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Zhu D, Rai R, Mechel E, Shah PP, Hymowitz M, Rohring V, Cheela I, Samson CM. Exogenous cryptococcal endophthalmitis in an immunocompetent patient. Taiwan J Ophthalmol 2023; 13:552-555. [PMID: 38249497 PMCID: PMC10798385 DOI: 10.4103/tjo.tjo-d-22-00095] [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: 07/21/2022] [Accepted: 09/25/2022] [Indexed: 01/12/2023] Open
Abstract
We describe a case of exogenous cryptococcal endophthalmitis without central nervous system (CNS) involvement or systemic infection in an immunocompetent patient. An 82-year-old male with hypertension, hyperlipidemia, type 2 diabetes mellitus, and primary open-angle glaucoma with a history of left eye trabeculectomy presented with 3 months of worsening left eye pain and redness. Vitreous cultures resulted as Cryptococcus, prompting treatment with intravitreal amphotericin and further investigation. Systemic workup was unrevealing for an endogenous source, CNS involvement, or immunocompromising conditions. He was treated with an aggressive regimen of systemic antifungals, leading to subjective improvements in clinical exam and in vision.
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Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Ravneet Rai
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Elzbieta Mechel
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Paras P. Shah
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Maggie Hymowitz
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Victoria Rohring
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Isha Cheela
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - C. Michael Samson
- Department of Ophthalmology, Northwell Health Eye Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
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Abstract
PURPOSE Coronavirus disease 2019 has had a wide-ranging public health impact, contributing to at least five million deaths globally at the time of this report. Although thromboembolic events following coronavirus disease 2019 vaccination have been an ongoing concern, only a limited number of ophthalmic manifestations have been reported to date. METHODS A detailed history, hypercoagulable workup, best-corrected visual acuity (BCVA), Humphrey visual field, dilated fundus examination, and multimodal imaging including optical coherence tomography, fundus fluorescein angiography, and fundus photography were obtained. RESULTS A 27-year-old woman was diagnosed with central retinal vein occlusion a few days after her first dose of the BNT162b2 (Pfizer-BioNTech) coronavirus disease 2019 vaccine. Detailed elicitation of her history and a full hypercoagulable workup did not reveal any primary risk factors that could have explained her disease process. After the patient received the second dose, her symptoms deteriorated significantly and worsening peripapillary hemorrhage were seen on dilated fundus examination. The patient was treated with intravitreal injections of ranibizumab and followed closely, which showed improvement in her central retinal vein occlusion. CONCLUSION Given the chronology of the patient's condition, it is believed that the central retinal vein occlusion that occurred as a result of the first dose was exacerbated by an intense immunological reaction after the second dose. The severity of this complication, despite its rarity, must be emphasized and weighed in but should not preclude the extensive benefits of vaccination.
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Affiliation(s)
- Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Samuel Gelnick
- Department of Ophthalmology, Northwell Health, Great Neck, New York; and
| | - Jonathan Jonisch
- Department of Ophthalmology, Northwell Health, Great Neck, New York; and
- Long Island Vitreoretinal Consultants, Great Neck, New York
| | - Rashmi Verma
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Ophthalmology, Northwell Health, Great Neck, New York; and
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3
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Tirsi A, Shah PP, Gliagias V, Barmas-Alamdari D, Orshan D, Tsai J, Tello C. Posterior Pole Asymmetry Analysis as a Diagnostic Tool in Glaucoma Suspects: An Electrophysiological Approach. Clin Ophthalmol 2023; 17:1777-1787. [PMID: 37366515 PMCID: PMC10290849 DOI: 10.2147/opth.s411647] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Spectral domain optical coherence tomography (SD-OCT) with posterior pole asymmetry analysis (PPAA) provides a mapping of posterior pole retinal thickness with asymmetry analysis between hemispheres of each eye. We investigated whether these structural abnormalities were correlated with functional retinal ganglion cell (RGC) loss, quantified by steady state pattern electroretinogram (ssPERG), in glaucoma suspects (GS). Methods Twenty GS (34 eyes) were enrolled in a prospective study at the Manhattan Eye, Ear, and Throat Hospital. All subjects underwent ophthalmological examination, including Humphrey visual field, Spectralis Glaucoma Module Premium Edition (GMPE) SD-OCT PPAA, and ssPERG testing. The ability of ssPERG parameters (Magnitude [Mag, µv], MagnitudeD [MagD, µv], and MagD/Mag ratio) to predict PPAA thickness (total, superior, and inferior thickness, [µm]) was tested via adjusted multivariate linear regression analysis. Results Mag explained 8% of variance in total PPAA change (F(1,29)=6.33, B=6.86, 95% CI: 1.29-12.44, p=0.018), 8% in superior PPAA change (F(1,29)=5.57, B=6.92, 95% CI: 0.92-12.92, p=0.025), and 7.1% in inferior PPAA change (F(1,29)=5.83, B=6.80, 95% CI: 1.04-12.56, p=0.022). Similarly, MagD explained 9.7% of variance in total PPAA change (F(1,29)=8.09, B=6.47, 95% CI: 1.82-11.13, p=0.008), 10% in superior PPAA change (F(1,29)=7.33, B=6.63, 95% CI: 1.62-11.63, p=0.011), and 8.5% in inferior PPAA change (F(1,29)=7.25, B=6.36, 95% CI: 1.53-11.18, p=0.012). MagD/Mag ratio and PPAA were not significantly associated. Conclusion To the best of our knowledge, this is the first study demonstrating a positive relationship between RGC dysfunction and retinal thickness changes between the superior and inferior hemispheres. The detection of asymmetrical structural loss, combined with functional RGC assessment using ssPERG, may be an informative tool for early glaucoma diagnosis.
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Affiliation(s)
- Andrew Tirsi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Vasiliki Gliagias
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Daniel Barmas-Alamdari
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Derek Orshan
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Joby Tsai
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Celso Tello
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
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Shah PP, Hasan A, Winokur J, Braunstein R, Ritterband DC, Seedor JA, Cheela I. Impact of Donor, Recipient, and Graft Characteristics on Corneal Transplantation Outcomes. Clin Ophthalmol 2023; 17:633-640. [PMID: 36866241 PMCID: PMC9970880 DOI: 10.2147/opth.s399847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose Although several donor, recipient, and graft characteristics have been studied in relation to corneal transplantation outcomes, no study to our knowledge has assessed the impact of donor cooling times on postoperative outcomes longitudinally. With only one corneal graft available for every 70 needed worldwide, this study seeks to identify any factors that could alleviate this shortage. Methods Patients undergoing corneal transplantation at the Manhattan Eye, Ear & Throat Hospital over a 2-year period were retrospectively studied. Study metrics included age, diabetic history, hypertensive history, endothelial cell density, death-to-preservation time (DTP), death-to-cooling time (DTC), and time-in-preservation (TIP). Postoperative transplantation outcomes, including best corrected visual acuity (BCVA) at 6- and 12-month follow-up visits, need for re-bubbling, and need for re-grafting, were assessed. Unadjusted univariate and adjusted multivariate binary logistic regressions were performed to determine the association of cooling and preservation parameters with corneal transplantation outcomes. Results Among 111 transplants, our adjusted model found that DTC ≥4 hours was associated with significantly worse BCVA, but only at 6-month postoperative follow-up (odds ratio [OR]: 0.234; 95% confidence interval [CI]: 0.073-0.747; p = 0.014). By 12-month follow-up, DTC >4 hours was no longer associated with BCVA in a statistically significant manner (OR: 0.472; 95% CI: 0.135-1.653; p = 0.240). A similar trend was found at a DTC cutoff of ≥3 hours. None of the other studied parameters, including DTP, TIP, donor age, or medical history were significantly correlated with transplantation outcomes. Conclusion Longer DTC or DTP did not have a statistically significant effect on corneal graft outcomes after one year, though short-term outcomes were improved in donor tissues with DTC below four hours. None of the other studied variables correlated with transplantation outcomes. Given the global shortage of corneal tissue, these findings should be considered when determining suitability for transplantation.
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Affiliation(s)
- Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Correspondence: Paras P Shah, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA, Email
| | - Aisha Hasan
- Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Jules Winokur
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Richard Braunstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - David C Ritterband
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - John A Seedor
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
| | - Isha Cheela
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Department of Ophthalmology, Northwell Health/Manhattan Eye, Ear & Throat Hospital, New York, NY, USA
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Nord JM, Shah PP, Verma R. Complete and Uneventful Recovery in a Case of Lymphocytic Hypophysitis Causing a Third Nerve Palsy. Neuroophthalmology 2022; 47:110-116. [PMID: 36891401 PMCID: PMC9988335 DOI: 10.1080/01658107.2022.2146143] [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: 06/01/2022] [Revised: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
Lymphocytic hypophysitis (LH) is a neuroendocrine disorder characterised by autoimmune inflammation of the pituitary gland with resultant pituitary dysfunction. Rarely, the presenting symptom can be diplopia due to irritation of the third, fourth, or sixth cranial nerves secondary to cavernous sinus involvement of the mass or increased intracranial pressure. We describe the case of a healthy, 20-year-old female with a pupillary sparing third nerve palsy, who was subsequently diagnosed with LH after an endoscopic transsphenoidal biopsy of the mass. She was treated with hormone replacement therapy and corticosteroids, resulting in full resolution of symptoms with no recurrence to date. To our knowledge, this is the first report of a third nerve palsy due to definitive biopsy proven LH. Despite its rarity, the unique presentation and favourable evolution of this case should aid clinicians in its timely recognition, appropriate workup, and treatment.
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Affiliation(s)
- Jamie M. Nord
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Paras P. Shah
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Rashmi Verma
- Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
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Zhu D, Wong A, Shah PP, Pomeranz HD. Neuro-ophthalmology malpractice: A review of the Westlaw Database. Med Leg J 2022; 90:200-205. [PMID: 36189929 DOI: 10.1177/00258172221109731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Neuro-ophthalmologic conditions are at a higher risk of misdiagnosis compared to other ophthalmic conditions. Increased awareness of the most common diagnostic errors in neuro-ophthalmology that lead to malpractice claims can allow ophthalmologists to further improve their diagnostic workup to reduce delays in diagnosis and management, while also mitigating the risk of litigation. METHODS Malpractice trials in the Westlaw Legal Database that involved cases of neuro-ophthalmologic diagnostic errors or failures by ophthalmologists were included in this study. RESULTS A total of 43 cases were included, all citing failure to diagnose as the main reason for litigation. The most common diagnoses missed were cerebrovascular pathologies (30.2%), intracranial tumours (27.9%) and giant cell arteritis (25.6%). The majority of verdicts were in favour of the defendants (48.8%). After adjusting for inflation, the average amount awarded was $1,952,154. CONCLUSION Nearly half of the cases resulted in a defendant verdict. Settlement and plaintiff verdicts were costly, with average awards of approximately two million inflation-adjusted dollars. Failure to diagnose cerebrovascular pathologies was the most common diagnostic error followed by failure to diagnose intracranial tumours and giant cell arteritis. It is crucial for ophthalmologists to be aware of the most common pitfalls that lead to misdiagnosis or delays in diagnosis of neuro-ophthalmologic conditions.
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Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Amanda Wong
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Howard D Pomeranz
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
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Shah PP, Glidai Y, Braunstein R, Gorski M, Lee J, Anwar F, Schrier A, Winokur J, Steiner AS. Reports of New and Recurrent Keratitis following mRNA-based COVID-19 Vaccination. Ocul Immunol Inflamm 2022:1-6. [PMID: 36345233 DOI: 10.1080/09273948.2022.2133730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE As ophthalmic side effects of messenger RNA (mRNA)-based COVID-19 vaccination are not well understood, it is crucial to document and report such instances should they occur. METHODS In this observational case series, we report nine patients (55.6% male, mean age 58.9) who received either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) COVID-19 vaccinations from January to June of 2021, and presented with symptoms of keratitis within 14 days. All patients underwent slit-lamp examination and histories were taken. RESULTS Most subjects (66.7%) had a history of corneal inflammatory diseases and resolved under antiviral and/or steroidal treatment. Patients who reported symptoms after their second vaccine dose presented earlier than those who reported symptoms after the first dose (mean 4.4 days vs 10.5 days, respectively). CONCLUSIONS The immunological reaction following mRNA-based COVID-19 vaccinations may trigger new-onset or reactivation of keratitis, though causality cannot be proven. Despite its rarity, clinicians should be aware of this possible complication and be prepared to treat.
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Affiliation(s)
- Paras P. Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Yoav Glidai
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Richard Braunstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Matthew Gorski
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Jung Lee
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Farihah Anwar
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Amelia Schrier
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Jules Winokur
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
| | - Anne S. Steiner
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Ophthalmology, Northwell Health, Great Neck, New York, USA
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Shah R, Shah PP, Nahar P, Patidar S, Patidar S, Jain R. Spatial Relationship of Maxillary Posterior Teeth with Maxillary Sinus Floor in Sagittal, Coronal and Axial Planes by Using Cone-Beam Computed Tomography in a Subpopulation of Central India. Mymensingh Med J 2022; 31:1162-1169. [PMID: 36189567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Inadvertent perforation of the root apex during endodontic procedure in maxillary posterior teeth may unnecessarily invite the complications of sinusitis or inflammatory responses. This becomes even more important when performing endodontic surgical procedures. Thus, it is mandatory to have the precise knowledge of anatomic structures which are in close proximity to the apex of roots and its variations among different geographic area. This retrospective observational study was performed in the Central India to assess the spatial relationships between the maxillary second pre-molar (sPM), maxillary first molar (M1), maxillary second molar (M2) with the maxillary sinus floor using cone beam computed tomography (CBCT) in all three axial, sagittal and coronal sections from year 2016 to 2021. Three hundred and sixty teeth were examined through sixty full volumes CBCT scans of the patients in between year 2016-2021 in Indore, (MP, India). The Distances (D) between the examined roots and the sinus floor, were evaluated using CBCT in all three sections, and grouped in 7 classes. To simplify, Class 1 and 2 were grouped as Negative Configuration where apices are protruding into sinus floor, Class 3 as Zero and Class 4-7 as Positive configuration. The data were analyzed statistically using SPSS system. The prevalence of class 1 and 2 (negative configuration) was the highest for the Palatal of M1 (16.67%) followed by Distobuccal of M1 (13.34%). The prevalence of class 3 that is Zero configuration was the highest for the Mesiobuccal of M2 (63.33%). The results suggested all the three teeth roots showed closed proximity with sinus floor, closest relationship with the sinus floor was seen in palatal of M1 in this study.
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Affiliation(s)
- R Shah
- Dr Ruchi Shah, Reader, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Sumandeep Vidhyapeeth, Vadodara, Gujarat, India; E-mail:
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Shah PP, Gelnick S, Zhu D, Wong A, Verma R. Optic neuritis secondary to the Pfizer-BioNTech-162b2 COVID-19 vaccine managed with plasmapheresis: A case report and review. Oman J Ophthalmol 2022; 15:397-402. [PMID: 36760953 PMCID: PMC9905924 DOI: 10.4103/ojo.ojo_354_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/16/2022] [Accepted: 06/21/2022] [Indexed: 02/11/2023] Open
Abstract
The COVID‑19 pandemic has had a significant public health impact globally, with inoculation now paramount in limiting the spread of the disease. Although the safety and efficacy profiles of COVID‑19 vaccines are well documented, it is upon the medical community to be aware of adverse effects to appropriately advise and treat patients. We report the case of a 39‑year‑old female who was hospitalized with optic neuritis (ON) 1 week after her second dose of the Pfizer‑BioNTech (BNT162b2) COVID‑19 vaccine. The patient did not have any significant medical history, including personal or familial history of multiple sclerosis or any other demyelinating disease, other than prior COVID‑19 infection. She had since made a full recovery and tested negative at the time of hospitalization for ON. Over the course of her admission, the patient's visual acuity (VA) deteriorated from 20/400 to no light perception. After methylprednisolone was ineffective, she was started on plasmapheresis (PLEX) therapy which resulted in mild improvement of VA. To our knowledge and after a thorough PubMed literature search, this is the first reported case of isolated ON associated with COVID‑19 vaccination.
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Affiliation(s)
- Paras P. Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Samuel Gelnick
- Department of Ophthalmology, Northwell Health, Great Neck, NY, USA
| | - Daniel Zhu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Amanda Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Rashmi Verma
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA,Department of Ophthalmology, Northwell Health, Great Neck, NY, USA,Address for correspondence: Dr. Rashmi Verma, 4300 Hempstead Turnpike, Bethpage, NY 11714, USA. E-mail:
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Shah PP, Brady TM, Meyers KEC, O'Shaughnessy MM, Gibson KL, Srivastava T, Zee J, Cattran D, Tuttle KR, Gadegbeku C, Glenn D, Derebail V, Smith A, Wang CS, Gillespie BW, Bitzer M, Sethna CB. Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies. Nephron Clin Pract 2021; 145:245-255. [PMID: 33677435 DOI: 10.1159/000513869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. METHODS In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots. RESULTS The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p < 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p < 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p < 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p < 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p < 0.001). CONCLUSION Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group.
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Affiliation(s)
- Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Tammy M Brady
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin E C Meyers
- The Children Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Keisha L Gibson
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Daniel Cattran
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine R Tuttle
- Providence Health Care, University of Washington, Spokane, Washington, USA
| | - Crystal Gadegbeku
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dorey Glenn
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Vimal Derebail
- UNC Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Abigail Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Chia-Shi Wang
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brenda W Gillespie
- Consulting for Statistics, Computing and Analytics Research and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Markus Bitzer
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine B Sethna
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA, .,Cohen Children's Medical Center of NY, New Hyde Park, New York, USA,
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Merchant K, Shah PP, Singer P, Castellanos L, Sethna CB. Comparison of Pediatric and Adult Ambulatory Blood Pressure Monitoring Criteria for the Diagnosis of Hypertension and Detection of Left Ventricular Hypertrophy in Adolescents. J Pediatr 2021; 230:161-166. [PMID: 33181197 DOI: 10.1016/j.jpeds.2020.11.003] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare pediatric ambulatory blood pressure monitoring (ABPM) criteria with adult ABPM criteria for the diagnosis of hypertension and detection of left ventricular hypertrophy (LVH) in adolescents. STUDY DESIGN ABPM and echocardiography reports from adolescents age 13-21 years from 2015 to 2019 were analyzed. The concordance of hypertension based on pediatric criteria (American Heart Association 2014) was compared with adult criteria from American College of Cardiology/American Heart Association 2017 (overall BP ≥125/75 mm Hg, wake BP ≥130/80 mm Hg, sleep BP ≥110/65 mm Hg) using the Cohen kappa statistic. Logistic regression, adjusted for body mass index z score, and receiver operating characteristic curves (ROCs) compared pediatric criteria vs adult criteria in predicting LVH (left ventricular mass index >95th percentile reference values and left ventricular mass index >51 g/m2.7). RESULTS Of 306 adolescents, 140 (45.8%) had hypertension based on pediatric criteria vs 228 (74.5%) based on adult criteria; the agreement was poor (59.3%, n = 137, kappa = 0.41). A higher prevalence of LVH was captured by adult criteria only (n = 91) compared with pediatric criteria only (n = 3). Logistic regression found no significant differences between pediatric and adult criteria in the detection of LVH >95th percentile (OR 1.24, CI 0.66, 2.31, P = .51) or >51 g/m2.7 (OR 1.06, CI 0.47, 2.40, P = .89). ROCs for pediatric criteria were not significant for detecting LVH >95th percentile (0.50, P = .91) or >51 g/m2.7 (0.55, P = .45), whereas the ROC for adult criteria was significant for detecting LVH >95th percentile (0.59, P = .045) but not >51 g/m2.7 (0.63, P = .07). Although all individuals with LVH >51 g/m2.7 were hypertensive by adult criteria, 8 of these individuals were missed by pediatric criteria. CONCLUSIONS Adult criteria captured a higher prevalence of LVH and appeared to predict better LVH than pediatric criteria. A consideration to align ABPM criteria for diagnosing hypertension in adolescents with adult guidelines is warranted.
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Affiliation(s)
- Kumail Merchant
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | - Paras P Shah
- Cohen Children's Medical Center of New York, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Pamela Singer
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - Christine B Sethna
- Cohen Children's Medical Center of New York, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
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12
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Soda EA, Barskey AE, Shah PP, Schrag S, Whitney CG, Arduino MJ, Reddy SC, Kunz JM, Hunter CM, Raphael BH, Cooley LA. Vital Signs: Health Care-Associated Legionnaires' Disease Surveillance Data From 20 States and a Large Metropolitan Area-United States, 2015. Am J Transplant 2017; 17:2215-2220. [PMID: 28724206 DOI: 10.1111/ajt.14407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Legionnaires' disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. METHODS Using national surveillance data, Legionnaires' disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care-associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires' disease cases were considered unrelated to health care. RESULTS A total of 2,809 confirmed Legionnaires' disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care-associated cases. Among the 21 jurisdictions, 16 (76%) reported 1-21 definite health care-associated cases per jurisdiction. Among definite health care-associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care-associated Legionnaires' disease. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE Exposure to Legionella from health care facility water systems can result in Legionnaires' disease. The high case fatality rate of health care-associated Legionnaires' disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.
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Affiliation(s)
- E A Soda
- Epidemic Intelligence Service, CDC, Atlanta, GA.,Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - A E Barskey
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - P P Shah
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - S Schrag
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - C G Whitney
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - M J Arduino
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - S C Reddy
- Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - J M Kunz
- Division of Emergency and Environmental Health Services, National Center for Environmental Health, CDC, Atlanta, GA
| | - C M Hunter
- Division of Emergency and Environmental Health Services, National Center for Environmental Health, CDC, Atlanta, GA
| | - B H Raphael
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
| | - L A Cooley
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, CDC, Atlanta, GA
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13
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Shah PP, Lockwood WW, Saurabh K, Kurlawala Z, Shannon SP, Waigel S, Zacharias W, Beverly LJ. Ubiquilin1 represses migration and epithelial-to-mesenchymal transition of human non-small cell lung cancer cells. Oncogene 2014; 34:1709-17. [PMID: 24747970 PMCID: PMC4205225 DOI: 10.1038/onc.2014.97] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023]
Abstract
Ubiquilin1 (UBQLN1) is a ubiquitin-like domain and a ubiquitin-associated domain containing protein that has been reported to be involved in shuttling proteins to the proteasome, especially during endoplasmic reticulum-associated protein degradation (ERAD). Thus, UBQLN1 function has been shown to be critical for combating a number of neurological disorders caused by protein aggregation, such as Amyotrophic lateral sclerosis (ALS), Alzheimer’s disease and Huntington’s disease. A role for UBQLN1 in regulating processes involved in tumorigenesis has not been demonstrated. Herein, we show that loss of UBQLN1 causes increased cell migration and invasion, actin cytoskeleton reorganization and induction of epithelial mesenchymal transition (EMT). Loss of UBQLN1 results in a significant decrease in the expression of epithelial markers including E-cadherin and claudin1, whereas expression of mesenchymal markers including Vimentin, Snail and ZEB1 are significantly elevated. Interestingly, we found that ZEB1 is required for induction of mesenchymal-like properties following loss of UBQLN1 and ZEB1 is capable of repressing expression of UBQLN1, suggesting a physiological, reciprocal regulation of EMT by UBQLN1 and ZEB1. Further, we find evidence for a role for UBQLN2 in also regulating EMT and cell migration. These observations have potential clinical relevance because the UBQLN1 gene is lost and under-expressed in a large percentage of human cancer cell lines and primary human lung cancer samples and recurrent mutations in both all five Ubiquilin family members have been identified in human lung cancers. Taken together, our results suggest for the first time a role for Ubiquilin family members in cancer biology.
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Affiliation(s)
- P P Shah
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - W W Lockwood
- Cancer Biology and Genetics Section, Cancer Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - K Saurabh
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Z Kurlawala
- 1] James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA [2] Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA
| | - S P Shannon
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - S Waigel
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - W Zacharias
- 1] James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA [2] Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA [3] Division of Hematology and Oncology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - L J Beverly
- 1] James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA [2] Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA [3] Division of Hematology and Oncology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
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14
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Abstract
Pituitary tumor transforming gene (PTTG) is a well-studied oncogene for its role in tumorigenesis and serves as a marker of malignancy in several cancer types including lung. In the present study, we defined the role of PTTG in actin cytoskeleton remodeling, cell migration and induction of epithelial mesenchymal transition (EMT) through the regulation of integrin α(V)β(3)-FAK (focal adhesion kinase) signaling pathway. Overexpression of PTTG through an adenovirus vector resulted in a significant increase in the expression of integrins α(V) and β(3), a process that was reversed with the downregulation of PTTG expression through the use of an adenovirus expressing PTTG-specific small interfering RNA (siRNA). Western blot analysis of cells infected with adenovirus PTTG cDNA resulted in increased FAK and enhanced expression of adhesion complex molecules paxillin, metavincullin, and talin. Furthermore, downstream signaling genes Rac1, RhoA, Cdc42 and DOCK180 showed upregulation upon PTTG overexpression. This process was dependent on integrin α(V), as blockage by antagonist echistatin (RGD peptide) or α(V)-specific siRNA resulted in a decrease in FAK and subsequent adhesion molecules. Actin cytoskeleton disruption was detected as a result of integrin-FAK signaling by PTTG as well as enhanced cell motility. Taken together, our results suggest for the first time an important role of PTTG in regulation of integrins α(V) and β(3) and adhesion-complex proteins leading to induction of EMT.
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Affiliation(s)
- P P Shah
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
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15
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Yagi M, Kanzaki S, Kawamoto K, Shin B, Shah PP, Magal E, Sheng J, Raphael Y. Spiral ganglion neurons are protected from degeneration by GDNF gene therapy. J Assoc Res Otolaryngol 2000; 1:315-25. [PMID: 11547811 PMCID: PMC2957193 DOI: 10.1007/s101620010011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Perceptual benefits from the cochlear prosthesis are related to the quantity and quality of the patient's auditory nerve population. Multiple neurotrophic factors, such as glial cell line-derived neurotrophic factor (GDNF), have been shown to have important roles in the survival of inner ear auditory neurons, including protection of deafferented spiral ganglion cells (SGCs). In this study, GDNF gene therapy was tested for its ability to enhance survival of SGCs after aminoglycoside/diuretic-induced insult that eliminated the inner hair cells. The GDNF transgene was delivered by adenoviral vectors. Similar vectors with a reporter gene (lacZ) insert served as controls. Four or seven days after bilateral deafening, 5 microl of an adenoviral suspension (Ad-GDNF or Ad-lacZ) or an artificial perilymph was injected into the left scala tympani of guinea pigs. Animals were sacrificed 28 days after deafening and their inner ears prepared for SGC counts. Adenoviral-mediated GDNF transgene expression enhanced SGC survival in the left (viral-treated) deafened ears. This observation suggests that GDNF is one of the survival factors in the inner ear and may help maintain the auditory neurons after insult. Application of GDNF and other survival factors via gene therapy has great potential for inducing survival of auditory neurons following hair cell loss.
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Affiliation(s)
- M Yagi
- Kresge Hearing Research Institute, University of Michigan, Ann Arbor 48109-0506, USA
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16
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Abstract
Adverse neurological events during hypoxic episodes in high-risk patients or in patients not thought to be at risk while undergoing procedures increase morbidity and mortality. The ability to reliably monitor cerebral oxygenation could serve as an indicator for the need of therapeutic intervention and it's overall effect. This study was designed to verify the reliability of the only commercially available continuous noninvasive monitor, the INVOS 3100 (Somanetics Corp., Troy, MI), in subjects with varying levels of hypoxemia. Six adult volunteer subjects were enrolled. After placement of electrocardiogram (EKG), noninvasive blood pressure (NIBP), pulse oximeter (SpO2), cerebral oximeter (rSO2), a 20 g radial artery catheter, and a 4 F oximetric jugular bulb catheter, the subjects were given hypoxic mixtures to breathe to varying levels of desaturation. Arterial and mixed venous blood was drawn for blood-gas analysis at each level of O2 saturation. The cerebral hemoglobin saturation value from the cerebral oximeter was compared to the combined brain saturation using the formula: estimated field saturation between the light source and the detector (fSO2) = 0.25 x the arterial oxygen saturation (SaO2) + 0.75 x the jugular bulb venous oxygen saturation (SjvO2), (fSO2 = 0.25 SaO2 + 0.75 SjvO2). Statistical analysis demonstrated a correlation of 0.67 between rSO2 and fSO2 and a bias of -3.1% with a precision of 12.1%. Minimal bias of 0.38% and precision of 6.22% were calculated for transitional error. We concluded from the study that rSO2 may serve as a reliable indicator of changes in brain oxygenation induced by hypoxemia.
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Affiliation(s)
- N Shah
- Department of Anesthesiology, University of California at Irvine, Orange, USA
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17
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Abstract
This study examined the effects of procedural justice on state-dependent self-esteem using the group-value model and attribution theory to present competing theoretical perspectives. The group-value model predicts a positive relationship between self-esteem and fair procedures. In contrast, attribution theory suggests procedural fairness interacts with outcome favorability to influence self-esteem. Thus, fair procedures will result in higher self-esteem ratings than unfair procedures when the outcome is positive but will result in lower self-esteem ratings than unfair procedures when the outcome is negative. The results of a laboratory and field study provide converging evidence to support the attribution theory predictions. The results of a 2nd laboratory study suggest that self-esteem is influenced by outcome expectancies, not actual outcomes.
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Affiliation(s)
- H A Schroth
- Haas School of Business, University of California, Berkeley 94720, USA.
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18
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Shah PP, Nair M, Dhall A, Verman KK, Midha KK, Mohan JC, Kaul UA, Arora R. False-positive exercise stress electrocardiogram due to accessory pathway in the absence of manifest preexcitation. Pacing Clin Electrophysiol 2000; 23:1051-3. [PMID: 10879395 DOI: 10.1111/j.1540-8159.2000.tb00897.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
False-positive exercise testing in patients with an accessory pathway has been described only in patients with manifest preexcitation during exercise. We describe a patient in whom marked ST-segment changes were seen during an exercise test in the absence of any preexcitation of the QRS complexes. The role of the accessory pathway in producing the ST changes was reaffirmed by absence of this abnormality following catheter ablation of the accessory pathway.
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Affiliation(s)
- P P Shah
- Department of Cardiology, G.B. Pant Hospital, Jawahar Lal Nehru Marg, New Delhi, India
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19
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Shah PP, Singh S, Trehan V, Dubey S, Mohan JC, Kaul UA, Arora R. Surgical repair of pulmonary artery aneurysm following infective endocarditis in a patient with persistent ductus arteriosus. Indian Heart J 1999; 51:537-40. [PMID: 10721646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- P P Shah
- Department of Cardiology, GB Pant Hospital, New Delhi
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20
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Gambhir DS, Shah PP, Singh S, Kaul UA, Arora R. Non-surgical treatment of major coronary artery perforation using a stent graft. Indian Heart J 1999; 51:215-7. [PMID: 10407556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Affiliation(s)
- D S Gambhir
- Department of Cardiology, GB Pant Hospital, New Delhi
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21
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Joshi K, Patel S, Shah PP, Parikh DJ, Bilimoria FE. Granuloma faciale. Indian J Dermatol Venereol Leprol 1998; 64:291-292. [PMID: 20921800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 40-year old woman presented with asymptomatic erythematous well-demarcated, infiltrated plaque of 8 cm x 7 cm in size on the right cheek for past four years. Histopathological study of skin biopsy revealed features of granuloma faciale. Oral dapsone and intralesional corticosteroid caused marked improvement.
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Affiliation(s)
- K Joshi
- Department of Dermatology, Venereology and Leprology, B J Medical College and Civil Hospital, Asarwa, Ahmedabad-16, India
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22
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Abstract
OBJECTIVE To develop, implement, and assess the outcomes of a system for providing pharmaceutical care to medical progressive care patients. METHODS A system for providing pharmaceutical care was developed and implemented for an 8-week period beginning in June 1995. Both patient care outcomes and drug therapy cost change from the intervention period were compared with those of an 8-week baseline period. Variables compared included unit length of stay, hospital length of stay, transfers to the intensive care unit, readmissions, and adverse drug reactions requiring treatment. Differences between periods for these variables were assessed by using chi 2 tests and t-tests with alpha set at p less than 0.05. The clinical significance of the interventions were assessed independently by four physicians: two intensivists and two internists. The total drug therapy cost change from the intervention period was calculated as follows: total cost avoidance from individual recommendations subtracted from the total cost incurred from individual recommendations. RESULTS The pharmacist evaluated 152 patients during the intervention period. A total of 235 pharmacotherapy recommendations were made on 103 patients, of whom 86.4% were accepted. Significantly fewer adverse drug reactions (ADRs) received treatment during the intervention period (p = 0.027). The mean unit length of stay was lower during the intervention period (4.8 +/- 3.7 d) than during the baseline period (6.0 +/- 5.6 d); however, this difference was not significant (p = 0.053). Individual physician assessment of the pharmacists' recommendations revealed that 75.8% were considered somewhat significant, significant, or very significant. The total drug therapy cost change from the intervention period was -$6534.53. The projected annual drug therapy cost reduction from this study is $42,474.45. CONCLUSIONS The provision of pharmaceutical care to medical progressive care patients was associated with a substantial decrease in drug therapy cost and a decrease in the number of ADRs that required treatment.
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Affiliation(s)
- M A Smythe
- Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI, USA
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23
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Shah MK, Shah PP, Rawal RC, Bilimoria FE. Lipoid proteinosis. Indian J Dermatol Venereol Leprol 1996; 62:375-376. [PMID: 20948132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 20-year old male presented with hoarseness of voice since birth, beaded papular lesions on both eyelids, multiple hypopigmented atrophic scars on trunk and extremities and yellowish infiltrated plaques on tongue, palate and buccal mucosae. Patient was diagnosed clinically as a case of lipoid proteinosis. It was confirmed by mucosal biopsy.
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Affiliation(s)
- M K Shah
- Department of Dermatology, BJ Medical College, Civil Hospital, Ahmedabad-16, India
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24
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Patankar SY, Shah PP. Tangential excision with a skin-grafting knife as an alternative for dermabrasion. Plast Reconstr Surg 1995; 95:1137-8. [PMID: 7732141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
The various ultrasound (US) findings in 90 patients with abdominal (gastrointestinal, peritoneal, mesenteric and lymph node) tuberculosis (TB) studied in an area of high incidence of TB over a 1 year period were analysed. The lesions encountered were intestinal (n = 31), extraintestinal (n = 39), or a combination (n = 20). The extraintestinal lesions included free and loculated ascites (n = 36), localized ascites ('Club Sandwich sign') (n = 4), adhesions (n = 14), peritoneal thickening (n = 14), peritoneal nodules (n = 3), lymphadenopathy (n = 23) and cold abscesses (n = 10)-of these, the presence of fine fibrinous strands in the ascetic fluid, localized ascites and caseous or calcified lymph nodes were highly suspicious of a diagnosis of TB in appropriate clinical settings. The bowel lesions were characterized by concentric bowel wall thickening (n = 31) with ulceration in six. Bowel thickening, when present in the ileocaecal junction and especially when situated in the subhepatic position, was suggestive of a tuberculous etiology. Complex masses in the abdomen pointed to an advanced stage of the disease. US is a useful imaging modality in patients clinically suspected of having abdominal TB for diagnosis and follow-up, although in a few cases differentiation of it from metastatic disease is difficult. When bowel involvement is suspected, barium studies should be performed.
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Affiliation(s)
- R P Kedar
- Department of Radiology, King Edward Memorial Hospital, Bombay, India
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26
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Barjatiya MK, Shah NK, Kothari SS, Shah PP, Trivedi HL. Spontaneous left ventricle cavity thrombus in a patient of systemic lupus erythematosus. J Assoc Physicians India 1992; 40:195-6. [PMID: 1634487] [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: 12/28/2022]
Abstract
A 32 year old female with systemic lupus erythematosus having circulating lupus anticoagulant developed a thrombus in the left ventricle cavity, an unusual site. She responded to standard anticoagulant regime.
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Affiliation(s)
- M K Barjatiya
- Institute of Kidney Disease and Research Centre, Civil Hospital, Ahmedabad
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27
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Supe AN, Sathe SS, Redkar RG, Dalvi AN, Kulkarni BA, Shah PP. Amebic pericarditis following ruptured right liver lobe abscess. Indian J Gastroenterol 1991; 10:111. [PMID: 1916959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present an unusual case of suppurative pericarditis following rupture of a solitary right lobe amebic liver abscess. The condition was treated successfully by drainage of the liver abscess alone.
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Affiliation(s)
- A N Supe
- Department of Surgery, Seth GS Medical College, Parel, Bombay
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28
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Robson HG, Shah PP, Lalonde RG, Hayes L, Senikas VM. Comparison of rosaramicin and erythromycin stearate for treatment of cervical infection with Chlamydia trachomatis. Sex Transm Dis 1983; 10:130-4. [PMID: 6648747 DOI: 10.1097/00007435-198307000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The macrolide antibiotic rosaramicin inhibits in vitro growth of Chlamydia trachomatis. Rosaramicin (1 g daily given to 18 patients for seven days) and erythromycin stearate (2 g daily given to 19 patients for seven days) were compared in the treatment of chlamydial cervicitis. Cultures of cervical specimens obtained nine to 11 days and 24-32 days after commencement of therapy were negative for all rosaramicin-treated patients seen at follow-up. The first follow-up culture of one erythromycin recipient was positive. The extent of cervicitis decreased in all patients after treatment, but the only patients to achieve a completely normal cervical appearance were those with minimal-to-moderate lesions before treatment. Gastrointestinal side effects, including nausea, vomiting, and abdominal pain, occurred in ten of 19 patients given erythromycin and in 13 of 18 given rosaramicin. Minimally elevated levels of alanine aminotransferase in serum occurred in four (22.2%) of 18 rosaramicin recipients. It is concluded that rosaramicin and erythromycin stearate both eradicate C. trachomatis cervical infection but frequently cause adverse gastrointestinal effects.
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29
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Shah PP, Briedis DJ, Robson HG, Conterato JP. In vitro activity of piperacillin compared with that of carbenicillin, ticarcillin, ampicillin, cephalothin, and cefamandole against Pseudomonas aeruginosa and Enterobacteriaceae. Antimicrob Agents Chemother 1979; 15:346-50. [PMID: 111609 PMCID: PMC352663 DOI: 10.1128/aac.15.3.346] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Piperacillin (T-1220), a semisynthetic derivative of aminobenzylpenicillin, was more active than either carbenicillin or ticarcillin against Pseudomonas aeruginosa; over 60% of isolates were inhibited at a concentration of 6.3 mug/ml. Piperacillin was bactericidal for 84% of Pseudomonas strains at 100 mug/ml, carbenicillin killed 60%, and ticarcillin killed 68% at that concentration. Piperacillin was also more active than the other penicillins against isolates of Escherichia coli, Enterobacter, and Proteus mirabilis. The combination of piperacillin and tobramycin, demonstrating synergistic inhibition of 87% of strains of P. aeruginosa, was the most active of the penicillin-aminoglycoside combinations tested for synergism.
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Abstract
1. Monosodium glutamate (MSG) was administered by various methods to mice and rats of various ages and the incidence of obesity was later measured. 2. Newborn mice were injected subcutaneously with 3 mg MSG/g body-weight at 1, 2, 3, 6, 7, and 8 d of age; 16% died before weaning. Of the survivors, 90% or more became markedly obese. Mean carcass lipid content was increased by about 120% in both sexes at 20-30 weeks old. In male mice, MSG treatment increased body-weight and epididymal fat pad weight, and greatly decreased adrenaline-stimulated lipolysis in isolated fat cells. Body-eright of females was not increased significantly. Food intake was not increased in either sex from weeks 13 to 15. Blood glucose level was not generally increased by MSG but some of the male mice had abnormally high values. 3. Obesity was not detected in the offspring of female mice that had received 100 g MSG/kg diet, either from 3 weeks before mating until weaning, or from the 14th day of pregnancy until weaning. 4. Intraperitoneal injection of 10 mg MSG/g body-weight (in two doses) at weaning increased carcass lipid content in female mice by 34% by 23 weeks of age, but female rats were not affected. 5. The addition of 20 g MSG/l to the drinking-water from weaning onwards did not increase carcass lipid content in female rats or mice. 6. The addition of 20 g MSG/kg diet from weaning onwards did not alter body-weight or carcass lipid content in male and female rats by 14 weeks of age. 7. The obesity induced in mice by MSG was not associated with hyperphagia, unlike genetic obesity and obesity induced by gold thioglucose (GTG). 8. All types of mouse studied, obese and lean, had essentially the same linear relationship between carcass water content and carcass lipid content. 9. Although MSG-obese mice could not readily be differentiated from normal mice by the increase in body-weight, which was only about 10% compared to 50-120% for genetic and GTG-induced obesity, the proposed schedule of injections in the newborn was almost 100% reliable in inducing a high extent of adiposity.
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Abstract
The mass spectrum of a lipolytic substance from purified sheep midbrain extract indicated that it was isoprenaline, not N-n-propylnoradrenaline, noradrenaline or adrenaline. The identification of the lipid-mobilizing factor as isoprenaline was confirmed qualitatively by t.l.c. and g.l.c. and quantitatively by determination of its lipolytic activity and u.v. absorption and by fluorimetric determination of its catecholamine content.
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Shah PP, Staple E, Shapiro IL, Kritichevsky D. Isolation of 3 alpha, 7 alpha, 12 alpha-trihydroxycoprostanic acid from baboon bile. Lipids 1969; 4:82-3. [PMID: 4974941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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