B epidemic peaked later than the influenza A epidemic. Influenza B is very common in children of school age but also affects other age groups. Finally, more than one-third of the analyzed influenza B viruses belonged to a different lineage than the one used in the composition of the trivalent vaccine. Our results are comparable to those described in other countries.
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Affiliation(s)
- A Mosnier
- Open Rome, 67, rue du Poteau, 75018 Paris, France.
| | - I Daviaud
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - J S Casalegno
- Centre national de référence des virus influenza, CBPE, hospices civils de Lyon et Virpath, université Claude-Bernard Lyon, 69000 Lyon, France
| | - M Ruetsch
- Réseau des Groupes régionaux d'observation de la grippe (GROG), 75018 Paris, France
| | - C Burugorri
- Réseau des Groupes régionaux d'observation de la grippe (GROG), 75018 Paris, France
| | - E Nauleau
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - T T Bui
- Open Rome, 67, rue du Poteau, 75018 Paris, France
| | - H Fleury
- Laboratoire de virologie, hôpital Pellegrin, 33000 Bordeaux, France
| | - B Lina
- Centre national de référence des virus influenza, CBPE, hospices civils de Lyon et Virpath, université Claude-Bernard Lyon, 69000 Lyon, France
| | - S van der Werf
- Centre national de référence des virus influenza, génétique moléculaire des virus respiratoires, Institut Pasteur, CNRS UMR 3569, université Paris Diderot Sorbonne Paris-Cité, 75015 Paris, France
| | - J M Cohen
- Open Rome, 67, rue du Poteau, 75018 Paris, France
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Rabinovich A, Cohen JM, Kahn SR. Predictive value of markers of inflammation in the postthrombotic syndrome: a systematic review: inflammatory biomarkers and PTS. Thromb Res 2015; 136:289-97. [PMID: 26139086 DOI: 10.1016/j.thromres.2015.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Inflammation may contribute to its pathophysiology. OBJECTIVES We conducted a systematic review of studies that analyzed the association between biomarkers of inflammation and PTS in DVT patients. METHODS The electronic databases PubMed, EMBASE, Medline, Scopus and Web of Science were searched for studies published until March 2015 that measured blood inflammation biomarker levels in adult DVT patients and reported their association with PTS development. Two reviewers independently performed full text assessment and data extraction. RESULTS Ten studies were included. Nine reported on the association between C-reactive protein and PTS; Interleukin (IL)-6 was measured in six studies; IL-8 in four studies; Intracellular adhesion molecule (ICAM)-1 in three studies; IL-10 and vascular cell adhesion molecule-1 in two studies; and monocyte chemotactic protein-1, matrix metalloprotease-9, P-Selectin, tumor necrosis factor α and erythrocyte sedimentation rate were measured in one study. Studies differed in terms of populations included, exclusion criteria, methods used for biomarker measurement and statistical measures of association between biomarkers and PTS. We were able to metaanalyze results only for IL-6 and found no significant association. Descriptively, ICAM-1 was significantly associated with PTS in two out of three studies that measured it. Other biomarkers did not demonstrate a significant association with PTS. CONCLUSIONS Our systematic review found conflicting results regarding the role of inflammatory biomarkers as predictors of PTS. ICAM -1 appears to be a promising marker for further investigation.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada
| | - J M Cohen
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - S R Kahn
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Canada.
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Wilson R, Cohen JM, Jose RJ, de Vogel C, Baxendale H, Brown JS. Protection against Streptococcus pneumoniae lung infection after nasopharyngeal colonization requires both humoral and cellular immune responses. Mucosal Immunol 2015; 8:627-39. [PMID: 25354319 PMCID: PMC4351900 DOI: 10.1038/mi.2014.95] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [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: 06/30/2014] [Accepted: 09/13/2014] [Indexed: 02/04/2023]
Abstract
Streptococcus pneumoniae is a common cause of pneumonia and infective exacerbations of chronic lung disease, yet there are few data on how adaptive immunity can specifically prevent S. pneumoniae lung infection. We have used a murine model of nasopharyngeal colonization by the serotype 19F S. pneumoniae strain EF3030 followed by lung infection to investigate whether colonization protects against subsequent lung infection and the mechanisms involved. EF3030 colonization induced systemic and local immunoglobulin G against a limited number of S. pneumoniae protein antigens rather than capsular polysaccharide. During lung infection, previously colonized mice had increased early cytokine responses and neutrophil recruitment and reduced bacterial colony-forming units in the lungs and bronchoalveolar lavage fluid compared with control mice. Colonization-induced protection was lost when experiments were repeated in B-cell- or neutrophil-deficient mice. Furthermore, the improved interleukin (IL)-17 response to infection in previously colonized mice was abolished by depletion of CD4+ cells, and prior colonization did not protect against lung infection in mice depleted of CD4+ cells or IL17. Together these data show that naturally acquired protective immunity to S. pneumoniae lung infection requires both humoral and cell-mediated immune responses, providing a template for the design of improved vaccines that can specifically prevent pneumonia or acute bronchitis.
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Affiliation(s)
- R Wilson
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK
| | - J M Cohen
- Infectious Diseases and Microbiology Unit, UCL Institute of Child Health, London, UK
| | - R J Jose
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK
| | - C de Vogel
- Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - H Baxendale
- Clinical Immunology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J S Brown
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College Medical School, Rayne Institute, London, UK,()
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Rabinovich A, Cohen JM, Cushman M, Wells PS, Rodger MA, Kovacs MJ, Anderson DR, Tagalakis V, Lazo-Langner A, Solymoss S, Miron MJ, Yeo E, Smith R, Schulman S, Kassis J, Kearon C, Chagnon I, Wong T, Demers C, Hanmiah R, Kaatz S, Selby R, Rathbun S, Desmarais S, Opatrny L, Ortel TL, Ginsberg JS, Kahn SR. Inflammation markers and their trajectories after deep vein thrombosis in relation to risk of post-thrombotic syndrome. J Thromb Haemost 2015; 13:398-408. [PMID: 25495610 DOI: 10.1111/jth.12814] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/09/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT). OBJECTIVE In the BioSOX study, we investigated whether inflammation markers predict the risk of PTS after DVT. METHODS We measured C-reactive protein (CRP), ICAM-1, interleukin (IL)-6, and IL-10, at baseline, and 1 month and 6 months after a first proximal DVT, among 803 participants in the SOX trial. Participants were prospectively followed for 24 months for development of PTS. RESULTS Median CRP levels at 1 month, ICAM-1 levels at baseline, 1 month and 6 months, IL-6 levels at 1 month and 6 months and IL-10 levels at 6 months were higher in patients who developed PTS than in those who did not. Multivariable regression with the median as a cutoff showed risk ratios (RRs) for PTS of 1.23 (95% confidence interval [CI] 1.05-1.45) and 1.25 (95% CI 1.05-1.48) for ICAM-1 at 1 month and 6 months, respectively, and 1.27 (95% CI 1.07-1.51) for IL-10 at 6 months. Quartile-based analysis demonstrated a dose-response association between ICAM-1 and PTS. ICAM-1 and IL-10 were also associated with PTS severity. Analysis of biomarker trajectories after DVT demonstrated an association between the highest-trajectory group of ICAM-1 and PTS. CONCLUSIONS In this prospective study, ICAM-1 over time was most consistently associated with the risk of PTS. Further study is required to confirm these findings and assess their potential clinical relevance.
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Affiliation(s)
- A Rabinovich
- Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Cohen JM, Kahn SR, Platt RW, Basso O, Evans RW, Kramer MS. Small-for-gestational-age birth and maternal plasma antioxidant levels in mid-gestation: a nested case-control study. BJOG 2015; 122:1313-21. [PMID: 25677044 DOI: 10.1111/1471-0528.13303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether maternal plasma antioxidant levels in mid-pregnancy are associated with small-for-gestational-age (SGA) birth. DESIGN Case-control study nested within a population-based cohort study. SETTING Four hospitals in Montreal, Canada. POPULATION Pregnant women recruited before 24 weeks of gestation, whose pregnancies were not complicated by pre-eclampsia or preterm delivery. METHODS Blood samples were obtained at 24-26 weeks and assayed for nutritionally derived antioxidant levels in SGA cases (n = 324) and randomly selected controls with birthweights between the 25th and 75th centiles (n = 672). We performed logistic regression analyses using the standardised z-score of each antioxidant as the main independent variable, after summing highly correlated antioxidants or combining via principle component analysis. We adjusted for risk factors for SGA that were associated with antioxidant levels. MAIN OUTCOME MEASURES SGA, birthweight <10th centile for gestational age and sex. RESULTS Retinol was positively associated with risk of SGA (adjusted odds ratio [OR] 1.41; 95% confidence interval [95% CI] 1.22-1.63, per SD increase). Carotenoids (log of the sum of β-carotene, lutein/zeaxanthin, α- and β-cryptoxanthin) were negatively associated with SGA (adjusted OR 0.64; 95% CI 0.54-0.78, per SD increase). We found no significant associations between SGA and lycopene or any of the forms of vitamin E assessed, including α-tocopherol, corrected α-tocopherol (per nmol/l of low-density lipoprotein articles), or γ-tocopherol. CONCLUSIONS Elevated retinol may be associated with an increased risk of SGA, whereas elevated carotenoid levels may reduce the risk. A better understanding of the nature of these associations is required, however, before recommending specific nutritional interventions in an attempt to prevent SGA birth.
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Affiliation(s)
- J M Cohen
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - S R Kahn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - R W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - O Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - R W Evans
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
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Cohen JM, Nambudiri VE, Kulke MH, Todd DJ, Murphy GF, LeBoeuf NR. Cutaneous paraneoplastic granulomatous eruptions secondary to metastatic carcinoid tumour. Br J Dermatol 2014; 172:1451-4. [PMID: 25388104 DOI: 10.1111/bjd.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J M Cohen
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - V E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - M H Kulke
- Program in Neuroendocrine and Carcinoid Tumors, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, U.S.A
| | - D J Todd
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - G F Murphy
- Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - N R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, U.S.A.,The Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02115, U.S.A
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Affiliation(s)
- M Lamure
- University Claude Bernard Lyon 1, Paris, France
| | - J M Cohen
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | | | | | - J Auray
- Cyklad Group, Rilleux la Pape, France
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Silva ML, Perrier L, Paget J, Mosnier A, Buthion V, Cohen JM, Späth HM. Information Used in the Decision-Making Process Regarding Influenza Vaccination Policy: Perceptions of Stakeholders in France and the Netherlands. Value Health 2014; 17:A329. [PMID: 27200564 DOI: 10.1016/j.jval.2014.08.603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M L Silva
- Research Group in Health Economics (GATE, UMR 5824, CNRS); University Lyon 2, Ecully, France
| | - L Perrier
- Cancer Centre Léon Bérard, Lyon, France
| | - J Paget
- Netherlands Institute For Health Services Research (NIVEL), Utrecht, The Netherlands
| | - A Mosnier
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | - V Buthion
- COACTIS EA 4161, University of Lyon, Lyon, France
| | - J M Cohen
- Regional Group for the Surveillance of Influenza - GROG, Open Rome, Paris, France
| | - H M Späth
- University Claude Bernard, Lyon 1 EAM 4128, Lyon, France
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Kissling E, Valenciano M, Buchholz U, Larrauri A, Cohen JM, Nunes B, Rogalska J, Pitigoi D, Paradowska-Stankiewicz I, Reuss A, Jiménez-Jorge S, Daviaud I, Guiomar R, O'Donnell J, Necula G, Głuchowska M, Moren A. Influenza vaccine effectiveness estimates in Europe in a season with three influenza type/subtypes circulating: the I-MOVE multicentre case-control study, influenza season 2012/13. ACTA ACUST UNITED AC 2014; 19. [PMID: 24556348 DOI: 10.2807/1560-7917.es2014.19.6.20701] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the fifth season of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE), we undertook a multicentre case-control study (MCCS) in seven European Union (EU) Member States to measure 2012/13 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory confirmed as influenza. The season was characterised by substantial co-circulation of influenza B, A(H1N1)pdm09 and A(H3N2) viruses. Practitioners systematically selected ILI patients to swab ≤7 days of symptom onset. We compared influenza-positive by type/subtype to influenza-negative patients among those who met the EU ILI case definition. We conducted a complete case analysis using logistic regression with study as fixed effect and calculated adjusted vaccine effectiveness (AVE), controlling for potential confounders (age, sex, symptom onset week and presence of chronic conditions). We calculated AVE by type/subtype. Study sites sent 7,954 ILI/acute respiratory infection records for analysis. After applying exclusion criteria, we included 4,627 ILI patients in the analysis of VE against influenza B (1,937 cases), 3,516 for A(H1N1)pdm09 (1,068 cases) and 3,340 for influenza A(H3N2) (730 cases). AVE was 49.3% (95% confidence interval (CI): 32.4 to 62.0) against influenza B, 50.4% (95% CI: 28.4 to 65.6) against A(H1N1)pdm09 and 42.2% (95% CI: 14.9 to 60.7) against A(H3N2). Our results suggest an overall low to moderate AVE against influenza B, A(H1N1)pdm09 and A(H3N2), between 42 and 50%. In this season with many co-circulating viruses, the high sample size enabled stratified AVE by type/subtype. The low estimates indicate seasonal influenza vaccines should be improved to achieve acceptable protection levels.
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Rabinovich A, Cohen JM, Prandoni P, Kahn SR. Association between thrombophilia and the post-thrombotic syndrome: a systematic review and meta-analysis. J Thromb Haemost 2014; 12:14-23. [PMID: 24406063 DOI: 10.1111/jth.12447] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The postthrombotic syndrome (PTS) is a frequent chronic complication of deep vein thrombosis (DVT), occurring in 20-40% of patients. Identifying risk factors for PTS may be useful to provide patients with prognostic information and target prevention strategies. OBJECTIVE To conduct a systematic review to assess whether, among patients with DVT, inherited and acquired thrombophilias are associated with a risk of PTS. METHODS We searched the electronic databases PubMed, EMBASE, Scopus, and Web of Science for studies published from 1990 to 2013 that assessed any thrombophilia in adult DVT patients and its association with the development of PTS. We calculated odds ratios and 95% confidence intervals for PTS according to the presence of thrombophilia. Meta-analysis was performed using the random-effects model. RESULTS Sixteen studies were included: 13 assessed factor V Leiden (FVL), 10 assessed prothrombin mutation, five assessed protein S and C deficiencies, three assessed antithrombin deficiency, four assessed elevated FVIII levels, and six assessed antiphospholipid antibodies. None of the meta-analyses identified any thrombophilia to be predictive of PTS. Both FVL and prothrombin mutation appeared protective among studies including patients with both first and recurrent DVT and studies in which more than 50% of patients had an unprovoked DVT. CONCLUSIONS Our meta-analysis did not demonstrate a significant association between any of the thrombophilias assessed and the risk of PTS in DVT patients. Other biomarkers in the pathophysiological pathway may be more predictive of PTS.
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Affiliation(s)
- A Rabinovich
- Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Wilson RJ, Jose RJ, Barabas M, Marshall H, Cohen JM, Sapey E, Baxendale H, Brown JS. P238 Role of naturally-acquired IgG in protection from S. pneumoniae lung infection. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.390] [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: 11/03/2022]
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Chiyaka C, Tatem AJ, Cohen JM, Gething PW, Johnston G, Gosling R, Laxminarayan R, Hay SI, Smith DL. Infectious disease. The stability of malaria elimination. Science 2013; 339:909-10. [PMID: 23430640 DOI: 10.1126/science.1229509] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Eradication may not be necessary before countries can eliminate, scale back control, and rely on health systems.
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Affiliation(s)
- C Chiyaka
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
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Kissling E, Valenciano M, Larrauri A, Oroszi B, Cohen JM, Nunes B, Pitigoi D, Rizzo C, Rebolledo J, Paradowska-Stankiewicz I, Jiménez-Jorge S, Horváth JK, Daviaud I, Guiomar R, Necula G, Bella A, O'Donnell J, Głuchowska M, Ciancio BC, Nicoll A, Moren A. Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study. ACTA ACUST UNITED AC 2013; 18. [PMID: 23399425 DOI: 10.2807/ese.18.05.20390-en] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case–control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection.
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Cohen JM, Hutcheon JA, Kramer MS, Joseph KS, Abenhaim H, Platt RW. Influence of ultrasound-to-delivery interval and maternal-fetal characteristics on validity of estimated fetal weight. Ultrasound Obstet Gynecol 2010; 35:434-441. [PMID: 20069655 DOI: 10.1002/uog.7506] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To explore the effects of ultrasound-to-delivery interval and maternal-fetal characteristics on the distribution of measurement error in estimated fetal weights (EFWs), and to determine the predictive ability of EFW for diagnosis of small-for-gestational age (SGA) and large-for-gestational age (LGA) among infants delivered within 1 day of an ultrasound examination. METHODS Percentage differences between EFW and birth weights were calculated in 3697 pregnancies. Linear regression was used to compare the accuracy of EFW for births on each of the 6 days after an ultrasound scan with the accuracy observed among births on the same day. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value for diagnosis of SGA and LGA according to EFW was assessed. RESULTS The mean +/- SD percentage difference among deliveries within 1 day of the last ultrasound scan was 0.2 +/- 9.0%. Mean percentage differences were not significantly different from day 0 on days 1, 2 and 3; however, combining the data from these 4 days obscured a slight bias towards an overestimation of weight evident on day 0 and day 1. Among deliveries within 1 day of an ultrasound scan, the PPV was 61% for SGA diagnosis and 54% for LGA diagnosis. CONCLUSION Combining data from births > 1 day after the last ultrasound examination may lead to a false conclusion that there is systematic underestimation of weight. EFW tended to underestimate the weight of macrosomic fetuses and overestimate that of small fetuses which limited sensitivity and PPV. Maternal-fetal characteristics are weak predictors of individual errors in EFW.
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Affiliation(s)
- J M Cohen
- Department of Biostatistics, The Montreal Children's Hospital Research Institute, Montreal, QC, Canada
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Abstract
A sharp drop in the prevalence of leprosy occurred in the last three decades. However, the incidence has not decreased at the same rate. Three years after the World Health Organization last deadline for leprosy control, patients considered healed still need special care for their incapacities and immunopathological reactions. Medical literature reffers blindness in 4% to 11% of studied patients and more than 20% with severe visual problems due to corneal exposure, bacillary invasion and hipersensibility. These mechanisms result in a population of nearly one million blind leprosy patients even though official prevalence accounts no more than 250,000 patients worldwide. The author calls for better patients management and follow-up and urges ophthalmologists to become more aware and interested in the treatment of the ocular complications of leprosy.
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Affiliation(s)
- Jacob Moysés Cohen
- Departamento de Clínica Cirúrgica, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brasil.
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Abstract
Radiosurgery is increasingly employed in the treatment of acoustic neuroma, but the optimal dose in terms of long-term tumour control and minimal adverse effects has not been established. We performed a systematic review of the published literature of radiosurgery of acoustic neuroma to assess whether the use of low dose radiosurgery is as effective as high dose treatment. Reports of radiosurgery for acoustic neuroma were identified through a Medline search. Studies with at least 15 patients and a median follow-up longer than 12 months were included. The relationship between actuarial 5-year progression-free survival (PFS), and tumour and treatment parameters was examined. Forty-two studies were included. Tumour control following lower radiosurgery doses was similar to that reported following high doses. Only 12 studies reported actuarial outcomes at 5 years. There was no relationship between PFS at 5 years and dose to the tumour margin. Radiosurgery of larger tumours was associated with lower 5 year PFS (p < 0.05). Although on initial inspection radiosurgery of acoustic neuroma with doses of 12 - 13 Gy seems to be as effective as higher dose treatment, the available reports are subject to a number of confounding factors, are not sufficiently statistically powered and there is only limited long-term actuarial outcome data. Currently, available studies do not provide sufficient confidence to support the claim that low dose radiosurgery is equally effective as higher doses in the long-term control of acoustic neuroma.
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Affiliation(s)
- R S Weil
- Neuro-Oncology Unit, Royal Marsden NHS Foundation Trust, London, UK
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Abstract
PURPOSE To evaluate eye manifestations in mansonelliasis patients from Coari, AM, rural area on the middle Amazonas River. METHODS Cross-sectional study consisted of evaluation of 543 subjects from Coari rural area on Solimões River right margin. All subjects were submitted to blood test for microfilaria and the subjects who had a positive test also were submitted to skin biopsies and ophthalmologic examination. Histopathology and PCR research for microfilaria were done on eye biopsies of suspect lesions. RESULTS Mansonella ozzardi was found in peripheral blood of 103 (18.9%) subjects. Ninety-five mansonelliasis patients were examined. Punctate keratitis was observed in 12 of them, nummular keratitis in one subject and sclerosing keratitis in another one. Skin biopsies were negative in all subjects. Conjunctival and limbal biopsies were done in five mansonelliasis patients and corneal biopsy in another three patients. Conjunctival and limbal biopsies of two patients and corneal biopsy of one patient showed no microfilaria or alterations due to its presence on histopathology. PCR showed no evidence of microfilaria in the other biopsies. CONCLUSION Association between Mansonella ozzardi infection and corneal lesions with no evident etiology was observed in this study, but the lack of conclusive findings on histopathology and PCR make us doubt the corneal involvement in mansonelliasis. Large studies of high mansonelliasis prevalence populations and extensive employment of microfilaria identification tests in ocular tissue are needed to evaluate the microfilaria corneal pathogenicity.
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Affiliation(s)
- Jacob Moysés Cohen
- Instituto de Oftalmologia de Manaus, Fundação de Medicina Tropical do Amazonas, Universidade do Estado do Amazonas e Universidade Federal do Amazonas, Manaus, AM, Brasil.
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Cohen JM, Whittaker E, Walters S, Lyall H, Tudor-Williams G, Kampmann B. Presentation, diagnosis and management of tuberculosis in HIV-infected children in the UK. HIV Med 2008; 9:277-84. [PMID: 18331563 DOI: 10.1111/j.1468-1293.2008.00559.x] [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: 11/28/2022]
Abstract
OBJECTIVES Management of HIV-infected children with tuberculosis (TB) is challenging. The objective of this study was to assess current treatment and outcomes in a resource-rich setting in the era of highly active antiretroviral therapy (HAART). METHODS A retrospective case-note review of coinfected children was carried out in a large UK-based HIV family clinic. RESULTS Of 328 HIV-infected children, 18 were diagnosed and treated for active TB. TB presentation led to HIV diagnosis in eight of these 18 children. TB was confirmed microbiologically in 33% of children. Fifteen of the 18 children presented with pulmonary TB, and three with extrapulmonary TB (EPTB). Immunological status at TB diagnosis did not predict EPTB. The mean CD4 T-cell count at TB presentation was 402 cells/microL (mean CD4 percentage 16%), with a range of 0-790 cells/microL (0-34%). In seven children concurrently treated with HAART and anti-tuberculous therapy (ATT), therapeutic drug monitoring (TDM) guided management. No immune reconstitution disease occurred. There was one death, unrelated to TB, 2 years after completion of ATT. CONCLUSIONS An HIV test should be considered in all children diagnosed with TB, especially if there are epidemiological risk factors. Our experience shows that, even with deferral of HAART in concurrently infected children, good therapeutic responses to ATT can be achieved. Where necessary, TDM guiding concurrent HAART and ATT can facilitate good clinical and virological responses.
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Affiliation(s)
- J M Cohen
- Department of Paediatric Infectious Diseases, Imperial College London, Norfolk Place, London, UK
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Cohen JM, Mosnier A, Valette M, Bensoussan JL, Van Der Werf S. [General practice and surveillance: the example of influenza in France]. Med Mal Infect 2005; 35:252-6. [PMID: 15878816 DOI: 10.1016/j.medmal.2005.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 02/18/2005] [Indexed: 11/15/2022]
Abstract
UNLABELLED Data registration by the GROG national network (Regional Group for the Surveillance of Influenza) since 1984 has helped to identify methodological problems. The choice of sentinels and the selection of indicators depend on the analysis of actual influenza consequences. Various sentinels may be concerned: health insurance companies, private companies, schools, physicians, pharmacists. Health care organization modifies the validity of indicators. In France, for instance, home visits were an excellent indicator for early warning before 1995 but this indicator is no longer as efficient as before. The virological detection of Influenza depends on the organization of transportation (samples, results). The predictive value of cases definitions depends on the incidence of infection. The level of choice between specificity and sensibility modifies the perception of outbreaks. Sentinel participation rate influences the sample representativity. The farther this rate is from 100%, the more result validity decreases (in the same way that patients lost to follow-up compromise the validity of results in clinical trials). The publication of results can modify health expenses and behaviors. CONCLUSION The GROG network stresses the important role that general practitioners play in health surveillance; it also raises questions in the field of mathematics, statistics, professional organization, training, education, and politics.
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Affiliation(s)
- J M Cohen
- Coordination nationale des GROG, open Rome, 67 rue du Poteau, 75018 Paris, France.
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29
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Abstract
For influenza monitoring, the use of laboratory data usually in combination with morbidity data from primary care facilities is common. The estimated excess morbidity, or resulting rates and consultation incidences are the basic parameter for the estimation of influenza activity in conjunction with antigen assays of influenza in a selected sub-sample of the recorded patients. The interpretation of such data is complicated by several selection processes, confounding influences and bias. The case definition (CD) given for the selection of cases is important for the sensitivity and specificity of the registrations. For the clinical morbidity data, the lower specificity found when more general (acute respiratory tract infections) criteria are used seems to be compensated by a higher statistical sensitivity due to the larger number of cases. The relative stability of the background morbidity against the expected values is critical for the interpretation. The sub-sample of patients tested by antigen assays is usually small due to cost constraints. Testing all patients with the defined symptoms in a sub-sample of practices is rarely possible because of the workload in the GPs offices during an influenza epidemic but does allow the number of positives to be used as an indicator. Usually, a sub-sample of GPs is asked to test a limited number of patients suffering with the symptoms given as selection criteria. In this case, the rate of positives is the better indicator for the influenza activity. However, the low number of tests particularly when flu is circulating at a low level limits the statistical sensitivity of this parameter. The specificity of the criteria given for the selection of patients being swabbed and the sensitivity of the test largely determine the function between the rate of positives and the influenza activity. The virological results are mostly interpreted in a more qualitative way, to see if influenza is circulating significantly. For this interpretation, more specific selection criteria (CD) seem useful and a high sensitivity for an increasing circulation can be expected.
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Affiliation(s)
- H Uphoff
- Deutsches Grünes Kreuz, Schuhmarkt 4, 35039 Marburg, Germany.
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Reis ADCPPD, Chaves C, Cohen JM, Belfort F, Oliveira NPD, Belfort Jr. R. Detecção de tracoma e doenças corneanas em índios da região do Alto Rio Negro. Arq Bras Oftalmol 2002. [DOI: 10.1590/s0004-27492002000100015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bricaire F, Cohen JM, Jacquet M, Boucot I, Nicolas M. Patient perspective on zanamivir in the treatment of influenza. Int J Clin Pract 2002; 56:7-10. [PMID: 11831842] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Placebo-controlled clinical studies have shown zanamivir to be an effective treatment of influenza A and influenza B illness. This survey, conducted in France, was done to evaluate patients' perception of zanamivir in clinical practice. Between January and mid-April 2000, 271 retail pharmacists gave questionnaires to patients with a prescription for zanamivir to be completed on a voluntary basis. A total of 514 patients returned completed questionnaires, of whom 97 (19%) were considered at high risk of developing influenza complications. Fifty-one (10%) patients, mainly those over 65 years, were vaccinated against influenza. Fever or feverishness was reported by 93% of patients, and cough, myalgia and headache by 72%. Most (58%) patients consulted their doctor within 24 hours of the onset of symptoms, and 96% within 48 hours. Eighty-five per cent of patients overall and 82% of high-risk individuals (82/97) reported being satisfied with their zanamivir treatment. Treatment compliance was high with 75% of patients completing the whole course of treatment. Symptom relief was reported by 45% of patients within 24 hours and by 74% of patients within 48 hours; 66% of patients resumed normal activities within 72 hours. These results suggest that patient satisfaction is high and compliance with zanamivir is highly satisfactory. In addition, the use of zanamivir was reported to be associated with rapidsymptom relief and return to normal activity
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Affiliation(s)
- F Bricaire
- Infectious and Tropical Diseases Department, Pitié Salpétrière Hospital, Paris, France
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Chhieng DC, Elgert P, Cohen JM, Cangiarella JF. Clinical implications of atypical glandular cells of undetermined significance, favor endometrial origin. Cancer 2001; 93:351-6. [PMID: 11748574 DOI: 10.1002/cncr.10139] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Bethesda System recommends qualifying atypical glandular cells with regard to their possible origin: endocervical versus endometrial. This study was undertaken to determine the clinical significance of atypical glandular cells of undetermined significance that favor an endometrial origin (AGUS-EM). METHODS A computer search identified 62 cervicovaginal smears (5.25% of all smears classified as AGUS) with a diagnosis of AGUS-EM in the files of Shared Cytopathology Laboratory of New York University Medical Center/Bellevue Hospital Medical Center between January 1995 and December 1999. The patients ranged in age from 29 years to 88 years (mean age, 53 years). Thirty-four patients were postmenopausal (55%), and 5 patients were on hormonal replacement therapy. Follow-up was available for 56 patients (90%); 45 patients (73%) underwent biopsy, and 11 patients (17%) had repeat cervicovaginal smears. Six patients were lost to follow-up. RESULTS Among patients who underwent biopsy, 14 patients (31%) had a clinically significant uterine lesions, including 6 (13%) endometrial adenocarcinomas, 5 (11%) endometrial hyperplasias, and 3 (7%) squamous lesions (2 high-grade squamous intraepithelial lesions and 1 squamous cell carcinoma). Ten of 11 patients with significant endometrial pathology findings were postmenopausal. The remaining 31 patients had benign pathology results, which included chronic cervicitis, endometritis, endometrial polyps, microglandular hyperplasia, and tubal metaplasia. Among the patients with repeat cervicovaginal smears, one patient had atypical squamous cells of undetermined significance; the remaining patients were within normal limits. CONCLUSIONS Approximately one-third of women with a diagnosis of AGUS-EM had a significant uterine lesion on subsequent biopsy; the majority of these lesions were endometrial in origin. Patients with a diagnosis of AGUS-EM on cervicovaginal smears should be followed closely, and endometrial curettage or biopsy should be included in their initial work-up.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, 35249-6823, USA.
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Chhieng DC, Cangiarella JF, Zakowski MF, Goswami S, Cohen JM, Yee HT. Use of thyroid transcription factor 1, PE-10, and cytokeratins 7 and 20 in discriminating between primary lung carcinomas and metastatic lesions in fine-needle aspiration biopsy specimens. Cancer 2001; 93:330-6. [PMID: 11668468 DOI: 10.1002/cncr.9048] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The distinction of a primary lung carcinoma from a metastatic lesion is important, because the treatment and prognosis differ for patients with these malignancies. Such a distinction can be difficult because of overlapping cytologic features. It has been shown that antibodies to thyroid transcription factor 1 (TTF-1) and PE-10 are fairly specific markers for primary lung tumors in histologic specimens. TTF-1 regulates the expression of surfactant protein production, and PE-10 is a monoclonal antibody against components of human surfactant proteins. The combination of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) immunoprofiling has been helpful in the identification of the primary site of origin of lung tumors. METHODS In the current study, the authors evaluated the utility of TTF-1 and PE-10 immunostaining and also compared the staining with expression of CK7 and CK20 in the discrimination between primary lung tumors and metastatic lesions in 55 specimens from fine-needle aspiration (FNA) biopsies of the lung. Formalin fixed, paraffin embedded cell blocks from 35 primary lung tumors (16 adenocarcinomas, 8 squamous cell carcinomas, 6 large cell undifferentiated carcinomas, and 5 small cell carcinomas) and 20 metastatic carcinomas (6 breast lesions, 6 colon lesions, 3 urinary bladder lesions, 2 kidney lesions, 1 biliary tract lesion, 1 endometrial lesion, and 1 thyroid lesion) were immunostained with monoclonal antibodies to TTF-1, PE-10, CK7, and CK 20. Positive immunostaining for CK7, CK20, and PE-10 was based on cytoplasmic staining, whereas TTF-1 positive staining was based on nuclear staining of the neoplastic cells. RESULTS Positive immunostaining with TTF-1 and PE-10 was noted in six primary lung tumors (17%). One metastatic lesion (5%) and two metastatic lesions (10%) were positive for TTF-1 and PE-10, respectively. The CK7 positive/CK20 negative immunophenotype was noted in 30 primary lung tumors (86%) and in 11 metastatic lesions (55%). The CK7 negative/CK20 negative immunophenotype was seen in four metastatic lesions and in the remaining five primary lung tumors. The CK7 negative/CK20 positive and CK7 positive/CK20 positive immunophenotypes were seen in two and three metastatic lesions, respectively, but in none of the primary lung tumors. When a CK7 positive/CK20 negative adenocarcinoma also demonstrated either TTF-1 positive or PE-10 positive staining, it was likely that the adenocarcinoma was of pulmonary origin (P < 0.035; Fisher exact test). The specificity of such a combination for discriminating between primary and metastatic adenocarcinomas was 94%. CONCLUSIONS The results suggest that TTF-1, PE-10, or CK7/CK20 alone did not distinguish reliably between primary pulmonary tumors carcinomas and metastatic neoplasms of the lung in FNA biopsy specimens because of low sensitivity and specificity. The use of a panel of antibodies that includes CK7/CK20, TTF-1, and PE-10 may be helpful in discriminating between primary and metastatic adenocarcinomas of the lung. An adenocarcinoma is likely a primary lung tumor when it is of the CK7 positive/CK20 negative phenotype and demonstrates either TTF-1 positive or PE-10 positive staining.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, 35249-6823, USA.
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Hummel P, Cangiarella JF, Cohen JM, Yang G, Waisman J, Chhieng DC. Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions: a study of 61 cases. Cancer 2001; 93:187-98. [PMID: 11391606 DOI: 10.1002/cncr.9028] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spindle cell and mesenchymal lesions of the lung encompass a wide variety of benign and malignant conditions. However, to the authors' knowledge, because of their rarity, few reports concerning their cytologic findings are available in the literature. The current review emphasizes the cytomorphologic features, differential diagnosis, and potential pitfalls associated with these lesions. METHODS Seven hundred seventy-nine percutaneous lung fine-needle aspiration (FNA) specimens were retrieved from the authors' cytopathology files over a period of 5 years. Sixty-one cases (7.8%) in which a spindle cell component was the dominant or key feature were identified. The authors reviewed the cytologic smears, immunocytochemical studies, and corresponding surgical material and clinical information. RESULTS Of these 61 aspirates, 33 (54%) were reactive processes (31 granulomas, 1 organizing pneumonia, and 1 inflammatory pseudotumor). Five cases (0.8%) were benign neoplasms (2 hamartomas, 2 solitary fibrous tumors, and 1 schwannoma). Twenty-three cases (38%) were malignant neoplasms (8 cases were primary tumors [including 5 carcinomas with spindle cell or sarcomatoid features, 1 spindle cell carcinoid tumor, 1 leiomyosarcoma, and 1 synovial sarcoma] and 15 cases were secondary tumors [including 9 melanomas, 2 leiomyosarcomas, 1 malignant fibrous histiocytoma, 1 meningioma, 1 sarcomatoid renal cell carcinoma, and 1 uterine malignant mixed müllerian tumor]). A specific diagnosis was rendered in 52 cases (85%). No false-positive cases were encountered but there was one false-negative case. One patient who was diagnosed with granulomatous inflammation on FNA was found to have nonsmall cell lung carcinoma on subsequent transbronchial biopsy. No malignant cells were identified in the smears on review. The FNA from the organizing pneumonia was interpreted as a solitary fibrous tumor whereas the inflammatory pseudotumor was diagnosed as granulomatous inflammation. The FNA from one pulmonary hamartoma initially was considered to be nondiagnostic. One solitary fibrous tumor and the schwannoma were diagnosed as smooth muscle tumor and spindle cell tumor, not otherwise specified, respectively. Among the malignant tumors, the primary synovial sarcoma and one of the metastatic malignant melanomas initially were interpreted as primitive neuroectodermal tumor/Ewing sarcoma and poorly differentiated carcinoma, respectively. CONCLUSIONS Spindle cell lesions of the lung rarely are encountered on transthoracic lung FNA and are comprised of a wide variety of benign and malignant entities. By correlating clinical and radiologic data, cytologic findings, and ancillary studies, a high diagnostic accuracy rate can be achieved with FNA.
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Affiliation(s)
- P Hummel
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Cangiarella J, Waisman J, Cohen JM, Chhieng D, Symmans WF, Axelrod D, Gross J. Radial sclerosing lesion: correlation between mammotome core biopsy and surgical excision. Breast J 2001; 7:66-7. [PMID: 11348419 DOI: 10.1046/j.1524-4741.2001.007001066.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Cangiarella
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Abstract
OBJECTIVE To determine the frequency of atypical glandular cells of undetermined significance (AGUS) for three consecutive calendar years from three different referral sources. STUDY DESIGN Cervicovaginal smears with a diagnosis of AGUS were identified from January 1995 through December 1997. The smears were submitted from three different sources: two were city government hospital clinics, one with predominantly African American and Hispanic patients and the other with predominantly Asian and Hispanic patients. The third referral source was private practitioners' offices with predominantly Caucasian patients. RESULTS A diagnosis of AGUS was made in 707 cases, accounting for 0.56% of all smears examined. This was in contrast to 6,872 smears reported as atypical squamous cells of undetermined significance (ASCUS) (5.4%) and 3,347 reported as squamous intraepithelial lesions (SIL) or above (2.7%). The incidence of AGUS ranged from 0.16% to 1.00% among different patient populations. This difference was also noted in the rate of ASCUS and SIL in the same patient population. There was a steady increase in the rate of AGUS for each referral source during the study period. The overall rate of patients who underwent histologic evaluation and the incidence of biopsy-proven preinvasive and invasive lesions were 62.4% and 23%, respectively. There was no significant difference in the rate of significant lesions after a diagnosis of AGUS during the study period or between the three referral sources. CONCLUSION The AGUS rate in our laboratory was low and within the range (0.17-1.83%) reported in the literature. The AGUS rate varies with different patient populations, particularly with the incidence of SIL and age distribution.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Diver CS, Cohen JM. Genophobia: what is wrong with genetic discrimination? Univ PA Law Rev 2001; 149:1439-1482. [PMID: 12741378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
OBJECTIVE To study the clinical significance of atypical glandular cells of undertermined significance (AGUS) in pregnant and postpartum women. STUDY DESIGN We evaluated 35 women who were pregnant (30) or within three months postpartum (5) and had a cytologic diagnosis of AGUS. Twenty-seven (77%) patients had follow-up: 17 (63%) patients underwent colposcopic examination and biopsy, and 10 (37%) had repeat Pap smears. Eight patients were lost to follow-up. RESULTS Five (29.4%) patients had a squamous intraepithelial lesion (SIL), including three high grade and two low grade, on subsequent biopsy. The remaining (70.6%) patients had benign pathology, which included 5 chronic cervicitis, 4 endocervical and/or endometrial polyps, 2 Arias-Stella reaction and 1 microglandular hyperplasia. Among the patients with repeat Pap smears, two had persistent AGUS/atypical squamous cells of undetermined significance, the remaining cases were within normal limits. CONCLUSION Pregnancy-related changes may present with glandular atypia. In addition, about one-third of pregnant and postpartum women with a diagnosis of AGUS had SIL on subsequent biopsy; that rate is similar to that in nonpregnant women. Therefore, pregnant women with a cytologic diagnosis of AGUS should be followed closely.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, New York, USA.
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Yao JL, Cangiarella JF, Cohen JM, Chhieng DC. Fine-needle aspiration biopsy of peripheral T-cell lymphomas. A cytologic and immunophenotypic study of 33 cases. Cancer 2001; 93:151-9. [PMID: 11309782 DOI: 10.1002/cncr.9022] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Peripheral T-cell lymphoma (PTCL) accounts for 10-20% of all non-Hodgkin lymphomas in the United States. In this study, the authors reviewed the cytologic and immunophenotypic findings of 33 fine-needle aspirations (FNAs) of PTCL. METHODS Thirty-three FNAs from 26 patients (12 females and 14 males) with PTCL were identified during 1991-1999. The patients' age ranged from 19 to 96 years. Immunophenotyping was performed in 24 cases by using either flow cytometry (FC; 21 cases) or immunocytochemistry (IC; 3 cases). Follow-up included review of prior or current histology and clinical records. RESULTS Nine cases were associated with mycosis fungoides, three cases were classified as T-cell chronic lymphocytic leukemia, and two were angioimmunoblastic adenopathy (AILD)-like T-cell lymphoma. The remaining 19 were classified as PTCL, not otherwise specified. The latter consisted of eight mixed cell variant, eight large cell variant, and three anaplastic variant. One of the mixed cell variant and one of the large cell variants contained numerous epithelioid histiocytes (Lennert lymphoma). Thirty (91%) cases had a definitive diagnosis of malignant lymphoma. Twenty-two cases (2 IC and 20 FC) showed a predominant population of T lymphocytes without a monoclonal B-cell population. In addition, FC revealed an aberrant expression of T-cell markers in 13 cases. Two cases were interpreted as "atypical lymphoid population"; one case was an AILD-like T-cell lymphoma, and the other case was PTCL, large cell type. One case initially was interpreted as granulomatous lymphadenitis; subsequent biopsy revealed PTCL, Lennert type. CONCLUSIONS Peripheral T-cell lymphoma is a heterogeneous group of lesions with diverse cytomorphology. Cytologic analysis and immunophenotyping is an accurate method of diagnosing peripheral T-cell lymphoma.
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Affiliation(s)
- J L Yao
- Department of Pathology, New York University Medical Center, New York, New York, USA
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Hummel P, Yang GC, Kumar A, Cohen JM, Winkler B, Melamed J, Scholes JV, Jagirdar J. PNET-like features of synovial sarcoma of the lung: a pitfall in the cytologic diagnosis of soft-tissue tumors. Diagn Cytopathol 2001; 24:283-8. [PMID: 11285627 DOI: 10.1002/dc.1060] [Citation(s) in RCA: 26] [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: 11/10/2022]
Abstract
Fine-needle aspiration (FNA) cytology of soft-tissue tumors is evolving. As more experience is gained, we are becoming aware of potential pitfalls. We describe 2 cases of synovial sarcoma of the lung, primary and metastatic, in patients who had FNA biopsy performed on a lung mass. The cytologic smears showed extremely cellular groups of malignant small round cells, intersected by small blood vessels, with numerous loose single cells, in a background of macrophages and mature lymphocytes. The tumors displayed monomorphic cells forming rosettes and displaying occasional mitoses. A diagnosis of neuroendocrine tumor/primitive neuroepithelial tumor (PNET) was suspected. Furthermore, this suspicion was supported by immunohistochemical stains, which showed positivity for a neuroendocrine marker, Leu 7 (case 1), and for a neural marker, CD 99 (O 13 or HBA 71) (both cases); and negativity for cytokeratins (case 1). The resection specimen of case 1 had mostly tightly packed small round cells, with occasional rosettes, similar to the FNA biopsy, and focal areas composed of spindle cells, organized in a focal fibrosarcoma-like and hemangiopericytoma-like pattern. A balanced translocation between chromosomes X and 18, demonstrated by both karyotyping and fluorescent in situ hybridization (FISH), enabled us to make a diagnosis of synovial sarcoma, which was histologically classified as poorly differentiated. Case 2 was a metastatic biphasic synovial sarcoma of the arm, with a prominent epithelial component. Synovial sarcoma, when composed mainly of small round cells on cytologic smears, is a great mimicker of neuroendocrine/PNET tumors, with light microscopic and immunohistochemical overlap. Awareness of this potential pitfall may aid in preventing a misdiagnosis. Its recognition is of major concern, especially for the poorly differentiated variant, because it is associated with a worse prognosis.
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Affiliation(s)
- P Hummel
- Department of Pathology, New York University Medical Center, New York, New York 10016, USA
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Abstract
Hypersensitivity syndrome is a rare but potentially fatal reaction to some pharmacologic agents, including some antiepileptic drugs. Typically, the syndrome presents with fever, rash, tender lymphadenopathy, hepatitis, and eosinophilia. We report a novel case of clinical hypersensitivity syndrome secondary to gabapentin. A patient developed altered mental status, fever, diffuse macular rash, and an enlarged spleen. This constellation of symptoms and signs began 9 days after gabapentin therapy was begun. Quick resolution was noted after gabapentin was discontinued. To our knowledge, there are no reports of hypersensitivity syndrome to gabapentin.
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Affiliation(s)
- M V Ragucci
- Department of Rehabilitation Medicine, Rusk Institute, New York University School of Medicine, New York, New York 10016, USA
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Chhieng DC, Elgert P, Cohen JM, Cangiarella JF. Clinical significance of atypical glandular cells of undetermined significance in postmenopausal women. Cancer 2001; 93:1-7. [PMID: 11241259] [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: 02/19/2023]
Abstract
BACKGROUND Glandular atypia in Papanicolaou (Pap) smears from postmenopausal women is encountered frequently. This finding can be the result of artifactual alterations such as drying artifacts and inflammatory changes or may represent a squamous or glandular, preneoplastic or neoplastic process. Therefore, it is important to determine the clinical implication of a diagnosis of atypical glandular cells of undetermined significance (AGUS) in postmenopausal patients. METHODS A total of 30,036 Pap smears were obtained from postmenopausal women between 1995 and 1997. Among these smears, 154 (0.51%) had a diagnosis of AGUS. Follow-up was available for 133 patients (86.4%); 110 patients (82.7%) had histologic follow-up (including cervical biopsy, endocervical [EC] curettage, and/or endometrial [EM] biopsy) and 23 patients (17.3%) had repeat smears. RESULTS Thirty-six of 110 patients (32.7%) were found to have a clinically significant lesion (defined as a preneoplastic or neoplastic, glandular or squamous lesion) on subsequent histologic follow-up. Nineteen patients (53%) had glandular lesions (15 EM adenocarcinoma [ACA] cases, 2 EC ACA cases, 1 EC adenocarcinoma is situ case, and 1 EM hyperplasia case). Seventeen patients (47%) had a squamous intraepithelial lesion (SIL) (6 cases of low-grade SIL, 9 cases of high-grade [HGIL], and 2 cases of squamous cell carcinoma). Among those patients with repeat Pap smears, five patients had persistent AGUS/atypical squamous cells of undetermined significance and one patient had an SIL. CONCLUSIONS The incidence of AGUS among postmenopausal patients was similar to that of the general population (0.51% vs. 0.56%; P > 0.05). A significant percentage of these patients were found to have a clinically significant lesion on subsequent follow-up. Furthermore, a majority of these lesions were ACA (53%) or HGSIL (26%). The findings of the current study strongly suggest the need for the close follow-up of postmenopausal patients with a diagnosis of AGUS. Cancer (Cancer Cytopathol)
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6823, USA.
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Abstract
UNLABELLED INTRODUCTION. Although the cytologic features of Hodgkin disease (HD) has been well described, HD accounts for most of the false-negative fine-needle aspiration (FNA) biopsies of malignant lymphomas. In this study, the authors examined the factors contributing to a false-negative diagnosis of HD. METHODS Eighty-nine cases from 72 patients (23 females and 49 males) with HD evaluated by FNA were identified between 1990 and 1999. The patients' ages ranged from 5 to 90 years (median, 38 years). Eighty-five FNAs were from lymph nodes, and 4 were from extranodal sites. Histologic correlation was available for all patients. RESULTS Based on the original cytologic diagnosis, 43 (48.3%) cases had a positive diagnosis of HD, 20 (22.5%) suspicious or atypical diagnosis, 13 (14.6%) a benign diagnosis (false-negative cases), and 10 (11.2%) were nondiagnostic. Three (3.4%) additional cases had a malignant diagnosis other than HD. After review, three false-negative cases were reclassified as HD and seven as atypical lymphoid proliferation. Three of these 10 cases also showed conspicuous collections of histiocytes mimicking poorly formed granulomas. In those "atypical" cases, only rare Reed-Sternberg (R-S) cells variants were identified. No R-S cells or its variants were identified in the remaining three false-negative cases; subsequent excisional biopsy showed partial involvement of the lymph node by HD in two cases. Among the nondiagnostic cases, nine cases showed considerable fibrosis in the resected lymph node. In addition, six cases were performed without on-site assessment. CONCLUSIONS The cytologic diagnosis of HD can be challenging when classic R-S cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node by HD, sampling error, and misinterpretation. On-site assessment significantly minimizes the false-negative diagnostic rate. Furthermore, additional material can be obtained for ancillary studies. Cancer (Cancer Cytopathol)
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249-6823, USA.
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Chhieng DC, Cohen JM, Cangiarella JF. Cytology and immunophenotyping of low- and intermediate-grade B-cell non-Hodgkin's lymphomas with a predominant small-cell component: a study of 56 cases. Diagn Cytopathol 2001; 24:90-7. [PMID: 11169886 DOI: 10.1002/1097-0339(200102)24:2<90::aid-dc1017>3.0.co;2-j] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diagnosis of non-Hodgkin's lymphomas based on cytologic evaluation of fine-needle aspirates and body cavity fluids has gained increasing acceptance. However, the accurate diagnosis and classification of low- and intermediate-grade B-cell lymphomas with a predominant small-cell population still present a diagnostic challenge. In this study, we reviewed the cytology and immunophenotype of 56 cases of low- and intermediate-grade non-Hodgkin's B-cell lymphomas composed of predominantly small cells, with histologic correlation in all cases. These cases consisted of 23 small lymphocytic lymphomas (SLL), 15 follicular center lymphomas (FCL), grade I (small cell predominant), 8 lymphoplasmacytoid lymphomas (LPL), 6 mantle-cell lymphomas (MCL), and 4 marginal zone lymphomas (MZL) including mucosa-associated lymphoid tissue (MALT) lymphoma. Histologic comparison was available in all cases. A cytologic diagnosis of malignant lymphoma was made in 46 (82%) cases. Based on cytomorphology and immunophenotyping of cytologic material, 39 (85%) cases were correctly classified using the Revised European and American Lymphoma classification. In 7 (11%) cases, which included 3 FCLs, 2 MALT lymphomas, and 2 SLLs, the findings were atypical but not diagnostic of lymphoma. There were 3 (5%) false-negative cases. They were 2 SLLs and a FCL. Immunophenotyping done in 4 "atypical" cases was noncontributory. No marker studies were done in the remaining "atypical" case and all false-negative cases. We conclude that cytology, when used in conjunction with immunophenotyping, can accurately diagnose and in most instances subclassify low- and intermediate-grade B-cell non-Hodgkin's lymphoma with a predominant small-cell population.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Female
- Flow Cytometry
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell, Marginal Zone/classification
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, Follicular/classification
- Lymphoma, Follicular/diagnosis
- Lymphoma, Mantle-Cell/classification
- Lymphoma, Mantle-Cell/diagnosis
- Male
- Middle Aged
- Neoplasm Staging
- Reproducibility of Results
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Affiliation(s)
- D C Chhieng
- Department of Pathology, KB 526, University of Alabama at Birmingham, 619 19 St. S., Birmingham, AL 35249-6823, USA.
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Cangiarella J, Waisman J, Symmans WF, Gross J, Cohen JM, Wu H, Axelrod D. Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsies from 142 women with surgical and radiologic followup. Cancer 2001; 91:173-7. [PMID: 11148574 DOI: 10.1002/1097-0142(20010101)91:1<173::aid-cncr22>3.0.co;2-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although stereotaxic fine-needle aspiration biopsy or core biopsy (14-gauge) have proven to be accurate techniques for the evaluation of mammographically detected microcalcification, the development of the Mammotome Biopsy System (Biopsys Medical, Inc., Irvine, CA) has led many medical centers to use this vacuum-assisted device for the sampling of microcalcification. METHODS One hundred forty-two women underwent 160 stereotaxic Mammotome core biopsies of mammographic calcification over a 1-year period. The stereotaxic procedure was performed by radiologists using the Mammotome Biopsy System. Microcalcification was evident on specimen radiographs and microscopic slides in 99% of the cases. Excisional biopsy was recommended for diagnoses of atypia or carcinoma. Patients with benign diagnoses underwent mammographic followup. RESULTS One hundred thirty-two benign, 12 atypical, and 15 adenocarcinoma diagnoses (comprising 1 lobular adenocarcinoma in situ [LCIS], 1 invasive ductal adenocarcinoma [IDC], and 13 intraductal adenocarcinomas [DCIS]: 10 comedo, 1 cribriform, 2 mixed cribriform and micropapillary) were rendered. Surgical excision in eight patients with atypia on Mammotome biopsy (two refused surgery, two were lost to followup) showed ductal hyperplasia in three, atypical ductal hyperplasia (ADH) in three and DCIS (low grade, solid) in two patients. Surgical excisions in 14 patients diagnosed with carcinoma (1 patient lost to followup) showed ADH in 3, ADH and LCIS in 1, residual DCIS in 8, IDC in 1, and microinvasive carcinoma in 1 patient. CONCLUSIONS A diagnosis of atypia on Mammotome biopsy warranted excision of the atypical area, yet the underestimation rate for the presence of carcinoma remained low. The likelihood of an invasive component at excision was low for microcalcification diagnosed as DCIS on Mammotome biopsy. Mammotome biopsy proved to be an accurate technique for the sampling and diagnosis of mammary microcalcification.
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Affiliation(s)
- J Cangiarella
- Department of Pathology, New York University Medical Center, New York, New York 10016, USA.
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Chhieng DC, Yee H, Cangiarella JF, Symmans WF, Cohen JM. Use of E-cadherin and CD44 aids in the differentiation between reactive mesothelial cells and carcinoma cells in pelvic washings. Cancer 2000; 90:299-306. [PMID: 11038427 DOI: 10.1002/1097-0142(20001025)90:5<299::aid-cncr6>3.0.co;2-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The presence of malignant cells in peritoneal washings is an independent prognostic factor in the evaluation of gynecologic malignancies. The differentiation between reactive mesothelial cells and carcinoma cells can be a diagnostic challenge based on morphology alone. The expression of some cell adhesion molecules may be helpful in the differential diagnosis. METHODS To evaluate the specificity of 2 transmembrane cell adhesion proteins (E-cadherin and CD44) in the differentiation of mesothelial cells from carcinoma cells in pelvic washings, formalin fixed, paraffin embedded cell blocks of pelvic washings from 19 cases of metastatic ovarian adenocarcinoma and 16 cases of benign peritoneal washings were immunostained with monoclonal antibodies to E-cadherin and CD44. The staining patterns were evaluated blindly by three observers. Positive staining was defined as uniform membranous staining for each marker. RESULTS Fourteen benign peritoneal washings (87.5%) demonstrated immunoreactivity with anti-CD44. On the contrary, only four adenocarcinomas (21.1%) demonstrated anti-CD44 immunoreactivity. E-cadherin expression was identified in only 2 benign peritoneal washings (12.5%) whereas 16 adenocarcinomas (84.2%) strongly expressed E-cadherin. The differences in immunostaining for both CD44 and E-cadherin between benign and malignant peritoneal washings were statistically significant. The combination of positive staining for E-cadherin and negative staining for CD44 was 100% specific for metastatic adenocarcinoma, whereas a combination of negative staining for E-cadherin and positive staining for CD44 was 100% specific for reactive mesothelial cells. CONCLUSIONS Both E-cadherin and CD44 reliably distinguish reactive mesothelial cells from adenocarcinoma. The combination of E-cadherin/CD44 is highly specific and is a useful diagnostic adjunct with which to distinguish benign reactive mesothelial cells from adenocarcinoma in pelvic washings.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
Fine-needle aspiration (FNA) biopsy can accurately diagnose epithelial lesions of the salivary gland. Its role in the evaluation of salivary gland lesions containing a significant spindle cell component is less clear. We describe the cytologic features of 25 spindle cell lesions of the salivary gland and discuss the differential diagnosis and potential diagnostic pitfalls. Twenty-five aspiration smears (3.0%) containing a significant spindle cell or mesenchymal component were identified out of 844 salivary gland FNAs performed over a 5-year period. These aspiration smears were from 25 patients. The smears were classified into three categories: 1) reactive or inflammatory conditions, including one granulation tissue and four granulomatous sialoadenitis; 2) benign neoplasms, including one schwannoma, one fibromatosis, four lipomas, and nine pleomorphic adenomas; 3) malignant neoplasms, including one recurrent malignant fibrous histiocytoma (MFH), two metastatic melanomas, and two metastatic osteosarcomas. There was one false-negative biopsy. The metastatic desmoplastic malignant melanoma was initially interpreted as a reactive lymph node with fibrosis. A specific diagnosis was rendered in 21 (84%) cases. The schwannoma was diagnosed cytologically as benign spindle cell lesion, not otherwise specified (NOS), fibromatosis as an atypical cellular proliferation, and MFH as poorly differentiated malignant neoplasm. Salivary gland lesions with a significant spindle cell component are rarely encountered on FNA and constitute a heterogeneous group. A specific diagnosis can be rendered in the majority of cases by correlating clinical and cytologic findings.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
A substantial percentage of women with a diagnosis of atypical glandular cells of undetermined significance (AGUS) on cervical smears harbor a significant squamous or glandular, preneoplastic or neoplastic lesion on subsequent follow-up. Attempts to subclassify AGUS smears by conventional methods have had mixed results. To determine whether subclassification of AGUS cervical smears using computer-assisted rescreening based on the neural network would improve correlation with subsequent histologic follow-up, 91 cervical smears, conventionally diagnosed as AGUS without concomitant squamous lesions, were subjected to analysis by a computer-assisted automated screening system. Computer-generated images were evaluated by a cytotechnologist without the knowledge of the histologic outcomes. Prior to manual review, each case was classified as either within normal limits, no review required; or abnormal, review required. Based on the degree of abnormality, the latter category was further subclassified into either low probability or high probability of abnormality. The results of the computer-assisted reclassification were then compared with the histologic follow-up of all patients. Thirty-three cases (38.8%) had a significant lesion on histologic follow-up. The lesions included 4 CIN I, 7 CIN II/III, 12 endocervical adenocarcinomas (ACA), and 10 endometrial ACA. Based on computer-generated images, 65% of the smears that were triaged as high probability of abnormality, 11.5% that were triaged as low probability of abnormality, and 10.5% that were triaged as within normal limits had a significant lesion on subsequent follow-up. We conclude that computer-assisted rescreening aids in the triage of AGUS smears and that computer-assisted rescreening based on the neural network or other algorithms may be a useful ancillary tool for subclassifying AGUS cervical smears.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, USA
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Chhieng DC, Yee H, Schaefer D, Cangiarella JF, Jagirdar J, Chiriboga LA, Jagirdar J, Chiriboga LA, Cohen JM. Calretinin staining pattern aids in the differentiation of mesothelioma from adenocarcinoma in serous effusions. Cancer 2000. [PMID: 10896333 DOI: 10.1002/1097-0142(20000625)90: 3<194: : aid-cncr8>3.0.co; 2-k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The differentiation between malignant mesothelioma and adenocarcinoma based on morphology alone can be a diagnostic challenge. The majority of the available antibodies recognize molecules expressed by adenocarcinoma whereas to the authors' knowledge specific markers for mesothelial cells are lacking. Calretinin, a calcium-binding protein, has been reported to be a selective marker for mesothelioma and largely is absent from adenocarcinoma on histologic material. The results with cytologic preparations have been inconsistent. METHODS To evaluate the specificity of calretinin in differentiating mesothelioma from adenocarcinoma in cytologic preparations, 21 paraffin embedded cells blocks of serous effusions from 15 patients with metastatic adenocarcinoma and 16 cell blocks from 9 patients with malignant mesothelioma were stained with a monoclonal antibody against calretinin. The immunoreactivity was evaluated blindly by two observers. Positive staining was defined as nuclear and cytoplasmic staining with or without intense membranous decoration. The former resulted in a characteristic "fried egg" appearance. RESULTS Calretinin staining was positive in all but 2 cases of mesothelioma (14 of 16 cases; 87.5%). The latter contained predominantly spindle-shaped neoplastic mesothelial cells in the cell block preparations. All adenocarcinoma specimens were classified as negative for calretinin staining; 9 (42.9%) lacked any immunoreactivity and 12 (57.1%) showed weak, sparse, coarse, granular cytoplasmic staining without nuclear or membranous staining. Benign reactive mesothelial cells, when observed in association with adenocarcinoma, also showed the characteristic "fried egg" appearance. The difference in the staining pattern of calretinin between cells of mesothelial origin and adenocarcinoma cells was statistically significant. CONCLUSIONS Calretinin is a useful marker in differentiating mesothelioma of the epithelial type from adenocarcinoma in serous effusions. The "fried-egg" appearance or cytoplasmic and nuclear staining pattern is characteristic of cells of mesothelial origin.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, USA
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Chhieng DC, Yee H, Schaefer D, Cangiarella JF, Jagirdar J, Chiriboga LA, Jagirdar J, Chiriboga LA, Cohen JM. Calretinin staining pattern aids in the differentiation of mesothelioma from adenocarcinoma in serous effusions. Cancer 2000. [PMID: 10896333 DOI: 10.1002/1097-0142(20000625)90:3<194::aid-cncr8>3.0.co;2-k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The differentiation between malignant mesothelioma and adenocarcinoma based on morphology alone can be a diagnostic challenge. The majority of the available antibodies recognize molecules expressed by adenocarcinoma whereas to the authors' knowledge specific markers for mesothelial cells are lacking. Calretinin, a calcium-binding protein, has been reported to be a selective marker for mesothelioma and largely is absent from adenocarcinoma on histologic material. The results with cytologic preparations have been inconsistent. METHODS To evaluate the specificity of calretinin in differentiating mesothelioma from adenocarcinoma in cytologic preparations, 21 paraffin embedded cells blocks of serous effusions from 15 patients with metastatic adenocarcinoma and 16 cell blocks from 9 patients with malignant mesothelioma were stained with a monoclonal antibody against calretinin. The immunoreactivity was evaluated blindly by two observers. Positive staining was defined as nuclear and cytoplasmic staining with or without intense membranous decoration. The former resulted in a characteristic "fried egg" appearance. RESULTS Calretinin staining was positive in all but 2 cases of mesothelioma (14 of 16 cases; 87.5%). The latter contained predominantly spindle-shaped neoplastic mesothelial cells in the cell block preparations. All adenocarcinoma specimens were classified as negative for calretinin staining; 9 (42.9%) lacked any immunoreactivity and 12 (57.1%) showed weak, sparse, coarse, granular cytoplasmic staining without nuclear or membranous staining. Benign reactive mesothelial cells, when observed in association with adenocarcinoma, also showed the characteristic "fried egg" appearance. The difference in the staining pattern of calretinin between cells of mesothelial origin and adenocarcinoma cells was statistically significant. CONCLUSIONS Calretinin is a useful marker in differentiating mesothelioma of the epithelial type from adenocarcinoma in serous effusions. The "fried-egg" appearance or cytoplasmic and nuclear staining pattern is characteristic of cells of mesothelial origin.
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Affiliation(s)
- D C Chhieng
- Department of Pathology, New York University Medical Center, New York, USA
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