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Maini R, Saini N, Bhavana K, Bharti B, Walia S, Kori N, Kataria S, Sharma P, Deswal V, Atluri K, Sethi Y, Mandke C, Chansoria M, Rawat S, Bhat R, Dravid A, Baranwal C, Sarkar N, Jariwala S, Puius Y, Arora S. Clinico-Epidemiologic Characteristics of Patients Reported in the Mycotic Infections in COVID-19 Registry. Am J Trop Med Hyg 2023; 108:584-587. [PMID: 36535246 PMCID: PMC9978542 DOI: 10.4269/ajtmh.22-0503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022] Open
Abstract
We update results from the Mycotic Infections in COVID-19 (MUNCO) Registry, May-September 2021. Data collection from May to September 2021 yielded 728 cases from India, Nepal, Bangladesh, Thailand, and the United States. The cases consisted of mostly mucormycosis (97.6%), primarily rhinocerebral, and were analyzed to investigate clinical characteristics associated with negative outcomes. Patients were mostly diabetic (85%) and male (76%), with significant mortality (11.7%). All patients received treatment of coronavirus disease 2019 (COVID-19) as well as antifungal treatment. The crude mortality rate was 11.3% for mucormycosis and 22.7% formixed infections. This study demonstrates the utility of online databases in the collection of high-caliber data.
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Affiliation(s)
- Rohan Maini
- Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Neha Saini
- Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kranti Bhavana
- ENT, All India Institute of Medical Sciences, Patna, India
| | | | - Shweta Walia
- Opthamology, Maharaja Yeshwantrao Hospital, Indore, India
| | - Neetu Kori
- Opthamology, Maharaja Yeshwantrao Hospital, Indore, India
| | | | - Pooja Sharma
- Medanta Institute of Medicine and Research, Delhi, India
| | - Vikas Deswal
- Medanta Institute of Medicine and Research, Delhi, India
| | - Kavya Atluri
- Department of Bioinformatics, University of California, Los Angeles, California
| | - Yatin Sethi
- ENT, Venkateshwara Hospital, Dwarka, New Delhi, Delhi
| | - Charuta Mandke
- Opthalmology, HinduHrudaySamrat Balasaheb Thackarey Medical College, Mumbai, India
| | - Mayank Chansoria
- Emergency Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Sumit Rawat
- Microbiology, Bundelkhand Medical College, Sagar, India
| | | | - Ameet Dravid
- Infectious Diseases, Noble Hospital, Pune, India
| | | | - Nirmal Sarkar
- Pulmonology and Chest Medicine, Sarkari Kormochari Hospital, Dhaka, Bangladesh
| | - Sunit Jariwala
- Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yoram Puius
- Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Address correspondence to Yoram Puius or Shitij Arora, Department of Internal Medicine, Montefiore Medical Center, NW651, 111 E 210TH STREET, BRONX, NY 10467. E-mails: or
| | - Shitij Arora
- Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Address correspondence to Yoram Puius or Shitij Arora, Department of Internal Medicine, Montefiore Medical Center, NW651, 111 E 210TH STREET, BRONX, NY 10467. E-mails: or
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Valle A, Yu NC, Giannakakos V, Maini R, Shaines M. A Case of Latent Plasmodium Falciparum Malaria in a Patient With Coexisting Systemic Lupus Erythematosus (SLE) and Neuromyelitis Optica Spectrum Disorder (NMOSD). Cureus 2022; 14:e30436. [DOI: 10.7759/cureus.30436] [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] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
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Oommen A, Thomas J, Parmar P, Rosengarten S, Wilson C, Maini R, Kim JM, Mecklenburg M, Daniel P, Brietman I. Altered Mental Status: An Important but Overlooked Presenting Symptom of COVID-19 in Older Adults. Am J Geriatr Psychiatry 2021; 29:1166-1170. [PMID: 34257003 PMCID: PMC8196474 DOI: 10.1016/j.jagp.2021.06.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine whether altered mental status (AMS) as a presenting symptom in older adults with COVID-19 is independently associated with adverse outcomes. METHODS A retrospective single center observational study of admitted patients (n = 421) age greater than 60 and a positive COVID-19 test. Outcomes included mortality, intubation, acute respiratory distress syndrome, acute kidney injury, and acute cardiac injury. Multivariate regression analysis was used to determine if presenting with AMS was associated with adverse outcomes. RESULTS There was an increased risk of mortality (RR 1.29, 95% CI 1.05-1.57), intubation (RR 1.52, 95% CI 1.09-2.12) and AKI (RR 1.42, 95% CI 1.13-1.78) in patients that presented with AMS. CONCLUSIONS During a global pandemic, prognostic indicators are vital to help guide the clinical course of patients, reduce healthcare cost, and preserve life. Our study suggests that AMS can play a major role in diagnostic algorithms in older adults with COVID-19.
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Affiliation(s)
- Alvin Oommen
- SUNY Downstate Health Sciences University, Brooklyn, NY.
| | - Joel Thomas
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | | | | | - Clara Wilson
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Rohan Maini
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | | | | | - Pia Daniel
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Igal Brietman
- Department of Bariatric Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY
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4
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Daniel P, Mecklenburg M, Massiah C, Joseph MA, Wilson C, Parmar P, Rosengarten S, Maini R, Kim J, Oomen A, Zehtabchi S. Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support. Am J Emerg Med 2021; 43:103-108. [PMID: 33550100 PMCID: PMC7844386 DOI: 10.1016/j.ajem.2021.01.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 01/16/2023] Open
Abstract
Importance Initial guidelines recommended prompt endotracheal intubation rather than non-invasive ventilation (NIV) for COVID-19 patients requiring ventilator support. There is insufficient data comparing the impact of intubation versus NIV on patient-centered outcomes of these patients. Objective To compare all-cause 30-day mortality for hospitalized COVID-19 patients with respiratory failure who underwent intubation first, intubation after NIV, or NIV only. Design Retrospective study of patients admitted in March and April of 2020. Setting A teaching hospital in Brooklyn, New York City. Participants Adult COVID-19 confirmed patients who required ventilator support (non-invasive ventilation and/or endotracheal intubation) at discretion of treating physician, were included. Exposures Patients were categorized into three exposure groups: intubation-first, intubation after NIV, or NIV-only. Primary outcome 30-day all-cause mortality, a predetermined outcome measured by multivariable logistic regression. Data are presented with medians and interquartile ranges, or percentages with 95% confidence intervals, for continuous and categorical variables, respectively. Covariates for the model were age, sex, qSOFA score ≥ 2, presenting oxygen saturation, vasopressor use, and greater than three comorbidities. A secondary multivariable model compared mortality of all patients that received NIV (intubation after NIV and NIV-only) with the intubation-first group. Results A total of 222 were enrolled. Overall mortality was 77.5% (95%CI, 72–83%). Mortality for intubation-first group was 82% (95%CI, 73–89%; 75/91), for Intubation after NIV was 84% (95%CI, 70–92%; 37/44), and for NIV-only was 69% (95%CI, 59–78%; 60/87). In multivariable analysis, NIV-only was associated with decreased all-cause mortality (odds ratio [OR]: 0.30, 95%CI, 0.13–0.69). No difference in mortality was observed between intubation-first and intubation after NIV. Secondary analysis found all patients who received NIV to have lower mortality than patients who were intubated only (OR: 0.44, 95%CI, 0.21–0.95). Conclusions & Relevance Utilization of NIV as the initial intervention in COVID-19 patients requiring ventilatory support is associated with significant survival benefit. For patients intubated after NIV, the mortality rate is not worse than those who undergo intubation as their initial intervention.
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Affiliation(s)
- Pia Daniel
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Max Mecklenburg
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Chanée Massiah
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Michael A Joseph
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Clara Wilson
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Priyanka Parmar
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Rohan Maini
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Julie Kim
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Alvin Oomen
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Shahriar Zehtabchi
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
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Parmar P, James A, Rosengarten S, Oommen A, Joseph M, Wilson C, Maini R, Mecklenburg M, Kim J, Edwards JA, Nakeshbandi M, Breitman I, Arquilla B, Daniel P. COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City. Int J Acad Med 2021. [DOI: 10.4103/ijam.ijam_116_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nakeshbandi M, Maini R, Daniel P, Rosengarten S, Parmar P, Wilson C, Kim JM, Oommen A, Mecklenburg M, Salvani J, Joseph MA, Breitman I. The impact of obesity on COVID-19 complications: a retrospective cohort study. Int J Obes (Lond) 2020; 44:1832-1837. [PMID: 32712623 PMCID: PMC7382318 DOI: 10.1038/s41366-020-0648-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/24/2020] [Accepted: 07/16/2020] [Indexed: 11/11/2022]
Abstract
Background Obesity is an epidemic in New York City, the global epicenter of the coronavirus pandemic. Previous studies suggest that obesity is a possible risk factor for adverse outcomes in COVID-19. Objective To elucidate the association between obesity and COVID-19 outcomes. Design Retrospective cohort study of COVID-19 hospitalized patients tested between March 10 and April 13, 2020. Setting SUNY Downstate Health Sciences University, a COVID-only hospital in New York. Participants In total, 684 patients were tested for COVID-19 and 504 were analyzed. Patients were categorized into three groups by BMI: normal (BMI 18.50–24.99), overweight (BMI 25.00–29.99), and obese (BMI ≥ 30.00). Measurements Primary outcome was 30-day in-hospital mortality, and secondary outcomes were intubation, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and acute cardiac injury (ACI). Results There were 139 patients (27%) with normal BMI, 150 patients who were overweight (30%), and 215 patients with obesity (43%). After controlling for age, gender, diabetes, hypertension, and qSOFA score, there was a significantly increased risk of mortality in the overweight (RR 1.4, 95% CI 1.1–1.9) and obese groups (RR 1.3, 95% CI 1.0–1.7) compared with those with normal BMI. Similarly, there was a significantly increased relative risk for intubation in the overweight (RR 2.0, 95% CI 1.2–3.3) and obese groups (RR 2.4, 95% CI 1.5–4.0) compared with those with normal BMI. Obesity did not affect rates of AKI, ACI, or ARDS. Furthermore, obesity appears to significantly increase the risk of mortality in males (RR 1.4, 95% CI 1.0-2.0, P = 0.03), but not in females (RR 1.2, 95% CI 0.77–1.9, P = 0.40). Conclusion This study reveals that patients with overweight and obesity who have COVID-19 are at increased risk for mortality and intubation compared to those with normal BMI. These findings support the hypothesis that obesity is a risk factor for COVID-19 complications and should be a consideration in management of COVID-19.
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Affiliation(s)
- Mohamed Nakeshbandi
- Department of Medicine, Division of Infectious Disease, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Rohan Maini
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Pia Daniel
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sabrina Rosengarten
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Priyanka Parmar
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Clara Wilson
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Julie Minjae Kim
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Alvin Oommen
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Max Mecklenburg
- Department of Emergency Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jerome Salvani
- Department of Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Michael A Joseph
- Department of Epidemiology and Biostatistics, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Igal Breitman
- Department of Bariatric Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
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Regmi MR, Tandan N, Parajuli P, Maini R, Lara Garcia OE, Jagtap P, Kulkarni A. Extracorporeal membranous oxygenation for a severe case of vaping associated lung injury. Pulmonology 2020; 27:69-70. [PMID: 32507701 DOI: 10.1016/j.pulmoe.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- M R Regmi
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States.
| | - N Tandan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - P Parajuli
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - R Maini
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - O E Lara Garcia
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - P Jagtap
- Division of Critical Care Medicine, HSHS St. John's Hospital, Springfield, IL, United States
| | - A Kulkarni
- Division of Cardiology Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
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Shanbhogue P, Hoffmann RM, Airola MV, Maini R, Hamelin DJ, Garcia-Diaz M, Burke JE, Hannun YA. The juxtamembrane linker in neutral sphingomyelinase-2 functions as an intramolecular allosteric switch that activates the enzyme. J Biol Chem 2019; 294:7488-7502. [PMID: 30890560 DOI: 10.1074/jbc.ra118.007288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/08/2019] [Indexed: 11/06/2022] Open
Abstract
Neutral sphingomyelinase 2 (nSMase2) produces the bioactive lipid ceramide and has important roles in neurodegeneration, cancer, and exosome formation. Although nSMase2 has low basal activity, it is fully activated by phosphatidylserine (PS). Previous work showed that interdomain interactions within nSMase2 are needed for PS activation. Here, we use multiple approaches, including small angle X-ray scattering, hydrogen-deuterium exchange-MS, circular dichroism and thermal shift assays, and membrane yeast two-hybrid assays, to define the mechanism mediating this interdomain interactions within nSMase2. In contrast to what we previously assumed, we demonstrate that PS binding at the N-terminal and juxtamembrane regions of nSMase2 rather acts as a conformational switch leading to interdomain interactions that are critical to enzyme activation. Our work assigns a unique function for a class of linkers of lipid-activated, membrane-associated proteins. It indicates that the linker actively participates in the activation mechanism via intramolecular interactions, unlike the canonical linkers that typically aid protein dimerization or localization.
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Affiliation(s)
- Prajna Shanbhogue
- From the Departments of Biochemistry and Cell Biology.,the Stony Brook University Cancer Center, Stony Brook, New York 11794, and
| | - Reece M Hoffmann
- the Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia V8N 1A1, Canada
| | | | - Rohan Maini
- From the Departments of Biochemistry and Cell Biology
| | - David J Hamelin
- the Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia V8N 1A1, Canada
| | - Miguel Garcia-Diaz
- Pharmacological Sciences, Stony Brook University, Stony Brook, New York 11794
| | - John E Burke
- the Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia V8N 1A1, Canada
| | - Yusuf A Hannun
- From the Departments of Biochemistry and Cell Biology, .,the Stony Brook University Cancer Center, Stony Brook, New York 11794, and.,Pharmacological Sciences, Stony Brook University, Stony Brook, New York 11794.,Medicine, and
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Abstract
A review of the development and application of haemoperfusion over ion exchange resins and polymeric adsorbents is presented. Aspects of biocompatibility and ion balance are discussed.
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Affiliation(s)
- R. Maini
- Bioengineering Unit, University of Liverpool Liverpool, England
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Airola MV, Shanbhogue P, Shamseddine AA, Guja KE, Senkal CE, Maini R, Bartke N, Wu BX, Obeid LM, Garcia-Diaz M, Hannun YA. Structure of human nSMase2 reveals an interdomain allosteric activation mechanism for ceramide generation. Proc Natl Acad Sci U S A 2017; 114:E5549-E5558. [PMID: 28652336 PMCID: PMC5514751 DOI: 10.1073/pnas.1705134114] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neutral sphingomyelinase 2 (nSMase2, product of the SMPD3 gene) is a key enzyme for ceramide generation that is involved in regulating cellular stress responses and exosome-mediated intercellular communication. nSMase2 is activated by diverse stimuli, including the anionic phospholipid phosphatidylserine. Phosphatidylserine binds to an integral-membrane N-terminal domain (NTD); however, how the NTD activates the C-terminal catalytic domain is unclear. Here, we identify the complete catalytic domain of nSMase2, which was misannotated because of a large insertion. We find the soluble catalytic domain interacts directly with the membrane-associated NTD, which serves as both a membrane anchor and an allosteric activator. The juxtamembrane region, which links the NTD and the catalytic domain, is necessary and sufficient for activation. Furthermore, we provide a mechanistic basis for this phenomenon using the crystal structure of the human nSMase2 catalytic domain determined at 1.85-Å resolution. The structure reveals a DNase-I-type fold with a hydrophobic track leading to the active site that is blocked by an evolutionarily conserved motif which we term the "DK switch." Structural analysis of nSMase2 and the extended N-SMase family shows that the DK switch can adopt different conformations to reposition a universally conserved Asp (D) residue involved in catalysis. Mutation of this Asp residue in nSMase2 disrupts catalysis, allosteric activation, stimulation by phosphatidylserine, and pharmacological inhibition by the lipid-competitive inhibitor GW4869. Taken together, these results demonstrate that the DK switch regulates ceramide generation by nSMase2 and is governed by an allosteric interdomain interaction at the membrane interface.
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Affiliation(s)
- Michael V Airola
- Stony Brook University Cancer Center, Stony Brook, NY 11794
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY 11794
| | - Prajna Shanbhogue
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY 11794
| | | | - Kip E Guja
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794
| | - Can E Senkal
- Stony Brook University Cancer Center, Stony Brook, NY 11794
- Department of Medicine, Stony Brook University, Stony Brook, NY 11794
| | - Rohan Maini
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY 11794
| | - Nana Bartke
- Danone Nutricia Research, Singapore 138671
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425
| | - Bill X Wu
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425
| | - Lina M Obeid
- Stony Brook University Cancer Center, Stony Brook, NY 11794
- Department of Medicine, Stony Brook University, Stony Brook, NY 11794
- Northport Veterans Affairs Medical Center, Northport, NY 11768
| | - Miguel Garcia-Diaz
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY 11794
| | - Yusuf A Hannun
- Stony Brook University Cancer Center, Stony Brook, NY 11794;
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY 11794
- Department of Medicine, Stony Brook University, Stony Brook, NY 11794
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Maini R, Naik F, Harrison TG, Mentasti M, Spala G, Velonakis E, Hadjichristodoulou C, de Jong B, Vatopoulos A, Phin N. Travel-associated Legionnaires’ disease in residents from England and Wales travelling to Corfu, Greece, August to October 2011. Euro Surveill 2012; 17. [PMID: 22913938 DOI: 10.2807/ese.17.32.20240-en] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- R Maini
- Health Protection Agency (HPA), London, United Kingdom
| | - F Naik
- Health Protection Agency (HPA), London, United Kingdom
| | - T G Harrison
- Health Protection Agency (HPA), London, United Kingdom
| | - M Mentasti
- Health Protection Agency (HPA), London, United Kingdom
| | - G Spala
- Hellenic Centre for Disease Control and Prevention (KEELPNO), Athens, Greece
| | - E Velonakis
- Hellenic Centre for Disease Control and Prevention (KEELPNO), Athens, Greece
| | | | - B de Jong
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A Vatopoulos
- Hellenic Centre for Disease Control and Prevention (KEELPNO), Athens, Greece
| | - N Phin
- Faculty of Health & Social Care, University of Chester, Chester, United Kingdom
- Health Protection Agency (HPA), London, United Kingdom
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Maini R, Kv P, Mg R, De Villiers F, Prj A. Fatal Cerebral Toxoplasmosis in a Heavily Immune Suppressed Patient with Waldentrom's Disease. Scott Med J 2008. [DOI: 10.1258/rsmsmj.53.4.10a] [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: 11/18/2022]
Abstract
A 57 year-old gentleman with Waldenstrom's disease developed ecthyma gangrenosum, molluscum contagiosum and fatal cerebral toxoplasmosis. The emergence of these infections is discussed in the light of drug-induced immune-suppression.
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Affiliation(s)
- R Maini
- Inverclyde Royal Hospital Larkfield Road Greenock PA16 0XN Scotland, UK
| | - Patil Kv
- Inverclyde Royal Hospital Larkfield Road Greenock PA16 0XN Scotland, UK
| | - Rainey Mg
- Inverclyde Royal Hospital Larkfield Road Greenock PA16 0XN Scotland, UK
| | - F De Villiers
- Departments of Haematology & Microbiology Road Greenock PA16 0XN Scotland, UK
| | - Ames Prj
- Inverclyde Royal Hospital Larkfield Road Greenock PA16 0XN Scotland, UK
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Maini R, Dart JKG. The management of severe sclerokeratitis following corneal transplantation surgery. Br J Ophthalmol 2006; 90:918-20. [PMID: 16782954 PMCID: PMC1857148 DOI: 10.1136/bjo.2005.089789] [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: 11/04/2022]
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Tan J, Olver J, Wright M, Maini R, Neoh C, Dickinson AJ. The use of porous polyethylene (Medpor) lower eyelid spacers in lid heightening and stabilisation. Br J Ophthalmol 2004; 88:1197-200. [PMID: 15317715 PMCID: PMC1772304 DOI: 10.1136/bjo.2003.029397] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The management of lower eyelid retraction can be challenging, and established techniques to correct it are not always successful. Previous reports have suggested a role for the ultrathin high density porous polyethylene lower eyelid spacer (Medpor LES) in such patients. The authors report the experience of three surgeons implanting Medpor LES over 1 year, and ascertain whether such implants are a safe and effective alternative to autogenous spacers. METHODS A prospective, interventional, non-comparative case series of consecutive patients. Surgical indications for Medpor LES were noted. Preoperative and postoperative lower marginal reflex distance (L-MRD), vertical palpebral aperture (PA), lagophthalmos, and scleral show inferior to the limbus (LSS) were recorded, together with major and minor complications. RESULTS 32 patients (35 eyelids) had a Medpor LES inserted, 22/32 under local anaesthetic, and nine with adjunctive procedures. Mean follow up was 22 months (range 15-28 months). The Medpor LES was effective in reducing the palpebral aperture (p<0.001) and lagophthalmos (p = 0.04) and raising the lower eyelid height by reducing both L-MRD (p = 0.006) and LSS (p<0.001). However there were major complications in 7/32 patients and minor complications in 8/32, most requiring further surgery. Final outcome was good in 24/35 eyelids and satisfactory in 5/35. CONCLUSIONS Despite a good or satisfactory final outcome in the majority of patients, the value of this technique is limited by complications, and should be reserved for those unsuitable for safer techniques.
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Affiliation(s)
- J Tan
- Eye Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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Abstract
AIMS To establish the frequency and risk factors for visual loss in a primary referral cohort of hospital patients with uveitis. METHODS 561 consecutive uveitis patients attending three district hospitals were recruited and the acuity at the end of the study period recorded. A retrospective case-control study of risk factors for visual loss (permanent loss of acuity <6/9) was performed. Risk factors examined included type of uveitis, age at onset of uveitis, race, type of systemic inflammatory disease, length of follow up, and treatment variables. RESULTS Visual loss of at least 6/12 in one eye was found in 111 patients (19.9%). Only four patients (0.7%) suffered severe bilateral visual loss (6/36 or less). Visual loss was associated with age at onset >60 years (odds ratio 3.9, 95% confidence interval (CI) 2.2 to 7.0, long follow up 2.0 (1.2 to 3.3) and a history of cataract surgery 3.9 (2.1 to 7.2). It was less likely in patients with acute anterior uveitis 0.2 (0.1 to 0.3). CONCLUSION The frequency of visual loss associated with uveitis in a district hospital cohort is less than that found in referral centres and levels of legal blindness are low. Although acute anterior uveitis has a low frequency of visual loss it contributes significantly to the total burden. The ocular co-morbidity of the elderly may contribute to the increased visual loss of late onset uveitis.
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Affiliation(s)
- R Maini
- Ipswich Hospital, Suffolk, UK
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Abstract
AIMS Phototherapeutic keratectomy with an excimer laser is commonly used to treat recurrent corneal erosion syndrome. The aim of this study was to determine the success of a repeat phototherapeutic keratectomy for patients with persistent macroerosions following initial treatment with phototherapeutic keratectomy. METHODS Eight patients who failed primary phototherapeutic keratectomy for recurrent corneal erosion syndrome were treated with repeat phototherapeutic keratectomy. All patients were treated with a superficial therapeutic ablation profile with a Visx, Nidek, or Summit 193 nm excimer laser. All patients were treated for both their primary treatment and re-treatment by the same surgeon. Retrospective analysis of case records of all patients requiring re-treatment was supplemented with a telephone interview. RESULTS Over a 5 year period (October 1995 to October 2000) 76 eyes were treated for recurrent erosion syndrome with phototherapeutic keratectomy. All patients had documented macroerosions and had failed previous treatment with a lubricant at night. Eight eyes (11%) continued to have macroerosions after this initial treatment; all opted for re-treatment with phototherapeutic keratectomy. Following re-treatment none reported symptoms consistent with a macroerosion. Six of eight patients (75%) are now symptom free; 2/8 (25%) have an occasional foreign body sensation relieved by lubricants. Follow up ranged from 9-60 months with a mean of 25.5 months. CONCLUSION Re-treatment with phototherapeutic keratectomy appears to be successful for patients with macroerosions complicating recurrent corneal erosion syndrome who have failed conservative management with ocular lubricants and a primary phototherapeutic keratectomy.
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Affiliation(s)
- R Maini
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Maini R, Keeffe J, Weih LA, McCarty CA, Taylor HR. Correction of refractive error in the Victorian population: the feasibility of "off the shelf" spectacles. Br J Ophthalmol 2001; 85:1283-6. [PMID: 11673288 PMCID: PMC1723768 DOI: 10.1136/bjo.85.11.1283] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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: 11/04/2022]
Abstract
AIMS To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population. METHODS Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as -1.0 to +1.0D spherical equivalent), and myopia documented in the 40-60 year age group. RESULTS 2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by "off the shelf" spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a -3.0 to +3.0D range or 89.2% of a -3.50 to +3.50D range. CONCLUSIONS Ready made "off the shelf" spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services.
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Affiliation(s)
- R Maini
- Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia
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Feldmann M, Brennan F, Bondeson J, Paleolog E, Foxwell B, Maini R. Analysis of cytokine expression in rheumatoid synovium has provided new insights into the pathogenesis of rheumatoid arthritis and new therapeutic opportunities. Transplant Proc 2001; 33:2085-6. [PMID: 11377461 DOI: 10.1016/s0041-1345(01)01958-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Feldmann
- Kennedy Institute of Rheumatology, London, UK
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Maini R, Sullivan L, Snibson GR, Taylor HR, Loughnan MS. A comparison of different depth ablations in the treatment of painful bullous keratopathy with phototherapeutic keratectomy. Br J Ophthalmol 2001; 85:912-5. [PMID: 11466243 PMCID: PMC1724067 DOI: 10.1136/bjo.85.8.912] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To study the efficacy of phototherapeutic keratectomy (PTK) for pain relief for patients with painful bullous keratopathy and poor visual potential. METHODS Patients with painful bullous keratopathy and poor visual potential were treated with superficial PTK (8-25 microm), intermediate (50-100 microm) or deep PTK (25% stromal thickness) using the Nidek EC5000 excimer laser after manual epithelial debridement. Follow up ranged from 1 to 24 months (mean 6.5 months). Outcome measures included symptomatic relief and need for further treatment. RESULTS In the superficial PTK group five of eight (62%) patients improved symptomatically after treatment. The three (38%) who did not improve went on to have penetrating keratoplasty for pain relief. In the intermediate depth group only two of five (40%) patients had symptom alleviation. The three others (60%) required further procedures. 20 of 24 (83%) patients treated with deep PTK had significant or total alleviation of symptoms. Of these, one developed acute anterior uveitis 9 months after PTK and two required botulinum ptosis for persistent corneal epithelial defects, one of whom had three consecutive episodes of microbial keratitis. Three of 24 suffered occasional discomfort and one patient required a penetrating keratoplasty for continued pain. CONCLUSION PTK can be a useful therapeutic measure in painful bullous keratopathy with poor visual potential. Deep PTK appears to be more successful in pain management than superficial treatment.
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Affiliation(s)
- R Maini
- Centre for Eye Research Australia, Australia
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Abstract
AIMS The present study was carried out to describe the patterns of prescription and drug use in Ophthalmology in out-patients at Dr Rajendra Prasad (R.P.) Centre for Ophthalmic Sciences of All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi. METHODS Prescriptions of 1017 out-patients were audited through a specially designed form and analysed for the following: average number of drugs per prescription, duration of treatment (recorded or not), dosage forms prescribed, frequency of administration (recorded or not), number of encounters with antibiotics and percentage of drugs prescribed by generic name. RESULTS Prescription analysis showed that the average number of drugs per prescription was 3.03. Duration of treatment was recorded for only 26.4% of the drugs prescribed. The maximum number of drugs prescribed were in the form of eye drops (76%), followed by tablets (10.9%), ointments (6.4%), syrups (1%), capsules (0.7%), lotions (0.3%) and injections (0.1%). No dosage form was recorded for 4.6% of the drugs prescribed. The frequency of administration was recorded for only 77.9% of the drugs prescribed. The number of antibiotics prescribed was 1059 which constitutes 34.2% of the total number of drugs prescribed. The percentage of drugs prescribed by generic name was only 35%. CONCLUSIONS The results obtained in this study indicated an awareness of polypharmacy but a high incidence of common prescription writing errors such as not recording the duration of therapy, frequency of administration and dosage form. Moreover prescribing by generic name was also low.
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Affiliation(s)
- N R Biswas
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110029, India.
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26
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Silman A, Klareskog L, Breedveld F, Bresnihan B, Maini R, Van Riel P, Symmons D. Proposal to establish a register for the long term surveillance of adverse events in patients with rheumatic diseases exposed to biological agents: the EULAR Surveillance Register for Biological Compounds. Ann Rheum Dis 2000; 59:419-20. [PMID: 10834856 PMCID: PMC1753170 DOI: 10.1136/ard.59.6.419] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, Smolen J, Emery P, Harriman G, Feldmann M, Lipsky P. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet 1999; 354:1932-9. [PMID: 10622295 DOI: 10.1016/s0140-6736(99)05246-0] [Citation(s) in RCA: 1582] [Impact Index Per Article: 63.3] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Not all patients with rheumatoid arthritis can tolerate or respond to methotrexate, a standard treatment for this disease. There is evidence that antitumour necrosis factor alpha (TNFalpha) is efficacious in relief of signs and symptoms. We therefore investigated whether infliximab, a chimeric human-mouse anti-TNFalpha monoclonal antibody would provide additional clinical benefit to patients who had active rheumatoid arthritis despite receiving methotrexate. METHODS In an international double-blind placebo-controlled phase III clinical trial, 428 patients who had active rheumatoid arthritis, who had received continuous methotrexate for at least 3 months and at a stable dose for at least 4 weeks, were randomised to placebo (n=88) or one of four regimens of infliximab at weeks 0, 2, and 6. Additional infusions of the same dose were given every 4 or 8 weeks thereafter on a background of a stable dose of methotrexate (median 15 mg/week for > or =6 months, range 10-35 mg/wk). Patients were assessed every 4 weeks for 30 weeks. FINDINGS At 30 weeks, the American College of Rheumatology (20) response criteria, representing a 20% improvement from baseline, were achieved in 53, 50, 58, and 52% of patients receiving 3 mg/kg every 4 or 8 weeks or 10 mg/kg every 4 or 8 weeks, respectively, compared with 20% of patients receiving placebo plus methotrexate (p<0.001 for each of the four infliximab regimens vs placebo). A 50% improvement was achieved in 29, 27, 26, and 31% of infliximab plus methotrexate in the same treatment groups, compared with 5% of patients on placebo plus methotrexate (p<0.001). Infliximab was well-tolerated; withdrawals for adverse events as well as the occurrence of serious adverse events or serious infections did not exceed those in the placebo group. INTERPRETATION During 30 weeks, treatment with infliximab plus methotrexate was more efficacious than methotrexate alone in patients with active rheumatoid arthritis not previously responding to methotrexate.
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Affiliation(s)
- R Maini
- The Kennedy Institute of Rheumatology and The Imperial College School of Medicine at Charing Cross Hospital, London, UK.
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Abstract
Cytokines are important protein mediators of immunity, inflammation, cell proliferation, differentiation, fibrosis, etc. (Oppenheim and Saklatvala, 1993). As these are the major biological processes underlying autoimmunity, it is not surprising that there is now convincing evidence that cytokines have an important role in the pathogenesis of autoimmunity (Brennan and Feldmann, 1996; Feldmann et al., 1996). There has been much progress since we first highlighted the role of cytokines such as IFN gamma in autoimmunity in the early 1980s (Bottazzo et al., 1983). The number of cytokines molecularly cloned has increased greatly, and the biochemical and structural basis of their action are partly understood, as cytokine genes and that of their receptors have been cloned. Knowledge of cytokine signalling is rapidly expanding (see Chapter XIII). In medical terms, clear evidence of the importance of cytokines in autoimmunity is demonstrated by therapeutic advances. Thus it is possible to dramatically improve patients with rheumatoid arthritis and Crohn's disease by blocking TNF alpha, and a new target for therapy, TNF alpha, has thus been validated for both these diseases.
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Affiliation(s)
- M Feldmann
- Kennedy Institute of Rheumatology, Hammersmith, London, UK
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Abstract
PURPOSE To investigate the incidence and aetiology of epiphora in a population of 7-year-old children and determine whether a conservative management policy for congenital nasolacrimal duct obstruction (CNLDO) results in excess lacrimal dysfunction in later childhood. METHODS A postal questionnaire was sent to the parents of a large cohort of 7-year-old children previously investigated to determine the incidence and natural progression of CNLDO. They were asked about the presence of epiphora, and its relationship to atopic disease and the presence of upper respiratory tract infections (URTI). Information on epiphora had also been gathered from the same cohort at age 3 1/2 years at a routine examination. Data were compared with those for epiphora in infancy in the same cohort. RESULTS The incidence of epiphora at 3 1/2 years was 5.5%, and 7 years 7.7%. At age 7 years 70% of cases were related to atopic disease or URTI. CNLDO was not significantly related to epiphora in later childhood (p = 0.000032). CONCLUSIONS A policy of delaying nasolacrimal probing in CNLDO until after the age of 1 year does not result in a detectable excess of lacrimal dysfunction in later childhood, when epiphora is more likely to be related to atopic disease or upper respiratory tract infection.
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Affiliation(s)
- R Maini
- Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK
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Abstract
The pace of T-cell research is matched only by the speed with which fundamental advances are being developed as new therapies. This report from a recent meeting updates developments in a number of immunointervention strategies.
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Affiliation(s)
- M Feldmann
- Charing Cross Sunley Research Centre, Hammersmith, London, UK
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35
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Brennan FM, Chantry D, Turner M, Foxwell B, Maini R, Feldmann M. Detection of transforming growth factor-beta in rheumatoid arthritis synovial tissue: lack of effect on spontaneous cytokine production in joint cell cultures. Clin Exp Immunol 1990; 81:278-85. [PMID: 2201470 PMCID: PMC1535061 DOI: 10.1111/j.1365-2249.1990.tb03331.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.2] [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: 12/30/2022] Open
Abstract
The presence of transforming growth factor-beta (TGF-beta) in inflammatory joint disease was investigated. Synovial fluid from patients with rheumatoid arthritis (RA) and patients with other non-autoimmune inflammatory joint diseases contained high levels of both active and latent TGF-beta. Levels of active TGF-beta did not correlate with drug regimen in either patient group or with the recovery period in the individuals with non-RA joint disease. Freshly isolated synovial cells from individuals with RA were shown by Northern blotting to express the mRNA for TGF-beta 1 and to secrete latent TGF-beta protein which could be neutralized by antibodies to TGF-beta 1 and TGF-beta 2. Lipopolysaccharide-stimulated peripheral blood mononuclear cells from normal donors produced interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF-alpha) which was inhibited by pretreatment of these cells with recombinant TGF-beta. Cytokine production was not inhibited if the addition of TGF-beta was used after the inducing stimulus, suggesting that in activated cells cytokine production cannot be inhibited. This was confirmed by the observation that neither TGF-beta 1 or TGF-beta 2 inhibited spontaneous IL-1 or TNF-alpha production by rheumatoid synovial mononuclear cells in culture. These findings show that despite the presence of active TGF-beta in RA synovial joints and the spontaneous production of latent (potentially active) TGF-beta by RA cells in culture, additional TGF-beta did not inhibit ongoing cytokine synthesis in vitro. This suggests that TGF-beta may not inhibit cytokine production in the rheumatoid joint although it cannot be ruled out that in vivo TGF-beta already has an immunosuppressive effect which cannot be further increased in vitro by exogenous protein.
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Affiliation(s)
- F M Brennan
- Charing Cross-Sunley Research Centre, London, England
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Abstract
The effect of tumour necrosis factor (TNF alpha) antibodies on synovial cell interleukin-1 (IL-1) production was investigated in 7 patients with rheumatoid arthritis and in 7 with osteoarthritis. Synovial cell IL-1 production was significantly reduced by anti-TNF alpha antibody in cultures from patients with rheumatoid arthritis, but antilymphotoxin antibody did not have this effect (except in 1 culture). In cultures from patients with osteoarthritis spontaneous IL-1 production was low, despite high concentrations of TNF alpha, and IL-1 production was not inhibited by anti-TNF alpha antibody. In rheumatoid arthritis, TNF alpha may be the main inducer of IL-1, and anti-TNF alpha agents may be useful in treatment.
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Affiliation(s)
- F M Brennan
- Charing Cross Sunley Research Centre, Hammersmith, London
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Hirano T, Matsuda T, Turner M, Miyasaka N, Buchan G, Tang B, Sato K, Shimizu M, Maini R, Feldmann M. Excessive production of interleukin 6/B cell stimulatory factor-2 in rheumatoid arthritis. Eur J Immunol 1988; 18:1797-801. [PMID: 2462501 DOI: 10.1002/eji.1830181122] [Citation(s) in RCA: 566] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
High levels of interleukin 6 (IL 6/B cell stimulatory factor-2) were detected in synovial fluids from the joints of patients with active rheumatoid arthritis (RA). The cells found in freshly isolated synovial fluid constitutively expressed IL 6 mRNA. The synovial tissues obtained by joint biopsy were also found to produce IL 6 in vitro. Immunohistochemical analysis demonstrated that CD2+ T cells as well as CD20+ blastoid B cells in the synovial tissues produce IL 6. The data indicate that IL 6 is generated constitutively in RA and its overproduction may explain the local as well as the generalized symptoms of RA, since IL 6 can function as B cell growth and differentiation factor as well as hepatocyte-stimulating factor.
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Affiliation(s)
- T Hirano
- Division of Immunology, Osaka University, Japan
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Buchan G, Barrett K, Fujita T, Taniguchi T, Maini R, Feldmann M. Detection of activated T cell products in the rheumatoid joint using cDNA probes to Interleukin-2 (IL-2) IL-2 receptor and IFN-gamma. Clin Exp Immunol 1988; 71:295-301. [PMID: 3127092 PMCID: PMC1541449] [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: 01/04/2023] Open
Abstract
Attempts to detect immune mediators in RA synovial fluids by bioassay or radioimmunoassay have yielded conflicting results, and so we have begun to analyse the complex immunological reactions occurring within the rheumatoid joint using recombinant DNA technology. High levels of Interleukin-2 (IL-2) and IL-2 receptor transcripts were found in the mononuclear cells of the rheumatoid lesions. Interferon gamma (IFN gamma) mRNA was also detected, although at lower level than IL-2. To investigate the possible relevance of IL-2 and IL-2 receptor mRNA expression to the chronicity of the disease, RA joint cells were cultured in the absence of any stimulus, and the duration of mRNA expression compared to that of blood mononuclear cells (PBM), optimally stimulated. IL-2 mRNA was found to persist in culture for many days, in contrast to its transient (less than 24 h) presence in stimulated PBM. IL-2 receptor expression was also prolonged. In contrast IFN gamma mRNA, present at biopsy in 10/12 RA samples, was found to increase significantly in vitro. These results suggest that persistent T cell activation is of importance in the pathogenesis of RA, and suggests that prolonged mediator production (IL-2 and IFN gamma) may be of importance. The elevation of IFN gamma mRNA in culture and its lower relative expression suggests that there are inhibitory immunoregulatory influences within the RA joint. To determine whether abnormal IL-2 mRNA expression may be due to a genetic defect in the region controlling IL-2 gene expression, Southern blotting analysis of genomic DNA was performed with a 5' flanking probe using normal, RA and systemic lupus erythematosis patients. No abnormalities were detected.
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Affiliation(s)
- G Buchan
- Charing Cross Sunley Research Centre, Hammersmith, London, UK
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Abstract
Laboratory and clinical evaluation of a knitted Dacron graft impregnated with gelatin to confer zero porosity is described. Graft performance was tested by standard methods for biodegradation of the sealant and in vitro thrombogenicity. The gelatin sealant was removed after seven to nine days and there was no platelet adhesion to Gelseal compared with unsealed Dacron. Animal experiments revealed normal macroscopic appearances in the graft and histological disappearance of the gelatin impregnate between five and ten days, allowing a cellular response similar to unsealed Dacron. The first 100 patients to have Gelseal aortic bifurcation graft implanted at Glasgow Royal Infirmary are described. The graft did not require preclotting. Blood transfusion was not necessary in 74% of patients. There is 100% patency at 21 months. A knitted Dacron graft sealed with gelatin is a safe, nonporous prosthesis at implantation.
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Affiliation(s)
- J K Drury
- Department of Peripheral Vascular Surgery, Glasgow Royal Infirmary, Scotland
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Affiliation(s)
- R Maini
- Vascutek Ltd, Inchinnan, Renfrewshire, UK
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Guidoin RG, King M, Marois M, Martin L, Marceau D, Hood R, Maini R. New polyester arterial prostheses from Great Britain: an in vitro and in vivo evaluation. Ann Biomed Eng 1986; 14:351-67. [PMID: 2944457 DOI: 10.1007/bf02367408] [Citation(s) in RCA: 16] [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: 01/03/2023]
Abstract
Two models of knitted velour polyester prostheses have been developed in Great Britain, i.e. the VP1200K and the VP50K Triaxial. The evaluation of these new devices in vitro and in vivo in dogs has demonstrated that, while the first model has similar surgical, mechanical and healing characteristics in the short term to other commercial knitted velour prostheses, the second model has lower water permeability and superior strength and dimensional stability. On the basis of these results, clinical investigations can be undertaken.
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Ryan CJ, Pusey CD, Aslam M, Gaylor JD, Maini R, Courtney JM. Repeated membrane plasma separation with on-line sorbent treatment of plasma in the conscious rat. Artif Organs 1986; 10:135-44. [PMID: 3718274 DOI: 10.1111/j.1525-1594.1986.tb02532.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Repeated membrane plasma separation with on-line sorbent treatment of plasma was performed in unrestrained and conscious rats, thus avoiding the possible effects of repeated stress and exposure to anesthetic agents. The procedure was well tolerated, even after four consecutive perfusions. Blood flow was 0.7 ml/min, with a transmembrane pressure of 18.6 mm Hg and plasma filtration rate of 0.21 ml/min. This allowed 12 ml of plasma (greater than 1 plasma volume) to be treated within 1 h. Levels of albumin, immunoglobulin G, and C3 remained constant during each perfusion and were not significantly different from those of animals subjected to control procedures. Results obtained from filtrate were comparable at 15 and 60 min with values obtained from whole blood, with sieving coefficients of approximately 1. Leukocyte, erythrocyte, and thrombocyte counts remained unchanged during each plasma perfusion. A progressive rise in leukocyte counts occurred following successive perfusions, but this was true also of animals subjected to control procedures.
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Iskander MF, Maini R, Durney CH, Bragg DG. A microwave method for measuring changes in lung water content: numerical simulation. IEEE Trans Biomed Eng 1981; 28:797-804. [PMID: 7343468 DOI: 10.1109/tbme.1981.324678] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Better OS, Brunner G, Chang TM, Courtney JM, Farrell PC, Gelfand MC, Gimson A, Gurland HJ, Hoffer E, Maeda K, Maini R, Rosenbaum JL, Sideman S, Taitleman U, Winchester JF. Controlled trials of hemoperfusion for intoxication. Ann Intern Med 1979; 91:925. [PMID: 391120 DOI: 10.7326/0003-4819-91-6-925_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Abstract
The rationale behind the design of a sorbent-based detoxification system for use as a liver assist is presented. A membrane-based plasmapheresis system giving high plasma flows (greater than 40 ml/min) with maximum transmission of albumin makes this concept feasible.
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Maini R. Haemoperfusion over ion exchange resins and polymeric adsorbents. Int J Artif Organs 1978; 1:196-201. [PMID: 669844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A review of the development and application of haemoperfusion over ion exchange resins and polymeric adsorbents is presented. Aspects of biocompatibility and ion balance are discussed.
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Baillie H, Maini R. Studies on sorbents for use in a hepatic support system. Int J Artif Organs 1978; 1:84-7. [PMID: 681004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A range of adsorbent and ion exchange materials has been tested for the sorption of fatty acids (hexanoic, octanoic and oleic), bilirubin and bromosulphthalein from human plasma. The importance of sorbent particle size for the kinetics of removal of strongly protein bound substances is shown. A system allowing the use of small particle size bioincompatible sorbents for detoxification is presented.
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Gaylor JDS, Gilroy K, Maini R, McNair A, Ton HY. Experimental Membrane Oxygenators with Convective Mixing for Gas Transfer Augmentation. Artif Organs 1977. [DOI: 10.1007/978-1-349-03458-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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