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Banerjee A, Kang CY, An M, Koff BB, Sunder S, Kumar A, Tenuta LMA, Stockbridge RB. Fluoride export is required for the competitive fitness of pathogenic microorganisms in dental biofilm models. mBio 2024:e0018424. [PMID: 38624207 DOI: 10.1128/mbio.00184-24] [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: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
Microorganisms resist fluoride toxicity using fluoride export proteins from one of several different molecular families. Cariogenic species Streptococcus mutans and Candida albicans extrude intracellular fluoride using a CLCF F-/H+ antiporter and FEX fluoride channel, respectively, whereas oral commensal eubacteria, such as Streptococcus gordonii, export fluoride using a Fluc fluoride channel. In this work, we examine how genetic knockout of fluoride export impacts pathogen fitness in single-species and three-species dental biofilm models. For biofilms generated using S. mutans with the genetic knockout of the CLCF transporter, exposure to low fluoride concentrations decreased S. mutans counts, synergistically reduced the populations of C. albicans, increased the relative proportion of oral commensal S. gordonii, and reduced properties associated with biofilm pathogenicity, including acid production and hydroxyapatite dissolution. Biofilms prepared with C. albicans with genetic knockout of the FEX channel also exhibited reduced fitness in the presence of fluoride but to a lesser degree. Imaging studies indicate that S. mutans is highly sensitive to fluoride, with the knockout strain undergoing complete lysis when exposed to low fluoride for a moderate amount of time. Biochemical purification of the S. mutans CLCF transporter and functional reconstitution establishes that the functional protein is a dimer encoded by a single gene. Together, these findings suggest that fluoride export by oral pathogens can be targeted by specific inhibitors to restore biofilm symbiosis in dental biofilms and that S. mutans is especially susceptible to fluoride toxicity. IMPORTANCE Dental caries is a globally prevalent condition that occurs when pathogenic species, including Streptococcus mutans and Candida albicans, outcompete beneficial species, such as Streptococcus gordonii, in the dental biofilm. Fluoride is routinely used in oral hygiene to prevent dental caries. Fluoride also has antimicrobial properties, although most microbes possess fluoride exporters to resist its toxicity. This work shows that sensitization of cariogenic species S. mutans and C. albicans to fluoride by genetic knockout of fluoride exporters alters the microbial composition and pathogenic properties of dental biofilms. These results suggest that the development of drugs that inhibit fluoride exporters could potentiate the anticaries effect of fluoride in over-the-counter products like toothpaste and mouth rinses. This is a novel strategy to treat dental caries.
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Affiliation(s)
- Aditya Banerjee
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chia-Yu Kang
- Program in Biophysics, University of Michigan, Ann Arbor, Michigan, USA
| | - Minjun An
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - B Ben Koff
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sham Sunder
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anuj Kumar
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Livia M A Tenuta
- School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Randy B Stockbridge
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
- Program in Biophysics, University of Michigan, Ann Arbor, Michigan, USA
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Sunder S, Bauman JS, Decker SJ, Lifton AR, Kumar A. The yeast AMP-activated protein kinase Snf1 phosphorylates the inositol polyphosphate kinase Kcs1. J Biol Chem 2024; 300:105657. [PMID: 38224949 PMCID: PMC10851228 DOI: 10.1016/j.jbc.2024.105657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
The yeast Snf1/AMP-activated kinase (AMPK) maintains energy homeostasis, controlling metabolic processes and glucose derepression in response to nutrient levels and environmental cues. Under conditions of nitrogen or glucose limitation, Snf1 regulates pseudohyphal growth, a morphological transition characterized by the formation of extended multicellular filaments. During pseudohyphal growth, Snf1 is required for wild-type levels of inositol polyphosphate (InsP), soluble phosphorylated species of the six-carbon cyclitol inositol that function as conserved metabolic second messengers. InsP levels are established through the activity of a family of inositol kinases, including the yeast inositol polyphosphate kinase Kcs1, which principally generates pyrophosphorylated InsP7. Here, we report that Snf1 regulates Kcs1, affecting Kcs1 phosphorylation and inositol kinase activity. A snf1 kinase-defective mutant exhibits decreased Kcs1 phosphorylation, and Kcs1 is phosphorylated in vivo at Ser residues 537 and 646 during pseudohyphal growth. By in vitro analysis, Snf1 directly phosphorylates Kcs1, predominantly at amino acids 537 and 646. A yeast strain carrying kcs1 encoding Ser-to-Ala point mutations at these residues (kcs1-S537A,S646A) shows elevated levels of pyrophosphorylated InsP7, comparable to InsP7 levels observed upon deletion of SNF1. The kcs1-S537A,S646A mutant exhibits decreased pseudohyphal growth, invasive growth, and cell elongation. Transcriptional profiling indicates extensive perturbation of metabolic pathways in kcs1-S537A,S646A. Growth of kcs1-S537A,S646A is affected on medium containing sucrose and antimycin A, consistent with decreased Snf1p signaling. This work identifies Snf1 phosphorylation of Kcs1, collectively highlighting the interconnectedness of AMPK activity and InsP signaling in coordinating nutrient availability, energy homoeostasis, and cell growth.
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Affiliation(s)
- Sham Sunder
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joshua S Bauman
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stuart J Decker
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra R Lifton
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anuj Kumar
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA.
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Banerjee A, Kang CY, An M, Koff BB, Sunder S, Kumar A, Tenuta LMA, Stockbridge RB. Fluoride export is required for competitive fitness of pathogenic microorganisms in dental biofilm models. bioRxiv 2024:2024.01.18.576223. [PMID: 38293214 PMCID: PMC10827179 DOI: 10.1101/2024.01.18.576223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Microorganisms resist fluoride toxicity using fluoride export proteins from one of several different molecular families. Cariogenic species Streptococcus mutans and Candida albicans extrude intracellular fluoride using a CLCF F-/H+ antiporter and FEX fluoride channel, respectively, whereas commensal eubacteria, such as Streptococcus gordonii, export fluoride using a Fluc fluoride channel. In this work, we examine how genetic knockout of fluoride export impacts pathogen fitness in single-species and three-species dental biofilm models. For biofilms generated using S. mutans with genetic knockout of the CLCF transporter, exposure to low fluoride concentrations decreased S. mutans counts, synergistically reduced the populations of C. albicans, increased the relative proportion of commensal S. gordonii, and reduced properties associated with biofilm pathogenicity, including acid production and hydroxyapatite dissolution. Biofilms prepared with C. albicans with genetic knockout of the FEX channel also exhibited reduced fitness in the presence of fluoride, but to a lesser degree. Imaging studies indicate that S. mutans is highly sensitive to fluoride, with the knockout strain undergoing complete lysis when exposed to low fluoride for a moderate amount of time, and biochemical purification the S. mutans CLCF transporter and functional reconstitution establishes that the functional protein is a dimer encoded by a single gene. Together, these findings suggest that fluoride export by oral pathogens can be targeted by specific inhibitors to restore biofilm symbiosis in dental biofilms, and that S. mutans is especially susceptible to fluoride toxicity.
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Affiliation(s)
- Aditya Banerjee
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chia-Yu Kang
- Program in Biophysics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Minjun An
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - B Ben Koff
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sham Sunder
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anuj Kumar
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Livia M A Tenuta
- School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Randy B Stockbridge
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
- Program in Biophysics, University of Michigan, Ann Arbor, MI 48109, USA
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Szkudelska K, Chan MH, Okulicz M, Jasaszwili M, Lukomska A, Malek E, Shah M, Sunder S, Szkudelski T. Betaine supplementation to rats alleviates disturbances induced by high-fat diet: pleiotropic effects in model of type 2 diabetes. J Physiol Pharmacol 2021; 72. [PMID: 35288478 DOI: 10.26402/jpp.2021.5.11] [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] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/30/2021] [Indexed: 11/03/2022]
Abstract
Betaine is a biologically active compound exerting beneficial effects in the organism, however, the exact mechanisms underlying its action are not fully elucidated. The present study aimed to explore, whether betaine alleviates disorders induced by feeding rats a high-fat diet (HFD). Rats were divided into 3 groups: control, fed an HFD and fed an HFD and receiving betaine (2% water solution for 8 weeks). Betaine improved glucose tolerance, decreased blood levels of non-esterified fatty acids and prevented lipid accumulation in the skeletal muscle of rats on an HFD. Betaine reduced activities of blood alanine aminotransferase, blood levels of bilirubin and hepatic lipid content. Expression of fatty acid synthase in the liver and the skeletal muscle was decreased in response to feeding an HFD, and this effect was deepened by betaine in the muscle tissue. Hepatic and muscular expression of genes related to insulin signaling were unchanged in HFD-fed rats. Lipolysis stimulated by epinephrine (an adrenergic receptor agonist), forskolin (an activator of adenylate cyclase), dibutyryl-cAMP (an activator of protein kinase A) and DPCPX (an adenosine A1 receptor antagonist) was diminished in the adipocytes of rats fed an HFD, however, this effect was alleviated by betaine. Moreover, blood leptin levels in HFD-fed rats were elevated, whereas leptinemia have normalized by betaine supplementation. Betaine prevented the increase in expression of N-methyl D-aspartate receptors in the hippocampus and in the cerebral cortex. These results indicate that betaine positively affects the insulin-sensitive tissues: liver (hepatoprotective effects), skeletal muscle (reduced lipid accumulation) and adipose tissue (a rise in lipolysis), which is associated with improved insulin sensitivity. Betaine-induced prevention of hyperleptinemia indicates restoration of leptin action, and changes in the brain reveal neuroprotective properties. Our results show that betaine induces positive changes in HFD-fed rats, its action is pleiotropic and involves different tissues.
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Affiliation(s)
- K Szkudelska
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland
| | - M H Chan
- Research Center for Mind, Brain, and Learning, National Changchi University, Taipei City, Taiwan.,Institute of Neuroscience, National Chengchi University, Taipei, Taiwan
| | - M Okulicz
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland
| | - M Jasaszwili
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland
| | - A Lukomska
- Department of Preclinical Sciences and Infectious Diseases, Poznan University of Life Sciences, Poznan, Poland
| | - E Malek
- Department of Preclinical Sciences and Infectious Diseases, Poznan University of Life Sciences, Poznan, Poland
| | - M Shah
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland
| | - S Sunder
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland
| | - T Szkudelski
- Department of Animal Physiology, Biochemistry and Biostructure, Poznan University of Life Sciences, Poznan, Poland.
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Chilukuri S, Gaikwad U, Nangia S, Patro K, Thiagarajan R, Mp N, Sunder S, Burela N, Thimma R, Panda P, Jalali R. PO-1460 Adaptive re-planning with image guided pencil beam scanning proton beam therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07911-1] [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] [Indexed: 10/20/2022]
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6
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Verma H, Sunder S, Sharma BB, Sharma N, Verma R. Prevalence of Vascular Calcification in Chronic Kidney Disease Stage 4 and 5 Patients and its Correlation with Inflammatory Markers of Atherosclerosis. Saudi J Kidney Dis Transpl 2021; 32:30-41. [PMID: 34145112 DOI: 10.4103/1319-2442.318546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular calcification is one of the independent risk factors associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) patients. This study evaluated the prevalence of vascular calcification in Indian patients with CKD stages 4 and 5. This was a prospective study conducted between January 2011 and June 2012. CKD stage 4 and 5 patients of either sex aged >18 years were screened for aortic vascular calcification using digital X-ray lumbar spine and multislice computed tomography (CT) scan. In addition, details of inflammatory markers [high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL-6)] were also collected. A total of 150 patients (stage 4, n = 98; stage 5, n = 56) were screened for vascular calcification, and the mean age was 56.56 years. Patients with CKD stage 5 had significantly higher (P ≤0.05) serum creatinine and lower estimated glomerular filtration rate, total cholesterol, and low-density lipoprotein than CKD stage 4. Significantly, more patients with CKD stage 5 had a history of CVD. A total of 113 (75.3%) patients had vascular calcification [aortic calcification index (ACI) >0] with significantly higher prevalence in CKD stage 5 (85.72%) as compared to CKD stage 4 (69.15%). Patients having high aortic calcification (ACI >20%) were older (P = 0.0013); had a higher frequency of diabetes, and CVD; and had significantly (P <0.05) higher blood urea, serum creatinine, phosphorus, Ca × PO4 product, intact parathyroid hormone, hs-CRP, and IL-6. The higher CKD stage was associated with a higher prevalence of vascular calcification and higher aortic calcification index (ACI). CT techniques (electron beam CT and multislice CT) are the gold standards for detection and quantification of progression of vascular calcification.
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Affiliation(s)
- Himanshu Verma
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - B B Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rashi Verma
- Department of Obstetrics, Institute of Gynecology and Obstetrics, Sir Gangaram Hospital, New Delhi, India
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7
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Bouvarel C, Barbarot S, Sunder S, Rimbert J, Motard C, Kupfer-Bessaguet I. Premier cas de granulome rubéolien cutané chez un patient adulte sans déficit immunitaire primaire. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.423] [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: 10/22/2022]
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8
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Sunder S, Kalra OP, Nashine S, Waghmare V, Ruchi R. Comparative Study of Adequacy of Dialysis and Health-Related Quality of Life in Patients on CAPD and APD. Perit Dial Int 2020. [DOI: 10.1177/089686080802800521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sham Sunder
- Department of Nephrology University College of Medical Sciences Delhi, India
| | - Om P. Kalra
- Dr. RML Hospital Division of Nephrology University College of Medical Sciences Delhi, India
| | - Santosh Nashine
- Department of Nephrology University College of Medical Sciences Delhi, India
| | - Vandana Waghmare
- Department of Nephrology University College of Medical Sciences Delhi, India
| | - Rupam Ruchi
- Dr. RML Hospital Division of Nephrology University College of Medical Sciences Delhi, India
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9
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Sunder S, Grammatico-Guillon L, Lemaignen A, Lacasse M, Gaborit C, Boutoille D, Tattevin P, Denes E, Guimard T, Dupont M, Fauchier L, Bernard L. Incidence, characteristics, and mortality of infective endocarditis in France in 2011. PLoS One 2019; 14:e0223857. [PMID: 31652280 PMCID: PMC6814232 DOI: 10.1371/journal.pone.0223857] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives We assessed the determinants of mortality in infective endocarditis (IE), using the national hospital discharge databases (HDD) in 2011. Methods IE stays were extracted from the national HDD, with a definition based on IE-related diagnosis codes. This definition has been assessed according to Duke criteria by checking a sample of medical charts of IE giving a predictive positive value of 86.1% (95% confidence interval (CI): 82.7% - 89.5%). The impact of heart valve surgery on survival has been studied if performed during the initial stay, and over the year of follow-up. Risk factors of in-hospital mortality were identified using logistic regression model for the initial stay and Cox Time-dependent model for the 1-year mortality. Results The analysis included 6,235 patients. The annual incidence of definite IEs was 63 cases/million residents. Staphylococci and Streptococci were the most common bacteria (44% and 45%, respectively). A valvular surgery was performed in 20% of cases, but substantial variations existed between hospitals. The in-hospital mortality was 21% (ranging 12% to 27% according to the region of patients), associated with age>70, chronic liver disease, renal failure, S. aureus, P. aeruginosa or candida infection and strokes whereas valvular surgery, a native valve IE or intraveinous drug use (right heart IE) were significantly protective for an initial death. The same factors were associated with the one-year mortality, except for valvular surgery which was associated with a 1.4-fold higher risk of death during the year post IE. Conclusion We reported a high IE incidence rate. Valvular surgery was considerably less frequent in this study than in the previous published data (near 50%) whereas mortality was similar. Surgery was associated with higher survival if undergone within the initial stay. There were significant regional differences in frequency of surgery but it did not impact mortality.
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Affiliation(s)
- S. Sunder
- CH de Niort, Service des Maladies Infectieuses et Tropicale, Niort, France
| | - L. Grammatico-Guillon
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- Unité Inserm 1259, Université de tours, Tours, France
- * E-mail:
| | - A. Lemaignen
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - M. Lacasse
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - C. Gaborit
- Unité Inserm 1259, Université de tours, Tours, France
| | - D. Boutoille
- CHU de Nantes, Service des Maladies Infectieuses et Tropicales, Nantes, France
| | - P. Tattevin
- CHU de Rennes, Service des Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - E. Denes
- CHU de Limoges, Service des Maladies Infectieuses et Tropicales, Limoges, France
| | - T. Guimard
- CH de La Roche sur Yon, Service des Maladies Infectieuses, La Roche sur Yon, France
| | - M. Dupont
- CH de Saint Malo, Service des Maladies Respiratoires et Infectieuses, Saint Malo, France
| | - L. Fauchier
- Equipe d’accueil EA 1275, Université de Tours, Tours, France
- CHRU de Tours, Service de cardiologie, Tours, France
| | - L. Bernard
- CHRU de Tours, Unité d’Épidémiologie des données cliniques, EpiDcliC, Tours, France
- CHRU de Tours, Service de Médecine Interne et Maladies Infectieuses, Tours, France
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IKIZLER T, Shah B, Kirpalani A, Sunder S, Gupta A, Khanna U, Chafekar D, Pahari D, Nath G, Aike S. SAT-270 Results from the Chronic Kidney Disease Observational Database (CKDOD), India. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.307] [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: 10/26/2022] Open
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11
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Prazuck T, Verdon R, Le Moal G, Ajana F, Bernard L, Sunder S, Roncato-Sabenan M, Avettand-Fenoel V, Parienti J, Hocqueloux L. Stratégie d’allègement par une bithérapie d’analogues nucléosidiques (TDF/FTC) chez des patients virologiquement contrôlés : résultats de l’essai randomisé TRULIGHT. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.065] [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: 10/26/2022]
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12
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Gadouin V, Dos Santos A, Lureau P, Roblot F, Sunder S. Prise en charge de la Fièvre Q–restons simples ! Retours sur une épidémie humaine survenue en 2017. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.376] [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: 10/26/2022]
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13
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Baijal V, Gurunadh VS, Palit MG, Sunder S, Thakur PK. PUPIL INVOLVING COMPLETE III N PALSY IN PITUITARY ADENOMA: Case Report. Med J Armed Forces India 2017; 55:69-70. [PMID: 28775575 DOI: 10.1016/s0377-1237(17)30323-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- V Baijal
- Classified Specialist (Ophthalmology) Army Hospital (R & R) Delhi-10
| | - V S Gurunadh
- Classified Specialist (Ophthalmology) Army Hospital (R & R) Delhi-10
| | - M G Palit
- Senior Adviser (Ophthalmology) Army Hospital (R & R) Delhi-10
| | - S Sunder
- Graded Specialist (Ophthalmology), Military Hospital Jalandhar Castt
| | - P K Thakur
- Classified Specialist Radiotherapy, Command Hospital (SC), Pune 40
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14
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Pouget-Abadie X, Roncato-Sabéran M, Bernard L, Sunder S, Turmel JM, Rammaert B, Roblot F. Caractéristiques épidémiologiques et cliniques de la tularémie. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.360] [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: 11/27/2022]
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15
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Sunder S, Lemaignen A, Gaborit C, Boutoille D, Tattevin P, Denes E, Guimard T, Dupont M, Grammatico-Guillon L, Bernard L. Épidémiologie et déterminants de la prise en charge des endocardites infectieuses en France en 2011. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.158] [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: 11/16/2022]
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16
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Neamati N, Mazumder A, Sunder S, Owen JM, Schultz RJ, Pommier Y. 2-Mercaptobenzenesulphonamides as Novel Inhibitors of Human Immunodeficiency virus Type 1 Integrase and Replication. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/095632029700800602] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- N Neamati
- Laboratory of Molecular Pharmacology, Division of Basic Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - A Mazumder
- Laboratory of Molecular Pharmacology, Division of Basic Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - S Sunder
- Laboratory of Molecular Pharmacology, Division of Basic Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - JM Owen
- Laboratory of Molecular Pharmacology, Division of Basic Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - RJ Schultz
- Drug Synthesis and Chemistry Branch, Developmental Therapeutics Program, Division of Cancer Treatment, Diagnosis and Centers, National Cancer Institute, Bethesda, MD 20892, USA
| | - Y Pommier
- Laboratory of Molecular Pharmacology, Division of Basic Sciences, National Cancer Institute, Bethesda, MD 20892, USA
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Affiliation(s)
- Peter Taylor
- Atomic Energy of Canada Ltd. Whiteshell Laboratories, Pinawa, Manitoba ROE ILO, Canada
| | - William H. Hocking
- Atomic Energy of Canada Ltd. Whiteshell Laboratories, Pinawa, Manitoba ROE ILO, Canada
| | - Lawrence H. Johnson
- Atomic Energy of Canada Ltd. Whiteshell Laboratories, Pinawa, Manitoba ROE ILO, Canada
| | - Roderick J. McEachern
- Atomic Energy of Canada Ltd. Whiteshell Laboratories, Pinawa, Manitoba ROE ILO, Canada
| | - Sham Sunder
- Atomic Energy of Canada Ltd. Whiteshell Laboratories, Pinawa, Manitoba ROE ILO, Canada
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18
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Affiliation(s)
- S. Sunder
- Atomic Energy of Canada Limited Research Chemistry Branch, Whiteshell Laboratories Pinawa, Manitoba, Canada ROE 1L0
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19
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Affiliation(s)
- Sham Sunder
- Atomic Energy of Canada Limited, Whiteshell Laboratories Research Chemistry Branch, Pinawa, Manitoba, Canada
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20
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Affiliation(s)
| | - S. Sunder
- Atomic Energy of Canada Limited Fuel Safety Branch, Chalk River, Ontario, Canada K0J 1J0
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Shah B, Kirpalani A, Sunder S, Gupta A, Khanna U, Chafekar D, Tan L, Sirivongs D, Pahari D, Nath G, Zhao H, Dong J, Zhang H, Wang Y, Ikizler TA. SP389KETOANALOGUE TREATMENT IN CKD: +PRELIMINARY RESULTS FROM CKDOD. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- S. Sunder
- Atomic Energy of Canada Limited, Chalk River Laboratories Reactor Safety Division, Fuel and Fuel Channel Safety Branch Chalk River, Ontario, Canada K0J 1J0
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McClure EM, Garces A, Saleem S, Moore JL, Bose CL, Esamai F, Goudar SS, Chomba E, Mwenechanya M, Pasha O, Tshefu A, Patel A, Dhaded SM, Tenge C, Marete I, Bauserman M, Sunder S, Kodkany BS, Carlo WA, Derman RJ, Hibberd PL, Liechty EA, Hambidge KM, Krebs NF, Koso-Thomas M, Miodovnik M, Wallace DD, Goldenberg RL. Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG 2017; 125:131-138. [PMID: 28139875 DOI: 10.1111/1471-0528.14493] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. DESIGN Prospective, observational study. SETTING Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. POPULATION Pregnant women residing in defined study regions. METHODS Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. MAIN OUTCOME MEASURES Primary cause of stillbirth. RESULTS Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. CONCLUSIONS Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. TWEETABLE ABSTRACT Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
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Affiliation(s)
| | - A Garces
- Materno Infantil Unidad de Planificación, INCAP, Guatemala City, Guatemala
| | - S Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - C L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F Esamai
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - S S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - E Chomba
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - M Mwenechanya
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - O Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | - S M Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - C Tenge
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - I Marete
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - M Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Sunder
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - W A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R J Derman
- Department of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - E A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - K M Hambidge
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - N F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - M Koso-Thomas
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
| | - M Miodovnik
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
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Prakash J, Ganiger V, Prakash S, Sivasankar M, Sunder S, Singh U. Kidney Disease in Human Immunodeficiency Virus-seropositive Patients: Absence of Human Immunodeficiency Virus-associated Nephropathy was a Characteristic Feature. Indian J Nephrol 2017; 27:271-276. [PMID: 28761228 PMCID: PMC5514822 DOI: 10.4103/0971-4065.202400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 12/24/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection can cause a broad spectrum of renal diseases. However, there is paucity of Indian data on the patterns of renal lesions in HIV-seropositive patients. The aim of the present study was to delineate the spectrum of renal lesions in HIV/acquired immunodeficiency syndrome patients. In this prospective study, all HIV-positive patients of both genders aged >18 years were screened for renal disease. Patients with proteinuria of more than 1 g/24 h were subjected to renal biopsy. A total of 293 HIV-positive patients were screened; of these, 136 (46.4%) patients found to have renal involvement. Dipstick-positive proteinuria of 1+ or more was observed in 112 (38.2%) patients, and 16 (14.2%) patients had proteinuria of more than 1 g/24 h. Renal biopsy in 14 cases revealed glomerulonephritis (GN) in 12 (85.7%) (isolated GN in 4 [28.5%] and GN mixed with chronic TIN in 8 [57.1%]) patients. These include mesangioproliferative GN in 5 (35.7%), membranoproliferative GN in 2 (14.2%), focal segmental glomerulosclerosis in 2 (14.2%), diffuse proliferative GN in 2 (14.2%), and diabetic nephropathy in 1 (7.1%) patients. Chronic interstitial nephritis was noted in 10 (71.42%) (superimposed on GN in 8 [57.1%], isolated in 2 [14.2%]) patients. Granulomatous interstitial nephritis was seen in 3 (24.1%) cases. GN and chronic interstitial nephritis were noted in 85.7% and 71.42% of patients, respectively, mostly superimposed on each other. Mesangioproliferative GN was the most common glomerular lesion, but classical HIV-associated nephropathy was not observed.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - V Ganiger
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S Prakash
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - M Sivasankar
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - S Sunder
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - U Singh
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract
Cutaneous metastases from hypopharyngeal cancers is rare constituting about 0.8-1.3% and represent a sub-group of head and neck cancer patients who have very poor prognosis even when treated. We report a case of 65-year-old male diagnosed as carcinoma hypo pharynx stage IV who was on radiotherapy when he developed cutaneous metastasis over the chest wall, which initially presented as small nodules and later progressed into a proliferative lesion. Patient received further radiation to the metastatic lesion, but the disease was progressive, demonstrating that head and neck squamous cell cancer patients with skin metastasis fare poorly.
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Affiliation(s)
- D Niharika
- Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bengaluru, Karnataka, India
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Sunder S, Martin-Barbaz F, Lombard J, Merienne J, Dos Santos A. IOA-05 - Infections ostéo-articulaires sans diagnostic microbiologique : penser à la fièvre Q ! Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liang Z, Sunder S, Nallasivam S, Wilson TE. Overhang polarity of chromosomal double-strand breaks impacts kinetics and fidelity of yeast non-homologous end joining. Nucleic Acids Res 2016; 44:2769-81. [PMID: 26773053 PMCID: PMC4824102 DOI: 10.1093/nar/gkw013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 08/10/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022] Open
Abstract
Non-homologous end joining (NHEJ) is the main repair pathway for DNA double-strand breaks (DSBs) in cells with limited 5′ resection. To better understand how overhang polarity of chromosomal DSBs affects NHEJ, we made site-specific 5′-overhanging DSBs (5′ DSBs) in yeast using an optimized zinc finger nuclease at an efficiency that approached HO-induced 3′ DSB formation. When controlled for the extent of DSB formation, repair monitoring suggested that chromosomal 5′ DSBs were rejoined more efficiently than 3′ DSBs, consistent with a robust recruitment of NHEJ proteins to 5′ DSBs. Ligation-mediated qPCR revealed that Mre11-Rad50-Xrs2 rapidly modified 5′ DSBs and facilitated protection of 3′ DSBs, likely through recognition of overhang polarity by the Mre11 nuclease. Next-generation sequencing revealed that NHEJ at 5′ DSBs had a higher mutation frequency, and validated the differential requirement of Pol4 polymerase at 3′ and 5′ DSBs. The end processing enzyme Tdp1 did not impact joining fidelity at chromosomal 5′ DSBs as in previous plasmid studies, although Tdp1 was recruited to only 5′ DSBs in a Ku-independent manner. These results suggest distinct DSB handling based on overhang polarity that impacts NHEJ kinetics and fidelity through differential recruitment and action of DSB modifying enzymes.
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Affiliation(s)
- Zhuobin Liang
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sham Sunder
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Thomas E Wilson
- Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
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Shah B, Kirpalani A, Sunder S, Gupta A, Khanna U, Chafekar D, Tan LP, Sirivongs D, Pahari D, Nath G, Ikizler TA. A prospective, multi-centre, observational study to examine kidney disease progression in adults with chronic kidney disease - CKDOD - Study design and preliminary results. BMC Nephrol 2015; 16:215. [PMID: 26696239 PMCID: PMC4687357 DOI: 10.1186/s12882-015-0191-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/15/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background The objective of this article is to describe the organisation of an international, clinical registry, the Chronic Kidney Disease Observational Database (CKDOD), the processes of enrolling patients and entering data and preliminary results to date. Design The Chronic Kidney Disease Observational Database (CKDOD) is designed to assess the association between different factors with a known influence on chronic kidney disease (CKD) progression as well as treatment strategies such as dietary modifications, blood pressure control and pharmacological interventions in Asian countries (India, China, Malaysia and Thailand). The only inclusion criterion is the presence of CKD stage 2 or higher as defined by the KDIGO guidelines. Demographic and clinical information are collected by a standardised electronic questionnaire, available in English and Chinese. The data are transferred to the CKDOD database either by e-mail or via web access. All data are checked for consistency and missing values. Collection of data started in September 2011 and by April 2015, data on 1323 individual patients had been submitted. The mean age at inclusion was 57 ± 14 years, 67 % were male and 36 % were diabetic. The baseline estimated glomerular filtration rate was 26 ml/min/1.73 m2. Of all enrolled patients, 324 (24 %) received ketoanalogue supplementation during at least one recorded visit. Discussion The CKDOD is a very large and comprehensive data repository, currently focused in subjects recruited from Asia. The database is expected to provide important long-term information on CKD progression, nutritional and metabolic derangements that accompany CKD progression and treatment strategies to ameliorate progression and complications of CKD. Trial Registration Clinical Trial Registry – India: CTRI/2012/06/002743; 25th July 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0191-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Sham Sunder
- Department of Nephrology, RML (Ram Manohar Lohiya) hospital, New Delhi, India.
| | | | | | | | - Li Ping Tan
- University Malaya Medical Centre, Renal unit, Faculty of Medicine, Kuala Lumpur, Malaysia.
| | - Dhavee Sirivongs
- Department of Medicine, Khon Kaen Medical School, Khon Kaen City, Thailand.
| | - Dilip Pahari
- Dr. Medica Institute of Kidney Diseases, Kolkata, India.
| | - Gokul Nath
- Department of Nephrology, St. John's Medical College & Hospital, Bangalore, India.
| | - Talat Alp Ikizler
- Vanderbilt University Medical Center, Division of Nephrology, 1161 21st Avenue South, S-3223 Medical Center North, Nashville, TN, 37232-2372, USA.
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Govardhan H, Ibrahim N, Pallad S, Sridhar P, Nabiza B, Nihanthy D, Pramod K, Krishna U, Sunder S. 59PD Comparison of incidental radiation dose to axilla and internal mammary nodal area by conventional, 3DCRT, and IMRT technique in carcinoma of breast. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv519.08] [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: 11/13/2022] Open
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Krishnamoorthy V, Sunder S, Mahapatra HS, Verma H, Sharma N, Jayaraman R, Sathi S, Khanna S, Mohamed A. Evaluation of Protein-Energy Wasting and Inflammation on Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and its Correlations. Nephrourol Mon 2015; 7:e33143. [PMID: 26866011 PMCID: PMC4744638 DOI: 10.5812/numonthly.33143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Protein-energy wasting (PEW) and heightened inflammation are prevalent in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and is a strong risk factor for morbidity and mortality in these patients. Evaluation of PEW, prevalence of inflammation as well as interrelationship between various nutritional indices and inflammation has not been studied in much detail in patients undergoing CAPD. OBJECTIVES This study was conducted to evaluate the interrelationship between PEW and inflammation in patients undergoing CAPD. PATIENTS AND METHODS Sixty-three patients undergoing CAPD (M = 28, F = 35) were assessed with regard to their nutritional status and inflammation after a minimum of 3 months CAPD initiation. Nutritional status was assessed by dietary diary, anthropometry, subjective global assessment, and multifrequency bioelectrical impedance analysis (BIA). In addition, their serum albumin, prealbumin, transferrin, and cholesterol level were measured. Also, inflammation in these patients was assessed by High-Sensitivity C-Reactive Protein (hs-CRP > 3 mg/L) and Interleukin-6 (IL-6 > 2 µg/mL). Later on, diagnosis of malnutrition was made based on different methods. Correlation between inflammation and various nutritional assessment indices were analyzed statistically. RESULTS Mean (SD) age of the patients was 57.6 (11.6) years. The average (SD) calorie and protein intake per day were 25.5 (4.6) kcal and 0.81 (0.2) mg, respectively. The mean and standard deviation of anthropometry variables of body mass index (BMI), mid-arm circumference (MAC), tricipital skin-fold thickness (TST), mid-arm muscle circumference (MAMC), and corrected mid-arm muscle area (cMAMA) were 23.7 ± 5 kg/m(2), 26.3 ± 4.5 cm, 1.624 ± 0.4 cm, 25.6 ± 4.5 cm, and 45.7 ± 19.7 cm(2), respectively. The mean values of serum protein, albumin, prealbumin, transferrin, cholesterol, triglyceride, hs-CRP, and IL-6 were 5.9 g/dL, 3.0 g/dL, 21.11 mg/dL, 130.6 mg/dL, 155.9 mg/dL, 136.1 mg/dL, 8.8 ± 7.6 mg/L, and 8.4 ± 12.2 µg/dL, respectively. Based on subjective global assessment (SGA); 11.63 (17.4%), 34.63 (54%), and 18.65 (28.6%) patients undergoing CAPD had normal, moderate, and severe malnutrition status, respectively. According to serum albumin level; 13.63 (21%), 39.63 (62%), and 11.63 (17%) patients undergoing CAPD had normal, moderate, and severe malnutrition status, respectively. Finally, based on BMI; 33.63 (52%), 23.63 (37%), and 7.63 (11%) patients undergoing CAPD had normal, moderate, and severe malnutrition status, respectively. About 76.1% and 9.5% of patients undergoing CAPD were malnourished based on lean tissue index (LTI) and fat tissue index (FTI), respectively. Based on hs-CRP and IL-6 findings, 70% (44/63) and 71.8% (45/63) of patients undergoing CAPD had high inflammation, respectively. High sensitive C-reactive protein correlated negatively (significantly) with serum albumin, prealbumin, and transferrin. Interleukin -6 correlated negatively (significantly) with MAC; MAMA; serum albumin, cholesterol, and transferrin. There was significant positive correlation between hs-CRP and IL-6. There is statistically significant difference in total protein intake (g/d), protein intake (g/kg/d), serum protein (g/dL), albumin (g/dL), transferrin (mg/dL), and cholesterol (mg/dL) between patients with and without inflammation. CONCLUSIONS Protein-energy wasting (80% - 85%) by various methods and inflammation (70%) was very prevalent among patients undergoing CAPD. Inflammatory markers show significant negative correlation with anthropometry and serological markers. Inflammatory markers are suggested to be included in the regular assessment of patients undergoing CAPD, for the better management of protein-energy wasting.
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Affiliation(s)
- Venkataramanan Krishnamoorthy
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
- Corresponding author: Venkataramanan Krishnamoorthy, Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India. Tel: +91-4162265611, Fax: +91-1123747053, E-mail:
| | - Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Himansu Sekhar Mahapatra
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Himanshu Verma
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Rajesh Jayaraman
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Satyanand Sathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Shikha Khanna
- Department of Dietetics, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - Ashik Mohamed
- Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
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Sunder S, Venkataramanan K, Verma H, Bhardwaj M. A rare case of type-I auto-immune hepatitis and thyroiditis presenting with crescentic glomerulonephritis. Saudi J Kidney Dis Transpl 2015; 26:983-6. [PMID: 26354574 DOI: 10.4103/1319-2442.164584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A middle-aged female patient with a past history of non-alcoholic liver disease and hypothyroidism presented with swelling of the body, off and on, for six months and rapidly worsening renal function. Renal biopsy showed crescentic glomerulonephritis with negative immunofluorescence. Serological tests were positive for anti-thyroglobulin, anti-nuclear antibody (1:80), p-anti-neutrophil cytoplasmic antibodies; gamma globulin was 5.23 g/dL and viral markers were negative. The patient was diagnosed to have autoimmune hepatitis type-1 and treated with injection methylprednisolone pulse (500 mg/day for 3 days) and maintained on oral steroids and azathioprine 100 mg. She responded dramatically to this treatment and has remained in complete remission at last follow-up.
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Affiliation(s)
| | - K Venkataramanan
- Department of Nephrology, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Tio CW, Omerza G, Sunder S, Winter E. Autophosphorylation of the Smk1 MAPK is spatially and temporally regulated by Ssp2 during meiotic development in yeast. Mol Biol Cell 2015; 26:3546-55. [PMID: 26246597 PMCID: PMC4591697 DOI: 10.1091/mbc.e15-05-0322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 05/29/2015] [Accepted: 07/29/2015] [Indexed: 12/03/2022] Open
Abstract
A mechanism is described for activating MAPK at a specific location in the cell at a specific developmental stage. The mechanism involves regulated cis-autophosphorylation of the activation-loop Y residue in the MAPK. This mechanism for spatiotemporally regulating MAPK autophosphorylation may be widespread in developmental systems. Smk1 is a meiosis-specific MAPK that controls spore wall morphogenesis in Saccharomyces cerevisiae. Although Smk1 is activated by phosphorylation of the threonine (T) and tyrosine (Y) in its activation loop, it is not phosphorylated by a dual-specificity MAPK kinase. Instead, the T is phosphorylated by the cyclin-dependent kinase (CDK)–activating kinase, Cak1. The Y is autophosphorylated in an intramolecular reaction that requires a meiosis-specific protein named Ssp2. The meiosis-specific CDK-like kinase, Ime2, was previously shown to positively regulate Smk1. Here we show that Ime2 activity is required to induce the translation of SSP2 mRNA at anaphase II. Ssp2 protein is then localized to the prospore membrane, the structure where spore wall assembly takes place. Next the carboxy-terminal portion of Ssp2 forms a complex with Smk1 and stimulates the autophosphorylation of its activation-loop Y residue. These findings link Ime2 to Smk1 activation through Ssp2 and define a developmentally regulated mechanism for activating MAPK at specific locations in the cell.
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Affiliation(s)
- Chong Wai Tio
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA 19107
| | - Gregory Omerza
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA 19107
| | - Sham Sunder
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Edward Winter
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, PA 19107
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Abstract
Acute kidney injury (AKI) is an important cause of hospitalization and morbidity in human immunodeficiency virus (HIV)-positive patients. However, the data on AKI in such patients is limited. The aim of the present study was to analyze the incidence, causes and outcome of AKI in HIV-positive patients from our antiretroviral therapy centre. All HIV-positive patients were evaluated for evidence of clinical AKI. AKI was noted in 138/3540 (3.9%) patients. Of 138 AKI patients, 96 (69.6%) had acquired immuno deficiency syndrome and 42 (30.4%) were HIV seropositive. Majority of AKI patients belonged to AKI network (AKIN) Stage II (42%) or III (48.5%) at presentation. Prerenal, intrinsic and postrenal AKI were noted in 53.6%, 44.2% and 2.2% of cases, respectively. Hypovolemia (44.2%) and sepsis (14.5%) contributed to AKI in vast majority of cases. AKI was multifactorial (volume depletion, sepsis and drugs) in 39% of patients. Acute tubular necrosis (ATN) was the most common intrinsic lesion. Acute interstitial nephritis and diffuse endocapillary proliferative glomerulonephritis were noted in five and two cases, respectively. In-hospital mortality was 24.64%. Lower CD4 count, decreased serum albumin level and Stage 4 WHO disease were associated with higher mortality. At 3 months or more follow-up complete recovery of renal function, chronic kidney disease Stage 3-5 and progression to end stage renal disease were noted in 58.69%, 14.5% and 2.2% of cases, respectively. Thus, prerenal factors and ischemic ATN were the most common cause of AKI in HIV-infected patients. Recovery of renal function was seen in 59% of cases, but AKI had high in-hospital mortality.
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Affiliation(s)
- J Prakash
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - T Gupta
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S Prakash
- Department of Medicine, TNMC, Mumbai, Maharashtra, India
| | - S S Rathore
- Department of Nephrology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - Usha
- Department of Pathology, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
| | - S Sunder
- Department of Medicine, Institute of Medical Sciences, Banares Hindu University, Varanasi, Uttar Pradesh, India
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Bouvet D, Gaudy-Graffin C, Garot D, Sunder S, De Gialluly C, Goudeau A. Diagnosis of community-acquired acute respiratory illness: From conventional microbiological methods to molecular detection (multiplex). ACTA ACUST UNITED AC 2015; 63:69-73. [PMID: 25596173 PMCID: PMC7126571 DOI: 10.1016/j.patbio.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
Investigations of the etiologic agents of community-acquired acute respiratory illness may lead to better treatment decisions and patient outcomes. In a routine care setting, we assessed the diagnostic performance of a multiplex PCR assay with respect to conventional microbiological methods, in a continuous series of adult cases of community-acquired acute respiratory illness. We enrolled 279 adult patients hospitalised for community-acquired acute respiratory illness at Tours University Hospital during the winter of 2011–2012. Respiratory samples (mostly nasopharyngeal aspirates) were studied prospectively by indirect immunofluorescence assay and multiplex PCR, that enable detection of 8 viruses and 21 respiratory pathogens respectively. In total, 255 of the 279 (91.4%) samples had interpretable results by both methods. At least one respiratory pathogen was detected by multiplex PCR in 171 specimens (65%). Overall, 130 (76%) of the 171 positive samples were positive for only one respiratory pathogen, 37 (22%) samples were positive for two pathogens and four (2%) were positive for three pathogens. With indirect immunofluorescence assay, a respiratory virus was detected in 27 of the 255 (11%) specimens. Indirect immunofluorescence assay detected some of the influenza virus A (15/51, 29%) infections identified by multiplex PCR and some (7/15, 47%) human metapneumovirus and (5/12, 42%) respiratory syncytial virus infections, but it did not detect all the adenovirus infections. Thus, access to multiplex molecular assays improves the diagnostic spectrum and accuracy over conventional methods, increasing the frequency of identification of the respiratory pathogens involved in community-acquired acute respiratory illness.
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Affiliation(s)
- D Bouvet
- Service de bactériologie et virologie, hôpital Bretonneau, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France
| | - C Gaudy-Graffin
- Service de bactériologie et virologie, hôpital Bretonneau, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France.
| | - D Garot
- Service de réanimation médicale, hôpital Bretonneau, CHRU, 37000 Tours, France
| | - S Sunder
- Service de médecine interne et maladies infectieuses, hôpital Bretonneau, CHRU, 37000 Tours, France
| | - C De Gialluly
- Laboratoire de bactériologie et hygiène hospitalière, hôpital Trousseau, CHRU, 37000 Tours, France
| | - A Goudeau
- Service de bactériologie et virologie, hôpital Bretonneau, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France
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Sathi S, Mahapatra H, Sunder S, Jayaraman R, Sharma N, Verma H, Krishnamoorthy V, Gupta A, Kanchi P, Daksh S, Pursnani L, Shadab F, Singh M. Nontraditional cardiovascular biomarkers and estimation of cardiovascular risk in predialysis chronic kidney disease patients and their correlations with carotid intima media thickness. Nephrourol Mon 2014; 6:e22112. [PMID: 25738114 PMCID: PMC4330673 DOI: 10.5812/numonthly.22112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 07/17/2014] [Revised: 07/27/2014] [Accepted: 08/05/2014] [Indexed: 01/18/2023] Open
Abstract
Background: Cardiovascular biomarkers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), hs-CRP (high sensitivity C-reactive protein), and albuminuria predict underlying heart disease in the general population as well as CKD patients. Objectives: We aimed to study the association of NT-proBNP, cTnT, hs-CRP, and spot urine albumin creatinine ratio with carotid intima media thickness (CIMT) for cardiovascular risk estimation in predialysis CKD (chronic kidney disease) patients. Patients and Methods: This cross-sectional study included a total of 120 adult predialysis CKD patients. Forty patients were allocated in each predialysis CKD group of stages 3, 4, and 5. Serum cTnT and hs-CRP, plasma NT-proBNP, and single spot urine albumin creatinine ratio (ACR) were measured. Ultrasonographic examination of carotid artery was done with 7.5 MHz linear probe in B mode ultrasonography and carotid intima media thickness was measured. Results: Mean values ± standard deviation of plasma NT-proBNP (pg/mL), serum hs-CRP (mg/L), spot urine ACR (mg/g of creatinine), and CIMT (mm) were 585.68 ± 514.84, 5.96 ± 2.52, 719.37 ± 411.36, and 0.78 ± 0.15, respectively in predialysis CKD patients (n = 120). Serum cTnT level was high in 40% of predialysis CKD patients. Among cardiovascular biomarkers, plasma NT-proBNP had maximum strength of correlation (Spearman Rho correlation coefficient; r = 0.575 and P < 0.0001) with the carotid intima media thickness followed by serum cTnT (Spearman Rho correlation coefficient; r = 0.419 and P < 0.0001), spot urine albumin creatinine ratio (Spearman Rho correlation coefficient; r = 0.322 and P < 0.0001), and serum hs-CRP (Spearman Rho correlation coefficient; r = 0.246 and P = 0.007). Conclusions: Nontraditional cardiovascular biomarkers such as plasma NT-proBNP, serum cTnT, serum hs-CRP, and spot urine ACR significantly correlate with CIMT. These biomarkers can estimate the cardiovascular risk in a predialysis CKD population with expected high cardiac morbidity and mortality.
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Affiliation(s)
- Satyanand Sathi
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
- Corresponding author: Satyanand Sathi, Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, P.O.Box: 110001, New Delhi, India. Tel: +91-9654848620, Fax: +91-1125739347, E-mail:
| | - Himanshu Mahapatra
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Sham Sunder
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Rajesh Jayaraman
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Himanshu Verma
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | | | - Anurag Gupta
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Prabhu Kanchi
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Sunil Daksh
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Lalit Pursnani
- Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Faisal Shadab
- Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Manveer Singh
- Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
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Sunder S, Jayaraman R, Mahapatra HS, Sathi S, Venkataramanan K, Prabhu K, Gupta A, Sethi S. Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study. Urol Ann 2014; 6:340-5. [PMID: 25371613 PMCID: PMC4216542 DOI: 10.4103/0974-7796.141002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 05/19/2013] [Accepted: 09/25/2013] [Indexed: 11/15/2022] Open
Abstract
Background: Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention. Aim: To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention. Materials and Methods: Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation. Results: 18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting. Conclusion: Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajesh Jayaraman
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Himanshu Sekhar Mahapatra
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Satyanand Sathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - K Venkataramanan
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - K Prabhu
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Suman Sethi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Jayaraman R, Sunder S, Sathi S, Gupta VK, Sharma N, Kanchi P, Gupta A, Daksh SK, Ram P, Mohamed A. Post cardiac surgery acute kidney injury: a woebegone status rejuvenated by the novel biomarkers. Nephrourol Mon 2014; 6:e19598. [PMID: 25068144 PMCID: PMC4109123 DOI: 10.5812/numonthly.19598] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 04/22/2014] [Revised: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Acute kidney injury (AKI) is common after cardiac surgery, the incidence varying between 7.7% and 28.1%. It significantly increases morbidity and mortality. Creatinine considerably delays the diagnosis with its own attended demerits. Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality. Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18). Objectives: To find out the incidence of AKI in post-cardiac surgery patients in our hospital, the ability of the two biomarkers in early diagnosis in predicting the severity of AKI based on RIFLE’s criteria and their ability to discriminate pre-renal from intrinsic AKI. Patients and Methods: One-hundred patients who underwent cardiac surgery were selected. Midstream urine samples were collected at 3 time intervals (baseline before surgery, 24 hours and 7 days after surgery). Biomarkers were measured by ELISA using BIORAD processors. Fractional excretion of sodium and urea were used to discriminate pre-renal from intrinsic AKI. Results: Out of 100 patients, 31 had AKI, 11 being pre-renal and 20 intrinsic AKI. Four patients required renal replacement therapy (12.9% among AKI cases and 4% in the overall study cohort). Four among 31 expired in intensive care unit. Identifiable risk factors for AKI included insulin requiring diabetes mellitus, chronic obstructive pulmonary disease, increased cardio-pulmonary bypass time, combined valvular surgery and coronary artery bypass grafting, employment of intra-aortic balloon counter pulsation, left main coronary artery occlusion and an ejection fraction of < 40%. NGAL was extremely sensitive (area under curve-0.96) in detecting intrinsic AKI at 24 hours followed by IL-18 ratio with an area under curve of 0.89. Creatinine at 24 hours was able to detect only 31.6% of intrinsic AKI. None of the pre-renal cases showed rise in the urinary biomarker levels. Patients with higher stages of AKI had higher levels of both biomarkers than those at lower stages. Conclusions: NGAL and IL-18 obviated the disadvantages of creatinine. They were efficient in early detection of AKI, in differentiating pre-renal from intrinsic AKI and in predicting the severity of AKI reliably in post-cardiac surgery patients.
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Affiliation(s)
- Rajesh Jayaraman
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
- Corresponding author: Rajesh Jayaraman, Department of Nephrology, Dr. Ram Manohar Lohia, Hospital Indraprastha University, New Delhi, India. Tel: +91-9953505508, Fax:+91-1125739347, E-mail:
| | - Sham Sunder
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Satyanand Sathi
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Vijay Kumar Gupta
- Department of Cardio Thoracic and Vascular Surgery, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Neera Sharma
- Department of Biochemistry, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Prabhu Kanchi
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Anurag Gupta
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Sunil Kumar Daksh
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Pranith Ram
- Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India
| | - Ashik Mohamed
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Sunder S, Jayaraman R, Mahapatra HS, Sathi S, Ramanan V, Kanchi P, Gupta A, Daksh SK, Ram P. Estimation of renal function in the intensive care unit: the covert concepts brought to light. J Intensive Care 2014; 2:31. [PMID: 25520843 PMCID: PMC4267588 DOI: 10.1186/2052-0492-2-31] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 01/13/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022] Open
Abstract
Frantic efforts have been made up to this date to derive consensus for estimating renal function in critically ill patients, only to open the Pandora's box. This article tries to explore the various methods available to date, the newer concepts, and the uncared issues that may still prove to be useful in estimating renal function in intensive care unit patients. The concept of augmented renal clearance, which is frequently encountered in critically ill patients, should always be taken into account, as correct therapeutic dosage of drugs sounds vital which in turn depends on correctly calculated glomerular filtration rate. Serum creatinine and creatinine-based formulae have their own demerits that are well known and established. While Cockcroft-Gault and 4-variable modification of diet in renal diseases formulae are highly inadequate in the intensive care setup for estimating glomerular filtration rate, employing isotopic methods is impractical and cumbersome. The 6-variable modification of diet in renal diseases formula fairs better as it takes into account the serum albumin and blood urea nitrogen, too. Jelliffe's and modified Jelliffe's equations take into account the rate of creatinine production and volume of distribution which in turn fluctuates heavily in a critically ill patient. Twenty-four-hour and timed creatinine clearances offer values close to reality although not accurate and cannot provide immediate results. Cystatin C is a novel agent that offers a sure promise as it is least influenced by factors that affect serum creatinine to a major extent. Aminoglycoside clearance, although still in the dark area, may prove a simple yet precise way of estimating glomerular filtration rate in those patients in whom these drugs are therapeutically employed. Optic ratiometric method has emerged as the most sophisticated one in glomerular filtration rate estimation in critically ill patients.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Rajesh Jayaraman
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Himanshu Sekhar Mahapatra
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Satyanand Sathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Venkata Ramanan
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Prabhu Kanchi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Anurag Gupta
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Sunil Kumar Daksh
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
| | - Pranit Ram
- Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Dr. Ram Manohar Lohia Hospital, 15/57, Second floor, Old Rajinder Nagar, New Delhi, Delhi, 110060 India
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Farag YMK, Mittal BV, Keithi-Reddy SR, Acharya VN, Almeida AF, C A, Ballal HS, Gaccione P, Issacs R, Jasuja S, Kirpalani AL, Kher V, Modi GK, Nainan G, Prakash J, Rajapurkar MM, Rana DS, Sreedhara R, Sinha DK, Shah BV, Sunder S, Sharma RK, Seetharam S, Raju TR, Singh AK. Burden and predictors of hypertension in India: results of SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2014; 15:42. [PMID: 24602391 PMCID: PMC4015417 DOI: 10.1186/1471-2369-15-42] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 11/19/2012] [Accepted: 10/04/2013] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension (HTN) is one of the major causes of cardiovascular morbidity and mortality. The objective of the study was to investigate the burden and predictors of HTN in India. Methods 6120 subjects participated in the Screening and Early Evaluation of Kidney disease (SEEK), a community-based screening program in 53 camps in 13 representative geographic locations in India. Of these, 5929 had recorded blood pressure (BP) measurements. Potential predictors of HTN were collected using a structured questionnaire for SEEK study. Results HTN was observed in 43.5% of our cohort. After adjusting for center variation (p < 0.0001), predictors of a higher prevalence of HTN were older age ≥40 years (p < 0.0001), BMI of ≥ 23 Kg/M2 (p < 0.0004), larger waist circumference (p < 0.0001), working in sedentary occupation (p < 0.0001), having diabetes mellitus (p < 0.0001), having proteinuria (p < 0.0016), and increased serum creatinine (p < 0.0001). High school/some college education (p = 0.0016), versus less than 9th grade education, was related with lower prevalence of HTN. Of note, proteinuria and CKD were observed in 19% and 23.5% of HTN subjects. About half (54%) of the hypertensive subjects were aware of their hypertension status. Conclusions HTN was common in this cohort from India. Older age, BMI ≥ 23 Kg/M2, waist circumference, sedentary occupation, education less, diabetes mellitus, presence of proteinuria, and raised serum creatinine were significant predictors of hypertension. Our data suggest that HTN is a major public health problem in India with low awareness, and requires aggressive community-based screening and education to improve health.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ajay K Singh
- Renal Division, Brigham & Women's Hospital & Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Affiliation(s)
- S. Sunder
- Whiteshell Laboratories, AECL, Pinawa, Manitoba, Canada, ROE ILO
| | - J. J. Cramer
- Whiteshell Laboratories, AECL, Pinawa, Manitoba, Canada, ROE ILO
| | - Ν. H. Miller
- Whiteshell Laboratories, AECL, Pinawa, Manitoba, Canada, ROE ILO
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Chaussade H, Sunder S, Bernard L, Coloby P, Guy L, Karsenty G, Bastide C, Bruyère F. Les médicaments antibiotiques en urologie. Prog Urol 2013; 23:1327-41. [DOI: 10.1016/j.purol.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 11/16/2022]
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Sunder S, Sathi S, Venkataramanan K, Verma H, Bhardwaj M, Rajesh J, Mahapatra H. A Rare Case of Type I RenalTubular Acidosis with Membranous Nephropathy Presenting as Hypokalemic Paralysis. Case Rep Nephrol Urol 2013; 3:91-8. [PMID: 23898345 PMCID: PMC3721128 DOI: 10.1159/000353768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Type 1 renal tubular acidosis (RTA), or distal RTA (dRTA), is a disorder of renal tubular acidification, which is generally asymptomatic but may rarely present as hypokalemic paralysis. Here, we report the case of a young male who presented with sudden onset weakness of all 4 limbs and a 2-month history of swelling of the legs. An investigation revealed hypokalemia, metabolic acidosis, and nephrotic syndrome. Additional analyses revealed normal anion gap metabolic acidosis with a positive urine anion gap and dRTA. Renal biopsy showed evidence of membranous nephropathy (MN). The patient's weakness improved with potassium supplements. Normalization of the serum potassium level and disappearance of proteinuria were established with an ACE inhibitor and potassium supplementation. This case is an unusual combination of dRTA with MN coupled with the rare presenting symptoms of hypokalemic paralysis and medullary nephrocalcinosis.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, PGIMER, Dr. R.M.L. Hospital, New Delhi, India
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Singh AK, Farag YMK, Mittal BV, Subramanian KK, Reddy SRK, Acharya VN, Almeida AF, Channakeshavamurthy A, Ballal HS, P G, Issacs R, Jasuja S, Kirpalani AL, Kher V, Modi GK, Nainan G, Prakash J, Rana DS, Sreedhara R, Sinha DK, V SB, Sunder S, Sharma RK, Seetharam S, Raju TR, Rajapurkar MM. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2013; 14:114. [PMID: 23714169 PMCID: PMC3848478 DOI: 10.1186/1471-2369-14-114] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [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: 05/31/2012] [Accepted: 03/20/2013] [Indexed: 01/14/2023] Open
Abstract
Background There is a rising incidence of chronic kidney disease that is likely to pose major problems for both healthcare and the economy in future years. In India, it has been recently estimated that the age-adjusted incidence rate of ESRD to be 229 per million population (pmp), and >100,000 new patients enter renal replacement programs annually. Methods We cross-sectionally screened 6120 Indian subjects from 13 academic and private medical centers all over India. We obtained personal and medical history data through a specifically designed questionnaire. Blood and urine samples were collected. Results The total cohort included in this analysis is 5588 subjects. The mean ± SD age of all participants was 45.22 ± 15.2 years (range 18–98 years) and 55.1% of them were males and 44.9% were females. The overall prevalence of CKD in the SEEK-India cohort was 17.2% with a mean eGFR of 84.27 ± 76.46 versus 116.94 ± 44.65 mL/min/1.73 m2 in non-CKD group while 79.5% in the CKD group had proteinuria. Prevalence of CKD stages 1, 2, 3, 4 and 5 was 7%, 4.3%, 4.3%, 0.8% and 0.8%, respectively. Conclusion The prevalence of CKD was observed to be 17.2% with ~6% have CKD stage 3 or worse. CKD risk factors were similar to those reported in earlier studies. It should be stressed to all primary care physicians taking care of hypertensive and diabetic patients to screen for early kidney damage. Early intervention may retard the progression of kidney disease. Planning for the preventive health policies and allocation of more resources for the treatment of CKD/ESRD patients are imperative in India.
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Affiliation(s)
- Ajay K Singh
- Brigham & Women's Hospital & Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Gupta S, Husain N, Kumar A, Sunder S. Adult primary pleomorphic leiomyosarcoma of forearm with axillary lymph node metastasis: a case report and literature review. J Cancer Res Ther 2012; 8:448-50. [PMID: 23174734 DOI: 10.4103/0973-1482.103532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A rare case of advanced pleomorphic leiomyosarcoma of forearm with axillary lymph node metastasis in a young adult, diagnosed with the aid of immunohistochemistry and electron microscopic examinations together with a review of the literature are reported. The primary tumor involved the extensor and flexor aspect of forearm without bone involvement and metastasized to the axillary lymph nodes. Patient showed poor treatment outcome with adjuvant chemoradiotherapy following incomplete surgery.
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Affiliation(s)
- Seema Gupta
- Department of Radiotherapy, C.S.M. Medical University, Lucknow, Uttar Pradesh, India.
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Abstract
Tumoral calcinosis is an uncommon and severe complication of chronic renal failure. It is generally associated with the presence of a high-serum calcium-and-phosphorus product. We report here a case of a patient on maintenance hemodialysis who presented with progressively increasing, solitary, tumor-like swelling over the nape of the neck. A 50-year-old female on thrice weekly maintenance hemodialysis for the last 3 years presented with a small swelling over the nape of the neck that had been progressively increasing over the last 1 year to cricket ball size. The patient was investigated and diagnosed as having tumoral calcinosis. The metastatic calcification occurring in the patient was most likely related to high calcium × phosphate product with coexistent secondary hyperparathyroidism possibly aggravated by vitamin D therapy. The patient was treated with withdrawal of vitamin D therapy, strict control of serum phosphate levels with noncalcemic phosphate binders, and subtotal parathyroidectomy. The neck swelling started decreasing in size after 2 months of parathyroidectomy and there was marked clinical improvement with drop in serum parathormone levels, over a period of 6 months. After 2 years of parathyroidectomy, the neck swelling again started increasing in size with increase in serum parathormone levels. The patient was treated with cinacalcet and the neck swelling gradually decreased in size along with control of serum parathormone and phosphate levels.
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Affiliation(s)
- Sham Sunder
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
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Potter K, Cremona N, Sunder S, Wise JA. A dominant role for meiosis-specific 3' RNA processing in controlling expression of a fission yeast cyclin gene. RNA 2012; 18:1408-1420. [PMID: 22647846 PMCID: PMC3383971 DOI: 10.1261/rna.033423.112] [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] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/15/2012] [Indexed: 06/01/2023]
Abstract
Meiotic gene regulation provides a rich source of insight into mechanisms of temporal control during development. We previously reported that accumulation of many meiotic mRNAs in fission yeast is governed by changes in 3' RNA processing and elucidated the molecular basis of this regulatory mechanism for an early meiotic gene. Here, we report that cleavage/polyadenylation is also the nexus of negative control for middle meiotic genes. Parallel profiles of splicing and polyadenylation are observed over a meiotic time course for both rem1 and spo4 but not for a constitutive control gene. Nevertheless, polyadenylation of rem1 transcripts is restricted to meiosis by a splicing-independent mechanism. Through systematic sequence substitutions, we identified a negative control region (NCR) located upstream of the rem1 transcription start site and found that it is required to block 3' RNA processing in proliferating cells. Ablation of the NCR relieves inhibition regardless of whether the intron is present, absent, or carries splice site mutations. Consistent with the previous report of a polypeptide encoded by the first exon of rem1, we discovered a second 3' processing site just downstream from the 5' splice site. Polyadenylation within the intron is activated concurrent with the downstream site during meiosis, is controlled by the NCR, and is enhanced when splicing is blocked via 5' junction or branch point mutations. Taken together, these data suggest a novel regulatory mechanism in which a 5' element modulates the dynamic interplay between splicing and polyadenylation.
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Affiliation(s)
- Kristine Potter
- Center for RNA Molecular Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4960, USA
| | - Nicole Cremona
- Center for RNA Molecular Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4960, USA
| | | | - Jo Ann Wise
- Center for RNA Molecular Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4960, USA
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Chatterjee K, Coshic P, Borgohain M, Thapliyal RM, Chakroborty S, Sunder S. Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital. Natl Med J India 2012; 25:207-209. [PMID: 23278777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. METHODS We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). RESULTS Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. CONCLUSION In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.
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Affiliation(s)
- K Chatterjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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48
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Sunder S, Greeson-Lott NT, Runge KW, Sanders SL. A new method to efficiently induce a site-specific double-strand break in the fission yeast Schizosaccharomyces pombe. Yeast 2012; 29:275-91. [PMID: 22674789 DOI: 10.1002/yea.2908] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 05/03/2012] [Indexed: 12/16/2022] Open
Abstract
Double-strand DNA breaks are a serious threat to cellular viability and yeast systems have proved invaluable in helping to understand how these potentially toxic lesions are sensed and repaired. An important method to study the processing of DNA breaks in the budding yeast Saccharomyces cerevisiae is to introduce a unique double-strand break into the genome by regulating the expression of the site-specific HO endonuclease with a galactose inducible promoter. Variations of the HO site-specific DSB assay have been adapted to many organisms, but the methodology has seen only limited use in the fission yeast Schizosaccharomyces pombe because of the lack of a promoter capable of inducing endonuclease expression on a relatively short time scale (~1 h). We have overcome this limitation by developing a new assay in which expression of the homing endonuclease I-PpoI is tightly regulated with a tetracycline-inducible promoter. We show that induction of the I-PpoI endonuclease produces rapid cutting of a defined cleavage site (> 80% after 1 h), efficient cell cycle arrest and significant accumulation of the checkpoint protein Crb2 at break-adjacent regions in a manner that is analogous to published findings with DSBs produced by an acute exposure to ionizing irradiation. This assay provides an important new tool for the fission yeast community and, because many aspects of mammalian chromatin organization have been well-conserved in Sz. pombe but not in S. cerevisiae, also offers an attractive system to decipher the role of chromatin structure in modulating the repair of double-stranded DNA breaks.
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Affiliation(s)
- Sham Sunder
- Department of Biochemistry and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Sunder S, Haguenoer E, Bouvet D, Lissandre S, Bree A, Perrotin D, Helloin E, Lanotte P, Schouler C, Guillon A. Life-threatening Escherichia coli cellulitis in patients with haematological malignancies. J Med Microbiol 2012; 61:1324-1327. [PMID: 22580917 DOI: 10.1099/jmm.0.042366-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cellulitis due to Escherichia coli is rare and usually secondary to a cutaneous portal of entry. Skin and soft tissue infections (SSTI) secondary to E. coli bacteraemia have been reported exclusively in immunodeficient patients. Here, we report two cases of serious cellulitis secondary to E. coli bacteraemia in patients with haematological malignancies. Both isolated strains belonged to phylogenetic group B2 and harboured some of the main virulence factor genes commonly found in extra-intestinal pathogenic E. coli (ExPEC), including neuC, iro and fimH. Cellulitis due to E. coli seems to be linked to the immunocompromised status of patients rather than to a highly virulent clone. Nevertheless, some of the virulence factors appear to be important because both isolates belong to phylogenetic group B2. This aetiology should be considered in SSTI in patients with haematological malignancies.
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Affiliation(s)
- S Sunder
- Université François Rabelais de Tours, France.,Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, France
| | - E Haguenoer
- Service de Bactériologie-Virologie, CHRU de Tours, France.,Université François Rabelais de Tours, France
| | - D Bouvet
- Service de Bactériologie-Virologie, CHRU de Tours, France.,Université François Rabelais de Tours, France
| | - S Lissandre
- Service d'Hématologie et Thérapie Cellulaire, CHRU de Tours, France
| | - A Bree
- INRA, UR 1282 Infectiologie Animale et Santé Publique, Nouzilly, France
| | - D Perrotin
- Service de Réanimation Médicale, CHRU de Tours, France.,Université François Rabelais de Tours, France
| | - E Helloin
- INRA, UR 1282 Infectiologie Animale et Santé Publique, Nouzilly, France
| | - P Lanotte
- Service de Bactériologie-Virologie, CHRU de Tours, France.,Université François Rabelais de Tours, France
| | - C Schouler
- INRA, UR 1282 Infectiologie Animale et Santé Publique, Nouzilly, France
| | - A Guillon
- Service de Réanimation Médicale, CHRU de Tours, France.,Université François Rabelais de Tours, France
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Sunder S, Gras G, Bastides F, De Gialluly C, Choutet P, Bernard L. Chronic Q Fever: Relevance of Serology. Clin Infect Dis 2011; 53:749-50. [DOI: 10.1093/cid/cir438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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