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Abdulfattah A, John S. Navigating Diagnostic Challenges: Severe Pulmonary Hypertension in Acute Exacerbation of Chronic Obstructive Pulmonary Disease vs. Pulmonary Embolism. Cureus 2024; 16:e56907. [PMID: 38659531 PMCID: PMC11042794 DOI: 10.7759/cureus.56907] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
A 63-year-old male with an unremarkable medical history presented to the emergency room (ER) with shortness of breath and bilateral lower extremity edema. In the ER, he was found to be hypoxic and hypercapnic on an arterial blood gas. CT angiography of the chest revealed severe emphysematous changes and large right apical bullae. A bedside point-of-care ultrasound demonstrated many bilateral B-lines as well as normal ejection fraction (EF). An echocardiogram revealed a small left ventricular cavity with an EF of 65%, severely dilated right ventricle, severe right ventricular dysfunction, "D" shaped interventricular septum, severely dilated right atrium, and severe pulmonary arterial hypertension (PAH) with a calculated pulmonary artery systolic pressure of 72 mmHg. The patient was initiated on bilevel positive airway pressure, glucocorticoids, bronchodilator nebulization, and diuretics with symptomatic improvement. Herein, this case report discusses similarities and differences between presentations and echocardiographic manifestations of severe PAH in the setting of acute exacerbation of chronic obstructive pulmonary disease and pulmonary embolism in the acute setting.
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Affiliation(s)
- Ammar Abdulfattah
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
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2
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Kurnick A, Akivis Y, Sabu J, John S. Echocardiographic Evaluation of Cardiac Masses. Curr Cardiol Rep 2023; 25:1281-1290. [PMID: 37728852 DOI: 10.1007/s11886-023-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Cardiac masses encompass a broad range of etiologies and are often initially revealed by echocardiography. The differential may change depending on the location of the mass and patients' medical history or presentation. It is important for clinicians to be aware of subtle visual characteristics on echocardiography in order to correctly diagnose the pathology. METHODS Patients who underwent transthoracic echocardiography and were found to have one or more cardiac masses between January 1, 2020, and May 15, 2023, were reviewed. Their demographic data, clinical presentation, medical history, imaging, and follow-up information were collected from hospital electronic medical records, de-identified, and used to complete this review paper. A detailed review of cardiac masses divided by cardiac chamber accompanied by real-world echocardiographic images from patients in a large inner city public hospital. We hope that this systematic review of cardiac masses with real-world echocardiographic images will help clinicians note subtle echocardiographic characteristics to aid in the diagnosis and treatment of cardiac masses.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Yonatan Akivis
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jacob Sabu
- College of Medicine, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sabu John
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Cardiovascular Medicine, Kings County Hospital, Brooklyn, NY, USA
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3
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Khatun N, Brown B, Francois J, Budzikowski AS, Salciccioli L, John S. Transthyretin Cardiac Amyloidosis Presenting as Bradycardia, Renal Failure, Atrioventricular-Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report. Cureus 2023; 15:e44532. [PMID: 37790068 PMCID: PMC10544653 DOI: 10.7759/cureus.44532] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BRASH syndrome involves the chain of events resulting from the collective effects of Bradycardia, Renal failure, Atrioventricular (AV)-nodal blockade, Shock, and Hyperkalemia. BRASH syndrome can rapidly progress to cardiac arrest. Early recognition is crucial. We present a case of transthyretin cardiac amyloidosis (ATTR-CA) in an elderly woman who presented with BRASH syndrome shortly after an AV-nodal blocker was prescribed for atrial fibrillation.
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Affiliation(s)
- Nazima Khatun
- Department of Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Bernard Brown
- Department of Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Jonathan Francois
- Department of Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Adam S Budzikowski
- Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Louis Salciccioli
- Department of Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, Kings County Hospital Center, Brooklyn, USA
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Chauhan R, Brown B, Ahmed A, Yacoub F, John S. A Case Report on Takotsubo Cardiomyopathy. Cureus 2023; 15:e45285. [PMID: 37846235 PMCID: PMC10576858 DOI: 10.7759/cureus.45285] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/18/2023] Open
Abstract
A 71-year-old female with a past medical history of hypertension, seizure disorder, chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, open abdominal aortic aneurysm repair complicated by spinal cord infarction resulting in lower extremity paraparesis with chronic urinary retention, and sacral decubitus ulcer initially presented to the emergency department (ED) complaining of a one-week history of chest pain. During her inpatient stay, acute myocardial infarction and pulmonary embolism were ruled out and the patient was hemodynamically stable for discharge until she started experiencing new-onset nausea and dyspnea. Bedside electrocardiogram demonstrated ST elevations in the anterior leads with concomitant T-wave inversions in the inferolateral leads as well as a prolonged QTc. Troponin-HS was elevated at 907.69. Bedside transthoracic echocardiogram (TTE) demonstrated a severely decreased left ventricular ejection fraction of 10%-15% (representing an acute decrease from a left ventricular ejection fraction of 55%-60% from a TTE performed seven days prior). Cardiac catheterization demonstrated mild non-obstructive coronary artery disease and no interventions were conducted. Such signs and symptoms of acute myocardial infarction, without demonstrable coronary artery stenosis, are consistent with stress induced or Takotsubo cardiomyopathy. This phenomenon occurs in approximately 1%-2% of patients presenting with troponin-positive suspected acute coronary syndrome (ACS) or suspected ST-elevation myocardial infarction (STEMI).
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Affiliation(s)
- Riddhi Chauhan
- Department of Cardiology, New York City Health and Hospitals/Kings County, Brooklyn, USA
| | - Bernard Brown
- Department of Cardiology, New York City Health and Hospitals/Kings County, Brooklyn, USA
| | - Alam Ahmed
- Department of Cardiology, New York City Health and Hospitals/Kings County, Brooklyn, USA
| | - Fadi Yacoub
- Department of Cardiology, New York City Health and Hospitals/Kings County, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, New York City Health and Hospitals/Kings County, Brooklyn, USA
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5
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Khatun N, Akivis Y, Ji B, Chandrakumar HP, Bukharovich I, John S. Tuberculous Pericarditis Presenting as Cardiac Tamponade: Role of Echocardiography. J Med Cases 2023; 14:271-276. [PMID: 37692365 PMCID: PMC10482598 DOI: 10.14740/jmc4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/06/2023] [Indexed: 09/12/2023] Open
Abstract
Tuberculous pericarditis, a rare but potentially lethal manifestation of tuberculosis, poses diagnostic and therapeutic challenges in clinical practice. Its nonspecific clinical presentation often mimics other conditions, leading to delayed or missed diagnoses. We report a 25-year-old male with no past medical history, who presented with nonspecific symptoms such as fatigue, weight loss, body aches, and dyspnea. An electrocardiogram showed low voltage QRS complex with electrical alternans, and transthoracic echocardiography (TTE) showed large pericardial effusion with tamponade physiology with right ventricular diastolic collapse, the collapse of the right atrium and the inferior vena cava was dilated with a respiratory variation of less than 50%. The diagnosis of tuberculous pericarditis was made based on clinical presentation, imaging, and laboratory findings, including a positive QuantiFERON-TB gold test and pericardial fluid analysis, despite negative cultures. This case highlights the significance of considering tuberculosis in the differential diagnosis of pericardial effusion and underscores the role of imaging and laboratory investigations in diagnosis. Management of tuberculous pericarditis involves a combination of antituberculous chemotherapy, pericardiocentesis, and corticosteroids. Despite its rarity, tuberculous pericarditis carries a high mortality rate and can present as cardiac tamponade, as illustrated in our case. This underscores the need for high clinical suspicion, especially in high-risk populations, for timely diagnosis and initiation of treatment.
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Affiliation(s)
- Nazima Khatun
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Yonatan Akivis
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Beisi Ji
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Harshith P. Chandrakumar
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | | | - Sabu John
- Kings County Hospital Center, Brooklyn, NY 11203, USA
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Kurnick A, Zaveri S, Tadayoni A, Chandrakumar HP, John S. Reversible severe pulmonary hypertension and right heart failure with cardiogenic shock due to scurvy: a case report. Eur Heart J Case Rep 2023; 7:ytad404. [PMID: 37650076 PMCID: PMC10464571 DOI: 10.1093/ehjcr/ytad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Background The systemic complications of vitamin C deficiency, otherwise known as scurvy, have been well-documented in history. Few case reports have documented severe cardiopulmonary complications such as right heart failure (RHF) and pulmonary hypertension (PH). Case summary A 25-year-old female presented to the hospital with two weeks of progressive fatigue, dyspnoea, myalgias, and arthralgias. She was admitted for symptomatic anaemia requiring transfusion. Her symptoms persisted and she developed severe PH and RHF, complicated by cardiogenic shock and multiple episodes of cardiac arrest. She was found to have severe vitamin C deficiency secondary to a severely self-restricted diet. After repletion of vitamin C, the patient had complete resolution of RHF and PH. Discussion This case adds to the sparse literature documenting severe cardiopulmonary complications of vitamin C deficiency. We believe that this is the first adult case of scurvy causing RHF and PH leading to cardiogenic shock and episodes of cardiac arrest. There are multiple hypotheses on the pathogenesis of scurvy-associated PH and RHF, including overactivation of hypoxia-inducible transcription factors and deficiency of vitamin C's vasodilatory effect that acts through increased nitric oxide production in endothelial cells. When recognized, early vitamin C repletion may prevent severe cardiopulmonary complications of scurvy.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sahil Zaveri
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Ashkan Tadayoni
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Harshith P Chandrakumar
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Sabu John
- Department of Internal Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
- Division of Cardiology, Kings County Hospital, 451 Clarkson Avenue, Brooklyn, NY 11203, USA
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Kurnick A, Burkhanova U, Friedman A, John S, Bukharovich I. A Rare Case of Massive Left Atrial Myxoma Presenting as Syncope. Cureus 2023; 15:e41249. [PMID: 37529806 PMCID: PMC10388804 DOI: 10.7759/cureus.41249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
We report a rare case of a large left atrial myxoma that manifested as syncope in a patient who presented to the hospital following a syncopal episode. Our patient had a history of hypertension and anemia with reported two months of dyspnea on exertion. He was found to have a large left atrial myxoma. Atrial myxomas are the most common benign primary cardiac tumors. Patients may be asymptomatic or experience shortness of breath, palpitations, syncope, or sudden death. Cases of syncope caused by left atrial myxoma have been rarely documented. Our case report adds to the growing literature documenting this phenomenon. Larger observational studies are needed to properly define the incidence of left atrial myxoma causing syncope.
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Affiliation(s)
- Adam Kurnick
- Department of Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Umida Burkhanova
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Adam Friedman
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
| | - Inna Bukharovich
- Department of Cardiology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
- Department of Cardiology, Kings County Hospital, Brooklyn, USA
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8
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John S, Barnett W, Abdala A, Zoccal D, Rubin J, Molkov Y. The role of Kölliker-Fuse nucleus in breathing variability. bioRxiv 2023:2023.06.15.545086. [PMID: 37398197 PMCID: PMC10312726 DOI: 10.1101/2023.06.15.545086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The Kölliker-Fuse nucleus (KF), which is part of the parabrachial complex, participates in the generation of eupnea under resting conditions and the control of active abdominal expiration when increased ventilation is required. Moreover, dysfunctions in KF neuronal activity are believed to play a role in the emergence of respiratory abnormalities seen in Rett syndrome (RTT), a progressive neurodevelopmental disorder associated with an irregular breathing pattern and frequent apneas. Relatively little is known, however, about the intrinsic dynamics of neurons within the KF and how their synaptic connections affect breathing pattern control and contribute to breathing irregularities. In this study, we use a reduced computational model to consider several dynamical regimes of KF activity paired with different input sources to determine which combinations are compatible with known experimental observations. We further build on these findings to identify possible interactions between the KF and other components of the respiratory neural circuitry. Specifically, we present two models that both simulate eupneic as well as RTT-like breathing phenotypes. Using nullcline analysis, we identify the types of inhibitory inputs to the KF leading to RTT-like respiratory patterns and suggest possible KF local circuit organizations. When the identified properties are present, the two models also exhibit quantal acceleration of late-expiratory activity, a hallmark of active expiration featuring forced exhalation, with increasing inhibition to KF, as reported experimentally. Hence, these models instantiate plausible hypotheses about possible KF dynamics and forms of local network interactions, thus providing a general framework as well as specific predictions for future experimental testing. Key points The Kölliker-Fuse nucleus (KF), a part of the parabrachial complex, is involved in regulating normal breathing and controlling active abdominal expiration during increased ventilation. Dysfunction in KF neuronal activity is thought to contribute to respiratory abnormalities seen in Rett syndrome (RTT). This study utilizes computational modeling to explore different dynamical regimes of KF activity and their compatibility with experimental observations. By analyzing different model configurations, the study identifies inhibitory inputs to the KF that lead to RTT-like respiratory patterns and proposes potential KF local circuit organizations. Two models are presented that simulate both normal breathing and RTT-like breathing patterns. These models provide plausible hypotheses and specific predictions for future experimental investigations, offering a general framework for understanding KF dynamics and potential network interactions.
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Akivis Y, Seidman I, Salciccioli L, Mcfarlane SI, Wengrofsky P, Muthu J, Budzikowski A, Khatun N, John S. Sickle Cell Disease and the Heart.. [DOI: 10.21203/rs.3.rs-3040535/v1] [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: 06/16/2023]
Abstract
Abstract
Purpose
The objective of this study was to explore the relationship between cardiac structure, cardiac index (CI), and diastolic function parameters, and laboratory values in patients with Sickle Cell Disease (SCD), and to characterize the distinct SCD cardiomyopathy phenotype
Methods
We conducted a retrospective review of 202 adult patients with SCD (mean age 41.02 ± 13.36) at our hospital who underwent outpatient echocardiographic screening from 2019–2022.
Results
Our study identified cardiac hypertrophy, chamber dilatation with preserved ejection fraction, elevated TRV, increased cardiac output, and diastolic dysfunction as defining echocardiographic features in SCD. There was a negative correlation between CI and lateral e’ (R = -0.182, P = 0.012), and a positive correlation between CI and E/e’ (R = 0.274, P = 0.0001).
Conclusions
Our study identified a unique cardiomyopathy in patients with SCD characterized by cardiac hypertrophy with preserved systolic function, abnormal mitral inflow patterns, and elevated cardiac output. These features are indicative of restrictive physiology, as evidenced by left atrial enlargement and diastolic dysfunction, superimposed on hyperdynamic physiology. Further research is needed to elucidate the pathophysiological mechanisms underlying these observations and determine their prognostic significance in vulnerable populations with an elevated burden of cardiovascular disease, including the risk of sudden cardiac death.
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10
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John S, Hermes C. [We are THE team]. Med Klin Intensivmed Notfmed 2023; 118:331-332. [PMID: 37261478 DOI: 10.1007/s00063-023-01015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/02/2023]
Affiliation(s)
- S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg (PMU Nürnberg) & Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, 90473, Nürnberg, Deutschland.
| | - C Hermes
- Akkon Hochschule für Humanwissenschaften, Berlin, Deutschland
- Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Deutschland
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Khatun N, Zaveri S, Salciccioli L, John S. A Rare Case of Coexisting Mutation in Desmin and Thioredoxin Reductase 2 Genes Causing Dilated Cardiomyopathy. Cureus 2023; 15:e40560. [PMID: 37465804 PMCID: PMC10351334 DOI: 10.7759/cureus.40560] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Desmin (DES) maintains the overall structure of cardiomyocytes and cytoskeletal organization within striated muscle cells. Mitochondrial thioredoxin reductase 2 (TXNRD-2) is essential for mitochondrial oxygen radical scavenging. We describe a rare case of dilated cardiomyopathy (DCM) in an 18-year-old female with a heterozygous mutation involving both DES and TXNRD-2 genes.
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Affiliation(s)
- Nazima Khatun
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sahil Zaveri
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Louis Salciccioli
- Cardiovascular Disease, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Sabu John
- Cardiology, Kings County Hospital Center, Brooklyn, USA
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12
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Kaliounji A, Alkoutami SS, Kaliounji H, Tucktuck M, John S, McFarlane SI. A Rare Case of Central Retinal Artery Occlusion in the Setting of Patent Foramen Ovale. Cureus 2023; 15:e39975. [PMID: 37416009 PMCID: PMC10321026 DOI: 10.7759/cureus.39975] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Patent foramen ovale (PFO) is a congenital heart anomaly with persistent non-closure of the atrial septum that generally closes six to 12 months after birth in the majority of adults. While remaining asymptomatic in the majority of cases, PFO could lead to paradoxical embolism and cryptogenic strokes in most symptomatic cases. The incidence of small arterial occlusion due to paradoxical emboli is quite uncommon. In this report, we present a case of a 51-year-old man who presented with acute left-sided painless visual loss due to central retinal artery occlusion (CRAO). Stroke work-up and hypercoagulability evaluations were negative. The patient was found to have PFO with the initial presentation as CRAO, a rather rare presentation in the setting of PFO. In this report also, we discuss the clinical presentation, pathogenesis, and the current evidence-based therapeutic options in the management of PFO in adults, highlighting the importance of considering this diagnostic entity in the setting of acute visual loss, as with our case presentation.
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Affiliation(s)
- Aboud Kaliounji
- Internal Medicine, State University of New York Downstate Medical Center, New York, USA
| | - Sami S Alkoutami
- Internal Medicine, East Carolina University, Brody School of Medicine, Greenville, USA
- Internal Medicine, St. George's University School of Medicine, New York, USA
| | - Haya Kaliounji
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Marina Tucktuck
- Internal Medicine, State University of New York Downstate Medical Center, New York, USA
| | - Sabu John
- Cardiology, State University of New York Downstate Medical Center, New York, USA
| | - Samy I McFarlane
- Internal Medicine, State University of New York Downstate Health Science University, New York, USA
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Khatun N, Kaliounji A, Alkoutami SS, Francois J, John S. Quadricuspid Aortic Valve: An Incidental Finding in an Elderly Man. Cureus 2023; 15:e39536. [PMID: 37366439 PMCID: PMC10290899 DOI: 10.7759/cureus.39536] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Quadricuspid aortic valve (QAV) is a very rare congenital abnormality. Here, we present a rare case of QAV incidentally noted in a patient at an advanced age during transthoracic echocardiography (TTE). A 73-year-old man with a history of hypertension, hyperlipidemia, diabetes, and treated prostate cancer was admitted to the hospital with palpitations. An electrocardiogram (ECG) showed T-wave inversion in V5-V6, with initial troponin levels mildly elevated. Acute coronary syndrome was ruled out by serial ECGs that were unchanged, and troponins downtrended. TTE showed a rare and incidental finding of type A QAV with four equal cusps with mild aortic regurgitation.
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Affiliation(s)
- Nazima Khatun
- Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Aboud Kaliounji
- Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Sami S Alkoutami
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
| | - Jonathan Francois
- Cardiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Sabu John
- Cardiology, Kings County Hospital Center, Brooklyn, USA
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Panduranga VT, Gorantla A, Ahmed A, Sabu J, Mallappallil M, John S. A Rare Case of Congestive Heart Failure due to Isolated Aortic Valve Disease in a Middle-Aged Man Secondary to Rheumatic Fever. J Med Cases 2023; 14:149-154. [PMID: 37303970 PMCID: PMC10251705 DOI: 10.14740/jmc4090] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
Rheumatic heart disease (RHD) is commonly seen in people from developing and low-income countries. More cases are being recorded in developed countries due to migration and globalization. RHD develops in people with a history of rheumatic fever; it is an autoimmune response to group A streptococcal infection due to similarities at the molecular level. Congestive heart failure, arrhythmia, atrial fibrillation, stroke, and infective endocarditis are a few of the many complications associated with RHD. Here we present a case of a 48-year-old male with a past medical history of rheumatic fever at the age of 12 years, who presented to the emergency room (ER) complaining of bilateral ankle swelling, dyspnea on exertion, and palpitations. The patient was tachycardic with a heart rate of 146 beats per minute and tachypneic with a respiratory rate of 22 breaths per minute. On physical exam, there was a harsh systolic and diastolic murmur at the right upper sternal border. A 12-lead electrocardiogram (EKG) revealed atrial flutter with a variable block. Chest X-ray revealed an enlarged cardiac silhouette with a pro-brain natriuretic peptide (proBNP) of 2,772 pg/mL (normal ≤ 125 pg/mL). The patient was stabilized with metoprolol and furosemide and was admitted to the hospital for further investigation. Transthoracic echocardiogram showed left ventricular ejection fraction (LVEF) of 50-55% with severe concentric hypertrophy of the left ventricle with a severely dilated left atrium. Increased thickness of the aortic valve with severe stenosis and a peak gradient of 139 mm Hg and a mean gradient of 82 mm Hg was noted. The valve area was measured to be 0.8 cm2. Transesophageal echocardiogram showed a tri-leaflet aortic valve with commissural fusion of valve cusps with severe leaflet thickening consistent with rheumatic valve disease. The patient underwent tissue aortic valve replacement with a bioprosthetic valve. The pathology report showed extensive fibrosis and calcification of the aortic valve. The patient came in for a follow-up visit 6 months later and expressed feeling better and more active.
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Affiliation(s)
- Varshitha Tumkur Panduranga
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
| | - Asher Gorantla
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
- Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Asad Ahmed
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
- Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Jacob Sabu
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
- Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Mary Mallappallil
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
- Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Sabu John
- Division of Cardiology, Department of Medicine, Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn NY, USA
- Kings County Hospital and SUNY Downstate Medical Centre, Brooklyn, NY, USA
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Mohan C, Entezami P, John S, Hewitt J, Sylevych V, Psirides A. Comparison of the Aotearoa New Zealand Early Warning Score and National Early Warning Score to predict adverse inpatient events in a vital sign dataset. Anaesthesia 2023. [PMID: 36991498 DOI: 10.1111/anae.16007] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
Aotearoa New Zealand uses a single early warning score (EWS) across all public and private hospitals to detect adult inpatient physiological deterioration. This combines the aggregate weighted scoring of the UK National Early Warning Score with single parameter activation from Australian medical emergency team systems. We conducted a retrospective analysis of a large vital sign dataset to validate the predictive performance of the New Zealand EWS in discriminating between patients at risk of serious adverse events and compared this with the UK EWS. We also compared predictive performance for patients admitted under medical vs. surgical specialties. A total of 1,738,787 aggregate scores (13,910,296 individual vital signs) were obtained from 102,394 hospital admissions to six hospitals within the Canterbury District Health Board of New Zealand's South Island. Predictive performance of each scoring system was determined using area under the receiver operating characteristic curve. Analysis showed that the New Zealand EWS is equivalent to the UK EWS in predicting patients at risk of serious adverse events (cardiac arrest, death and/or unanticipated ICU admission). Area under the receiver operating characteristic curve for both EWSs for any adverse outcome was 0.874 (95%CI 0.871-0.878) and 0.874 (95%CI 0.870-0.877), respectively. Both EWSs showed superior predictive value for cardiac arrest and/or death in patients admitted under surgical rather than medical specialties. Our study is the first validation of the New Zealand EWS in predicting serious adverse events in a broad dataset and supports previous work showing the UK EWS has superior predictive performance in surgical rather than medical patients.
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Affiliation(s)
- C Mohan
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - P Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - S John
- Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand
| | - J Hewitt
- Quality and Patient Safety, Christchurch Hospital, Christchurch, New Zealand
| | - V Sylevych
- Decision Support Unit, Christchurch Hospital, Christchurch, New Zealand
| | - A Psirides
- Department of Intensive Care, Wellington Regional Hospital, Wellington, New Zealand
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John S, Khatun N, Chandrakumar H, Akivis Y, Bukharovich I. TUBERCULOUS PERICARDITIS PRESENTING AS CARDIAC TAMPONADE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04294-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Khatun N, Brown B, Francois J, Nigussie B, Budzikowski AS, John S. A CASE OF TRANSTHYRETIN CARDIAC AMYLOIDOSIS PRESENTING AS BRADYCARDIA, RENAL FAILURE, ATRIOVENTRICULAR NODAL BLOCKADE, SHOCK, AND HYPERKALEMIA (BRASH) SYNDROME. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03100-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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John S, Gupta T, Khatun N, Chandrakumar H. A CLINICAL DILEMMA IN DEFFERENTATING LEFT ATRIAL MYXOMA AND THROMBUS BY ECHOCARDIOGRAPHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04293-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kurnick A, Zaveri S, Tadayoni A, Chandrakumar H, John S. SEVERE PULMONARY HYPERTENSION AND RIGHT HEART FAILURE SECONDARY TO VITAMIN C DEFICIENCY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02958-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Khatun N, Zaveri S, John S. A RARE CASE OF COEXISTING MUTATION IN DESMIN AND THIOREDOXIN REDUCTASE 2 GENE CAUSING DILATED CARDIOMYOPATHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03103-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Khatun N, Saeidifard F, Budzikowski AS, Pedalino RP, John S. A RARE CASE OF ASYSTOLE AND SYNCOPE TRIGGERED BY VOMITING AND POSSIBLY BY CIGUATERA TOXIN AFTER EATING FISH. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03214-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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22
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Sy K, Briottet M, John S, Wade Z, Valsecchi I, Botterel F, Urbach V. Specialized pro-resolving lipid mediators protect epithelial barrier integrity of airway epithelial cells subject to a mechanical or fungal lesion. Rev Mal Respir 2023. [DOI: 10.1016/j.rmr.2022.11.061] [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: 02/18/2023]
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23
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John S, Nelson D, Ponnambalam AM. A diagnostic conundrum: case of acute appendiceal abscess mimicking multisystem inflammatory syndrome in children in a toddler. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00052-6] [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: 01/28/2023]
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24
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Houshyar S, Yin H, Pope L, Zizhou R, Dekiwadia C, Hill-Yardin EL, Yeung JMC, John S, Fox K, Tran N, Cole I, Elbourne A, Truong VK, Truskewycz A. Smart Suture with Iodine Contrasting Nanoparticle for Computed Tomography. OpenNano 2022. [DOI: 10.1016/j.onano.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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25
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Jose N, Varghese A, Thomas H, Irodi A, Paul J, Mathew M, Isiah R, John S, Godson H, Peace T, Pavamani S, Devadhas D, Sasidharan B. Can CBCT-Based Delta Radiomics Predict Normal Lung Toxicity during Thoracic Radiation? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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John S, Ewing R, Baud M, Divecha N, Skipp P. 74P Characterizing the beta-catenin interactome using inhibitor screens and novel interaction proteomics techniques. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.075] [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: 11/01/2022] Open
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Akivis Y, Kurup M, John S. Statin-Induced Necrotizing Autoimmune Myositis. J Med Cases 2022; 13:513-516. [PMID: 36407864 PMCID: PMC9635764 DOI: 10.14740/jmc4010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
Statins are the most frequently prescribed medications for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The United States Preventative Services Task Force recommends that clinicians selectively offer a statin for the primary prevention of ASCVD for adults aged 40 - 75 years with one or more cardiovascular disease risk factors and an estimated 10-year risk of a cardiovascular event of 10% or greater. Despite their ubiquity, it is estimated that approximately 6-10% of patients remain intolerant due to muscle aches. Here, we present a case of a 71-year-old female that was taking atorvastatin for a year and presented to the emergency room with proximal muscle aches and weakness. Laboratory values were significant for an elevated creatinine kinase of 4,166 U/L (reference range, 20 - 180). Her magnetic resonance imaging was significant for edema in bilateral lower extremity proximal muscles. Serology revealed a high anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibody, confirming the diagnosis of statin-induced necrotizing autoimmune myositis. A muscle biopsy of the right vastus lateralis revealed necrotic muscle fibers. During her hospital course, she was treated with intravenous methylprednisolone, mycophenolate mofetil, and tacrolimus. Her symptoms gradually improved, and she was discharged after 14 days with a rheumatology follow-up. This is an exceedingly rare complication of statin use and has only recently received increasing attention. Here we present our experience with this disease.
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Affiliation(s)
- Yonatan Akivis
- Department of Internal Medicine, Division of Cardiovascular Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
| | - Meenakshi Kurup
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sabu John
- Department of Internal Medicine, Division of Cardiovascular Medicine, SUNY Downstate-Health Science University, Brooklyn, NY 11203, USA
- Kings County Hospital Center, Brooklyn, NY 11203, USA
- Corresponding Author: Sabu John, College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Downstate-Health Science University, Brooklyn, NY 11203-2098, USA.
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Khetan M, Kalhan S, John S, Sethi D, Kannaujiya P, Ramana B. MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome. Hernia 2022; 26:1325-1336. [DOI: 10.1007/s10029-022-02671-1] [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] [Received: 04/16/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
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Robinson E, John S, Singh P. P.115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI? Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103411] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Saxena SN, Swarup Meena R, Vishal MK, John S, Kumar Sharma L, Mishra BK, Agarwal D. Variation in essential oil constituents of coriander (Coriandrum sativum L.) germplasm across coriander growing regions in India. Journal of Essential Oil Research 2022. [DOI: 10.1080/10412905.2022.2036644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S. N. Saxena
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - R. Swarup Meena
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - M. K. Vishal
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - S. John
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - L. Kumar Sharma
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - B. K. Mishra
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
| | - D. Agarwal
- ICAR-National Research Centre on Seed Spices, Tabiji, Ajmer, India
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John S, Orlowski K, Mrkor K, Edelmann-Nusser J, Witte K. Differences in Hip Muscle Strength and Static Balance in Patients with Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study. Can Prosthet Orthot J 2022; 5:37456. [PMID: 37614483 PMCID: PMC10443478 DOI: 10.33137/cpoj.v5i1.37456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVES The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants.
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Affiliation(s)
- S John
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - K Orlowski
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Brandenburg an der Havel, Germany
| | - K.U. Mrkor
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Brandenburg an der Havel, Germany
| | - J Edelmann-Nusser
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
| | - K Witte
- Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany
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Ouyang J, Bajracharya S, John S, Wagner J, Xu J, Luo Y, Thaxton M, Salifu M, Yap E, Mallappallil M. Clotting of Hemodialysis Access in Patients with COVID-19 in an Inner-City Hospital. Nephron Clin Pract 2021; 146:179-184. [PMID: 34929702 PMCID: PMC8805045 DOI: 10.1159/000520174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An increased incidence of thrombotic complications in patients with coronavirus disease 2019 (COVID-19) has been reported. Severe acute kidney injury (AKI) is one of the major clinical manifestations of COVID-19 with the need for renal replacement therapy. It was observed that hemodialysis (HD) accesses tended to thrombose more often in the COVID-19 population than in non-COVID-19 patients. We hypothesize that the hypercoagulable state of COVID-19 is associated with higher incidence of access clotting. METHOD In this retrospective single-centered study at Kings County Hospital in New York City, 1,075 patients with COVID-19 were screened, and 174 patients who received HD from January 3, 2021 to May 15, 2020 were enrolled to examine the risk factors of dialysis access clotting in patients with COVID-19. RESULTS Of the 174 patients, 109 (63%) were COVID-19 positive. 39 (22.6%) patients had dialysis access clotting at least once during their hospitalization, and they had significantly higher body mass index (BMI) (p = 0.001), higher rates of COVID-19 (p = 0.015), AKI (p < 0.001), higher platelet counts (p = 0.029), higher lactate dehydrogenase levels (p = 0.009), and lower albumin levels (p = 0.001) than those without access malfunctions. Low albumin levels (p = 0.008), AKI (p = 0.008), and high BMI (p = 0.018) were risk factors associated with HD access clotting among COVID-19 patients. CONCLUSION Patients with COVID-19 who receive HD for AKI with high BMI are at a higher risk of clotting their HD access.
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Affiliation(s)
- Jie Ouyang
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA, .,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA,
| | - Siddhartha Bajracharya
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA.,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA
| | - Sabu John
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA.,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA
| | - John Wagner
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA
| | - Jiehui Xu
- Division of Biostatistics, New York University, New York, New York, USA
| | - Yiming Luo
- Rheumatology, National Institute of Arthritis and Musculoskeletal and Skin Disease, Bethesda, Maryland, USA
| | - Mariah Thaxton
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA
| | - Moro Salifu
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA.,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA
| | - Ernie Yap
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA.,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA
| | - Mary Mallappallil
- NYC Health + Hospitals, Kings County Hospital Center, Brooklyn, New York, USA.,Downstate Medical Center- State University of Brooklyn, Brooklyn, New York, USA
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Houshyar S, Rifai A, Zizhou R, Dekiwadia C, Booth MA, John S, Fox K, Truong VK. Liquid metal polymer composite: Flexible, conductive, biocompatible, and antimicrobial scaffold. J Biomed Mater Res B Appl Biomater 2021; 110:1131-1139. [PMID: 34910353 DOI: 10.1002/jbm.b.34987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 01/02/2023]
Abstract
Gallium and its alloys, such as eutectic gallium indium alloy (EGaIn), a form of liquid metal, have recently attracted the attention of researchers due to their low toxicity and electrical and thermal conductivity for biomedical application. However, further research is required to harness EGaIn-composites advantages and address their application as a biomedical scaffold. In this research, EGaIn-polylactic acid/polycaprolactone composites with and without a second conductive filler, MXene, were prepared and characterized. The addition of MXene, into the EGaIn-composite, can improve the composite's electrochemical properties by connecting the liquid metal droplets resulting in electrically conductive continuous pathways within the polymeric matrix. The results showed that the composite with 50% EGaIn and 4% MXene, displayed optimal electrochemical properties and enhanced mechanical and radiopacity properties. Furthermore, the composite showed good biocompatibility, examined through interactions with fibroblast cells, and antibacterial properties against methicillin-resistant Staphylococcus aureus. Therefore, the liquid metal (EGaIn) polymer composite with MXene provides a first proof-of-concept engineering scaffold strategy with low toxicity, functional electrochemical properties, and promising antimicrobial properties.
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Affiliation(s)
- Shadi Houshyar
- STEM College, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Aaqil Rifai
- STEM College, School of Engineering, RMIT University, Melbourne, Victoria, Australia.,Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Rumbidzai Zizhou
- School of Fashion and Textile, Centre for Materials Innovation and Future Fashion, RMIT University, Victoria, Australia
| | - Chaitali Dekiwadia
- RMIT Microscopy and Microanalysis Facility, STEM College, RMIT University, Melbourne, Victoria, Australia
| | - Marsilea A Booth
- STEM College, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Sabu John
- STEM College, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Kate Fox
- STEM College, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Vi Khanh Truong
- School of Science, STEM College, RMIT University, Melbourne, Victoria, Australia
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Affiliation(s)
- S John
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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John S, Hegde S, Hussain S, Bukharovich I, Graham-Hill S, Mallappallil M, Pedalino R. COVID-19 Pneumonia Precipitating Acute Anterior Wall Myocardial Infarction With Large Left Ventricular Apical Thrombus. J Med Cases 2021; 12:251-255. [PMID: 34429797 PMCID: PMC8279283 DOI: 10.14740/jmc3687] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/11/2022] Open
Abstract
Initial reports suggest an increased thrombotic risk in coronavirus disease 2019 (COVID-19). We present a case of COVID-19 pneumonia that precipitated chest pain, an acute anterior wall ST-elevation myocardial infarction on the fifth day of hospitalization resulting in large left ventricular apical thrombus.
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Affiliation(s)
- Sabu John
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Sudhanva Hegde
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Syed Hussain
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Inna Bukharovich
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Suzette Graham-Hill
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Mary Mallappallil
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Ronald Pedalino
- Division of Cardiovascular Disease, Department of Medicine, Kings County Hospital Center, Brooklyn, NY 11203, USA
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Render L, Truss A, Waddington H, John S, Henderson C, Aldaraggi A, Page O. 91 An audit of COVID-19 Awareness and Public Health Message Effectiveness in the Hospital Setting Over the Course of the Pandemic. Br J Surg 2021. [PMCID: PMC8135649 DOI: 10.1093/bjs/znab134.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction An audit of healthcare workers investigated the effectiveness of Public Health England’s (PHE) information campaign across COVID’s timeline and assess knowledge between job roles. Method Data was collected across 3 cycles in 3 hospitals. A questionnaire assessed four domains: symptoms; spread; risk factors and the means to reduce transmission. PHE materials were shown before cycle 2 and respondents then subjected to the general campaign. Results 253 responses were collected. Symptom recognition was 84%, increasing to 88% post-intervention, longer-term recognition remained high at 81% - including the new symptom of anosmia. Identification of COVID’s means of transmission increased from 76% to 95% post intervention, risk factor recognition increased from 85% to 93% post-intervention. This fell to 74% later in the pandemic when recognised risk factors increased. Recognition of the new risk factors BAME status and BMI was 73% and 79% respectively in the final cycle. Doctors had the highest number of pre-intervention correct answers for 3 domains and nurses gave the most incorrect answers for 3 domains pre-intervention. Conclusions We have shown the PHE message is being transmitted effectively. We have also shown an increase in hospital workers recognition of aspects of COVIDs characteristics that have since been verified in the literature.
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Affiliation(s)
- L Render
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Truss
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - H Waddington
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - S John
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - C Henderson
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Aldaraggi
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - O Page
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
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John S, Ignatyeva Y, Greenberg B, Lin A, Wettersten N, Urey M, Kim P, Hong K, Tran H, Encisco JS, Pretorius V, Yagil A, Adler E. Machine Learning for Prognostication in Patients Undergoing LVAD Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1220] [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: 10/21/2022] Open
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Hong K, Battikha C, Lin A, John S, Brambatti M, Garcia-Alvarez A, Garcia-Guereta L, Diez C, Perez-Gomez L, Garcia-Pavia P, Taylor M, Adler E. Cardiac Transplantation in Danon Disease. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.781] [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: 10/21/2022] Open
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John S, Kochanek M. [Immunocompromised patients in the intensive care unit]. Med Klin Intensivmed Notfmed 2021; 116:102-103. [PMID: 33666704 PMCID: PMC7934350 DOI: 10.1007/s00063-021-00787-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg und Universität Erlangen-Nürnberg, Klinikum Nürnberg-Süd, Breslauer Str. 20, 90471, Nürnberg, Deutschland.
| | - M Kochanek
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Saleh Alghamdi S, John S, Roy Choudhury N, Dutta NK. Additive Manufacturing of Polymer Materials: Progress, Promise and Challenges. Polymers (Basel) 2021; 13:753. [PMID: 33670934 PMCID: PMC7957542 DOI: 10.3390/polym13050753] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 01/03/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/21/2022] Open
Abstract
The use of additive manufacturing (AM) has moved well beyond prototyping and has been established as a highly versatile manufacturing method with demonstrated potential to completely transform traditional manufacturing in the future. In this paper, a comprehensive review and critical analyses of the recent advances and achievements in the field of different AM processes for polymers, their composites and nanocomposites, elastomers and multi materials, shape memory polymers and thermo-responsive materials are presented. Moreover, their applications in different fields such as bio-medical, electronics, textiles, and aerospace industries are also discussed. We conclude the article with an account of further research needs and future perspectives of AM process with polymeric materials.
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Affiliation(s)
- Saad Saleh Alghamdi
- School of Engineering, Chemical and Environmental Engineering, RMIT University, Melbourne 3000, Australia
| | - Sabu John
- School of Engineering, Manufacturing, Materials and Mechatronics, RMIT University, Bundoora 3083, Australia
| | - Namita Roy Choudhury
- School of Engineering, Chemical and Environmental Engineering, RMIT University, Melbourne 3000, Australia
| | - Naba K Dutta
- School of Engineering, Chemical and Environmental Engineering, RMIT University, Melbourne 3000, Australia
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41
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John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
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Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
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Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H, Heller T, Gagelmann N. [S3 guideline sepsis-prevention, diagnosis, treatment, and aftercare : Summary of the strong recommendations]. Med Klin Intensivmed Notfmed 2020; 115:178-188. [PMID: 32185422 DOI: 10.1007/s00063-020-00671-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- F M Brunkhorst
- Zentrum für Klinische Studien, Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Salvador-Allende-Platz 27, 07747, Jena, Deutschland.
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S W Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - A Meier-Hellmann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt GmbH, Erfurt, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - A Weyland
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Bucher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Halle, Deutschland
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, Klinikum der Universität München, München, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum der MLU Halle-Wittenberg, Halle, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H G Bone
- Zentrum für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| | - C Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S John
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Potsdam, Deutschland
| | - A Jörres
- Medizinische Klinik I, Klinik für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Krankenhaus Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Kiel, Kiel, Deutschland
| | - M Gründling
- Klinik für Anästhesiologie - Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - K Mayer
- Medizinische Klinik und Poliklinik II, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - A Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum "St. Georg" Leipzig gGmbH, Leipzig, Deutschland
| | - T W Felbinger
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Städtisches Klinikum München, München, Deutschland
| | - H Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - T Heller
- Universitätsklinikum Jena, Jena, Deutschland
| | - N Gagelmann
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Trifan G, Goldenberg FD, Caprio FZ, Biller J, Schneck M, Khaja A, Terna T, Brorson J, Lazaridis C, Bulwa Z, Alvarado Dyer R, Saleh Velez FG, Prabhakaran S, Liotta EM, Batra A, Reish NJ, Ruland S, Teitcher M, Taylor W, De la Pena P, Conners JJ, Grewal PK, Pinna P, Dafer RM, Osteraas ND, DaSilva I, Hall JP, John S, Shafi N, Miller K, Moustafa B, Vargas A, Gorelick PB, Testai FD. Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex. J Stroke Cerebrovasc Dis 2020; 29:105314. [PMID: 32951959 PMCID: PMC7486061 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105314] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 disease is associated with stroke All strokes subtypes are seen in association with COVID-19, with ischemic stroke being most prevalent The most common etiology for ischemic stroke in SARS-CoV2 infection is cryptogenic Sex plays an important role in stroke outcomes in patients with COVID-19 disease Males have higher rates of ICU admission, in-hospital complications and more likely to have worse outcome at hospital discharge compare with females
Background and Purpose Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. Methods This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. Results The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03–2.09). Conclusion In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.
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Affiliation(s)
- G Trifan
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - F D Goldenberg
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - F Z Caprio
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - J Biller
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - M Schneck
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - A Khaja
- AMITA Health - Alexian Brothers Hospital, 800 Biesterfield Rd, IL 60007, U.S.A..
| | - T Terna
- AMITA Health - Alexian Brothers Hospital, 800 Biesterfield Rd, IL 60007, U.S.A..
| | - J Brorson
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A
| | - C Lazaridis
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - Z Bulwa
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - R Alvarado Dyer
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - F G Saleh Velez
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - S Prabhakaran
- Department of Neurology, University of Chicago Hospital, Chicago, IL 60612, U.S.A..
| | - E M Liotta
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - A Batra
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - N J Reish
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - S Ruland
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - M Teitcher
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - W Taylor
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - P De la Pena
- Department of Neurology, Loyola University Health System, 2160 S 1st Ave, Maywood, IL 60153, U.S.A..
| | - J J Conners
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P K Grewal
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P Pinna
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - R M Dafer
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - N D Osteraas
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - I DaSilva
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - J P Hall
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - S John
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - N Shafi
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - K Miller
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - B Moustafa
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
| | - A Vargas
- Department of Neurological Sciences, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, U.S.A..
| | - P B Gorelick
- Department of Neurology, Northwestern University, 633 Clark St, Evanston, IL 60208, U.S.A..
| | - F D Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL 60612, U.S.A..
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Battisti N, Lee K, Nash T, Mappouridou S, Senthivel N, Asavisanu K, Obeid M, Tripodaki ES, Angelis V, Fleming E, Goode E, John S, Andres M, Allen M, Lyon A, Ring A. 222P Rates of cardiac adverse events in older versus younger adults receiving trastuzumab for HER2-positive early breast cancer: Results from 931 patients treated at The Royal Marsden. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.344] [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] Open
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Gupte AN, Selvaraju S, Paradkar M, Danasekaran K, Shivakumar SVBY, Thiruvengadam K, Dolla C, Shivaramakrishnan G, Pradhan N, Kohli R, John S, Raskar S, Jain D, Momin A, Subramanian B, Gaikwad A, Lokhande R, Suryavanshi N, Gupte N, Salvi S, Murali L, Checkley W, Golub JE, Bollinger R, Chandrasekaran P, Mave V, Gupta A. Respiratory health status is associated with treatment outcomes in pulmonary tuberculosis. Int J Tuberc Lung Dis 2020; 23:450-457. [PMID: 31064624 DOI: 10.5588/ijtld.18.0551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec id="st1"> <title>BACKGROUND</title> The association between respiratory impairment and tuberculosis (TB) treatment outcomes is not clear. </sec> <sec id="st2"> <title>METHODS</title> We prospectively evaluated respiratory health status, measured using the Saint George's Respiratory Questionnaire (SGRQ), in a cohort of new adult pulmonary TB cases during and up to 18 months following treatment in India. Associations between total SGRQ scores and poor treatment outcomes of failure, recurrence and all-cause death were measured using multivariable Poisson regression. </sec> <sec id="st3"> <title>RESULTS</title> We enrolled 455 participants contributing 619 person-years at risk; 39 failed treatment, 23 had recurrence and 16 died. The median age was 38 years (interquartile range 26-49); 147 (32%) ever smoked. SGRQ scores at treatment initiation were predictive of death during treatment (14% higher risk per 4-point increase in baseline SGRQ scores, 95%CI 2-28, P = 0.01). Improvement in SGRQ scores during treatment was associated with a lower risk of failure (1% lower risk for every per cent improvement during treatment, 95%CI 1-2, P = 0.05). Clinically relevant worsening in SGRQ scores following successful treatment was associated with a higher risk of recurrence (15% higher risk per 4-point increase scores, 95%CI 4-27, P = 0.004). </sec> <sec id="st4"> <title>CONCLUSION</title> Impaired respiratory health status was associated with poor TB treatment outcomes. The SGRQ may be used to monitor treatment response and predict the risk of death in pulmonary TB. </sec>.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Selvaraju
- National Institute for Research in Tuberculosis, Chennai
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - K Danasekaran
- National Institute for Research in Tuberculosis, Chennai
| | | | | | - C Dolla
- National Institute for Research in Tuberculosis, Chennai
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S John
- National Institute for Research in Tuberculosis, Chennai
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - B Subramanian
- National Institute for Research in Tuberculosis, Chennai
| | - A Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - L Murali
- National Institute for Research in Tuberculosis, Chennai
| | - W Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - V Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gkekas I, Novotny J, Fabian P, Nemecek R, Palmqvist R, Strigård K, John S, Pecen L, Reginacova K, Gunnarsson U. Mismatch repair status predicts survival after adjuvant treatment in stage II colon cancer patients. J Surg Oncol 2020; 121:392-401. [PMID: 31828810 DOI: 10.1002/jso.25798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/15/2019] [Accepted: 11/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Stage II colon cancer is primarily a surgical disease. Only a still not well-defined subset of patients may benefit from postoperative adjuvant chemotherapy. The relationship between adjuvant chemotherapy and survival after relapse is furthermore still not definitely explored in this group of patients. A number of reports suggest some association between defective mismatch repair (dMMR) and colorectal cancer stage II prognosis, but due to contradictory results from existing studies, the exact predictive role is still not fully understood. METHODS Retrospective multicenter study including 451 stage II colon cancer patients. The proficiency or deficiency of mismatch repair was tested using immunohistochemistry and analyzed in relationship to two survival outcomes: overall survival (OS) and postrelapse survival. RESULTS Patients with dMMR (20.4%) derived no OS benefit from adjuvant chemotherapy (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.47-2.38; P = .897). Patients with proficient mismatch repair (pMMR) tumors receiving adjuvant chemotherapy had the significantly better OS in comparison to those not receiving chemotherapy (HR, 0.54; 95% CI, 0.35-0.82; P = .004). This relationship remained significant in multivariable analysis (HR, 0.42; 95% CI, 0.22-0.78; P = .007). Patients with pMMR relapsing after adjuvant treatment lived significantly longer than those relapsing without previous adjuvant treatment (HR, 0.55; 95% CI, 0.32-0.96; P = .033) and this result remained significant in the multivariable model (HR, 0.49; 95% CI, 0.26-0.93; P = .030). CONCLUSION In stage II CC patients, adjuvant chemotherapy improves therapeutic outcomes only in patients with pMMR tumors. Survival after relapse in patients having received adjuvant chemotherapy is significantly longer for patients with pMMR. No survival benefit from adjuvant chemotherapy was seen among patients with dMMR tumors.
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Affiliation(s)
- I Gkekas
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - J Novotny
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - P Fabian
- Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Nemecek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Palmqvist
- Department of Medical Biosciences/Pathology, Umea University, Umea, Sweden
| | - K Strigård
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
| | - S John
- Department of Medical Biology and Genetics, Faculty of Medicine Hradec Kralove, Charles University, Prague, Czech Republic
| | - L Pecen
- Faculty Hospital Pilsen, Charles University, Prague, Czech Republic
| | - K Reginacova
- Department of Radiotherapy and Oncology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden
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Jones M, Kujundzic M, John S, Bismarck A. Crab vs. Mushroom: A Review of Crustacean and Fungal Chitin in Wound Treatment. Mar Drugs 2020; 18:E64. [PMID: 31963764 PMCID: PMC7024172 DOI: 10.3390/md18010064] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
Chitin and its derivative chitosan are popular constituents in wound-treatment technologies due to their nanoscale fibrous morphology and attractive biomedical properties that accelerate healing and reduce scarring. These abundant natural polymers found in arthropod exoskeletons and fungal cell walls affect almost every phase of the healing process, acting as hemostatic and antibacterial agents that also support cell proliferation and attachment. However, key differences exist in the structure, properties, processing, and associated polymers of fungal and arthropod chitin, affecting their respective application to wound treatment. High purity crustacean-derived chitin and chitosan have been widely investigated for wound-treatment applications, with research incorporating chemically modified chitosan derivatives and advanced nanocomposite dressings utilizing biocompatible additives, such as natural polysaccharides, mineral clays, and metal nanoparticles used to achieve excellent mechanical and biomedical properties. Conversely, fungi-derived chitin is covalently decorated with -glucan and has received less research interest despite its mass production potential, simple extraction process, variations in chitin and associated polymer content, and the established healing properties of fungal exopolysaccharides. This review investigates the proven biomedical properties of both fungal- and crustacean-derived chitin and chitosan, their healing mechanisms, and their potential to advance modern wound-treatment methods through further research and practical application.
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Affiliation(s)
- Mitchell Jones
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Marina Kujundzic
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
| | - Sabu John
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Alexander Bismarck
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
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Pareek V, Chandra M, Bhalavat R, Ambekar U, John S, Jain D, Iyer L. OC-085: Role of intervention-Patient reported sexual adjustment following brachytherapy for cervical cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(20)30454-0] [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: 11/28/2022]
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Jozwiak BP, O'Sullivan A, Hussain S, John S, Navarro R, Zahra K, Kumar V, Samples S, Mifsud V. Cleveland clinic Abu Dhabi stroke registry (CCADSR) methodology. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Jozwiak BP, Kumar V, Hussain S, John S, Navarro R, Zahra K, O'Sullivan A, Samples S, Mifsud V. Cleveland clinic Abu Dhabi stroke registry (CCADSR) young hemorrhagic strokes - Initial results. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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