1
|
Wakil A, Niazi M, Lunsford KE, Pyrsopoulos N. Future Approaches and Therapeutic Modalities for Acute-on-Chronic Liver Failure. Clin Liver Dis 2023; 27:777-790. [PMID: 37380297 DOI: 10.1016/j.cld.2023.03.017] [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: 06/30/2023]
Abstract
Acute-on-chronic liver failure (ACLF) results from an acute decompensation of cirrhosis due to exogenous insult. The condition is characterized by a severe systemic inflammatory response, inappropriate compensatory anti-inflammatory response, multisystem extrahepatic organ failure, and high short-term mortality. Here, the authors evaluate the current status of potential treatments for ACLF and assess their efficacy and therapeutic potential.
Collapse
Affiliation(s)
- Ali Wakil
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Mumtaz Niazi
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Keri E Lunsford
- Department of Surgery, Division of Liver Transplant and HPB Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA
| | - Nikolaos Pyrsopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB H536, Newark, NJ 07103, USA.
| |
Collapse
|
2
|
Wakil A, Niazi M, Meybodi MA, Pyrsopoulos NT. Emerging Pharmacotherapies in Alcohol-Associated Hepatitis. J Clin Exp Hepatol 2023; 13:116-126. [PMID: 36647403 PMCID: PMC9840076 DOI: 10.1016/j.jceh.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
The incidence of alcoholic-associated hepatitis (AH) is increasing. The treatment options for severe AH (sAH) are scarce and limited to corticosteroid therapy which showed limited mortality benefit in short-term use only. Therefore, there is a dire need for developing safe and effective therapies for patients with sAH and to improve their high mortality rates.This review article focuses on the current novel therapeutics targeting various mechanisms in the pathogenesis of alcohol-related hepatitis. Anti-inflammatory agents such as IL-1 inhibitor, Pan-caspase inhibitor, Apoptosis signal-regulating kinase-1, and CCL2 inhibitors are under investigation. Other group of agents include gut-liver axis modulators, hepatic regeneration, antioxidants, and Epigenic modulators. We describe the ongoing clinical trials of some of the new agents for alcohol-related hepatitis. Conclusion A combination of therapies was investigated, possibly providing a synergistic effect of drugs with different mechanisms. Multiple clinical trials of novel therapies in AH remain ongoing. Their result could potentially make a difference in the clinical course of the disease. DUR-928 and granulocyte colony-stimulating factor had promising results and further trials are ongoing to evaluate their efficacy in the large patient sample.
Collapse
Key Words
- AH, alcohol-Associated hepatitis
- ALD, Alcohol-associated liver disease
- ASK-1, Apoptosis signal-regulating kinase-1
- AUD, alcohol use disorder
- CCL2, C–C chemokine ligand type 2
- CVC, Cenicriviroc
- ELAD, Extracorporeal liver assist device
- FMT, Fecal Microbiota Transplant
- G-CSF, Granulocyte colony-stimulating factor
- HA35, Hyaluronic Acid 35KD
- IL-1, interleukin 1
- IL-6, interleukin 6
- LCFA, saturated long-chain fatty acids
- LDL, low-density lipoprotein cholesterol
- LPS, Lipopolysaccharides
- MCP-1, monocyte chemoattractant protein −1
- MDF, Maddrey's discriminant function
- MELD, Model for end-stage disease
- NAC, N-acetylcysteine
- NLRs, nucleotide-binding oligomerization domain-like receptors
- PAMPs, Pathogen-associated molecular patterns
- RCT, Randomized controlled trial
- SAM, S-Adenosyl methionine
- SCFA, short-chain fatty acids. 5
- TLRs, Toll-like receptors
- TNF, tumor necrotic factor
- alcohol-associated hepatitis
- anti-inflammatory
- antioxidants
- liver-gut axis
- microbiome
- sAH, severe alcohol-associated hepatitis
Collapse
Affiliation(s)
- Ali Wakil
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Mumtaz Niazi
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Mohamad A. Meybodi
- Department of Internal Medicine, Rutgers New Jersey Medical School, New York, New Jersey, USA
| | - Nikolaos T. Pyrsopoulos
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, New York, New Jersey, USA
| |
Collapse
|
3
|
Wakil A, Mohamed M, Tafesh Z, Niazi M, Olivo R, Xia W, Greenberg P, Pyrsopoulos N. Trends in hospitalization for alcoholic hepatitis from 2011 to 2017: A USA nationwide study. World J Gastroenterol 2022; 28:5036-5046. [PMID: 36160652 PMCID: PMC9494933 DOI: 10.3748/wjg.v28.i34.5036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/01/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe alcoholic hepatitis (AH) is one of the most lethal manifestations of alcohol-associated liver disease. In light of the increase in alcohol consumption worldwide, the incidence of AH is on the rise, and data examining the trends of AH admission is needed.
AIM To examine inpatient admission trends secondary to AH, along with their clinical outcomes and epidemiological characteristics.
METHODS The National Inpatient Sample (NIS) database was utilized, and data from 2011 to 2017 were reviewed. We included individuals aged ≥ 21 years who were admitted with a primary or secondary diagnosis of AH using the International Classification of Diseases (ICD)-9 and its correspondent ICD-10 codes. Hepatitis not related to alcohol was excluded. The national estimates of inpatient admissions were obtained using sample weights provided by the NIS.
RESULTS AH-related hospitalization demonstrated a significant increase in the USA from 281506 (0.7% of the total admission in 2011) to 324050 (0.9% of the total admission in 2017). The median age was 54 years. The most common age group was 45–65 years (range 57.8%–60.7%). The most common race was white (63.2%–66.4%), and patients were predominantly male (69.7%–71.2%). The primary healthcare payers were Medicare (29.4%–30.7%) and Medicaid (21.5%–32.5%). The most common geographical location was the Southern USA (33.6%–34.4%). Most patients were admitted to a tertiary care center (50.2%–62.3%) located in urban areas. Mortality of AH in this inpatient sample was 5.3% in 2011 and 5.5% in 2017. The most common mortality-associated risk factors were acute renal failure (59.6%–72.1%) and gastrointestinal hemorrhage (17.2%–20.3%). The total charges were noted to range between $25242.62 and $34874.50.
CONCLUSION The number of AH inpatient hospitalizations significantly increased from 2011 to 2017. This could have a substantial financial impact with increasing healthcare costs and utilization. AH-mortality remained the same.
Collapse
Affiliation(s)
- Ali Wakil
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mujtaba Mohamed
- Department of Gastroenterology and Hepatology, Marshall University Hospital, Huntington, WV 25701, USA
| | - Zaid Tafesh
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Mumtaz Niazi
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Raquel Olivo
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Weiyi Xia
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Patricia Greenberg
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Nikolaos Pyrsopoulos
- Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| |
Collapse
|
4
|
Damiris K, Aghaie Meybodi M, Niazi M, Pyrsopoulos N. Hepatitis E in immunocompromised individuals. World J Hepatol 2022; 14:482-494. [PMID: 35582299 PMCID: PMC9055194 DOI: 10.4254/wjh.v14.i3.482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/15/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.
Collapse
Affiliation(s)
- Konstantinos Damiris
- Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Mohamad Aghaie Meybodi
- Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Mumtaz Niazi
- Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| | - Nikolaos Pyrsopoulos
- Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
| |
Collapse
|
5
|
Ali H, Rizvi T, Niazi M, Galan M, Pyrsopoulos N. Autoimmune Hepatitis Induced after Treatment of Syphilitic Hepatitis. J Clin Transl Hepatol 2022; 10:174-177. [PMID: 35233387 PMCID: PMC8845154 DOI: 10.14218/jcth.2020.00178] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
We present a unique case of biopsy-proven syphilitic hepatitis which presented as severe acute liver injury with significant elevation in aminotransferases and bilirubin, and improved with antibiotic therapy. However, the patient returned weeks after initial presentation with new-onset acute liver injury and had developed hypergammaglobulinemia, positive autoantibody titers, and repeat liver biopsy demonstrating interface hepatitis, supporting a diagnosis of autoimmune hepatitis. He had an otherwise unrevealing etiologic workup, and responded to glucocorticoid therapy. We believe that syphilitic hepatitis and its treatment subsequently triggered an immunogenic response, leading to autoimmune hepatitis. Autoimmune hepatitis is a chronic liver disease thought to manifest as a result of predisposing genetic factors in combination with environmental insults, especially hepatotropic pathogens. Syphilis is a sexually transmitted disease caused by Treponema pallidum that has been associated with autoimmunity and the development of autoantibodies. We propose that in the setting of syphilitic hepatitis, a molecular mimicry event resulting from structural similarities between T. pallidum and liver antigens, as well as impaired regulatory T-cell function, led to the breakdown of immune tolerance and the onset of autoimmune hepatitis. To support this hypothesis, further molecular analyses and case series are necessary to determine if syphilitic hepatitis and its treatment are risk factors for the onset of autoimmune hepatitis. Autoimmune hepatitis should be considered early as the cause of acute liver injury in susceptible patients with risk factors for the disease, as prompt recognition and appropriate treatment may prevent progression of liver injury and result in improved outcomes.
Collapse
Affiliation(s)
- Hasan Ali
- Department of Internal Medicine, Rutgers University New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Hasan Ali, Rutgers University New Jersey Medical School, Department of Medicine, University Hospital, Room I-248, 150 Bergen Street, Newark, NJ 07103, USA. ORCID: https://orcid.org/0000-0001-5726-5657. Tel: +1-732-861-5116, E-mail: ,
| | - Taqi Rizvi
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Mumtaz Niazi
- Division of Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Mark Galan
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers University New Jersey Medical School, Newark, NJ, USA
| | - Nikolaos Pyrsopoulos
- Division of Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
6
|
Latt NL, Niazi M, Pyrsopoulos NT. Liver transplant allocation policies and outcomes in United States: A comprehensive review. World J Methodol 2022; 12:32-42. [PMID: 35117980 PMCID: PMC8790309 DOI: 10.5662/wjm.v12.i1.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/21/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Liver transplant allocation policies in the United States has evolved over 3 decades. The donor liver organs are matched, allocated and procured by the Organ Procurement and Transplantation Network which is administered by the United Network of Organ Sharing (UNOS), a not-for-profit organization governed by the United States human health services. We reviewed the evolution of liver transplant allocation policies. Prior to 2002, UNOS used Child-Turcotte-Pugh score to list and stratify patients for liver transplantation (LT). After 2002, UNOS changed its allocation policy based on model for end-stage liver disease (MELD) score. The serum sodium is the independent indicator of mortality risk in patients with chronic liver disease. The priority assignment of MELD-sodium score resulted in LT and prevented mortality on waitlist. MELD-Sodium score was implemented for liver allocation policy in 2016. Prior to the current and most recent policy, livers from adult donors were matched first to the status 1A/1B patients located within the boundaries of the UNOS regions and donor-service areas (DSA). We reviewed the disadvantages of the DSA-based allocation policies and the advantages of the newest acuity circle allocation model. We then reviewed the standard and non-standard indications for MELD exceptions and the decision-making process of the National Review Liver Review Board. Finally, we reviewed the liver transplant waitlist, donation and survival outcomes in the United States.
Collapse
Affiliation(s)
- Nyan L Latt
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07101-1709, United States
| | - Mumtaz Niazi
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07101-1709, United States
| | - Nikolaos T Pyrsopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ 07101-1709, United States
| |
Collapse
|
7
|
Choi C, Botros Y, Shah J, Xue P, Jones A, Galan M, Olivo R, Niazi M, Paterno F, Guarrera J, Pyrsopoulos NT. A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral Treatment in a Liver Transplant Patient. J Clin Transl Hepatol 2020; 8:459-462. [PMID: 33447530 PMCID: PMC7782114 DOI: 10.14218/jcth.2020.00062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023] Open
Abstract
Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later developed alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilaprevir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.
Collapse
Affiliation(s)
- Catherine Choi
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Youssef Botros
- Division of Gastroenterology, St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Jamil Shah
- Division of Gastroenterology & Hepatology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Pei Xue
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anja Jones
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mark Galan
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Raquel Olivo
- Division of Gastroenterology & Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mumtaz Niazi
- Division of Gastroenterology & Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Flavio Paterno
- Division of Liver Transplantation & Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - James Guarrera
- Division of Liver Transplantation & Hepatobiliary Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nikolaos T. Pyrsopoulos
- Division of Gastroenterology & Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Nikolaos T. Pyrsopoulos, Division of Gastroenterology & Hepatology, Department of Medicine, Rutgers New Jersey Medical School, Medical Science Building, Room I-506, 185 South Orange Avenue, Newark, NJ 07103, USA. Tel: +1-973-972-5252, E-mail:
| |
Collapse
|
8
|
Lingiah VA, Niazi M, Olivo R, Paterno F, Guarrera JV, Pyrsopoulos NT. Liver Transplantation Beyond Milan Criteria. J Clin Transl Hepatol 2020; 8:69-75. [PMID: 32274347 PMCID: PMC7132012 DOI: 10.14218/jcth.2019.00050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/04/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide, being the fifth most common cancer and the third most common cause of cancer-related mortality. The incidence of HCC has been rising in the USA over the last 20 years. Liver transplantation is an optimal treatment option, as it eliminates HCC as well as the underlying liver disease. The Milan criteria (1 lesion greater than or equal to 2 cm and less than or equal to 5 cm, or up to 3 lesions, each greater than or equal to 1 cm and less than or equal to 3 cm) have been adopted by many transplant societies worldwide as the criteria to determine whether patients with HCC can move forward with liver transplantation. However, many believe that the Milan criteria may be too strict in regard to its size requirements for lesions. This has led to a number of expanded criteria for liver transplantation, concerning both overall size and number of lesions, as well as incorporation of other markers of tumor biology. Tumor markers, such as alpha-fetoprotein, can also be used to follow treatment of HCC and possibly exclude patients from transplant. HCC presenting beyond Milan criteria can also be down-staged with locoregional therapy. Monitoring response to locoregional therapy and longer wait times after locoregional therapy prior to transplant can serve as surrogate markers of tumor biology as well.
Collapse
Affiliation(s)
- Vivek A Lingiah
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Nikolaos T Pyrsopoulos, Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-355, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail: ; Vivek A Lingiah, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-350, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail:
| | - Mumtaz Niazi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Raquel Olivo
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Flavio Paterno
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - James V Guarrera
- Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Nikolaos T Pyrsopoulos
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
- Correspondence to: Nikolaos T Pyrsopoulos, Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-355, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail: ; Vivek A Lingiah, Division of Gastroenterology and Hepatology, Rutgers University, New Jersey Medical School, MSB H-350, 185 S Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail:
| |
Collapse
|
9
|
Xie C, Abdullah HMA, Abdallah M, Quist E, Niazi M. Anastrozole-induced liver injury after a prolonged latency: a very rare complication of a commonly prescribed medication. BMJ Case Rep 2019; 12:12/11/e231741. [PMID: 31780604 DOI: 10.1136/bcr-2019-231741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Anastrozole is an aromatase inhibitor that has been used more frequently over the last decade especially for oestrogen receptor-positive breast cancer. It has a relatively safe side effect profile. However, occasionally it has been associated with serious adverse events. Here, we present the case of a 58-year-old woman who presented with significantly elevated liver enzymes 4 years after starting anastrozole. She was not taking any other medications and an extensive workup did not reveal any other cause for her liver injury. The patient's liver enzymes normalised after discounting the anastrozole. She scored 4 on the updated Roussel Uclaf Causality Assessment Method grading system which was possible for drug-induced liver injury. A review of the literature revealed six prior cases of anastrozole-related liver injury. Anastrozole should be considered as a possible culprit in patients who develop an unexplained acute liver injury.
Collapse
Affiliation(s)
- Chencheng Xie
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | | | - Mohamed Abdallah
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Erin Quist
- Depratment of Pathology, Avera Mckennan University Health Center, Sioux Falls, South Dakota, USA
| | - Mumtaz Niazi
- Division of Gastroenterology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
10
|
Aghajanzade M, Momeni M, Niazi M, Ghorbani H, Saberi M, Kheirkhah R, Rahbar H, Karimi H. Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients. Ann Burns Fire Disasters 2019; 32:147-152. [PMID: 31528156 PMCID: PMC6733213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 06/10/2023]
Abstract
One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.
Collapse
Affiliation(s)
| | - M. Momeni
- Iran University of Medical Sciences, Tehran, Iran
| | - M. Niazi
- Iran University of Medical Sciences, Tehran, Iran
| | - H. Ghorbani
- Iran University of Medical Sciences, Tehran, Iran
| | - M. Saberi
- Quran and Health Research Centre and Department of Community Medicine, Faculty of Medicine, Tehran, Iran
| | - R. Kheirkhah
- Rowan University, Graduate School of Biomedical Sciences, New Jersey, USA
| | - H. Rahbar
- Iran University of Medical Sciences, Tehran, Iran
| | - H. Karimi
- Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Davuluri S, Tieng A, Franchin G, Niazi M. IMPROVEMENT OF SYSTEMIC SCLEROSIS-LIKE SYMPTOMS AFTER THERAPY FOR MULTIPLE MYELOMA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.437] [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]
|
12
|
Niazi M, Karaman M, Das S, Zhou XJ, Yushkevich P, Cai K. Quantitative MRI of Perivascular Spaces at 3T for Early Diagnosis of Mild Cognitive Impairment. AJNR Am J Neuroradiol 2018; 39:1622-1628. [PMID: 30093484 DOI: 10.3174/ajnr.a5734] [Citation(s) in RCA: 22] [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] [Received: 02/08/2018] [Accepted: 06/02/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The limitations inherent in the current methods of diagnosing mild cognitive impairment have constrained the use of early therapeutic interventions to delay the progression of mild cognitive impairment to dementia. This study evaluated whether quantifying enlarged perivascular spaces observed on MR imaging can help differentiate those with mild cognitive impairment from cognitively healthy controls and, thus, have an application in the diagnosis of mild cognitive impairment. MATERIALS AND METHODS We automated the identification of enlarged perivascular spaces in brain MR Images using a custom quantitative program designed with Matlab. We then quantified the densities of enlarged perivascular spaces for patients with mild cognitive impairment (n = 14) and age-matched cognitively healthy controls (n = 15) and compared them to determine whether the density of enlarged perivascular spaces can serve as an imaging surrogate for mild cognitive impairment diagnosis. RESULTS Quantified as a percentage of volume fraction (v/v%), densities of enlarged perivascular spaces were calculated to be 2.82 ± 0.40 v/v% for controls and 4.17 ± 0.57 v/v% for the mild cognitive impairment group in the subcortical brain (P < .001), and 2.74 ± 0.57 v/v% for the controls and 3.90 ± 0.62 v/v% for the mild cognitive impairment cohort in the basal ganglia (P < .001). Maximum intensity projections exhibited a visually conspicuous difference in the distributions of enlarged perivascular spaces for a patient with mild cognitive impairment and a control patient. By means of receiver operating characteristic curve analysis, we determined the sensitivity and specificity of using enlarged perivascular spaces as a differentiating biomarker between mild cognitive impairment and controls to be 92.86% and 93.33%, respectively. CONCLUSIONS The density of enlarged perivascular spaces was found to be significantly higher in those with mild cognitive impairment compared with age-matched healthy control subjects. The density of enlarged perivascular spaces, therefore, may be a useful imaging biomarker for the diagnosis of mild cognitive impairment.
Collapse
Affiliation(s)
- M Niazi
- From the Department of Radiology (M.N., X.J.Z., K.C.).,Chicago College of Osteopathic Medicine (M.N.), Midwestern University, Downers Grove, Illinois
| | - M Karaman
- Center for MR Research (M.K., X.J.Z., K.C.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - S Das
- Department of Radiology (S.D., P.Y.), School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - X J Zhou
- From the Department of Radiology (M.N., X.J.Z., K.C.).,Center for MR Research (M.K., X.J.Z., K.C.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - P Yushkevich
- Department of Radiology (S.D., P.Y.), School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - K Cai
- From the Department of Radiology (M.N., X.J.Z., K.C.) .,Center for MR Research (M.K., X.J.Z., K.C.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
13
|
Niazi M, Chavda S, Hjartarson E, Bailey RJ, Tandon P, brisebois AJ. A190 A PROSPECTIVE EVALUATION OF SYMPTOM BURDEN, OPIOID RISK, AND PERCEIVED BENEFITS OF NON-PHARMACOLOGICAL THERAPY IN CIRRHOSIS PATIENTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Niazi
- University of Alberta, Edmonton, AB, Canada
| | - S Chavda
- University of Alberta, Edmonton, AB, Canada
| | | | - R J Bailey
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | | |
Collapse
|
14
|
Niazi M. A334 A CASE OF PORTAL CAVERNOMA CHOLANGIOPATHY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Niazi
- University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
15
|
Elgouhari H, Ahmed K, Niazi M, Huntington MK. Multiple Myeloma Light Chain Amyloidosis Presenting as Hepatic Failure. S D Med 2018; 71:112-115. [PMID: 29991097] [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: 06/08/2023]
Abstract
Amyloidosis is characterized by abnormal deposition of aggregations of amyloid fibril proteins. Systemic amyloidosis usually involves multiple organs, with kidneys being the most common organ involved, followed by the heart. In general, the presentation of hepatic amyloidosis varies with minimal or no symptoms commonly seen. Hepatic amyloidosis is rarely associated with multiple myeloma. We report here a case of portal hypertension, ascites, and severe intrahepatic cholestasis as the initial presentation of hepatic amyloidosis and multiple myeloma, which followed a rapidly progressive clinical course.
Collapse
Affiliation(s)
- Hesham Elgouhari
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Department of Hepatology, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota
| | - Kabir Ahmed
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Mumtaz Niazi
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Mark K Huntington
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
- Center for Family Medicine, Sioux Falls, South Dakota
| |
Collapse
|
16
|
Hashemi N, Araya V, Tufail K, Thummalakunta L, Feyssa E, Azhar A, Niazi M, Ortiz J. An extended treatment protocol with pegylated interferon and ribavirin for hepatitis C recurrence after liver transplantation. World J Hepatol 2011; 3:198-204. [PMID: 21866251 PMCID: PMC3158908 DOI: 10.4254/wjh.v3.i7.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 06/02/2011] [Accepted: 06/09/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy and tolerability of an extended treatment protocol and to determine the predictors of sustained virological response (SVR) after liver transplantation (LT). METHODS Between August 2005 and November 2008, patients with recurrent hepatitis C virus (HCV) after LT were selected for treatment if liver biopsy showed at least grade 2 inflammation and/or stage 2 fibrosis. All patients were to receive pegylated interferon (PEG)/regimens combining ribavirin (RBV) for an additional 48 wk after HCV undetectability. RESULTS Extended protocol treatment was initiated in thirty patients. Overall, 73% had end of treatment response and 60% had SVR. Nineteen patients completed treatment per protocol, of them, sixteen (84%) had end of treatment response, and fourteen (74%) achieved SVR. Both early virological response and 24-week virological response were individually associated with SVR but this association was not significant on multivariate analysis. Eleven patients (37%) discontinued therapy due to adverse effects. Cytopenias were the most common and most severe adverse effect, and required frquent growth factor use, dose adjustments and treatment cessations. The risk of rejection was not increased. CONCLUSION Recurrent HCV after LT can be safely treated with extended virological response-guided therpy using PEG/RBV, but requires close monitoring for treatment-related adverse effects, particularly cytopenias.
Collapse
Affiliation(s)
- Nikroo Hashemi
- Nikroo Hashemi, Victor Araya, Kashif Tufail, Laxmi Thumma-lakunta, Eyob Feyssa, Ashaur Azhar, Mumtaz Niazi, Division of Hepatology, Center for Liver Disease and Transplantation, Albert Einstein Medical Center, Philadelphia, PA 19141, United States
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Torok N, Niazi M, Al Ahwel Y, Taleb M, Taji J, Assaly R. Thrombotic thrombocytopenic purpura associated with anti-glomerular basement membrane disease. Nephrol Dial Transplant 2010; 25:3446-9. [DOI: 10.1093/ndt/gfq437] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
Hassan-Alin M, Andersson T, Niazi M, Liljeblad M, Persson BA, Röhss K. Studies on drug interactions between esomeprazole, amoxicillin and clarithromycin in healthy subjects. Int J Clin Pharmacol Ther 2006; 44:119-27. [PMID: 16550734 DOI: 10.5414/cpp44119] [Citation(s) in RCA: 14] [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: 11/18/2022] Open
Abstract
OBJECTIVE A combination of esomeprazole, amoxicillin and clarithromycin may be used for Helicobacter pylori eradication. We explored the potential for interactions between these drugs. METHODS In 2 randomized, 4-way crossover studies, healthy CYP2C19 extensive metabolizers (EMs) received esomeprazole 40 mg once daily (n = 20) or 20 mg twice daily (b.i.d.) (n = 20), clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d. or the combination of the 3 drugs for 7 days. In a third randomized, 2-way, crossover study, 6 healthy CYP2C 19 poor metabolizers (PMs) received esomeprazole 40 mg once daily with and without clarithromycin 500 mg b.i.d. for 1 week. RESULTS Triple therapy with esomeprazole 40 mg increased the area under the plasma concentration-time curve during the dosing interval (AUCtau) from 13.31 micromol x h/l (11.12-15.93) for esomeprazole alone to 22.69 micromol x h/l (18.94-27.17) for triple treatment. Respective AUCtau values with esomeprazole 20 mg b.i.d. were 4.97 micromol.h/l (3.97-6.21) and 11.29 micromol x h/l (9.03-14.12). Clarithromycin and amoxicillin plasma levels were largely unchanged by combination therapy. In PMs, the esomeprazole AUC also approximately doubled when administered in combination with clarithromycin. All treatments were well tolerated. CONCLUSION Clarithromycin decreases the metabolism rate of esomeprazole, leading to approximately doubled AUC values, both in EMs and PMs.
Collapse
Affiliation(s)
- M Hassan-Alin
- Clinical Pharmacology, AstraZeneca Research and Development, Mölndal, Sweden.
| | | | | | | | | | | |
Collapse
|
19
|
Hassan-Alin M, Andersson T, Niazi M, Röhss K. A pharmacokinetic study comparing single and repeated oral doses of 20 mg and 40 mg omeprazole and its two optical isomers, S-omeprazole (esomeprazole) and R-omeprazole, in healthy subjects. Eur J Clin Pharmacol 2004; 60:779-84. [PMID: 15578172 DOI: 10.1007/s00228-004-0841-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [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: 06/03/2004] [Accepted: 09/16/2004] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the pharmacokinetics of S-omeprazole (esomeprazole), R-omeprazole and racemic omeprazole following single and repeated oral doses of 20 mg and 40 mg of each compound in healthy male and female subjects. METHODS In an open, randomised, three-way, cross-over study, 12 subjects received 20 mg and another 12 subjects received 40 mg S-omeprazole, R-omeprazole and racemic omeprazole as oral solutions once daily for 5 days, separated by washout periods of at least 10 days. Blood samples were taken for analysis pre-dose and at selected time points during a 12-h period following drug administration on study day 1 and day 5. Pharmacokinetic parameters of S-omeprazole, R-omeprazole, racemic omeprazole and the two main metabolites (5-hydroxy and sulphone) were calculated using non-compartmental analysis. RESULTS Following the 20-mg dose of each compound, values of the total area under the plasma concentration-time curve (AUC) were 1.52, 0.62 and 1.04 micromol h/l for S-omeprazole, R-omeprazole and racemic omeprazole, respectively, on day 1. Respectively, AUC values on day 5 were 2.84, 0.68 and 1.63 micromol h/l. Corresponding values after the 40-mg doses were 3.88, 1.39 and 2.44 micromol h/l on day 1 and 9.32, 1.80 and 5.79 micromol h/l on day 5. CONCLUSION Treatment with S-omeprazole (esomeprazole; 20 mg and 40 mg) resulted in higher AUC values than with either R-omeprazole or racemic omeprazole after both single and repeated doses due to a lower metabolic rate of S-omeprazole than R-omeprazole and, consequently, racemic omeprazole. S-Omeprazole, R-omeprazole and the racemate were well tolerated.
Collapse
Affiliation(s)
- M Hassan-Alin
- Experimental Medicine, AstraZeneca R & D Mölndal, 43183, Mölndal, Sweden.
| | | | | | | |
Collapse
|
20
|
Abstract
In the present study, we investigated whether and how chronic morphine administration changes seizure susceptibility in rats. The role of morphine-dependence on the seizure susceptibility has been evaluated with models of pentylenetetrazol (PTZ)-kindling and acute convulsions induced by PTZ, N-methyl-D-aspartic acid (NMDA), picrotoxin and caffeine in adult male rats. The results showed that morphine-dependence increased seizure severity only at 1-4th PTZ injections in the kindling model. In acute convulsion tests, dependent rats demonstrated a significantly lower seizure threshold only for PTZ, while they demonstrated a significantly lower tendency to show tonic-clonic convulsions only for NMDA. It is concluded that morphine-dependence may modulate PTZ-kindling and seizure susceptibility in rats with emphasis on the role of GABA and NMDA neurotransmitter systems.
Collapse
Affiliation(s)
- N Atapour
- Neuroscience Research Center, Kerman University of Medical Sciences, P.O. Box 76175-113, Kerman, Iran.
| | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND AND OBJECTIVES Our hospital serves an area with a significant number of patients seropositive for the human immunodeficiency virus (HIV). Intravenous drug abuse and heterosexual exposure are by far the predominant risk factors for HIV and acquired immunodeficiency syndrome (AIDS). Seven percent of these patients develop malignancies. Our aim was to study the types of tumor, their distribution, and to evaluate the patients' outcome. METHODS Of 3,578 patients with HIV infection or AIDS treated between 1993 and 1998, 245 had 1 or more malignancies. Information was collected on age, sex, race, predisposing risk factors for AIDS, malignancies, symptoms at presentation, the time of the onset of AIDS, CD4 cell counts, pathology findings, and mortality. RESULTS Although aspects of our patients resembled those of previously studied groups of patients with AIDS, there also were ways in which our patients differed from those other groups. Of our patients, 21. 6% had non-AIDS-defining (NAD) invasive malignancies. This was considerably higher than the rate in most studies. Twenty-seven patients with such malignancies died during the study. Forty-two other patients had pre-invasive cancers. Among patients having AIDS-defining (AD) malignancies, 55.9% died, a fact that was related to patients' low CD4 cell counts and late presentation. Our 97 patients with Kaposi sarcoma included 22 women, a relatively high number that may be related to the fact that most of our patients were intravenous drug abusers or had become infected by heterosexual transmission of HIV. CONCLUSIONS AIDS is associated with a high risk of malignancy and an unusual spectrum of tumors. Patients with invasive tumors have advanced disease at the time of initial presentation. Those with AD tumors have a worse prognosis than patients with NAD tumors. The impact of highly active antiretroviral therapy on both AD and NAD tumors needs to be further evaluated.
Collapse
Affiliation(s)
- E Albu
- Department of Surgery, Division of Oncology, Bronx-Lebanon Hospital Center, Bronx, New York, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Parithivel VS, Niazi M, Shah AK, Ha JP, Mailapur RV, Kaul K, Remey P, Albu E. Gastric stromal tumor. Am Surg 2000; 66:689-91. [PMID: 10917484] [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: 02/17/2023]
Abstract
Gastric stromal tumors display a bewildering array of immunohistological and ultrastructural features as well as variable biological behavior. These tumors are rare as compared with ones that arise from the gastric epithelium. Moreover, they have been the subjects of controversy because of their uncertain histogenesis. We report the pathological features of gastric stromal tumors we recently encountered in three patients.
Collapse
Affiliation(s)
- V S Parithivel
- Department of Surgery, Bronx-Lebanon Hospital Center, New York 10457, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Extraadrenal paragangliomas are very rare tumors arising from cells derived from the neural crest. These tumors are encountered only as case reports, and as a result, little is known of their natural history. We present a case of pancreatic paraganglioma and review all previously reported cases.
Collapse
Affiliation(s)
- V S Parithivel
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York 10457, USA
| | | | | | | | | | | |
Collapse
|
24
|
Pai NB, Kim S, Pathak R, Niazi M, Girishkumar HT, Gerst PH. Syncytial variant of nodular sclerosing Hodgkin lymphoma. Lymphology 1999; 32:75-9. [PMID: 10389115] [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: 02/13/2023]
Abstract
We report the case history of a 31-year old woman with a rare morphologic form of nodular sclerosing Hodgkin disease (NSHD) termed "syncytial variant." Its histologic features mimic metastatic carcinoma, thymoma, melanoma, non-Hodgkin lymphoma and germ-cell tumor. Antigens expressed on Reed-Sternberg cells, the hallmark of Hodgkin disease, and other neoplastic cells were screened to determine the correct diagnosis. This patient demonstrates the importance of using specific immunohistochemical techniques to clarify the diagnosis of NSHD of the "syncytial variant" subtype.
Collapse
Affiliation(s)
- N B Pai
- Department of Surgery, Bronx-Lebanon Hospital Center, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
We present a case of an in-situ lobular carcinoma within an otherwise benign fibroadenoma in a 45-year-old woman.
Collapse
Affiliation(s)
- A K Shah
- Department of Surgery and Pathology, Bronx-Lebanon Hospital Center, Bronx, NY 10457, USA
| | | | | | | | | | | |
Collapse
|
26
|
Niazi M, van Dijken PJ, al Moutaery K. A patient with meningioma showing multiple cytogenetic abnormalities and a constitutional translocation (3;9)(q13.3;q22). Cancer Genet Cytogenet 1998; 105:11-3. [PMID: 9689923 DOI: 10.1016/s0165-4608(97)00480-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several different clonal abnormalities in both hypo- and hyperdiploid cell lines were observed in tumor cells of a 35-year-old man with a syncytial meningioma. A translocation involving chromosomes 3 and 9, t(3;9)(q13.3;q22), was present in all analyzable tumor cells and proved to be constitutional. The breakpoints 3q13.3 and 9q22 are involved in acquired karyotypic abnormalities in a number of tumors and might be situated near a tumor suppressor gene. The development of malignancies has been observed in patients with constitutional translocations involving 3q13.3 but not 9q22. We conclude that translocations involving 3q13.3 and maybe 9q22 could present constitutional chromosomal abnormalities predisposing for the development of a malignancy. Patients in whose tumor cells a translocation involving 3q13.3 or 9q22 is observed should be checked for a similar constitutional abnormality.
Collapse
Affiliation(s)
- M Niazi
- Department of Pathology, Armed Forces Hospital, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
27
|
Affiliation(s)
- E Geisler
- Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Ischemic enterocolitis is a well-recognized entity occurring in cocaine users. Diagnosis is based on the presence of rectal bleeding, abdominal pain, a history of cocaine use, supportive endoscopic and histopathologic findings, and the absence of other etiologic mechanisms of ischemic colitis. In this study, we evaluated endoscopic and histopathologic findings in seven patients with cocaine colitis. Lesions seen by endoscopy, which were restricted to the left colon, included hemorrhagic edematous mucosa, pseudopolyps, and ulcerations. Rectal involvement, not a common feature of ischemic colitis, was seen in five patients. In two patients histologic lesions were classified acute/subacute, and in three patients as subacute/chronic. In the remaining two patients lesions were combined acute/subacute and chronic. The presence of subacute/chronic lesions suggested recurrent ischemic episodes and could reflect repeated use of cocaine. Future studies will be needed to define the long-term clinical and histopathologic significance of these subacute/chronic lesions.
Collapse
Affiliation(s)
- M Niazi
- Department of Internal Medicine, Bronx Lebanon Hospital Center, New York 10457, USA
| | | | | | | |
Collapse
|
29
|
Gerst PH, Niazi M, Narasimha V, Saraiya R, Albu E. Primary non-Hodgkin lymphoma presenting as ileocolic intussusception. Lymphology 1996; 29:166-9. [PMID: 9013468] [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: 02/03/2023]
Abstract
We report the case of an HIV-seropositive patient with non-Hodgkin lymphoma of the small intestine who presented with an ileocolic intussusception. This lesion fulfilled the diagnostic criteria for primary gastrointestinal lymphoma. Such a neoplasm in an immuno-compromised patient is usually more aggressive and less responsive to treatment than in an HIV-seronegative patient.
Collapse
Affiliation(s)
- P H Gerst
- Department of Surgery, Bronx-Lebanon Hospital Center, New York, USA
| | | | | | | | | |
Collapse
|
30
|
Van Dijken PJ, Niazi M, al-Asiri RH. Extramedullary blastic transformation in a child with adult chronic myelocytic leukemia. Cancer Genet Cytogenet 1994; 76:151-3. [PMID: 7923067 DOI: 10.1016/0165-4608(94)90468-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report a case of Philadelphia chromosome positive (Ph+) chronic myelocytic leukemia (CML) in a 4-year-old child presenting with a one-sided cervical chloroma (granulocytic sarcoma) of 5 months duration preceded by an inflammatory reaction in the same area. Blood and bone marrow were consistent with CML in chronic phase. Cytogenetic analysis of blood, bone marrow and chloroma showed, in addition to the classical Ph+ cell line, another clone with additional aberrations: 50,XY,+Y,+8,t(9;22)(q34;q11), +19,+21, present predominantly in the chloroma. In conclusion, this is the first report of a Ph+ CML in a young child with a chloroma as an isolated extramedullary localization of blastic transformation. It is hypothesized that local events such as inflammation might be inductive of extramedullary blastic transformation.
Collapse
Affiliation(s)
- P J Van Dijken
- Department of Pediatric Oncology/Hematology, University Children's Hospital for Children, Utrecht, The Netherlands
| | | | | |
Collapse
|
31
|
Abdullah MA, Katugampola M, al-Habib S, al-Jurayyan N, al-Samarrai A, Al-Nuaim A, Patel PJ, Niazi M. Ambiguous genitalia: medical, socio-cultural and religious factors affecting management in Saudi Arabia. Ann Trop Paediatr 1991; 11:343-8. [PMID: 1721791 DOI: 10.1080/02724936.1991.11747526] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-eight children with ambiguous genitalia were seen at King Khalid University Hospital over a 6-year period. The incidence of this disorder was 0.4/1000 live births. Of the total, 21 (75%) were Saudis and seven (25%) were non-Saudis. The consanguinity rate was 67.9%. Twenty-four (85.7%) were born in hospital and four (14.3%) at home. In only three (10.7%) was the news first broken to the parents by a senior doctor, in 13 (46.4%) by a junior doctor, and in 11 (39.3%) by a nurse. Ambiguous genitalia were observed in 22 (78.6%) at birth and in six (21.4%) were picked up later. Owing to a lack of immediate investigative facilities and for some socio-cultural reasons, 19 of the latter groups were assigned sex without prior investigations. There was an obvious preference to assign male sex. On investigation, 13 (46.4%) had XX chromosomes, 11 (39%) XY and one (3.6%) XO: in three (10.7%), chromosomal results were not available. There were 14 cases (50%) of congenital adrenal hyperplasia, two of 5-alpha reductase deficiency (7.1%), and five of testicular feminization syndrome (17.9%), in addition to others. After investigation, five (17.9%) of the children needed sex reassignment. This was accepted by two and rejected for socio-cultural reasons by three. The opinion of the religious leaders was obtained. Some recommendations on management of these cases are made, based on our local experience.
Collapse
Affiliation(s)
- M A Abdullah
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Chorionic villi can be obtained by direct transcervical aspiration at 9 to 10 weeks' gestation and used for analysis of fetal DNA. However, for the method to be reliable, there must be no detectable contamination by maternal DNA. To investigate the question of contamination, we compared the DNA of chorionic villi from five fetuses with that obtained from maternal lymphocytes, using the restriction endonuclease Taql and specific DNA probes for a pair of alleles on the X chromosome. The alleles yield fragments of different lengths when digested with Taql (length polymorphism), which can be demonstrated by electrophoresis and hybridization with the radioactive DNA probes. If the pattern obtained with the chorionic DNA is different from that obtained with the maternal DNA, contamination is not present. In two cases the fetal DNA of the chorionic villi was shown to be uncontaminated by maternal tissue. In one of these cases the mother was heterozygous and the fetus was homozygous; in the other the mother was homozygous and the fetus was heterozygous. In three other cases no definitive conclusions could be drawn, because the genotypes of the fetus and mother were identical. We conclude that chorionic villi at 9 to 10 weeks' gestation are a source of fetal DNA that can be used for gene analysis, with no detectable contamination by maternal DNA.
Collapse
|
33
|
Williamson R, Eskdale J, Coleman DV, Niazi M, Loeffler FE, Modell BM. Direct gene analysis of chorionic villi: A possible technique for first-trimester antenatal diagnosis of haemoglobinopathies. Lancet 1981; 2:1125-7. [PMID: 6118574 DOI: 10.1016/s0140-6736(81)90583-3] [Citation(s) in RCA: 150] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
34
|
Niazi M, Coleman DV, Loeffler FE. Trophoblast sampling in early pregnancy. Culture of rapidly dividing cells from immature placental villi. Br J Obstet Gynaecol 1981; 88:1081-5. [PMID: 7295596 DOI: 10.1111/j.1471-0528.1981.tb01756.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Trophoblast was obtained by ordinary suction curettage and by transcervical aspiration with a medicut cannula from women having a therapeutic abortion in the first trimester of pregnancy. The decidual tissue which is invariably attached to early placental villi was separated and pure cultures obtained from the trophoblast layers and from the mesenchymal core of placental villi. Cytotrophoblast had a very limited life span in tissue culture, whereas mesenchymal cells grew rapidly and could be used for antenatal diagnosis.
Collapse
|
35
|
Niazi M, Coleman DV, Mowbray JF, Blunt S. Tissue typing amniotic fluid cells: potential use for detection of contaminating maternal cells. J Med Genet 1979; 16:21-3. [PMID: 469881 PMCID: PMC1012775 DOI: 10.1136/jmg.16.1.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The presence of contaminating maternal cells in amniotic fluid is an important, though infrequent, cause of error in karyotyping the fetus. A method of detecting contaminating maternal cells in amniocentesis specimens by determining the HLA phenotype of the cells of amniotic fluid and the mother is described. Tissue typing of 15 amniocentesis specimens was performed, and in 14 cases the fetal origin of the cells was established. In one case, the results of tissue typing suggested maternal cell contamination, though this had not been suspected from chromosome studies of the amniotic fluid cell cultures. Other possible uses for tissue typing of amniotic fluid specimens for prenatal diagnosis are also described.
Collapse
|
36
|
Abstract
A family is described in which 2 sibs had similar congenital abnormalities. Chromosome investigation of the mother and another child disclosed they were carriers of a translocation t(18;21)(q21;q22). The karyotype of one of the abnormal infants was determined and was found to be consistent with partial trisomy 18,46,XY,-21,+der (21),t(18;21) ((18pter leads to 18q21::21q22 leads to 2 lqter)mat.
Collapse
|