1
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George JT, Lenin A, Koshy M, Vignesh CV, Sathyendra S. Central nervous system manifestations of dengue infection: data from a tertiary care Centre in South India. Postgrad Med J 2023; 99:50-55. [PMID: 36828393 DOI: 10.1093/postmj/qgad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 01/10/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Dengue fever is the second most common mosquito-borne disease affecting human beings and neurological manifestations (NMs) of this arboviral infection are increasingly being reported. METHODS In this retrospective study, conducted in a tertiary care centre in south India, we sought to describe the spectrum of NMs of dengue fever. The records of all patients admitted in the Department of Internal Medicine over 8 years, with a diagnosis of dengue-based on clinical symptoms and the detection of dengue IgM antibodies or detection of NS1 antigen or nucleic acid by reverse transcriptase-polymerase chain reaction (RT-PCR); with Glasgow coma score (GCS) ≤14, neck stiffness, focal neurological signs, seizures, or visual disturbances-were explored. RESULTS Of 1121 patients admitted with dengue fever, 341 (30%) had severe dengue and 23 (2%) had NMs. Encephalopathy was seen in 9 patients (39%), encephalitis in 6 (27%), cerebellitis in 4 (17%), acute disseminated encephalomyelitis (ADEM) in 2 (9%), ischaemic stroke in 1 (4%) patient, and neuro-ophthalmological manifestations in 1 (4%) patient. The median duration of hospital stay was 7 days. Nine (39% of) patients required intensive care unit (ICU) admission and 5 (22%) had fatal outcomes. There was no association between thrombocytopenia, metabolic acidosis, transaminitis, hyponatremia, the type of dengue infection, and the various NMs described. CONCLUSIONS The NMs of dengue infection are varied, and a high index of suspicion is needed to identify them in patients who present with lethargy or altered sensorium on the background of an acute febrile illness suggestive of dengue.
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Affiliation(s)
- John Titus George
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, 632004, India
| | - Audrin Lenin
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, 632004, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, 632004, India
| | - C V Vignesh
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, 632004, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamilnadu, 632004, India
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2
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Ganesh A, Korpics M, Pasquinelli M, Feldman L, Koshy M. EP02.02-002 Increased Utilization of Stereotactic Body Radiotherapy Has Decreased Treatment Disparities for Early-Stage NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.347] [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: 11/24/2022]
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3
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Elango K, Mudgal M, Murthi S, Yella PR, Nagrecha S, Srinivasan V, Sekar V, Koshy M, Ramalingam S, Gunasekaran K. Trends in the Epidemiology and Outcomes of Pneumocystis Pneumonia among Human Immunodeficiency Virus (HIV) Hospitalizations. Int J Environ Res Public Health 2022; 19:ijerph19052768. [PMID: 35270461 PMCID: PMC8910294 DOI: 10.3390/ijerph19052768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002−2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality.
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Affiliation(s)
- Kalaimani Elango
- Division of Cardiology, University of Nevada, 4505 S Maryland Pkwy, Las Vegas, NV 89154, USA;
| | - Mayuri Mudgal
- Department of Geriatric Medicine, Montefiore Medical Center, Wakefield Campus, 600 E 233rd Street Bronx, New York, NY 10466, USA;
| | - Swetha Murthi
- Department of Endocrinology, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Prashanth Reddy Yella
- Department of Internal Medicine, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Savan Nagrecha
- Department of Pharmacy, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA;
| | - Vedhapriya Srinivasan
- Department of Internal Medicine, Suny Downstate Medical Center, New York, NY 11203, USA;
| | - Vijaykumar Sekar
- Department of Endocrinology, Lehigh Valley Health Center, 1243 S Cedar Crest Blvd, Allentown, PA 18103, USA;
| | - Maria Koshy
- Department of Internal Medicine, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA;
| | - Sathishkumar Ramalingam
- Department of Internal Medicine, Lovelace Medical Center, 601 Dr. Martin Luther King Jr. Avenue NE, Albuquerque, NM 87102, USA;
| | - Kulothungan Gunasekaran
- Department of Pulmonary Diseases and Critical Care, Yuma Regional Medical Center, 2400 S Avenue A, Yuma, AZ 85364, USA
- Correspondence: ; Tel.: +1-928-336-2434
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4
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Ninan K F, Iyadurai R, Varghese JK, Geevar T, Nair SC, Yadav B, Carey RAB, Sadiq J M, Koshy M, Ralph R, Peter JV. Thromboelastograph:A prognostic marker in sepsis with organ dysfunction without overt bleeding. J Crit Care 2021; 65:177-183. [PMID: 34171693 DOI: 10.1016/j.jcrc.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coagulation abnormalities are not infrequent in sepsis. It is unclear if abnormalities in thromboelastogram (TEG) are associated with mortality in patients with severe sepsis without overt bleeding. MATERIALS AND METHODS In this prospective study, patients were categorised as those with normal coagulation, hypercoagulable or hypercoagulable state based on admission TEG parameters (R time, K time, Maximum amplitude (MA), α angle). Their association with mortality was explored using Fisher's exact and Mann-Whitney U test as appropriate. RESULTS The study cohort (n = 87; 49 male) with median (IQR) age 51 (42-60) years and admission SOFA score 8 (6-11) included scrub typhus (24.1%), pneumonia (22.6%) and urosepsis (10.3%). Non-invasive and invasive ventilation and vasopressors were required in 28.1%, 68.9% and 74%, respectively. Mortality was 24.1%. Based on R time, K time and α angle, 3.5% to 9.3% had a hypercoagulable state and 26.7 to 29.9% were hypocoagulable. Prolonged R time (p = 0.04) and reduced alpha angle (p = 0.01) in patients with hypocoagulable state was associated with mortality. K time, α angle and MA were significantly different in patients requiring transfusion (p < 0.001). CONCLUSION A subset of patients with severe sepsis without overt bleeding are hypocoagulable. Hypocoagulability is associated with mortality and need for transfusion.
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Affiliation(s)
- Fibi Ninan K
- Department of Medicine, Christian Medical College (CMC), Vellore, India.
| | - Ramya Iyadurai
- Department of Medicine, Christian Medical College (CMC), Vellore, India
| | | | - Tulasi Geevar
- Department of Transfusion Medicine and Immunohematology, CMC, Vellore, India
| | - Sukesh C Nair
- Department of Transfusion Medicine and Immunohematology, CMC, Vellore, India
| | - Bijesh Yadav
- Department of Biostatistics, CMC, Vellore, India
| | | | - Mohammad Sadiq J
- Department of Medicine, Christian Medical College (CMC), Vellore, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College (CMC), Vellore, India
| | - Ravikar Ralph
- Department of Medicine, Christian Medical College (CMC), Vellore, India
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5
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Koshy M, Mische L, Rizza S, Mahmood M, Bedimo R, Bhatia R, El Atrouni W, Curran J, Temesgen Z. Point-of-care program in HIV, tuberculosis, and associated conditions: A virtual global technical assistance platform to strengthen HIV and tuberculosis workforce capacity. J Clin Tuberc Other Mycobact Dis 2021; 23:100238. [PMID: 33997312 PMCID: PMC8102617 DOI: 10.1016/j.jctube.2021.100238] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A global multi-disciplinary faculty was established to work collaboratively and provide virtual technical assistance, using a point-of-care continuing education model, to clinicians across the world engaged in the care of patients with either HIV infection or tuberculosis. Ancillary offerings included live or virtual lectures, case-based conferences, and courses. In spite of the considerable disruption of the program due to the COVID-19 pandemic, we engaged and assisted a substantial number of clinicians across the world and provided meaningful contributions to their continuous professional development and patient care. In light of the ongoing pandemic, virtual technical assistance models such as this should be scaled to continue essential high-quality HIV/TB services.
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Affiliation(s)
- Maria Koshy
- Internal Medicine, Bridgeport Hospital, Yale New Haven Health, CT, USA
| | | | - Stacey Rizza
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
| | - Maryam Mahmood
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
| | - Roger Bedimo
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, USA
| | - Ramona Bhatia
- Department of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| | - Wissam El Atrouni
- The University of Kansas School of Medicine, Division of Infectious Diseases, Kansas City, KS, USA
| | - Jennifer Curran
- Mayo Clinic School of Continuous Professional Development, USA
| | - Zelalem Temesgen
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
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6
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Mannam P, Arvind VH, Koshy M, Varghese GM, Alexander M, Elizabeth SM. Neuromelioidosis: A Single-Center Experience with Emphasis on Imaging. Indian J Radiol Imaging 2021; 31:57-64. [PMID: 34316112 PMCID: PMC8299505 DOI: 10.1055/s-0041-1729125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction
Infection with
Burkholderia pseudomallei
, a gram-negative bacterium found in soil and surface water, is termed melioidosis and is commonly reported to occur in Southeast Asia and Northern Australia, where it is endemic. It is being increasingly reported in India, and transmission occurs through inhalation, inoculation, and ingestion. The neuroparenchyma, the adjacent soft tissue, and bone are known to be affected in both the acute and chronic disease forms. Involvement of these structures is rare but causes significant mortality and morbidity.
Material and Methods
Eighteen culture-proven cases of neuromelioidosis were identified between January 2008 and December 2019. The patients were retrospectively identified via search of the hospital’s electronic database.
Results
Cranial disease was in the form of parenchymal abscesses (
n
= 4), cerebritis/encephalitis (
n
= 5), and extradural (
n
= 4) and dural disease (
n
= 1). Acute myelitis (
n
= 1) and spondylodiscitis (
n
= 3) were seen in the spinal disease form. Neuroparenchymal involvement ranged from cerebritis/encephalitis to early and mature parenchymal abscesses. Extradural involvement was in the form of extradural abscesses and/or thick irregular enhancement in the extradural region. Early diagnosis and initiation of appropriate therapy had favorable outcomes in 15 out of 18 patients. Two patients with parenchymal abscesses and one with myelitis succumbed to the illness.
Conclusion
Neuromelioidosis is a rare manifestation of melioidosis with significant morbidity and mortality, necessitating a high index of clinical suspicion, especially if there has been travel to endemic regions. Imaging plays a key role in facilitating early diagnosis and initiation of therapy.
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Affiliation(s)
- Pavithra Mannam
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Vanjare H Arvind
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi M Elizabeth
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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7
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D'Sa S, Chacko B, Sudarsan T, Sundar Raj Mani S, Paul H, Victor P, Iyyadurai R, Das S, Koshy M, Victor Peter J. Nosocomial infection acquired during intensive care admission impacts mortality in patients admitted with deliberate self-harm. Journal of Emergency Medicine, Trauma and Acute Care 2021. [DOI: 10.5339/jemtac.2020.12] [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: 11/03/2022] Open
Affiliation(s)
| | | | | | | | - Hema Paul
- Hospital Infection Control Committee; Christian Medical College, Vellore, India
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8
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Ahn K, Koshy M, Aydogan B. Knowledge-Based VMAT Planning of Total Marrow Irradiation as a Part of Conditioning Regimen Before Allo-SCT in a Prospective Phase I/II Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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9
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Abstract
Extranodal presentation in lymphoproliferative disorders is a well-recognised entity. However, musculoskeletal involvement is extremely rare. We describe the case of a 64-year-old farmer who presented to us with constitutional symptoms of fever, loss of weight and loss of appetite for 2 years and physical examination revealing generalised lymphadenopathy with hepatosplenomegaly. Biopsy of an axillary lymph node showed mixed cellularity variant of Hodgkin's lymphoma. CT of the thorax and abdomen revealed a collection in the right psoas muscle. Guided biopsy of the psoas deposit was suggestive of Hodgkin's lymphoma. PCR and cultures for Mycobacterium tuberculosis tested negative. Here we describe a rare presentation of Hodgkin's lymphoma with intramuscular involvement.
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Affiliation(s)
- Vijay Alexander
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Rachana Shenoy
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Anu Korula
- Hematology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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10
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Jacob MS, Gunasekaran K, Miraclin AT, Sadiq M, Kumar CV, Oommen A, Koshy M, Mishra AK, Iyadurai R. Clinical Profile and Outcome of Patients with Cerebral Venous Thrombosis Secondary to Bacterial Infections. Ann Indian Acad Neurol 2020; 23:477-481. [PMID: 33223663 PMCID: PMC7657302 DOI: 10.4103/aian.aian_341_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/03/2020] [Accepted: 06/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Cerebral venous thrombosis (CVT) secondary to infectious aetiology has become rare in the antibiotic era, but is still encountered in clinical practice occasionally. In this study, we describe the clinical profile, diagnosis, and management of patients with CVT secondary to an infectious aetiology. Methods: This retrospective study included all adult patients over 15 years (1 January 2002 to 1 January 2017). Adult patients with a diagnosis of infective CVT secondary to bacterial infections were included in the study. Results: Totally, 22 patients were identified with CVT complicating bacterial infections. The focus of infection in 12 (54.54%) patients was pyogenic meningitis, 9 (40.9%) patients had a parameningeal focus and one patient developed CVT secondary to bacterial sepsis from a remote focus. Fever was the most common symptom seen in 77.3% followed by headache and depressed sensorium in 72.7% and 63.6%, respectively. The most common organism in the meningitis group was Streptococcus species, and in the parameningeal group was Staphylococcus aureus. At presentation MRI identified CVT in all 7 patients as compared to CT brain with contrast in 2/3 (66.6%). Transverse sinus was the most commonly involved sinus in meningitis. All patients were treated with appropriate antibiotics and anticoagulation was used in 50% of the patients. The in hospital, mortaility was 9%. Conclusion: Septic CVT, though rare can be a complication of bacterial meningitis and facial infections. Clinical symptoms that suggest a co-existing CVT should be identified and diagnosed at the earliest. The mainstay of treatment is antibiotics; the role of anticoagulation is controversial.
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Affiliation(s)
- Manna S Jacob
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Gunasekaran
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Angel T Miraclin
- Department of Neurological Science, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mohammad Sadiq
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - C Vignesh Kumar
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajoy Oommen
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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11
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Jiang W, Verma V, Haque W, Moreno AC, Koshy M, Butler EB, Teh BS. Post-treatment mortality after definitive chemoradiotherapy versus resection for esophageal cancer. Dis Esophagus 2020; 33:5555765. [PMID: 31504359 DOI: 10.1093/dote/doz073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 12/11/2022]
Abstract
In efforts to better characterize incidence and predictors of 30- and 90-day mortality following operative versus nonoperative approaches for locally advanced esophageal cancer (EC), we conducted a novel investigation of a large, contemporary US database. The National Cancer Database was queried for newly-diagnosed T1-3N0-1 squamous cell or adenocarcinoma receiving surgical-based therapy (esophagectomy alone or preceded by chemotherapy and/or radiotherapy) versus definitive chemoradiotherapy (dCRT). Statistics included graphing cumulative incidences of mortality before and following propensity score matching (PSM), based on age-based intervals. Cox regression determined factors independently predictive of 30- and 90-day mortality. Of 15,585 patients, 9,278 (59.5%) received surgical-based therapy and 6,307 (40.5%) underwent dCRT. In the unadjusted population, despite nonsignificant differences at 30 days (3.3% dCRT, 3.6% surgical-based), the dCRT cohort experienced higher 90-day mortality (11.0% vs. 7.5%, P < 0.001). Following PSM, however, dCRT patients experienced significantly lower 30-day mortality (P < 0.001), with nonsignificant differences at 90 days (P = 0.092). Surgical-based management yielded similar (or better) mortality as dCRT in ≤70-year-old patients; however, dCRT was associated with reduced mortality in subjects > 70 years old. In addition to the intervention group, factors predictive for 30- and 90-day mortality included age, gender, insurance status, facility type, comorbidity index, tumor location, histology, and T/N classification. In summary, surgical-based therapy for EC is associated with higher 30-day mortality, which becomes statistically similar to dCRT by 90 days. Differences between surgery and dCRT were most pronounced in patients > 70 years of age. These data may better inform shared decision-making between multidisciplinary providers and patients.
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Affiliation(s)
- W Jiang
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong Province, China
| | - V Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - W Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - A C Moreno
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - M Koshy
- Department of Radiation Oncology, University of Chicago School of Medicine, Chicago, IL, USA
| | - E B Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - B S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
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12
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Rooney M, Turchan W, Korpics M, Koshy M, Spiotto M. Treatment patterns and survival outcomes for odontogenic cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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John KJ, Turaka VP, Muruga Bharathy K, Vignesh Kumar C, Jayaseelan L, Visalakshi J, Nadaraj A, Mathew A, Mariam F, Nellimala NJ, Joy A, Punitha JV, Koshy M, Chandy G, Gunasekaran K, Sudarsanam TD. Predictors of mortality, strategies to reduce readmission, and economic impact of acute decompensated heart failure: Results of the Vellore Heart Failure Registry. Indian Heart J 2020; 72:20-26. [PMID: 32423556 PMCID: PMC7231859 DOI: 10.1016/j.ihj.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/22/2020] [Accepted: 03/12/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Heart failure is a global problem that is increasing in prevalence. We undertook the initiative to compile the Vellore Heart Failure Registry (VHFR) to assess the clinical profile, mortality, risk factors and economic burden of heart failure by conducting a prospective, observational, hospital-based cohort study in Vellore, Tamil Nadu. METHODS AND RESULTS This study was a prospective observational cohort study conducted at the Christian Medical College and Hospital, Vellore, between January 2014 and December 2016. A total of 572 patients who satisfied the Boston criteria for "definite heart failure" were included and the primary outcome was all-cause mortality. The median duration of hospital stay was eight days and the in-hospital, one, three and six month mortalities were 13.25%, 27.3%, 32.53% and 38.15%, respectively. The median duration of survival was 921 days. Readmission for heart failure constituted 42%, and the most common cause of decompensation was an infection(31.5%). The presence of cyanosis at admission, history of previous stroke or transient ischemic attack, and American College of Cardiology (ACC)/American Heart Association (AHA) stage D at the time of discharge were independently associated with mortality at six months. The median total direct cost of admission was INR 84,881.00 ($ 1232.34) CONCLUSION: The VHFR cohort had younger, more diabetic, and fewer hypertensive subjects than most cohorts. Admission for heart failure is a catastrophic health expenditure. Attempts should be made to ensure a reduction in readmission rates by targeting goal-directed therapy. As the most common cause of acute decompensation is pneumonia, vaccinating all patients before discharge may also help in this regard.
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Affiliation(s)
- Kevin John John
- Department of Medicine, Christian Medical College, Vellore, India
| | | | | | - C Vignesh Kumar
- Department of Medicine, Christian Medical College, Vellore, India
| | - L Jayaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - J Visalakshi
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Anoop Mathew
- Interventional Cardiology, Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | | | | | - Anisha Joy
- Christian Medical College, Vellore, India
| | - J V Punitha
- Department of Medicine, Christian Medical College, Vellore, India
| | - Maria Koshy
- Department of Medicine, Christian Medical College, Vellore, India
| | - Gina Chandy
- Department of Medicine, Christian Medical College, Vellore, India
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14
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Pasquinelli M, Tammemägi M, Kovitz K, Durham M, Deliu Z, Rygalski K, Liu L, Koshy M, Winn R, Feldman L. P2.11-22 Comparison of the Sensitivity of USPSTF and PLCOm2012 Lung Cancer Screening Criteria in a Racially Diverse Population. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Koshy M, Son C, Spiotto M, Rondelli D, Saraf S. Prospective Evaluation of Total Body Radiation in the Conditioning Regimen of Patients Undergoing Allogeneic Stem Cell Transplantation for Sickle Cell Disease. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Koshy M, Jagannati M, Ralph R, Victor P, David T, Sathyendra S, Veeraraghavan B, Varghese GM. Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India. Emerg Infect Dis 2019; 25:316-320. [PMID: 30666953 PMCID: PMC6346473 DOI: 10.3201/eid2502.170745] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We studied the clinical manifestations and outcomes of 114 patients with culture-confirmed melioidosis treated at a tertiary hospital in southern India. Diabetes mellitus is the main risk factor, and chronic melioidosis mimicking tuberculosis was more common than acute disease. Septicemia and respiratory involvement were associated with poor outcomes.
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Foster C, Sher D, Rusthoven C, Verma V, Spiotto M, Weichselbaum R, Koshy M. Overall Survival According to Systemic and Radiation Treatment Approaches in Metastatic Non-Small-Cell Lung Cancer: A National Cancer Database Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alexander V, Koshy M, Dasgupta R, Carey RA. Arterial thrombosis as primary presentation of endogenous Cushing’s syndrome. BMJ Case Rep 2019; 12:12/2/bcr-2018-227491. [DOI: 10.1136/bcr-2018-227491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cushing’s syndrome is known to present with a characteristic set of clinical manifestations and complications, well described in literature. However, hypercoagulability remains an under recognised entity in Cushing’s syndrome. A 31-year-old woman from Southern India presented with history of fever, left upper quadrant pain and progressive breathing difficulty for 3 weeks. Clinical examination revealed discriminatory features of Cushing’s syndrome. Laboratory investigations showed biochemical features of endogenous ACTH-dependent Cushing’s syndrome. Imaging of the abdomen revealed splenic collection, left-sided empyema and extensive arterial thrombosis. Gadolinium enhanced dynamic MRI of the pituitary gland revealed no evidence of an adenoma while a Ga-68 DOTATATE positron emission tomography CT scan ruled out an ectopic Cushing’s. A diagnosis of endogenous Cushing’s syndrome causing a prothrombotic state with extensive arterial thrombosis was made. She was initiated on oral anticoagulation and oral ketoconazole for medical adrenal suppression. She subsequently underwent bilateral adrenalectomy and was well at follow-up.
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Abstract
Melioidosis is the disease caused by the soil and water bacterium, Burkholderia pseudomallei. Our study aimed to delineate its genitourinary manifestations. Over a 10-year period (2006-2016), 20 adults with culture-confirmed genitourinary melioidosis were identified. The patients were all men with a mean age of 45.3 ± 12.3 years. The common risk factors were diabetes mellitus (65%) and alcoholism (25%); a majority of patients (90%) had chronic melioidosis. Most had disseminated disease (n = 17) and 55% were bacteraemic. The prostate was the organ most frequently involved (60%, n = 12), followed by the kidney, bladder and seminal vesicles. Diagnosis was established by blood and urine cultures and imaging. Patients were successfully treated with ceftazidime intensive therapy followed by eradicative therapy, with surgical debridement and guided aspiration, when deemed necessary. There was one case fatality and no relapses. Melioidosis is an important differential to be considered in chronic genitourinary infections in the appropriate setting.
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Affiliation(s)
- Maria Koshy
- 1 Assistant Professor, Department of Medicine, Christian Medical College, Vellore, India
| | - Prashansa Sadanshiv
- 2 Post graduate registrar, Department of Medicine, Christian Medical College, Vellore, India
| | - Sowmya Sathyendra
- 3 Professor, Department of Medicine, Christian Medical College, Vellore, India
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Koshy M, Mathew J, Alex R, Jude JA, Ralph R, Sudarsanam TD, Sathyendra S, Visalakshi J, Peter JV. Antinuclear antibodies in scrub typhus: Transient occurrence during acute illness. J Vector Borne Dis 2018; 55:52-57. [PMID: 29916449 DOI: 10.4103/0972-9062.234627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives The pathological hallmark of scrub typhus infection is focal or disseminated vasculitis. As with other infections, antinuclear antibodies (ANA) have been previously described in scrub typhus. However, the underlying mechanisms and implications of this immunological phenomenon is not well understood. In the present work it was assessed whether ANA is associated with illness severity and outcomes. Methods In this prospective study spanning one year, patients fulfilling the diagnostic criteria for scrub typhus were recruited. Patients with other acute infective febrile illnesses were taken as controls. ANA positivity was compared between the cases and controls. ANA in scrub typhus was assessed for correlation with disease severity, organ dysfunction and outcomes. Results The cohort comprised of 149 patients (scrub 89; controls 60) with mean age 46.5 (SD=16.9) yr; 48.3% were female. ANA was detected in 48 (53.9%) patients with scrub typhus and 9(15%) controls (p < 0.001). The ANA pattern was predominantly speckled (93.8%) in both scrub typhus patients and controls. In patients with scrub typhus, ANA positivity was associated with increasing APACHE-III score [Odds ratio (OR) 1.01; 95% CI 0.99-1.03; p = 0.09]. On bivariate analysis, ANA tended to be correlated with acute respiratory distress syndrome (OR 2.32; 95% CI 0.98-5.46; p = 0.06), hepatic dysfunction (OR 2.25; 95% CI 0.94-5.39, p = 0.06) and aseptic meningitis (OR 6.83; 95% CI 0.80-58.05, p = 0.08). The presence of these antibodies did not correlate with duration of hospitalization or mortality. Convalescent sera on 31 ANA positive scrub typhus patients demonstrated persistence of ANA in only 5 (16.1%) patients. Interpretation & conclusion The disappearance of ANA during the convalescent phase suggests that ANA is expressed during the acute phase of scrub typhus infection. Its association with organ dysfunction warrants further study of the mechanisms and impact of autoantibody formation in scrub typhus.
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Affiliation(s)
- Maria Koshy
- Department of Medicine, Christian Medical College & Vellore, India
| | - John Mathew
- Department of Rheumatology, Christian Medical College & Vellore, India
| | - Reginald Alex
- Department of Medicine, Christian Medical College & Vellore, India
| | - John Antony Jude
- Department of Microbiology, Christian Medical College & Vellore, India
| | - Ravikar Ralph
- Department of Medicine, Christian Medical College & Vellore, India
| | | | | | - J Visalakshi
- Department of Biostatistics, Christian Medical College & Vellore, India
| | - John Victor Peter
- Department of Critical Care, Christian Medical College & Vellore, India
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Koshy M, Raj Mani SS, Rajan SJ, Iyyadurai R, Sathyendra S. Vertical integration in the teaching of final year medical students. J Adv Med Educ Prof 2018; 6:188-189. [PMID: 30349832 PMCID: PMC6191831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Maria Koshy
- Department of Medicine, Christian Medical College, Vellore, India
| | | | | | - Ramya Iyyadurai
- Department of Medicine, Christian Medical College, Vellore, India
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Lwin M, Rahman E, Koshy M, Neill J, Radford D, Pohlner P, Strugnell W, Hamilton-Craig C. Quantitation of Pulmonary Regurgitation in Repaired Tetralogy of Fallot by Cardiac Magnetic Resonance. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.501] [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: 11/29/2022]
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Koshy M, Alexander V, Shenoy R, Sudarsanam T. Chronic multifocal osteomyelitis: A rare presentation of melioidosis. J Family Med Prim Care 2018; 7:1133-1135. [PMID: 30598977 PMCID: PMC6259495 DOI: 10.4103/jfmpc.jfmpc_227_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 45-year-old gentleman presented with fever, weight loss, and painful swelling of both knees. His history was significant for type 2 diabetes mellitus. Blood cultures grew Burkholderia pseudomallei, and imaging revealed osteomyelitis of bilateral distal femura and proximal tibiae, with no involvement of the joint space. He underwent debridement and was initiated on ceftazidime followed by eradication therapy with trimethoprim–sulfamethoxazole. He recovered well with no further complications. Melioidosis is a rare cause of multifocal osteomyelitis and is a differential to be considered in an appropriate clinicoepidemiological setting.
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Bhave S, Koshy M, Akthar A, Sengul A, Weichselbaum R, Patel P, Rondelli D, Aydogan B. Long-Term Toxicities Using Intensity Modulated Total Marrow Irradiation as a Conditioning Regimen for Advanced Hematologic Malignancies. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Ni L, Koshy M, Connell P, Hubert G, Vokes E, Patel J, Hoffman P, Al-Hallaq H, Malik R. Impact of Cardiac Dose on Cardiac Events and Survival in Unresectable Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Strychnine poisoning is a rare method of deliberate self-harm in adults. Poisoning with strychnine leaves is a rare form of strychnine poisoning, as the usual plant parts used are nuts, bark, and seeds. Although the common cardiac manifestations of strychnine positioning include tachycardia and hypertension, we report a patient with mild strychnine poisoning with bradycardia.
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Affiliation(s)
- Lesley Ponraj
- Department of Internal Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Maria Koshy
- Department of Internal Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Akthar A, Koshy M, Ferguson M, Murgu S, Hogarth D, Davies E, Malik R. Does Endoscopic Bronchial Ultrasound (EBUS) Impact Outcomes in Stage I Non-Small Cell Lung Cancer (NSCLC) Patients Receiving Hypofractionated Radiation Therapy (HFRT)? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spiotto M, Koshy M. Impact of Fraction Size in Nasopharyngeal and Oropharyngeal Squamous Cell Cancers Treated With Chemoradiation: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spiotto M, Koshy M. Postoperative Chemoradiation Improves Survival for Tongue Cancers Having Multiple Metastatic Lymph Nodes or Advanced T Stage: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Spiotto M, Koshy M. Comparison of Surgery and Postoperative Radiation to Definitive Chemoradiation for Locally Advanced Squamous Cell Carcinoma of the Oral Cavity: An Analysis of the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Koshy M, Jagannati M, David T, Jasmine S, Punitha J, Veeraraghavan B, Varghese G. Clinical profile, susceptibility patterns, treatment and outcomes of melioidosis in India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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32
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Rusthoven CG, Rabinovitch RA, Jones BL, Koshy M, Amini A, Yeh N, Jackson MW, Fisher CM. The impact of postmastectomy and regional nodal radiation after neoadjuvant chemotherapy for clinically lymph node-positive breast cancer: a National Cancer Database (NCDB) analysis. Ann Oncol 2016; 27:818-27. [PMID: 26861597 DOI: 10.1093/annonc/mdw046] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following neoadjuvant chemotherapy (NAC), the optimal strategies for postmastectomy radiotherapy (PMRT) and regional nodal irradiation (RNI) after breast-conserving surgery (BCS) are controversial. In this analysis, we evaluate the impact of these radiotherapy (RT) approaches for women with clinically node-positive breast cancer treated with NAC in the National Cancer Database (NCDB). PATIENTS AND METHODS Women with cT1-3 cN1 M0 breast cancer treated with NAC were divided into four cohorts by surgery [Mastectomy (Mast) versus BCS] and post-chemotherapy pathologic nodal status (ypN0 versus ypN+). Overall survival (OS) was estimated using the Kaplan-Meier method and RT approaches were analyzed using the log-rank test, multivariate Cox models, and propensity score-matched analyses. RESULTS From 2003 to 2011, 15 315 cases were identified including 3040 Mast-ypN0, 7243 Mast-ypN+, 2070 BCS-ypN0, and 2962 BCS-ypN+ patients. On univariate analysis, PMRT was associated with improved OS for both Mast-ypN0 (P = 0.019) and Mast-ypN+ (P < 0.001) patients. On multivariate analyses adjusted for factors including age, comorbidity score, cT stage, in-breast pathologic complete response, axillary surgery, ypN stage, estrogen receptor status and hormone therapy, PMRT remained independently associated with improved OS among Mast-ypN0 [hazard ratio (HR) = 0.729, 95% confidence interval (CI) 0.566-0.939, P = 0.015] and Mast-ypN+ patients (HR = 0.772, 95% CI 0.689-0.866, P < 0.001). No differences in OS were observed with the addition of RNI to breast RT for BCS-ypN0 or BCS-ypN+ patients. Propensity score-matched analyses demonstrated identical patterns of significance. On subset analysis, OS was improved with PMRT in each pathologic nodal subgroup (ypN0, ypN1, and ypN2-3) (all P < 0.05). CONCLUSIONS In the largest reported analysis of RT for cN1 patients treated with NAC, PMRT was associated with improved OS for all pathologic nodal subgroups. No OS differences were observed with the addition of RNI to breast RT.
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Affiliation(s)
- C G Rusthoven
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - R A Rabinovitch
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - B L Jones
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - M Koshy
- Department of Radiation Oncology Department of Radiation and Cellular Oncology, The University of Chicago School of Medicine, Chicago, USA
| | - A Amini
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - N Yeh
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - M W Jackson
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
| | - C M Fisher
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora
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Abstract
Dengue is a common acute viral febrile illness in the tropics. Although the usual presentation is that of a self-limiting illness, its complications are protean. We report a 29-year-old man who presented with an acute febrile illness and was diagnosed with dengue hemorrhagic fever. Despite appropriate supportive therapy, the patient initially improved, but subsequently had clinical deterioration. Evaluation revealed features of hemophagocytic lymphohistiocytosis. He was successfully treated with glucocorticoids and had an uneventful recovery. This case adds to the limited adult cases of virus-associated hemophagocytic syndrome in the literature and the need for prompt recognition and treatment of this rare complication.
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Affiliation(s)
- Maria Koshy
- Department of Medicine, Unit 4, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ajay Kumar Mishra
- Department of Medicine, Unit 4, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Bhumi Agrawal
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Akhil Rajendra Kurup
- Department of Medicine, Unit 4, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Samuel George Hansdak
- Department of Medicine, Unit 4, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Rajendra A, Koshy M, Mishra A, Hansdak S. Lithophagia: Presenting as spurious diarrhea. J Family Med Prim Care 2016; 5:499-500. [PMID: 27843877 PMCID: PMC5084597 DOI: 10.4103/2249-4863.192328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sood S, Winn T, Ibrahim S, Gobindram A, Arumugam AAV, Razali NC, Yasmin P, Hidayu N, Sani H, Mustafa MH, Fatinah A, Devi A, Karim AA, Obaid KJ, Haron NH, Fitjerald H, Koshy M. Natural history of asymptomatic gallstones: differential behaviour in male and female subjects. Med J Malaysia 2015; 70:341-345. [PMID: 26988206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The natural history of asymptomatic (silent) gallstones has been inadequately studied. Existing information derives from studies based on oral cholecystography or relatively small sample sizes. We planned a retrospective cohort study in subjects with gallstones to determine conversion rates from asymptomatic to symptomatic. METHODS We extracted data from computerised databases of one government hospital and two private clinics in Malaysia. Files were scrutinised to ensure that criteria for asymptomatic gallstones were fulfilled. Patients were called on telephone, further questioned to confirm that the gallstones at detection were truly asymptomatic, and asked about symptoms that were consistent with previously defined criteria for biliary colic. Appropriate ethical clearances were taken. RESULTS 213 (112 males) patients fulfilled the criteria for asymptomatic gallstones and could be contacted. 23 (10.8%) developed pain after an average follow up interval of 4.02 years (range 0.1-11 years). Conversion rates from asymptomatic to symptomatic gallstones were high in the first two years of follow up, averaging 4.03±0.965 per year. Over time the conversion rates slowed, and by year 10 the annual conversion rate averaged only 1.38±0.29. Conversion rates were much higher for females compared to males (F:M hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for conversion approached 6.15% for males, and 22.1% for females. CONCLUSION In conclusion, asymptomatic gallstones are much more likely to convert to symptomatic in females than in males. Males in whom asymptomatic stones are discovered should be advised conservative treatment. Surgery may be preferable to conservative management if the subject is a young female.
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Affiliation(s)
- S Sood
- Monash University Malaysia, Jeffrey Cheah School of Medicine, 8 Jalan Masjid Abu Bakar, 80100 Johor Bahru, Johor, Malaysia.
| | - T Winn
- MAHSA University, Jalan University Campus, Kuala Lumpur, Malaysia
| | - S Ibrahim
- Hospital Putrajaya, Putrajaya, Selangor, Malaysia
| | - A Gobindram
- Mahameru International Medical Centre, Kuala Lumpur, Malaysia
| | | | - N C Razali
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - P Yasmin
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - N Hidayu
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - H Sani
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - M H Mustafa
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - A Fatinah
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - A Devi
- National Defence University of Malaysia, Faculty of Medicine and Defence Health, Kuala Lumpur, Malaysia
| | - A A Karim
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - K J Obaid
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | - N H Haron
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
| | | | - M Koshy
- Universiti Teknologi MARA, Faculty of Medicine, Malaysia
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Woerner A, Roeske J, Harkenrider M, Fan J, Aydogan B, Koshy M, Laureckas R, Vali F, Surucu M. A Multi-institutional Study to Assess Adherence to Lung Stereotactic Body Radiation Therapy Planning Goals. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.204] [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: 11/24/2022]
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Fairchild A, Son C, Koshy M. Stage Migration and Improved Survival Time Trends in Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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38
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Koshy M, Malik R, Mahmood U, Sher D. Comparative Effectiveness of Aggressive Locoregional Therapy in Metastatic Lung Cancer: Associations Between High-Dose Thoracic Radiation Therapy and/or Chemoradiation Therapy and Survival in a Large Population-Based Cohort. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Fernandez C, Engelhard H, Nicholas M, Slavin K, Koshy M. An Analysis of Prognostic Factors Associated With Recurrence in the Treatment of Atypical Meningiomas. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.785] [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: 11/29/2022]
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40
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Mishra A, Chandiraesharan V, Koshy M, Mani S. Uncommon presentation of idiopathic intracranial hypertension. Arch Med Health Sci 2015. [DOI: 10.4103/2321-4848.171926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sher D, Fidler M, Liptay M, Koshy M. Comparative Effectiveness of Neoadjuvant Chemoradiation Therapy Versus Chemotherapy Alone Followed by Surgery for Patients With Stage III Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Spiotto M, Koshy M. Unplanned Hospitalizations Greater Than 5 Days Predict for Worse Outcomes After Radiation Therapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1703] [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: 11/24/2022]
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43
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Sher D, Fidler M, Liptay M, Koshy M. Comparative Effectiveness of Neoadjuvant Chemoradiation Therapy Versus Chemotherapy Alone Followed by Surgery for Patients With Stage III Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Akthar A, Ferguson M, Koshy M, Vigneswaran W, Malik R. Incidence of Occult N1 Disease in Patients With Clinical Stage I Non-Small Cell Lung Cancer: Implications for Patients Considered for Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alicezah MK, Razali R, Rahman T, Hoh BP, Suhana NH, Muid S, Nawawi HM, Koshy M. Homozygous familial hypercholesterolemia. Malays J Pathol 2014; 36:131-137. [PMID: 25194536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a rare case of homozygous familial hypercholesterolemia (HoFH), a 22-year-old Malay woman who presented initially with minor soft tissue injury due to a cycling accident. She was then incidentally found to have severe xanthelasma and hypercholesterolemia (serum TC 15.3 mmol/L and LDL-C 13.9 mmol/L). She was referred to the Specialized Lipid Clinic and was diagnosed with familial hypercholesterolemia (FH) based on the Simon Broome (SB) diagnostic criteria. There was a family history of premature coronary heart disease (CHD) in that three siblings had sudden cardiac death, and of consanguineous marriage in that her parents are cousins. DNA screening of LDLR and APOB genes was done by Polymerase Chain Reaction (PCR), followed by Denaturing High Performance Liquid Chromatography (DHPLC). Homozygous mutation C255S in Exon 5 of her LDLR gene was found. There was no mutation was found in Exon 26 and Exon 29 of the APOB gene. This report is to emphasize the importance of identifying patients with FH and cascade screening through established diagnostic criteria and genetic studies in order to ensure early detection and early treatment intervention to minimize the risk of developing CHD and related complications.
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Affiliation(s)
- M K Alicezah
- UiTM, Faculty of Medicine, Centre for Pathology Diagnostic and Research Laboratories, Malaysia.
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Solanki A, LeMieux M, Mahmood U, Hasan Y, Koshy M. Excellent Long-term Outcomes in Patients With Early Stage Nodular Lymphocyte-Predominant Hodgkin Lymphoma Treated With Radiation Therapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aydogan B, Koshy M, Rondelli D, Surucu M, Ahn K, Kavak G, Brett S, Patel P, Ozturk N, Weichselbaum R. EP-1316: Clinical experience with intensity modulated radiation total marrow irradiation (IMTMI). Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Koshy M, Rahman EA, Strugnell W, Neill J, Hamilton-Craig C. Accuracy and Reproducibility of Single Breath-hold Real-time Cardiac MRI in Patients with Arrhythmia. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu G, Bair R, Bair E, Liauw S, Koshy M. Clinical Outcomes for Gastric Cancer Following Adjuvant Chemoradiation Utilizing Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spraker M, Bair E, Bair R, Connell P, Mahmood U, Koshy M. An Analysis of Patient Characteristics and Clinical Outcomes in Primary Pulmonary Sarcoma. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1756] [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: 12/01/2022]
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