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Novitsky V, Nyandiko W, Vreeman R, DeLong AK, Manne A, Scanlon M, Ngeresa A, Aluoch J, Sang F, Ashimosi C, Jepkemboi E, Orido M, Hogan JW, Kantor R. Added Value of Next Generation over Sanger Sequencing in Kenyan Youth with Extensive HIV-1 Drug Resistance. Microbiol Spectr 2022; 10:e0345422. [PMID: 36445146 PMCID: PMC9769539 DOI: 10.1128/spectrum.03454-22] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
HIV-1 drug resistance testing in children and adolescents in low-resource settings is both important and challenging. New (more sensitive) drug resistance testing technologies may improve clinical care, but evaluation of their added value is limited. We assessed the potential added value of using next-generation sequencing (NGS) over Sanger sequencing for detecting nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRMs). Participants included 132 treatment-experienced Kenyan children and adolescents with diverse HIV-1 subtypes and with already high levels of drug resistance detected by Sanger sequencing. We examined overall and DRM-specific resistance and its predicted impact on antiretroviral therapy and evaluated the discrepancy between Sanger sequencing and six NGS thresholds (1%, 2%, 5%, 10%, 15%, and 20%). Depending on the NGS threshold, agreement between the two technologies was 62% to 88% for any DRM, 83% to 92% for NRTI DRMs, and 73% to 94% for NNRTI DRMs, with more DRMs detected at low NGS thresholds. NGS identified 96% to 100% of DRMs detected by Sanger sequencing, while Sanger identified 83% to 99% of DRMs detected by NGS. Higher discrepancy between technologies was associated with higher DRM prevalence. Even in this resistance-saturated cohort, 12% of participants had higher, potentially clinically relevant predicted resistance detected only by NGS. These findings, in a young, vulnerable Kenyan population with diverse HIV-1 subtypes and already high resistance levels, suggest potential benefits of more sensitive NGS over existing technology. Good agreement between technologies at high NGS thresholds supports their interchangeable use; however, the significance of DRMs identified at lower thresholds to patient care should be explored further. IMPORTANCE HIV-1 drug resistance in children and adolescents remains a significant problem in countries facing the highest burden of the HIV epidemic. Surveillance of HIV-1 drug resistance in children and adolescents is an important public health strategy, particularly in resource-limited settings, and yet, it is limited due mostly to cost and infrastructure constraints. Whether newer and more sensitive next-generation sequencing (NGS) adds substantial value beyond traditional Sanger sequencing in detecting HIV-1 drug resistance in real life settings remains an open and debatable question. In this paper, we attempt to address this issue by performing a comprehensive comparison of drug resistance identified by Sanger sequencing and six NGS thresholds. We conducted this study in a well-characterized, vulnerable cohort of children and adolescents living with diverse HIV-1 subtypes in Kenya and, importantly, failing antiretroviral therapy (ART) with already extensive drug resistance. Our findings suggest a potential added value of NGS over Sanger even in this unique cohort.
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Affiliation(s)
- V. Novitsky
- Brown University, Providence, Rhode Island, USA
| | - W. Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
| | - R. Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
| | | | - A. Manne
- Brown University, Providence, Rhode Island, USA
| | - M. Scanlon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
| | - A. Ngeresa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - J. Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - F. Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - C. Ashimosi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - E. Jepkemboi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - M. Orido
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - J. W. Hogan
- Brown University, Providence, Rhode Island, USA
| | - R. Kantor
- Brown University, Providence, Rhode Island, USA
| | - for the RESistance in a PEdiatric CohorT (RESPECT) Study
- Brown University, Providence, Rhode Island, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Arnhold Institute for Global Health, New York, New York, USA
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. What are the best endpoints for Eczema Area and Severity Index and Scoring Atopic Dermatitis in clinical practice? A prospective observational study. Br J Dermatol 2020; 184:888-895. [PMID: 32959390 DOI: 10.1111/bjd.19457] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD). OBJECTIVES To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 826). An anchor-based approach was used to determine thresholds for the percentage and absolute MICs of EASI, SCORAD and objective SCORAD (O-SCORAD) at follow-up from baseline. RESULTS One-grade improvements of Physician's Global Assessment (PGA) and validated Investigator Global Assessment scale for AD (vIGA-AD) were associated with 50%, 35% and 35% decreases of EASI, SCORAD and O-SCORAD, respectively. The thresholds for percentage MIC of EASI (Kruskal-Wallis test, P = 0·61), SCORAD (P = 0·07) and O-SCORAD (P = 0·09) were similar across baseline AD severities. One-grade improvements of PGA and vIGA-AD were associated with 14·0- and 14·9-point decreases of EASI, 19·9- and 14·9-point decreases of SCORAD, and 15·5- and 17·4-point decreases of O-SCORAD. The thresholds for the absolute MIC of EASI (P < 0·001), SCORAD (P < 0·001) and O-SCORAD (P < 0·001) significantly differed by baseline AD severity. Percentage and absolute MICs for EASI and SCORAD were associated with improvements of AD symptoms and quality of life. CONCLUSIONS EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity. The absolute MICs for EASI, SCORAD and O-SCORAD varied by baseline AD severity.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - D Lei
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - M Yousaf
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - S R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Y Hsu
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, Jette, 1090, Belgium
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. Measurement properties of the product of investigator's global assessment and body surface area in children and adults with atopic dermatitis. J Eur Acad Dermatol Venereol 2020; 35:180-187. [PMID: 32745300 DOI: 10.1111/jdv.16846] [Citation(s) in RCA: 9] [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] [Received: 02/13/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple clinician-reported outcome measures exist for atopic dermatitis (AD) severity. However, there is no gold standard for use in clinical practice. OBJECTIVES To determine the measurement properties of the product of validated Investigator's Global Assessment for AD (vIGA) and body surface area (BSA) overall or divided into six categories (cBSA: 0%/0.1, <10%/10, <30%/30, <50%/50, <70%/70 and <90%/90-100%) and compare with other clinician-reported and patient-reported outcomes in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 653). RESULTS vIGA*BSA and vIGA*cBSA had good convergent validity with BSA (Spearman's ρ = 0.97 and 0.93), eczema area and severity index (ρ = 0.94 and 0.92), and objective SCORAD (ρ = 0.88 and 0.89); and weak-to-good convergent validity with Numeric Rating Scale average itch (ρ = 0.22 and 0.22) and worst itch (ρ = 0.27 and 0.28), Patient-Oriented Eczema Measure (ρ = 0.44 and 0.43), Dermatology Life Quality Index (ρ = 0.48 and 0.49), ItchyQOL (ρ = 0.45 and 0.46), PROMIS Sleep Disturbance (ρ = 0.46 and 0.37) and sleep-related impairment (ρ = 0.31 and 0.31) in adults and/or children; very good discriminant validity for physician-reported global AD severity; good responsiveness to change of severity of AD and itch; and good reliability (intraclass correlation coefficient [95% confidence interval]: 0.72 [0.60-0.81] and 0.74 [0.62-0.82]) with no floor or ceiling effects. Thresholds for interpretability bands and clinically important difference were established. CONCLUSIONS vIGA*BSA and vIGA*cBSA scores showed good convergent and discriminant validity, reliability, responsiveness and interpretability in adults and children with AD, and were feasible for use in clinical practice. vIGA*BSA and vIGA*cBSA had slightly lower convergent validity than EASI or objective SCORAD, but might be more efficient to collect and score.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA, Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Y Hsu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, Chavda R, Gabriel S, Patel KR, Singam V, Kantor R, Hsu DY. Measurement properties of the Rajka-Langeland severity score in children and adults with atopic dermatitis. Br J Dermatol 2020; 184:87-95. [PMID: 32348552 DOI: 10.1111/bjd.19159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple atopic dermatitis (AD) severity scales exist, with no gold standard for use in clinical practice. OBJECTIVES To determine the measurement properties of the Rajka-Langeland score and compare it with other clinician-reported outcomes in adults and children with AD. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 427). RESULTS Rajka-Langeland had good concurrent validity with the Eczema Area and Severity Index (Spearman rho = 0·63), SCORing AD (SCORAD) (rho = 0·61), objective-SCORAD (rho = 0·52) and body surface area (rho = 0·51); good convergent validity with the numeric rating scale average-itch (rho = 0·60) and worst-itch (rho = 0·59), Patient-Oriented Eczema Measure (rho = 0·57), Dermatology Life Quality Index (rho = 0·53), Patient-Reported Outcomes Measurement Information System Itch Questionnaire (rho = 0·35-0·55) in adults and/or children; fair discriminant validity for patient- and physician-reported global AD severity; good responsiveness to change of severity of AD and itch; good reliability; internal consistency; with no floor or ceiling effects. Interpretability bands (3, clear/almost clear; 4-5, mild; 6-7, moderate; 8-9, severe) and minimal clinically important difference (1 point) were established. CONCLUSIONS The Rajka-Langeland score showed good construct validity, reliability, internal consistency and responsiveness in adults and children with AD.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-425, 2150 Pennsylvania Avenue, Washington, DC, 20037, USA.,Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - D Lei
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - M Yousaf
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - P P Vakharia
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Chopra
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Chavda
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - S Gabriel
- Galderma SA
- Rx Strategy & Innovation Group, La Tour-de-Peliz, Switzerland
| | - K R Patel
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - V Singam
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - R Kantor
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Derek Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Silverberg J, Lei D, Yousaf M, Janmohamed S, Vakharia P, Chopra R, Chavda R, Gabriel S, Patel K, Singam V, Kantor R, Hsu D, Cella D. 534 Association of itch triggers with atopic dermatitis severity, persistence, flares and seasonality in adults. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lei D, Yousaf M, Janmohamed S, Vakharia P, Chopra R, Chavda R, Gabriel S, Sacotte R, Patel K, Singam V, Immaneni S, Kantor R, Hsu D, Cella D, Silverberg J. 549 Measurement properties of four different patient-reported outcomes to assess sleep disturbance in adults with atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Silverberg J, Shei J, Patel K, Singam V, Vakharia P, Chopra R, Sacotte R, Kantor R, Cella D. 539 Validation of the PROMIS Itch Questionnaire – itch severity assessments in adults with atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Silverberg J, Lai J, Patel K, Singam V, Vakharia P, Chopra R, Sacotte R, Kantor R, Hsu D, Cella D. Measurement properties of the Patient‐Reported Outcomes Information System (PROMIS
®
) Itch Questionnaire: itch severity assessments in adults with atopic dermatitis*. Br J Dermatol 2020; 183:891-898. [DOI: 10.1111/bjd.18978] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 01/15/2023]
Affiliation(s)
- J.I. Silverberg
- Department of Dermatology The George Washington University School of Medicine and Health Sciences Washington DC USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - J.‐S. Lai
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
| | - K.R. Patel
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - V. Singam
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - P.P. Vakharia
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - R. Chopra
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - R. Sacotte
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - R. Kantor
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - D.Y. Hsu
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - D. Cella
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL USA
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Lei D, Yousaf M, Janmohamed S, Vakharia P, Chopra R, Sacotte R, Patel K, Singam V, Immaneni S, Kantor R, Hsu D, Silverberg J. Validation of Patient‐Reported Outcomes Information System Sleep Disturbance and Sleep‐Related Impairment in adults with atopic dermatitis*. Br J Dermatol 2020; 183:875-882. [DOI: 10.1111/bjd.18920] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 12/17/2022]
Affiliation(s)
- D.K. Lei
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - M. Yousaf
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - S.R. Janmohamed
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - P.P. Vakharia
- Department of Dermatology University of Texas Southwestern Medical Center Dallas TX USA
| | - R. Chopra
- State University of New York Downstate Medical Center Brooklyn NY USA
| | - R. Sacotte
- Department of Dermatology Medical College of Wisconsin Milwaukee WI USA
| | - K.R. Patel
- Department of Internal Medicine Massachusetts General Hospital Boston MA USA
| | - V. Singam
- Department of Internal Medicine Weiss Memorial Hospital Chicago IL USA
| | - S. Immaneni
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - R. Kantor
- State University of New York Downstate Medical Center Brooklyn NY USA
| | - D.Y. Hsu
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - J.I. Silverberg
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology The George Washington University School of Medicine and Health Sciences Washington DC USA
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Patel KR, Singam V, Vakharia PP, Chopra R, Sacotte R, Patel N, Immaneni S, Kantor R, Hsu DY, Silverberg JI. Measurement properties of three assessments of burden used in atopic dermatitis in adults. Br J Dermatol 2018; 180:1083-1089. [PMID: 30246360 DOI: 10.1111/bjd.17243] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Standardized quality-of-life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). OBJECTIVES To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5-dimensions (5-D) itch scales for assessing burden of AD in adults and to compare their performance. METHODS Self-administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. RESULTS DLQI, ItchyQoL and 5-D all had good content validity. DLQI, mean ItchyQoL and 5-D itch all had strong correlations with frequency of AD symptoms (Patient-Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0·001 for all). DLQI and 5-D itch showed good internal consistency (Cronbach's alpha = 0·89 and 0·84), although ItchyQoL appeared to have several redundant items (alpha = 0·96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5-D itch. DLQI, ItchyQoL and 5-D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5-D itch were 2 min. CONCLUSIONS The DLQI, ItchyQoL and 5-D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice.
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Affiliation(s)
- K R Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - V Singam
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - P P Vakharia
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Chopra
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Sacotte
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - N Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - S Immaneni
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - R Kantor
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - D Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A
| | - J I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
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Patel K, Singam V, Vakharia P, Chopra R, Sacotte R, Rastogi S, Lee H, Patel N, Immaneni S, Kantor R, Hsu D, Silverberg J. LB1526 Comparison of DLQI, ItchyQOL, and 5-D itch scale for the assessment of the burden of atopic dermatitis in adults. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.06.058] [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: 10/28/2022]
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Vakharia P, Chopra R, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Simpson E, Silverberg J. 成年异位性皮炎患者中的五种患者报告结果的严重性等级. Br J Dermatol 2018. [DOI: 10.1111/bjd.16581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vakharia P, Chopra R, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Simpson E, Silverberg J. Severity strata for five patient‐reported outcomes in adults with atopic dermatitis. Br J Dermatol 2018. [DOI: 10.1111/bjd.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vakharia PP, Chopra R, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu DY, Simpson EL, Silverberg JI. Severity strata for five patient-reported outcomes in adults with atopic dermatitis. Br J Dermatol 2018; 178:925-930. [PMID: 29048751 DOI: 10.1111/bjd.16078] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several patient-reported outcomes have been used to assess the burden of atopic dermatitis (AD). Some are disease specific, such as the Patient-Oriented Eczema Measure (POEM), while others pertain to itch, for example the numerical rating scale (NRS)-itch, ItchyQoL and 5-D itch, or dermatological disease in general, for example the Dermatology Life Quality Index (DLQI). Development of severity strata is essential for proper interpretability of these assessments. OBJECTIVES To confirm previously developed strata for POEM, DLQI and raw ItchyQoL, and develop strata for the NRS-itch, mean ItchyQoL and 5-D itch scale for use in adults with AD. METHODS Self-administered questionnaires were completed by 210 adults with AD in a dermatology practice setting. Strata were selected using an anchoring approach based on patient-reported disease severity. RESULTS We confirmed the existing strata for POEM (mild 0-7, moderate 8-16, severe 17-28; κ = 0·440), DLQI (mild 0-5, moderate 6-10, severe 11-30; κ = 0·398) and NRS-itch (mild 0-3, moderate 4-6, severe 7-10; κ = 0·499). However, the preferred band for raw ItchyQoL was mild 22-58, moderate 59-74 and severe 75-110 (κ = 0·379) and for mean ItchyQoL, mild 1-2·9, moderate 3·0-3·9, severe 4·0-5·0 (κ = 0·374). The preferred band for 5-D itch scale was mild 0-11, moderate 12-17 and severe 18-25 (κ = 0·331). CONCLUSIONS Existing strata for POEM and DLQI performed well in adult AD. Previously reported strata for visual analogue scale-itch performed best for NRS-itch. We identified banding for the raw ItchyQoL for our AD population that varies slightly from the banding published for a more heterogeneous population. Finally, we proposed strata for mean ItchyQoL and 5-D itch scale in adult AD.
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Affiliation(s)
- P P Vakharia
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - R Chopra
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - R Sacotte
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - N Patel
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - S Immaneni
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - T White
- Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
| | - R Kantor
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - D Y Hsu
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Preventive Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A
| | - E L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - J I Silverberg
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, 60611, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
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15
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Vakharia PP, Chopra R, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu DY, Silverberg JI. Validation of patient-reported global severity of atopic dermatitis in adults. Allergy 2018; 73:451-458. [PMID: 28905999 DOI: 10.1111/all.13309] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research. OBJECTIVES We sought to validate patient-reported global AD severity in adults. METHODS We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 265). RESULTS At baseline and follow-up, patient-reported global AD severity significantly correlated with oSCORAD (Spearman ρ = 0.56 and 0.49), SCORAD (0.64 and 0.56), EASI (0.56 and 0.50), BSA (0.52 and 0.45), NRS-itch (0.60 and 0.53), POEM (0.50 and 0.48), and DLQI (0.50 and 0.49) (P < .0001 for all). Patient-reported moderate and severe AD vs mild AD were associated with significantly higher oSCORAD, SCORAD, EASI, BSA, NRS-itch, POEM, and DLQI (P < .0001 for all). There was moderate concordance between patient-reported AD severity (mild, moderate, and severe) and previously developed severity strata for oSCORAD (κ = 0.39), SCORAD (κ = 0.47), EASI (κ = 0.37), NRS-itch (κ = 0.49), POEM (κ = 0.37), and DLQI (κ = 0.40). Among patients with severe disease at baseline, those who reported mild or moderate disease on follow-up had significantly greater absolute reductions of oSCORAD (-23.4/-9.7/-1.8), SCORAD (-33.0/-13.2/-2.3), EASI (-17.1/-9.8/-3.2), BSA (-46%/-15%/-4%), NRS-itch (-5/-2/0), POEM (-5/-2/0), and DLQI (-8/-6/-1) than those who continued to report severe disease (Kruskal-Wallis, P ≤ .0003 for all). CONCLUSIONS Patient-reported AD severity appears to be sufficiently valid for assessing AD severity in the clinical and epidemiological setting.
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Affiliation(s)
- P. P. Vakharia
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - R. Chopra
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - R. Sacotte
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - N. Patel
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - S. Immaneni
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - T. White
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - R. Kantor
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - D. Y. Hsu
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; Chicago IL USA
| | - J. I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences; Feinberg School of Medicine at Northwestern University; Chicago IL USA
- Northwestern Medicine Multidisciplinary Eczema Center; Chicago IL USA
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16
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Chopra R, Vakharia P, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Silverberg J. Severity strata for Eczema Area and Severity Index (
EASI
), modified
EASI
, Scoring Atopic Dermatitis (
SCORAD
), objective
SCORAD
, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol 2017; 177:1316-1321. [DOI: 10.1111/bjd.15641] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 01/13/2023]
Affiliation(s)
- R. Chopra
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - P.P. Vakharia
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - R. Sacotte
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - N. Patel
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - S. Immaneni
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - T. White
- Northwestern Medicine Multidisciplinary Eczema Center Chicago IL U.S.A
| | - R. Kantor
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - D.Y. Hsu
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
| | - J.I. Silverberg
- Department of Dermatology Feinberg School of Medicine at Northwestern University Chicago IL 60611 U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center Chicago IL U.S.A
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Vakharia P, Chopra R, Sacotte R, Patel N, Immaneni S, Kantor R, Hsu D, Silverberg J. 382 Adult-onset atopic dermatitis is associated with a distinct phenotype. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.399] [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: 10/19/2022]
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18
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Sacotte R, Vakharia P, Chopra R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Simpson E, Silverberg J. 383 Establishing severity strata for 5 different patient-reported outcomes in adults with atopic dermatitis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Chopra R, Vakharia P, Sacotte R, Patel N, Immaneni S, White T, Kantor R, Hsu D, Silverberg J. 394 Comparison of EASI and objective-SCORAD assessments in adult atopic dermatitis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.411] [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: 10/19/2022]
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20
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Kantor R, Thyssen JP, Paller AS, Silverberg JI. Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'. Allergy 2016; 71:1480-5. [PMID: 27392131 DOI: 10.1111/all.12982] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The lack of standardized nomenclature for atopic dermatitis (AD) creates unnecessary confusion for patients, healthcare providers, and researchers. It also negatively impacts accurate communication of research in the scientific literature. We sought to determine the most commonly used terms for AD. METHODS A systematic review of the MEDLINE, EMBASE, and LILACS (1945-2016) for the terms AD, atopic eczema (AE), and multiple other eczematous disorders. RESULTS In MEDLINE, 33 060 were identified, of which 21 299 (64.4%) publications used the term 'AD', 15 510 (46.9%) 'eczema', and only 2471 (7.5%) AE. Most of these publications used the term AD (82.0%) or eczema (70.8%) without additional nomenclature; only 1.2% used AE alone. Few publications used the terminology 'childhood eczema', 'flexural eczema', 'infantile eczema', 'atopic neurodermatitis', or 'Besnier's prurigo'. AD was rarely used until the late 1970s, after which it became the most commonly used of the three terms and continuously increased until 2015. Atopic eczema decreased between 2008 and 2015. Atopic dermatitis was the most commonly used term in studies across almost all publication types, languages, and journals. CONCLUSION Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education. Support from researchers, reviewers, and editors is key to success.
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Affiliation(s)
- R. Kantor
- Department of Dermatology; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - J. P. Thyssen
- Department of Dermatology and Allergy; Herlev-Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
| | - A. S. Paller
- Departments of Dermatology and Pediatrics; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - J. I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
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21
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Hsu D, Kantor R, Silverberg J. 164 The inpatient burden of psoriasis: A nationwide analysis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Hsu D, Brieva J, Kantor R, Silverberg J. 163 Comorbidities and inpatient mortality of pemphigus: A nationwide analysis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Dinesha T, Sivamalar S, Gomathi S, Boobalan J, Poongulali S, Kumarasamy N, Balakrishnan P, Solomon S, Solomon S, katzenstein D, Kantor R, Saravanan S. Archived drug resistance profile among suppressed HIV patients using conventional and sensitive allele specific PCR in Tenofovir experienced patients in South India. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Kantor R, Bonblík T. Vapour Liquid Equilibria for Pure Fluids from the Perturbation Theory of the Kihara Molecule Systems. ACTA ACUST UNITED AC 2014. [DOI: 10.1002/bbpc.198800284] [Citation(s) in RCA: 10] [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: 11/06/2022]
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25
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26
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Deforche K, Camacho R, Grossman Z, Silander T, Soares MA, Moreau Y, Shafer RW, Van Laethem K, Carvalho AP, Wynhoven B, Cane P, Snoeck J, Clarke J, Sirivichayakul S, Ariyoshi K, Holguin A, Rudich H, Rodrigues R, Bouzas MB, Cahn P, Brigido LF, Soriano V, Sugiura W, Phanuphak P, Morris L, Weber J, Pillay D, Tanuri A, Harrigan PR, Shapiro JM, Katzenstein DA, Kantor R, Vandamme AM. Bayesian network analysis of resistance pathways against HIV-1 protease inhibitors. Infect Genet Evol 2006; 7:382-90. [PMID: 17127103 DOI: 10.1016/j.meegid.2006.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 11/23/2022]
Abstract
Interpretation of Human Immunodeficiency Virus 1 (HIV-1) genotypic drug resistance is still a major challenge in the follow-up of antiviral therapy in infected patients. Because of the high degree of HIV-1 natural variation, complex interactions and stochastic behaviour of evolution, the role of resistance mutations is in many cases not well understood. Using Bayesian network learning of HIV-1 sequence data from diverse subtypes (A, B, C, F and G), we could determine the specific role of many resistance mutations against the protease inhibitors (PIs) nelfinavir (NFV), indinavir (IDV), and saquinavir (SQV). Such networks visualize relationships between treatment, selection of resistance mutations and presence of polymorphisms in a graphical way. The analysis identified 30N, 88S, and 90M for nelfinavir, 90M for saquinavir, and 82A/T and 46I/L for indinavir as most probable major resistance mutations. Moreover we found striking similarities for the role of many mutations against all of these drugs. For example, for all three inhibitors, we found that the novel mutation 89I was minor and associated with mutations at positions 90 and 71. Bayesian network learning provides an autonomous method to gain insight in the role of resistance mutations and the influence of HIV-1 natural variation. We successfully applied the method to three protease inhibitors. The analysis shows differences with current knowledge especially concerning resistance development in several non-B subtypes.
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Affiliation(s)
- K Deforche
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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27
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Deforche K, Silander T, Camacho R, Grossman Z, Soares MA, Van Laethem K, Kantor R, Moreau Y, Vandamme AM. Analysis of HIV-1 pol sequences using Bayesian Networks: implications for drug resistance. ACTA ACUST UNITED AC 2006; 22:2975-9. [PMID: 17021157 DOI: 10.1093/bioinformatics/btl508] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [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: 11/13/2022]
Abstract
Human Immunodeficiency Virus-1 (HIV-1) antiviral resistance is a major cause of antiviral therapy failure and compromises future treatment options. As a consequence, resistance testing is the standard of care. Because of the high degree of HIV-1 natural variation and complex interactions, the role of resistance mutations is in many cases insufficiently understood. We applied a probabilistic model, Bayesian networks, to analyze direct influences between protein residues and exposure to treatment in clinical HIV-1 protease sequences from diverse subtypes. We can determine the specific role of many resistance mutations against the protease inhibitor nelfinavir, and determine relationships between resistance mutations and polymorphisms. We can show for example that in addition to the well-known major mutations 90M and 30N for nelfinavir resistance, 88S should not be treated as 88D but instead considered as a major mutation and explain the subtype-dependent prevalence of the 30N resistance pathway.
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Affiliation(s)
- K Deforche
- Rega Institute for Medical Research, Katholieke Universiteit Leuven Leuven, Belgium.
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28
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Mayan H, Kantor R, Rimon U, Golubev N, Heyman Z, Goshen E, Shalmon B, Weiss P. Fatal liver infarction after transjugular intrahepatic portosystemic shunt procedure. Liver 2001; 21:361-4. [PMID: 11589774 DOI: 10.1034/j.1600-0676.2001.210510.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hepatic infarction is a rare disease. We describe here a cirrhotic patient with end-stage renal failure and recurrent tense ascites with fatal hepatic infarction after transjugular intrahepatic portosystemic shunt (TIPS) procedure. Abdominal ultrasound, radionuclide liver scan, abdominal computed tomography scan, and finally liver biopsy established the diagnosis. The mechanism causing the infarct is not clear. However, as the infarct appeared after the patient had an episode of shock and disseminated intravascular coagulation, it could well be that the concomitant hepatic arterial insufficiency contributed to the infarct. Physicians should be aware of this possible catastrophic complication.
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Affiliation(s)
- H Mayan
- Department of Medicine E, The Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
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29
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Kantor R, Pauzner R, Golubev N, Shinfeld A, Farfel Z, Smolinsky AK. Ascending aortic pseudoaneurysm following coronary bypass in a hemodialysis patient with fever of unknown origin. J Cardiovasc Surg (Torino) 2001; 42:633-4. [PMID: 11562590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A unique patient who developed pseudoaneurysm of the ascending aorta after coronary artery bypass grafting is presented. This case is peculiar due to the presenting symptom being fever of unknown origin. It is the first description of a patient on hemodialysis, who developed ascending aortic pseudoaneurysm.
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Affiliation(s)
- R Kantor
- Department of Medicine E, Sheba Medical Center, Tel-Hashomer, 52621 Israel
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30
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Abstract
BACKGROUND Trans-tubular potassium gradient (TTKG) is considered to reflect mainly aldosterone bioactivity with regard to its kaliuretic response. We determined both TTKG and aldosterone serum concentrations in patients with severe drug-induced hyperkalemia (DIH). METHODS Ten hyperkalemic patients with serum potassium of more than 5.5 mEq/l, and serum creatinine of less than 2.5 mg/dl (221 micromol/l) were studied prospectively. Two control groups of 10 patients each were used. Control 1 group with normal renal function, and control 2 group with normokalemia and renal failure of the same magnitude as that of the hyperkalemic patients. Serum osmolarity, electrolytes, creatinine, aldosterone and urine electrolytes and osmolarity were measured and TTKG calculated. RESULTS DIH patients had lower TTKG values than control 1 patients (2.58 +/- 0.36 vs. 6.68 +/- 0.55, p < 0.001), and also lower than that of the control 2 patients (2.58 +/- 0.36 vs. 5.51 +/- 0.87, p < 0.01). Serum aldosterone concentration in the DIH group was higher than that of the control 1 group [24.30 +/- 5.0 vs. 7.4 +/- 2.1 pg/ml (674 +/- 139 vs. 205 +/- 58 pmol/l), p < 0.006] but not different from that of the control 2 group [24.3 +/- 5.0 vs. 15.3 +/- 3.8 pg/ml (674 +/- 139 vs. 424 +/- 106 pmol/l), respectively, p = 0.18]. Although there was some overlap in TTKG between DIH and control groups, 6 of 10 DIH patients had TTKG of less than 2.5, while none of the control patients had such a low value. CONCLUSION DIH is characterized by lower TTKG values than those observed in patients with normal or mild-to-moderate renal failure. Other factors in addition to aldosterone seem to be involved.
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Affiliation(s)
- H Mayan
- Department of Medicine E, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel.
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31
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Kantor R, Machekano R, Gonzales MJ, Dupnik K, Schapiro JM, Shafer RW. Human Immunodeficiency Virus Reverse Transcriptase and Protease Sequence Database: an expanded data model integrating natural language text and sequence analysis programs. Nucleic Acids Res 2001; 29:296-9. [PMID: 11125118 PMCID: PMC29795 DOI: 10.1093/nar/29.1.296] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [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: 11/12/2022] Open
Abstract
The HIV Reverse Transcriptase and Protease Sequence Database is an on-line relational database that catalogs evolutionary and drug-related sequence variation in the human immunodeficiency virus (HIV) reverse transcriptase (RT) and protease enzymes, the molecular targets of anti-HIV therapy (http://hivdb.stanford.edu). The database contains a compilation of nearly all published HIV RT and protease sequences, including submissions from International Collaboration databases and sequences published in journal articles. Sequences are linked to data about the source of the sequence sample and the antiretroviral drug treatment history of the individual from whom the isolate was obtained. During the past year 3500 sequences have been added and the data model has been expanded to include drug susceptibility data on sequenced isolates. Database content has also been integrated with didactic text and the output of two sequence analysis programs.
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Affiliation(s)
- R Kantor
- Division of Infectious Diseases, Stanford University Medical Center, Stanford, CA 94305, USA
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32
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Mayan H, Kantor R, Wollner A, Farfel Z. Acute respiratory failure with massive pulmonary infiltrates six weeks after coronary artery bypass operation. Isr Med Assoc J 2001; 3:67-8. [PMID: 11344810] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- H Mayan
- Department of Medicine E, Sheba Medical Center, Tel-Hashomer, Israel.
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33
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Kantor R, Mayan H, Yaron D. [Acquired hemophilia]. Harefuah 2000; 138:860-4. [PMID: 10883255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
One of the four types of Kaposi's sarcoma (KS), KS after organ transplantation under immunosuppression, is a well-known entity and has been abundantly described in renal, heart and liver recipients. We report the second case of cutaneous KS after lung transplantation, under regular immunosuppression, in a Sephardic Jewish woman. This case, when added to the other 10 cases of posttransplantation KS reported from Israel, all being Sephardic Jews, indicates that in Israel, Sephardic Jews are at higher risk than Ashkenazi Jews to develop posttransplantation KS. This observation should be added to the well-known increased risk of Ashkenazi Jews to develop classic KS. Moreover, in Israel Ashkenazi Jews develop classic KS at higher rates than Sephardic Jews. This apparent discrepancy in the ethnic distribution between Sephardic and Ashkenazi Jews in classic versus posttransplantation KS may shed light on the pathogenesis of KS in general.
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Affiliation(s)
- R Kantor
- Department of Medicine E, Sheba Medical Center, Tel-Hashomer, Israel
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Abstract
People without hemophilia but with autoantibodies specifically directed against the procoagulant activity of factor VIII are known to have acquired hemophilia. The bleeding diathesis in these patients is often severe and life-threatening. The definite laboratory diagnosis of this disorder includes demonstration of low factor VIII levels in plasma with a high titer of factor VIII inhibitors, but the initial suspicion for its presence should rise in view of a prolonged partial thromboblastin time (PTT) and a normal prothrombin time associated with an acquired bleeding disorder. Oral anticoagulant treatment is known to prolong PTT as well, and the merger of these 2 situations may cause delayed diagnosis of acquired hemophilia with devastating consequences. We describe here the first reported case of acquired hemophilia diagnosed in a patient treated with warfarin. In such patients prolonged PTT may be ascribed to warfarin therapy rather than to acquired hemophilia, thus causing a dangerous delay in diagnosis.
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Affiliation(s)
- R Kantor
- Department of Medicine E, Sheba Medical Center, Tel-Hashomer, Israel.
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Kantor R, Gershoni JM. [CCR5--the HIV co-receptor--now in Israel]. Harefuah 1999; 137:405-9. [PMID: 11419046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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37
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Affiliation(s)
- S Redla
- Department of Diagnostic Radiology, Hillingdon Hospital, Middlesex, UK
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38
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Kantor R, Pauzner R, Pali E, Farfel Z. [High alkaline phosphatase in subacute thyroiditis]. Harefuah 1999; 136:599-602, 659. [PMID: 10955064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Subacute thyroiditis may be hard to diagnose, therefore patients are sometimes misdiagnosed and subjected to unnecessary work-up. We report a 37-year-old man with subacute thyroiditis and a high concentration of serum alkaline phosphatase. After aspirin treatment there was clinical improvement and decrease in rapid ESR, and in high serum thyroxin and alkaline phosphatase. The increased alkaline phosphatase, seen in as many as 50% of patients, is of hepatic origin, and is not caused by high serum thyroxin. Awareness of this relationship may help in diagnosis and may prevent unnecessary diagnostic procedures, which may be invasive.
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Affiliation(s)
- R Kantor
- Dept. of Internal Medicine E, Chaim Sheba Medical Center, Tel Hashomer
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39
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Gross C, Stamilio C, Nelson H, Kantor R. Utilization of a hospital information system to identify patients who require contact precautions. Am J Infect Control 1999. [DOI: 10.1016/s0196-6553(99)80065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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40
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Abstract
The discovery of inhibition of HIV-1 by selected chemokines and their receptors instills hope in AIDS researchers, especially because a 32-bp deletion in the chemokine receptor CCR5 (delta32-CCR5) provides resistance to HIV infection. A recent report found that the highest delta32-CCR5 frequency is among Ashkenazi Jews (20.93%). In the present study, we have determined by PCR the allelic frequency of delta32-CCR5 in 520 individuals representing a spectrum of ethnic groups living in Israel. The samples were obtained from the Israeli National Laboratory of Genetic Diversity. Our results showed that Ashkenazi Jews, as to be expected, have the highest frequency (10.19%), yet not significantly higher than that which has been reported for whites of European decent. Other ethnic groups, North African Jews, non-Jews, Middle Eastern Jews, and Ethiopian Jews, gave allelic frequencies of 2.08, 1.35, 1.15, and 0, respectively. Thus, the delta32-CCR5 mutation is found in Jews with the same allelic frequency as that found for residents of their countries of origin. Therefore, it appears that the delta32-CCR5 allele has been introduced into Jewish communities world wide through intermarriage and genetic drift.
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Affiliation(s)
- R Kantor
- Department of Internal Medicine E, Sheba Medical Center, Tel-Hashomer, in connection with Tel Aviv University, Israel.
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41
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Jing J, Reed J, Huang J, Hu X, Clarke V, Edington J, Housman D, Anantharaman TS, Huff EJ, Mishra B, Porter B, Shenker A, Wolfson E, Hiort C, Kantor R, Aston C, Schwartz DC. Automated high resolution optical mapping using arrayed, fluid-fixed DNA molecules. Proc Natl Acad Sci U S A 1998; 95:8046-51. [PMID: 9653137 PMCID: PMC20926 DOI: 10.1073/pnas.95.14.8046] [Citation(s) in RCA: 229] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/1998] [Accepted: 04/23/1998] [Indexed: 02/08/2023] Open
Abstract
New mapping approaches construct ordered restriction maps from fluorescence microscope images of individual, endonuclease-digested DNA molecules. In optical mapping, molecules are elongated and fixed onto derivatized glass surfaces, preserving biochemical accessibility and fragment order after enzymatic digestion. Measurements of relative fluorescence intensity and apparent length determine the sizes of restriction fragments, enabling ordered map construction without electrophoretic analysis. The optical mapping system reported here is based on our physical characterization of an effect using fluid flows developed within tiny, evaporating droplets to elongate and fix DNA molecules onto derivatized surfaces. Such evaporation-driven molecular fixation produces well elongated molecules accessible to restriction endonucleases, and notably, DNA polymerase I. We then developed the robotic means to grid DNA spots in well defined arrays that are digested and analyzed in parallel. To effectively harness this effect for high-throughput genome mapping, we developed: (i) machine vision and automatic image acquisition techniques to work with fixed, digested molecules within gridded samples, and (ii) Bayesian inference approaches that are used to analyze machine vision data, automatically producing high-resolution restriction maps from images of individual DNA molecules. The aggregate significance of this work is the development of an integrated system for mapping small insert clones allowing biochemical data obtained from engineered ensembles of individual molecules to be automatically accumulated and analyzed for map construction. These approaches are sufficiently general for varied biochemical analyses of individual molecules using statistically meaningful population sizes.
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Affiliation(s)
- J Jing
- W. M. Keck Laboratory for Biomolecular Imaging, Department of Chemistry, New York University, 31 Washington Place, New York, NY 10003, USA
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Kantor R, Barzilai A, Varon D, Martinowitz U, Gershoni JM. Prevalence of a CCR5 gene 32-bp deletion in an Israeli cohort of HIV-1-infected and uninfected hemophilia patients. J Hum Virol 1998; 1:299-301. [PMID: 10195255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The recently discovered connection of chemokines and their receptors to HIV pathogenesis, and the description of the 32-bp deletion in the CCR5 gene (delta 32 CCR5), led to heightened excitement and numerous reports regarding their role in HIV transmission and disease progression. The populations in most of these reports, except for one, consisted of homosexual men. Our objective was to investigate the significance of delta 32 CCR5 in hemophilia patients in Israel. STUDY DESIGN/METHODS We have determined by polymerase chain reaction (PCR) the prevalence of delta 32 CCR5 in 34 HIV-seropositive Israeli patients with hemophilia A and compared them with a control group of 42 HIV-seronegative hemophilia patients. RESULTS Thirteen heterozygotes were identified among the 76 hemophilia patients tested (allelic frequency, 8.5%), 5 (14.7%) among the HIV-seropositive patients, and 8 (19%) among the noninfected. CONCLUSIONS No protective advantage to delta 32 CCR5 heterozygosity was seen as far as infection with HIV is concerned. However, a trend of a slower progression to AIDS in delta 32 CCR5 heterozygotes compared with wild-type homozygotes may be apparent, although no absolute correlation could be made.
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Affiliation(s)
- R Kantor
- Department of Internal Medicine E, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Kantor R, Salai M, Ganel A. Orthopaedic long term aspects of bladder exstrophy. Clin Orthop Relat Res 1997:240-5. [PMID: 9020224] [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: 01/31/2023]
Abstract
This study evaluates long term orthopaedic aspects of children with bladder exstrophy who were operated on using different techniques and at different ages. Data were accumulated from 20 patients with an age range of 2 to 29 years (average, 13 years). Fourteen patients underwent pelvic osteotomy. Interviews and physical examinations confirmed that, in the long term, children with classical bladder exstrophy do not have significant orthopaedic problems or disability, whether or not they underwent pelvic osteotomy. Radiographic imaging showed normal hip joint configuration with marked pubic diastasis. There were no clinical problems associated with the diastasis. Pelvic computed tomography studies in 7 patients showed marked remodeling of the femora and acetabula. Radiographs of the spine showed a curve in 7 (47%) of the patients, but in only 3 cases was the curve larger than 10 degrees. Pelvic osteotomy is indicated during surgical correction of bladder exstrophy to facilitate closure of the abdominal wall to prevent postoperative wound dehiscence and possibly achieve better urinary control in older age. However, there is no clear indication for pelvic osteotomy from an orthopaedic point of view.
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Affiliation(s)
- R Kantor
- Sheba Medical Center, Tel-Hashomer, Israel
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44
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Ruffin MT, Kantor R. Adults' knowledge about the use of child restraint devices. Fam Med 1992; 24:382-5. [PMID: 1526388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Injuries are the number one cause of morbidity and mortality among children age 14 and younger in the United States, and motor vehicle crashes account for most of these injuries. Although child restraint devices (CRDs) have been shown to protect children involved in motor vehicle crashes, only minimal decreases in mortality and morbidity have occurred since their introduction. This study evaluated the accuracy and sources of adult knowledge about CRDs. METHODS A self-administered questionnaire was completed by patients at a community-based family practice clinic to obtain demographic information, assess knowledge of recommendations for CRD use, and identify sources of this knowledge. RESULTS Of the 368 participants, 36% were men, 52% were women, and 12% did not indicate gender. The frequencies of correct responses on positioning infants younger than nine months of age and weighing less than 20 lbs in a CRD were: upright, 47%; rear middle-seat location, 22%; and rear facing, 54%. For toddlers older than nine months who weighed more than 20 lbs, the frequencies of correct responses on positioning were: using a booster seat plus a seat belt, 71%; rear-middle location, 17%; and front facing, 66%. In addition, only 42% of the respondents correctly identified the booster seat as not crash-test certified, and 44% indicated that a CRD should not be reused after an accident. The majority of respondents indicated that the year of manufacture was important and that loose objects in the car were not safe. TV/radio (51%), newspaper/magazine (41%), and relatives (31%) were the most common sources of information about CRD use. CONCLUSION Our findings suggest that a lack of knowledge about CRD use among adults contributes to improper use of these devices. This may explain the minimal effect CRD use has had on reducing morbidity and mortality of children from motor vehicle crashes.
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Affiliation(s)
- M T Ruffin
- Department of Family Practice, University of Michigan Medical School, Ann Arbor 48109-0708
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Le Rebeller MJ, Safi N, Larson S, Beba R, Kantor R, Donoso L. [Monoclonal antibodies and uveal melanomas]. Ophtalmologie 1989; 3:180-2. [PMID: 2641105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The authors, who have succeeded since 1976 in cultivating cells of ocular melanoma in continuous lines report the different stages for producing specific monoclonal antibodies. They particularly insist on the demonstration, through radioimmunoassay, of the specificity of marked monoclonal antibodies, on the immunohistochemical study and on biodistribution. From these data, an immunotherapy protocol has been perfected and starts being applied to human beings.
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Ortaldo JR, Winkler-Pickett R, Morgan AC, Woodhouse C, Kantor R, Reynolds CW. Analysis of rat natural killer cytotoxic factor (NKCF) produced by rat NK cell lines and the production of a murine monoclonal antibody that neutralizes NKCF. J Immunol 1987; 139:3159-65. [PMID: 3668253] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Natural killer cytotoxic factor (NKCF) is produced as a result of the interaction of murine, rat, or human natural killer (NK) cells with NK-susceptible targets. This factor has been linked to the target cell lysis mediated by the NK effector cell. In the present results, culture supernatants from rat large granular lymphocyte (LGL) tumors exhibited NKCF activity which lysed the susceptible targets, MBL-2 and YAC-1. NKCF production from these rat tumor lines was spontaneous and was not significantly increased by co-incubation of the LGL tumors with target cells, target cell membranes, or by preincubation of the LGL tumor cells with interferon or interleukin 2. In addition to NKCF activity, the supernatants lysed L929, indicating the presence of tumor necrosis factor (TNF) in these preparations. The presence of this latter cytokine was verified using specific antibodies to recombinant murine TNF which neutralized the L929 activity while not affecting the NKCF activity against MBL-2 or YAC-1. Mouse monoclonal antibodies (mAb) A0287, A0462, and A0316) which significantly inhibit the NKCF cytolytic activity of these LGL-derived supernatants were also produced. These antibodies were shown to cross-react with human NKCF in a manner similar to that seen in the rat. Interestingly these same mAb demonstrated no inhibition of L929 cytotoxicity from either LGL-derived supernatants or by recombinant murine or human TNF. To examine further the specificity of these antibodies, they were chemically linked to Sepharose 4B and found to remove a significant proportion of the NKCF cytolytic activity from LGL supernatants, while not affecting the TNF reactivities in these preparations. In addition, these antibodies demonstrated significant inhibition of cell-mediated cytotoxicity by rat LGL against YAC-1 target cells. Biochemical analysis of labeled NKCF-containing supernatants indicated the major protein recognized by these anti-NKCF mAb to be approximately 12,000 m.w. The use of these mAb against NKCF should be very useful in further purification and biochemical characterization of NKCF and in studying its role in a variety of cell-mediated cytotoxicity assays.
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Affiliation(s)
- J R Ortaldo
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
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47
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Ortaldo JR, Winkler-Pickett R, Morgan AC, Woodhouse C, Kantor R, Reynolds CW. Analysis of rat natural killer cytotoxic factor (NKCF) produced by rat NK cell lines and the production of a murine monoclonal antibody that neutralizes NKCF. The Journal of Immunology 1987. [DOI: 10.4049/jimmunol.139.9.3159] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Natural killer cytotoxic factor (NKCF) is produced as a result of the interaction of murine, rat, or human natural killer (NK) cells with NK-susceptible targets. This factor has been linked to the target cell lysis mediated by the NK effector cell. In the present results, culture supernatants from rat large granular lymphocyte (LGL) tumors exhibited NKCF activity which lysed the susceptible targets, MBL-2 and YAC-1. NKCF production from these rat tumor lines was spontaneous and was not significantly increased by co-incubation of the LGL tumors with target cells, target cell membranes, or by preincubation of the LGL tumor cells with interferon or interleukin 2. In addition to NKCF activity, the supernatants lysed L929, indicating the presence of tumor necrosis factor (TNF) in these preparations. The presence of this latter cytokine was verified using specific antibodies to recombinant murine TNF which neutralized the L929 activity while not affecting the NKCF activity against MBL-2 or YAC-1. Mouse monoclonal antibodies (mAb) A0287, A0462, and A0316) which significantly inhibit the NKCF cytolytic activity of these LGL-derived supernatants were also produced. These antibodies were shown to cross-react with human NKCF in a manner similar to that seen in the rat. Interestingly these same mAb demonstrated no inhibition of L929 cytotoxicity from either LGL-derived supernatants or by recombinant murine or human TNF. To examine further the specificity of these antibodies, they were chemically linked to Sepharose 4B and found to remove a significant proportion of the NKCF cytolytic activity from LGL supernatants, while not affecting the TNF reactivities in these preparations. In addition, these antibodies demonstrated significant inhibition of cell-mediated cytotoxicity by rat LGL against YAC-1 target cells. Biochemical analysis of labeled NKCF-containing supernatants indicated the major protein recognized by these anti-NKCF mAb to be approximately 12,000 m.w. The use of these mAb against NKCF should be very useful in further purification and biochemical characterization of NKCF and in studying its role in a variety of cell-mediated cytotoxicity assays.
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Affiliation(s)
- J R Ortaldo
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
| | - R Winkler-Pickett
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
| | - A C Morgan
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
| | - C Woodhouse
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
| | - R Kantor
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
| | - C W Reynolds
- Laboratory of Experimental Immunology, National Cancer Institute-Frederick Cancer Research Facility, MD 21701-1013
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Kantor R, Saxton H. Abnormal head and neck movements associated with esophageal perforation and abscess caused by an ingested foreign body. Dysphagia 1987; 2:50-1. [PMID: 3507292 DOI: 10.1007/bf02406979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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49
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Emerson D, Kantor R, Arnaud P, Galbraith RM. Studies of the normal human placental syncytiotrophoblast membrane: a combined immunological and physiochemical approach. Am J Reprod Immunol (1980) 1983; 3:32-42. [PMID: 6859373 DOI: 10.1111/j.1600-0897.1983.tb00209.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In view of the importance of the syncytiotrophoblast in the immunobiology of human pregnancy, the composition of this interface between fetus and mother was further studied by a combination of physicochemical and immunological approaches. Trophoblast membranes were solubilized using three classes of detergents: zwitterionic (sulfobetaine14), non-ionic (Triton X-100), and anionic (deoxycholate). Quantitative studies of protein released demonstrated the importance of dispersion of membranes into detergent, and optimum solubilization was then obtained at detergent:protein ratios of 1.3:1 for sulfobetaine, 2.5:1 for Triton X-100, and 4.4:1 for deoxycholate. Analysis of chaotrope-treated detergent-solubilized membrane components was performed by preparative isoelectric focusing followed by combined physiocochemical and immunological methods. The results revealed three major proteins which were identified as placental alkaline phosphatase, albumin, and transferrin. Certain additional low molecular weight proteins were also evident; one of these components displayed physicochemical properties similar to those of actin, but none appeared to be recognized by conventional heteroantisera raised to trophoblast membrane. These findings and the results of further immunological analysis by affinity chromatography are consistent with the concept that human trophoblast may express limited immunogenicity due in part to the presence of large amounts of absorbed maternal serum components and limited expression of fetal proteins.
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50
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Ng AK, Giacomini P, Kantor R, Ferrone S. Molecular heterogeneity and shedding of a high-molecular-mass melanoma-associated antigen identified with monoclonal antibodies. Clin Chem 1982; 28:2347-50. [PMID: 6183026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This review briefly discusses some recent developments in the use of monoclonal antibodies to study antigens of high molecular mass associated with melanomas, including information on their molecular profile, their heterogeneity, and the effect of interferon on their shedding by melanoma cells.
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