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Wan EYF, Mathur S, Zhang R, Lam AHY, Wang B, Yan VKC, Chui CSL, Li X, Wong CKH, Lai FTT, Cheung CL, Chan EWY, Tan KCB, Wong ICK. Long-term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong. Diabetes Obes Metab 2023; 25:3807-3816. [PMID: 37735816 DOI: 10.1111/dom.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
AIM To evaluate the long-term associations between coronavirus disease 2019 (COVID-19) and diabetes complications and mortality, in patients with diabetes. MATERIALS AND METHODS People with diabetes diagnosed with COVID-19 infection (exposed group), from 16 March 2020 to 31 May 2021 from the UK Biobank (UKB cohort; n = 2456), and from 1 April 2020 to 31 May 2022 from the electronic health records in Hong Kong (HK cohort; n = 80 546), were recruited. Each patient was randomly matched with participants with diabetes but without COVID-19 (unexposed group), based on age and sex (UKB, n = 41 801; HK, n = 391 849). Patients were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. Long-term association of COVID-19 with multi-organ disease complications and all-cause mortality after 21 days of diagnosis was evaluated by Cox regression. RESULTS Compared with uninfected participants, patients with COVID-19 infection with diabetes were consistently associated with higher risks of cardiovascular diseases (coronary heart disease [CHD]: hazard ratio [HR] [UKB]: 1.6 [95% confidence interval {CI}: 1.0, 2.4], HR [HK]: 1.2 [95% CI: 1.0, 1.5]; and stroke: HR [UKB]: 2.0 [95% CI: 1.1, 3.6], HR [HK]: 1.5 [95% CI: 1.3, 1.8]), microvascular disease (end stage renal disease: HR [UKB]: 2.1 [95% CI: 1.1, 4.0], HR [HK]: 1.2 [95% CI: 1.1, 1.4]) and all-cause mortality (HR [UKB]: 4.6 [95% CI: 3.8, 5.5], HR [HK]: 2.6 [95% CI: 2.5, 2.8]), in both cohorts. CONCLUSIONS COVID-19 infection is associated with long-term increased risks of diabetes complications (especially cardiovascular complications, and mortality) in people with diabetes. Monitoring for signs/symptoms of developing these long-term complications post-COVID-19 infection in the infected patient population of people with diabetes may be beneficial in minimizing their morbidity and mortality.
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Affiliation(s)
- Eric Yuk Fai Wan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sukriti Mathur
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ran Zhang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Athene Hoi Ying Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Boyuan Wang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
| | - Ching Lung Cheung
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Kathryn Choon Beng Tan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
- Aston Pharmacy School, Aston University, Birmingham, UK
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Wan EYF, Zhang R, Mathur S, Yan VKC, Lai FTT, Chui CSL, Li X, Wong CKH, Chan EWY, Lau CS, Wong ICK. Post-acute sequelae of COVID-19 in older persons: multi-organ complications and mortality. J Travel Med 2023; 30:taad082. [PMID: 37310901 DOI: 10.1093/jtm/taad082] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Evidence on long-term associations between coronavirus disease 2019 (COVID-19) and risks of multi-organ complications and mortality in older population is limited. This study evaluates these associations. RESEARCH DESIGN AND METHODS The cohorts included patients aged ≥60 year diagnosed with COVID-19 infection (cases), between 16 March 2020 and 31 May 2021 from the UK Biobank; and between 01 April 2020 and 31 May 2022 from the electronic health records in Hong Kong. Each patient was randomly matched with individuals without COVID-19 infection based on year of birth and sex and were followed for up to 18 months until 31 August 2021 for UKB, and up to 28 months until 15 August 2022 for HK cohort. Patients with COVID-19 infection over 6 months after the date of last dose of vaccination and their corresponding controls were excluded from our study. Characteristics between cohorts were further adjusted with Inverse Probability Treatment Weighting. For evaluating long-term association of COVID-19 with multi-organ disease complications and mortality after 21-days of diagnosis, Cox regression was employed. RESULT 10,759 (UKB) and 165,259 (HK) older adults with COVID-19 infection with matched 291,077 (UKB) and 1,100,394 (HK) non-COVID-19-diagnosed older adults were recruited. Older adults with COVID-19 were associated with a significantly higher risk of cardiovascular outcomes [major cardiovascular disease (stroke, heart failure and coronary heart disease): hazard ratio(UKB): 1.4 (95% Confidence interval: 1.1,1.6), HK:1.2 (95% CI: 1.1,1.3)]; myocardial infarction: HR(UKB): 1.8 (95% CI: 1.3,2.4), HK:1.2 (95% CI: 1.0,1.4)]; respiratory outcomes [interstitial lung disease: HR(UKB: 3.4 (95% CI: 2.5,4.5), HK: 4.0 (95% CI: 1.3,12.8); chronic pulmonary disease: HR(UKB): 1.7 (95% CI: 1.3,2.2), HK:1.6 (95% CI: 1.3,2.1)]; neuropsychiatric outcomes [seizure: HR(UKB): 2.6 (95% CI: 1.7,4.1), HK: 1.6 (95% CI: 1.2,2.1)]; and renal outcomes [acute kidney disease: HR(UKB): 1.4 (95% CI: 1.1,1.6), HK:1.6 (95% CI: 1.3,2.1)]; and all-cause mortality [HR(UKB): 4.9 (95% CI: 4.4,5.4), HK:2.5 (95% CI: 2.5,2.6)]. CONCLUSION COVID-19 is associated with long-term risks of multi-organ complications in older adults (aged ≥ 60). Infected patients in this age-group may benefit from appropriate monitoring of signs/symptoms for developing these complications.
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Affiliation(s)
- Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ran Zhang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sukriti Mathur
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen 518053, China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
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Wan EYF, Mathur S, Zhang R, Yan VKC, Lai FTT, Chui CSL, Li X, Wong CKH, Chan EWY, Yiu KH, Wong ICK. Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: a prospective cohort in UK Biobank. Cardiovasc Res 2023; 119:1718-1727. [PMID: 36652991 DOI: 10.1093/cvr/cvac195] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/20/2023] Open
Abstract
AIMS This study aims to evaluate the short- and long-term associations between COVID-19 and development of cardiovascular disease (CVD) outcomes and mortality in the general population. METHODS AND RESULTS A prospective cohort of patients with COVID-19 infection between 16 March 2020 and 30 November 2020 was identified from UK Biobank, and followed for up to 18 months, until 31 August 2021. Based on age (within 5 years) and sex, each case was randomly matched with up to 10 participants without COVID-19 infection from two cohorts-a contemporary cohort between 16 March 2020 and 30 November 2020 and a historical cohort between 16 March 2018 and 30 November 2018. The characteristics between groups were further adjusted with propensity score-based marginal mean weighting through stratification. To determine the association of COVID-19 with CVD and mortality within 21 days of diagnosis (acute phase) and after this period (post-acute phase), Cox regression was employed. In the acute phase, patients with COVID-19 (n = 7584) were associated with a significantly higher short-term risk of CVD {hazard ratio (HR): 4.3 [95% confidence interval (CI): 2.6- 6.9]; HR: 5.0 (95% CI: 3.0-8.1)} and all-cause mortality [HR: 81.1 (95% CI: 58.5-112.4); HR: 67.5 (95% CI: 49.9-91.1)] than the contemporary (n = 75 790) and historical controls (n = 75 774), respectively. Regarding the post-acute phase, patients with COVID-19 (n = 7139) persisted with a significantly higher risk of CVD in the long-term [HR: 1.4 (95% CI: 1.2-1.8); HR: 1.3 (95% CI: 1.1- 1.6)] and all-cause mortality [HR: 5.0 (95% CI: 4.3-5.8); HR: 4.5 (95% CI: 3.9-5.2) compared to the contemporary (n = 71 296) and historical controls (n = 71 314), respectively. CONCLUSIONS COVID-19 infection, including long-COVID, is associated with increased short- and long-term risks of CVD and mortality. Ongoing monitoring of signs and symptoms of developing these cardiovascular complications post diagnosis and up till at least a year post recovery may benefit infected patients, especially those with severe disease.
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Affiliation(s)
- Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sukriti Mathur
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ran Zhang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, No.1, Haiyuan 1st Road, Futian District, Shenzhen, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kai Hang Yiu
- Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Cardiology Division, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, General Office, L02-56 2/F, Laboratory Block, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Special Administrative Region, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, No.1, Haiyuan 1st Road, Futian District, Shenzhen, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Aston Pharmacy School, Aston University, Aston Street, Birmingham B4 7ET, UK
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Wan EYF, Mathur S, Zhang R, Yan VKC, Lai F, Chui C, Li X, Wong CKH, Yiu KH, Chan EWY, Wong I. Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: a prospective cohort in UK Biobank. Br J Gen Pract 2023; 73:bjgp23X734121. [PMID: 37479295 DOI: 10.3399/bjgp23x734121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The evidence on the short- and long-term associations of COVID-19 with cardiovascular disease (CVD) outcomes and mortality is limited. AIM This study aimed to evaluate these associations. METHOD COVID-19 patients (cases) diagnosed between 16 March 2020 and 30 November 2020 were identified from UK Biobank and followed prospectively for up to 18 months. Based on age and sex, cases were randomly matched with uninfected participants from two control cohorts - a contemporary cohort between 16 March 2020 and 30 November 2020, and a historical cohort between 16 March 2018 and 30 November 2018. Characteristics between groups were adjusted with propensity score-based marginal mean-weighting through stratification. The association of COVID-19 with CVD and mortality within 21 days of diagnosis (acute phase) and after this period (post-acute phase) was determined by Cox regression. RESULTS In the acute phase, patients with COVID-19 (n = 7584) were associated with a significantly higher risk of CVD (hazard ratio [HR] 4.3 [95% confidence interval (CI) = 2.6 to 6.9]); 5.0 (95% CI = 3.0 to 8.1)] and all-cause mortality (HR 81.1 [95% CI = 58.5 to 112.4); 67.5 [95% CI = 49.9 to 91.1]) than the contemporary (n = 75 790) and historical controls (n = 75 774), respectively. In the post-acute phase, infected patients' (n = 7139) association with higher risk of CVD (HR 1.4 [95% CI = 1.2 to 1.8]; 1.3 [95% CI = 1.1 to 1.6]) and all-cause mortality (HR 5.0 [95% CI = 4.3 to 5.8); 4.5 (95% CI = 3.9 to 5.2]) persisted, compared with the contemporary (n = 71 296) and historical controls (n = 71 314), respectively. CONCLUSION COVID-19 is associated with increased short- and long-term risks of CVD and mortality. Ongoing monitoring of signs and symptoms of developing cardiovascular complications post-diagnosis and up till at least a year post-recovery may benefit infected patients, especially those with severe disease.
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Singh K, Jhingan P, Malik M, Mathur S. In vitro comparative evaluation of physical and chemical properties of surface enamel after using APF and SDF with or without laser activation. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00808-z. [PMID: 37296235 DOI: 10.1007/s40368-023-00808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate and compare the changes in physical and chemical properties of the enamel surface after application of Silver Diamine Fluoride (SDF), Acidulated Phosphate Fluoride (APF), LASER activated SDF and LASER activated APF. METHODS Sample consisted of 72 freshly extracted healthy human premolar teeth, extracted for orthodontic purpose, free from caries, fracture or any anomalies. The selected samples were randomly divided into four groups (n = 18): Group 1 (SDF); Group 2 (APF); Group 3 (LASER activated SDF) and Group 4 (LASER activated APF). All samples were evaluated for values of DIAGNOdent at baseline, after demineralisation and after remineralisation. They were further divided and assessed for colour changes, surface alterations and fluoride content of surface enamel using Spectrophotometer, Scanning Electron Microscopy and Energy Dispersive X-ray Spectrometry respectively. The statistical analysis was done using One-Way ANOVA, Tukey's HSD test, Mann-Whitney U test and Kruskal-Wallis Test. RESULTS Highest remineralising potential and maximum colour changes of surface enamel was exhibited by Group 3. Scanning Electron Micrographs of Group 3 and Group 4 exhibited regular globular structures of enamel whereas Group 1 and Group 2 showed irregular globular surface of the enamel at 2000× and 5000× magnification. Maximum fluoride uptake on the surface enamel was seen in Group 4 followed by Group 3. CONCLUSION Use of LASER activated topical fluorides helps to achieve superior caries prevention. LASER activated APF can be used as an aesthetic alternative to SDF, as LASER activated APF showed higher uptake of fluoride on the enamel surface without discoloration effect.
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Affiliation(s)
- K Singh
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, India.
| | - P Jhingan
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, India
| | - M Malik
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, India
| | - S Mathur
- Department of Pediatric and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, India
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Wan EYF, Wang B, Mathur S, Chan CIY, Yan VKC, Lai FTT, Chui CSL, Li X, Wong CKH, Li PH, Lau CS, Wong ICK, Chan EWY. Molnupiravir and nirmatrelvir-ritonavir reduce mortality risk during post-acute COVID-19 phase. J Infect 2023; 86:622-625. [PMID: 36822409 PMCID: PMC9943556 DOI: 10.1016/j.jinf.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Boyuan Wang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sukriti Mathur
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheyenne I Ying Chan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Philip Hei Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK.
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China; Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China.
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Mathur S, Jacobs J, Ambrose C, Martin N, Colice G, Lindsley A, Martin N. ASTHMA EXACERBATIONS BEFORE AND AFTER TEZEPELUMAB TREATMENT: A POOLED ANALYSIS OF PATHWAY AND NAVIGATOR STUDIES. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.520] [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: 11/11/2022]
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8
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Walsh CJ, Batt J, Herridge MS, Mathur S, Bader GD, Hu P, Khatri P, Dos Santos CC. Comprehensive multi-cohort transcriptional meta-analysis of muscle diseases identifies a signature of disease severity. Sci Rep 2022; 12:11260. [PMID: 35789175 PMCID: PMC9253003 DOI: 10.1038/s41598-022-15003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/03/2022] [Indexed: 11/09/2022] Open
Abstract
Muscle diseases share common pathological features suggesting common underlying mechanisms. We hypothesized there is a common set of genes dysregulated across muscle diseases compared to healthy muscle and that these genes correlate with severity of muscle disease. We performed meta-analysis of transcriptional profiles of muscle biopsies from human muscle diseases and healthy controls. Studies obtained from public microarray repositories fulfilling quality criteria were divided into six categories: (i) immobility, (ii) inflammatory myopathies, (iii) intensive care unit (ICU) acquired weakness (ICUAW), (iv) congenital muscle diseases, (v) chronic systemic diseases, (vi) motor neuron disease. Patient cohorts were separated in discovery and validation cohorts retaining roughly equal proportions of samples for the disease categories. To remove bias towards a specific muscle disease category we repeated the meta-analysis five times by removing data sets corresponding to one muscle disease class at a time in a "leave-one-disease-out" analysis. We used 636 muscle tissue samples from 30 independent cohorts to identify a 52 gene signature (36 up-regulated and 16 down-regulated genes). We validated the discriminatory power of this signature in 657 muscle biopsies from 12 additional patient cohorts encompassing five categories of muscle diseases with an area under the receiver operating characteristic curve of 0.91, 83% sensitivity, and 85.3% specificity. The expression score of the gene signature inversely correlated with quadriceps muscle mass (r = -0.50, p-value = 0.011) in ICUAW and shoulder abduction strength (r = -0.77, p-value = 0.014) in amyotrophic lateral sclerosis (ALS). The signature also positively correlated with histologic assessment of muscle atrophy in ALS (r = 0.88, p-value = 1.62 × 10-3) and fibrosis in muscular dystrophy (Jonckheere trend test p-value = 4.45 × 10-9). Our results identify a conserved transcriptional signature associated with clinical and histologic muscle disease severity. Several genes in this conserved signature have not been previously associated with muscle disease severity.
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Affiliation(s)
- C J Walsh
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - J Batt
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - M S Herridge
- Interdepartmental Division of Critical Care, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - G D Bader
- The Donnelly Center, University of Toronto, Toronto, ON, Canada
| | - P Hu
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada
| | - P Khatri
- Stanford Institute for Immunity, Transplantation and Infection (ITI), Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, Stanford Center for Biomedical Informatics Research (BMIR), Stanford University, Stanford, CA, USA
| | - C C Dos Santos
- Keenan Research Center for Biomedical Science, Saint Michael's Hospital, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
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Pulerwitz J, Valenzuela C, Gottert A, Siu G, Shabangu P, Mathur S. "A man without money getting a sexual partner? It doesn't exist in our community": male partners' perspectives on transactional sexual relationships in Uganda and Eswatini. Cult Health Sex 2022; 24:968-982. [PMID: 33821761 DOI: 10.1080/13691058.2021.1904521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/01/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Research on transactional sexual relationships has largely focused on women's perspectives. Better understanding the men's views-especially regarding relationships with adolescent girls and young women-can inform HIV prevention efforts. In 2017, 134 in-depth interviews were conducted with the male partners of girls and young women aged 19-47 years, 94 in Uganda and 40 in Eswatini. Respondents were recruited at venues such as bars where men and potential partners meet and through other young women. Most respondents believed that providing money/gifts was the way to establish relationships with women in their communities, a context that some found undesirable. Young women were mainly perceived as actively pursuing transactional sex for material goods, but respondents also described economically impoverished women who were manipulated into relationships. Men described conflict with longer term partners as a driver to seeking younger partners, who were more compliant. Transaction dominates the male partners of adolescent girls and young women's understanding of sexual relationships, and inequitable power dynamics are reinforced by seeking younger partners. However, some respondents' discontent with this dynamic suggests an opportunity for change. HIV prevention programmes should directly address the underlying drivers of transactional relationships (e.g. gender norms) and work with men who question the practice.
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Affiliation(s)
| | | | - A Gottert
- Population Council, Washington, DC, USA
| | - G Siu
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - P Shabangu
- Institute for Health Measurement-Southern Africa, Mbabane, Eswatini
| | - S Mathur
- Population Council, Washington, DC, USA
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10
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Dogra Y, Singh N, Kumar P, Mathur S, Sharma A. P-394 Peripheral and uterine natural killer cell cut-off levels and their correlation in fertile controls and women with unexplained recurrent implantation failure (RIF). Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.371] [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: 11/12/2022] Open
Abstract
Abstract
Study question
What is cut-off value for peripheral and uterine natural killer (pNK, uNK) cells and any correlation between them in fertile and RIF women?
Summary answer
Cut-off values were 7% for uNK and 11.6% for pNK in fertile controls. No significant correlation observed among fertile and infertile women with RIF.
What is known already
Association of uNK and pNK cells with infertility is debatable. It is not clear whether measuring NK cell levels in RIF has a role. pNk cell levels however has been used in various studies to guide the need of immunotherapy in RIF women. Definition of normal range of uNK cell numbers has also not been stated clearly because of lack of standardised protocol. Literature reveals the cut off values for pNk cells to be 12% or 18% and for uNK cells between 5-12.9%. Correlation between uNK and pNK cells in fertile or RIF women has not been studied earlier.
Study design, size, duration
A prospective study was conducted at ART Centre, Department of Obstetrics and Gynecology at tertiary care institute during a period from January 2019 to January 2021. Thirty women with RIF and fifty fertile controls with age <35 years having regular menstrual cycles and no hormonal treatment in last 3 months were enrolled in the study for uNK and pNK cell testing. The permission was obtained from the Institute Ethics Committee.
Participants/materials, setting, methods
Subjects included women with RIF with age 20-35 years, tubal and unexplained factors, normal ovarian reserve, normal karyotype and normal uterine cavity. In both subjects and controls, midluteal endometrial biopsy sample was taken for Immunohistochemistry staining of CD 56+ cells to determine uNK cells. Peripheral venous blood was also obtained at the time of biopsy for flow cytometry in peripheral blood mononuclear cells to determine pNK cells. Cut off values were derived from fertile controls.
Main results and the role of chance
The mean age and BMI were comparable between fertile control and study group(29.45±3.3 vs 31.17±3.3 years, 22.97±1.89 vs 23.21±2.2 kg/m2; p-value >0.05). The control group had median value of 7% for uNK cell levels and 11.6% for pNK cell levels. In RIF subjects, the median value for uNK cells was 13.5% and even though higher compared to controls it was not statistically significant(p-value >0.05) . The median pNK values were comparable among controls and RIF group (11.6% vs. 12%). All RIF subjects did not have elevated NK cell levels. 18 (60%) subjects had elevated uNK cell levels (more than 7%) whereas 40% had below the reference value. pNK cells were also elevated in only 53.3% of subject population. There was positive correlation found between uNK and pNK cell levels in RIF subjects, however it was not statistically significant (r 0.312, p-value 0.09). In fertile controls, there was insignificant negative correlation between uNK and pNK cell levels (r -0.231, p-value 0.33).
Limitations, reasons for caution
The small sample size is the foremost limitation of study.
Wider implications of the findings
uNK cell testing may be worthwhile in women with unexplained RIF so as to guide immunotherapy to improve pregnancy outcomes. As no significant correlation has been found between pNK and uNK cells in fertile and RIF women, pNK cell testing in RIF women may be done with caution.
Trial registration number
Not Applicable
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Affiliation(s)
- Y Dogra
- Indira Gandhi Medical College, Division of Reproductive Medicine- Department of Obs and Gynaecology, Shimla- Himachal Pradesh , India
| | - N Singh
- All India Institute of Medical Sciences, Department of Obs and Gynaecology , Delhi, India
| | - P Kumar
- All India Institute of Medical Sciences, Department of Biochemistry , Delhi, India
| | - S Mathur
- All India Institute of Medical Sciences, Department of Pathology , Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, Department of Biochemistry , Delhi, India
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11
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Rehermann C, Schröder V, Flatken M, Ünlü F, Shargaieva O, Hoell A, Merdasa A, Mathies F, Mathur S, Unger EL. Role of solution concentration in formation kinetics of bromide perovskite thin films during spin-coating monitored by optical in situ metrology. RSC Adv 2022; 12:32765-32774. [PMID: 36425710 PMCID: PMC9664315 DOI: 10.1039/d2ra06314j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Optoelectronic devices based on metal halide perovskites continue to show a improved performance, and solution-based coating techniques pave the way for large-area applications. However, not all parameters influencing the thin film formation process of metal halide perovskites are identified and entirely rationalised over their full compositional range, thus hampering optimised thin film fabrication. Furthermore, while the perovskite deposition via spin-coating and annealing is an easily accessible technique, more profound insights into the chemical formation process are still lacking. Varying the precursor solution concentration is commonly used to vary the resulting thin film thickness. This study shows that varying the precursor solution concentration also affects the thin film morphology and optoelectronic quality. Hence, we herein investigate the influence of the precursor solution concentration on the formation process of a pure bromide-based triple cation perovskite (Cs0.05MA0.10FA0.85PbBr3) by fiber-based optical in situ measurement. During the spin-coating process, in situ UV-vis and PL measurements reveal formation kinetics are strongly dependent on the concentration. Furthermore, we identify delayed nucleation and retarded growth kinetics for more concentrated precursor solutions. In addition, we quantify the shifting chemical equilibrium of colloidal pre-coordination in the precursor solution depending on concentration. Namely, colloids are pre-organised to a higher degree and higher-coordination lead–bromide complexes tend to form in more concentrated precursor solutions. Thus, the modified solution chemistry rationalises retarded perovskite formation kinetics and highlights the precursor concentration as an influential and optimisable parameter for solution-based thin film deposition. The solution chemistry of the precursor ink defines the formation kinetics of metal halide perovskites. Thus, rationalizing the formation process from solution via the deposition paves the way for high-quality thin films for optoelectronic devices.![]()
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Affiliation(s)
- C. Rehermann
- Department of Solution-Processed Materials and Devices, HySPRINT Innovation Lab, Helmholtz-Zentrum Berlin für Materialen und Energie GmbH, Kekuléstraße 5, 12489 Berlin, Germany
| | - V. Schröder
- Helmholtz Zentrum für Materialien und Energie GmbH, Hahn-Meitner-Platz 1, 14109 Berlin, Germany
| | - M. Flatken
- Department Novel Materials and Interfaces for Photovoltaic Solar Cells, HySPRINT Innovation Lab, Helmholtz-Zentrum Berlin für Materialen und Energie GmbH, Kekuléstraße 5, 12489 Berlin, Germany
| | - F. Ünlü
- Inorganic and Materials Chemistry, University of Cologne, Greinstr. 6, 50939 Cologne, Germany
| | - O. Shargaieva
- Department of Solution-Processed Materials and Devices, HySPRINT Innovation Lab, Helmholtz-Zentrum Berlin für Materialen und Energie GmbH, Kekuléstraße 5, 12489 Berlin, Germany
| | - A. Hoell
- Helmholtz Zentrum für Materialien und Energie GmbH, Hahn-Meitner-Platz 1, 14109 Berlin, Germany
| | - A. Merdasa
- Department of Clinical Sciences Lund, Lund University, Sölvegatan 17, Lund, Sweden
| | - F. Mathies
- Department of Solution-Processed Materials and Devices, HySPRINT Innovation Lab, Helmholtz-Zentrum Berlin für Materialen und Energie GmbH, Kekuléstraße 5, 12489 Berlin, Germany
| | - S. Mathur
- Inorganic and Materials Chemistry, University of Cologne, Greinstr. 6, 50939 Cologne, Germany
| | - E. L. Unger
- Department of Solution-Processed Materials and Devices, HySPRINT Innovation Lab, Helmholtz-Zentrum Berlin für Materialen und Energie GmbH, Kekuléstraße 5, 12489 Berlin, Germany
- Hybrid Materials: Formation and Scaling, IRIS Adlershof, Humboldt Universität zu Berlin, Am Großen Windkanal 2, 12489 Berlin, Germany
- Chemical Physics and Nano Lund, Lund University, Lund, Sweden
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12
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Searle K, McGrattan M, Murji A, Mathur S, Sobel M. Recurrent Hemorrhagic Ascites in Endometriosis: A Case Series and Systematic Review. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.362] [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: 11/17/2022]
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13
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Edwards D, Mathur S, Flores H, Whittle W, Murji A. Uterine Dehiscence: Laparoscopic Uterine Repair in Early Pregnancy. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.387] [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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14
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Dogra Y, Singh N, Mathur S. P–375 Intralipid supplementation in women with unexplained recurrent implantation failure and elevated uterine natural killer cell levels - A randomized placebo controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.374] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Does intralipid supplementation in women with unexplained recurrent implantation failure (RIF) with elevated uterine natural killer cell (uNK) levels improve pregnancy outcomes during IVF?
Summary answer
Intralipid supplementation appears to improve clinical pregnancy rate in women with unexplained RIF with elevated uNK cell levels.
What is known already
The increased numbers of uNK cells in peri-implantation endometrium have been reported in women with recurrent miscarriage (RM) and RIF after IVF. However, reports are contradictory when it comes to correlation of increased numbers of uNK cells with pregnancy outcome. Current opinion suggests there is a potential for intralipid therapy in improving reproductive outcome, although data on live birth rate is very limited. No studies have assessed the effect of intralipid on IVF outcomes in RIF women based on elevated uNK cells. Identified studies have all used pNK cell testing as preferred diagnostic tool for analysis of NK cell levels.
Study design, size, duration
A randomized placebo controlled trial was conducted at Division of Reproductive Medicine at tertiary care institute. Thirty women with RIF and fifty fertile controls with age <35 years having regular menstrual cycles and no hormonal treatment in last 3 months were enrolled in the study from January 2019 to December 2020 for uNK cell testing. Randomization was done using random numbers and sealed envelopes. Only the subjects were masked and allocation concealment was done.
Participants/materials, setting, methods
Subjects included RIF 20–35 years, normal ovarian reserve, unexplained and tubal factors, normal karyotype and normal uterine cavity. Cut off for uNK cells was derived from fertile controls by immunohistochemical staining of CD56+ cells from midluteal endometrial biopsy sample. Subjects with elevated uNK cell levels were randomized during IVF to group A (Intralipid) or group B ( saline ). The infusion was repeated within one week of positive pregnancy test and then every 2 weeks.
Main results and the role of chance
The mean age and BMI were comparable between fertile control and study group(29.45±3.3 vs 31.17±3.3 years, 22.97±1.89 vs 23.21±2.2 kg/m2 ;p>0.05). The median uNK cell levels was 7%(used as cut off) in fertile controls and 13.5% in RIF. 18 women (60%, 18/30) with RIF who had elevated uNK cell level (>7%) were randomized. Four women were lost to follow up. The median age, BMI, number of previous failed cycles and duration of infertility were comparable between Group A(n = 7) and Group B(n = 7){30(IQR:27–31) vs 33(IQR:30–34)years, 22.7(IQR:21.08–24.4) vs 22.6(IQR:21.37–24.2)kg/m2, 2(IQR:2–3) vs 2(IQR:2–3), 8(IQR:7–8) vs 8(IQR:7–10)years}. The median FSH, AMH and AFC were 5.86(IQR:5.13–7.67)mIU/l, 2.4(IQR:2.16–6.12)ng/ml, 10(IQR:8–12) in Group A which were comparable with Group B {6.2(IQR:4.78–6.5)mIU/l, 4.8(IQR:2.67–6.25)ng/ml, 12(IQR:12–16) }. All patients underwent antagonist protocol. The clinical pregnancy rate was 57.14%(4/7) in group A which was significantly higher as compared to 28.6%(2/7) in group B(p < 0.05). None of the patients reported any side effects due to intralipid.
Limitations, reasons for caution
The limitation of present study is its small sample size. However, the study is currently recruiting more RIF patients, and these are the interim results of the same. More RCTs with larger sample size are required to assess the efficacy of intralipid in this specific subset of population.
Wider implications of the findings: The present study suggests the beneficial effect of intralipid in women with unexplained RIF with elevated uNK cell levels in increasing the chemical and clinical pregnancy rate. However, ongoing pregnancy rate and live birth rate should be investigated further in this subset of population.
Trial registration number
CTRI/2019/01/017213
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Affiliation(s)
- Y Dogra
- All India Institute of Medical Sciences, Division of Reproductive Medicine- Department of Obs and Gynaecology, New Delhi, India
| | - N Singh
- All India Institute of Medical Sciences, Division of Reproductive Medicine- Department of Obs and Gynaecology, New Delhi, India
| | - S Mathur
- All India Institute of Medical Sciences, Department of Pathology, New Delhi, India
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15
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Abstract
Idiopathic spinal cord herniation is a rare but important and increasingly recognised cause of myelopathy seen in the thoracic spine. The factors that contribute to the aetiology of the condition and of the dural defect through which the cord herniates remain under debate. We discuss the clinical features and proposed pathophysiology of the condition, and illustrate key imaging findings on MRI, fluoroscopy and computed tomography (CT) myelography to establish the diagnosis, and discuss relevant differential diagnoses. Awareness and recognition of the condition is key as surgical intervention can improve outcomes for patients.
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Affiliation(s)
- K Bhatia
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
| | - A Madhavan
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - C Coutinho
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - S Mathur
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
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16
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Mathur S, Ferreira M, Maia N, Martin C, Chowdhury N, Islam A, Singer L. Is Frailty Associated with Sarcopenia and Dynapenia in Lung Transplant Candidates? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.501] [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] Open
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17
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Wickerson L, Rozenberg D, Helm D, Gottesman C, Mathur S, Singer L. Short Physical Performance Battery Scores at Lung Transplant Assessment: Relationship to Early Transplant Outcomes and Response to Pre-Habilitation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Veerappan S, Adhvaryu K, Mathur S, Bell A. 649 Anomalous Right Coronary Artery From the Pulmonary Artery (ARCAPA): An Unusual Cause for a Murmur. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.656] [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: 11/15/2022]
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19
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Theocharis P, Morrison ML, Storring N, Adhavaryu K, Jivanji S, Rosenthal E, Miller O, Mathur S, Speggiorin S. P1486 An unexpected case of paediatric heart failure. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.911] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
A 9-month-old male presented in heart failure with a 2-day history vomiting that followed a viral upper respiratory tract infection 10 days previously. Echocardiography demonstrated a normally connected heart with a severely dilated and poorly functioning left ventricle with bright mitral valve papillary muscles. It was difficult to demonstrate the origin of the left coronary artery and retrograde flow was seen in the vessel (Fig 1, Panel A). The right coronary artery appeared normal. A gated cardiac CT was performed and showed a normal right coronary origin and no clear connection of the LCA to Ao and there was suspicion of retrograde filling. Images of the left coronary origin did not show clear connection of the LCA to Ao (Fig 1, Panel B). As the case was extremely unusual coronary angiography was performed which confirmed the suspicion of a dominant right coronary system with collateral connection to the left coronary system and retrograde filling and no antegrade filling of the LCA from the Ao (Fig 1, Panel C). This was consistent with atresia of the left coronary ostium, which was confirmed at operation. The left coronary sinus was opened, as was the roof of the left coronary artery and an anastomosis was performed to aorta using an autologous patch. The post operative TOE showed good flow into the LCA (Fig 1, Panel D). There was good and quick post op clinical recovery but the left ventricular function remains still poor at the moment with slow recovery as expected. The cardiac function will be monitored echocardiographically and the reconstructed coronary artery with CT.
Abstract P1486 Figure 1
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Affiliation(s)
- P Theocharis
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M L Morrison
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Storring
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - K Adhavaryu
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Jivanji
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - E Rosenthal
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - O Miller
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Mathur
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Speggiorin
- Evelina Children"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
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20
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Mathur S, Cherniak R, Berezin L, Bodley J, Farrugia M. 2780 Surgical Coaching in Obstetrics and Gynecology: A Multi-Centre Pilot ProjecT. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Mathur S, McCaffrey C, Murji A, Mehra N, Po L, Kroft J, Liu G. 2788 Disseminated Intracavitary Leiomyomatosis: An Intra-Operative Diagnosis. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Mathur S, Calhoun A, Sun Z, Nianlan Y, Agarwal S. Comparison of transcutaneous with arterial and end tidal carbon dioxide during thoracic surgery - A prospective observational study. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Karmakar S, Mathur S, Sachdev V. A game of colours, changing emotions in children: a pilot study. Eur Arch Paediatr Dent 2019; 20:377-381. [DOI: 10.1007/s40368-018-0403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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24
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Raza-Knight SR, Mathur S, Lekka E. P2 A clinical pathway for the investigation and follow-up of incidental pineal cysts. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesPineal cysts (PCs) may be incidentally found on intracranial imaging. They are typically quiescent, benign and asymptomatic. However, imaging alone cannot exclude an underlying pineal malignancy. This study reviewed our hospital’s experience of managing PCs in order to develop a clinical pathway to guide their investigation and follow-up.DesignSingle-centre retrospective review of cases.SubjectsPatients referred to our hospital with a PC.MethodsCase notes and imaging from patients referred to our hospital with a clinically-coded ‘pineal cyst’ between 2007 and 2017 were reviewed.Results43 cases were included. The most common indication for intracranial imaging was headache (12/43), followed by seizures (4/43). No symptoms were attributable to the PC. Follow-up imaging to monitor the PC was performed in 13/43 cases; in a further 10/43 cases, it was carried out for an indication unrelated to the PC. Follow-up was arranged by the neurosurgical team in 12 cases. Uncertainty about the diagnosis led to an endoscopic biopsy in one case, which confirmed a PC. There was no consistent clinical rationale underlying the decision to undertake follow-up imaging, nor its interval or duration.ConclusionsClinical practice varied widely for the management of incidental PCs. We propose that all PCs should be investigated with standardised MRI, reported by a neuroradiologist and repeated at 6–12 months. Further follow-up and its duration should be guided by the patient’s clinical condition and the radiological features of the PC.
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Gogia A, Raina V, Deo S, Sharma D, Mathur S. Survival outcome of pregnancy associated breast cancer in resource limited country: an analysis. Breast 2019. [DOI: 10.1016/s0960-9776(19)30244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gogia A, Deo S, Mathur S, Sharma D, Gupta R. Predictive significance of derived Neutrophil to lymphocyte ratio with neo-adjuvant chemotherapy in triple negative breast cancer: a single center analysis. Breast 2019. [DOI: 10.1016/s0960-9776(19)30133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gogia A, Raina V, Deo S, Shukla N, Mohanti B, Sharma D, Mathur S. Neoadjuvant chemotherapy for young (</ = 35 years) locally advanced breast cancer patients: association of pathological complete response with survival. An Institutional analysis from developing country. Breast 2019. [DOI: 10.1016/s0960-9776(19)30426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sharma A, Panwar V, Parkar S, Mathur S, Sharma S, Sharma A, Panwar R. PO124 To AssesS the Correlation Between Severity of Coronary Artery Disease and Periodontitis. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Nambirajan A, Longchar M, Mallick S, Kakkar A, Madan K, Mathur S, Jain D. P1.05-11 Role of EBUS-TBNA in Evaluation of Mediastinal Lymphadenopathy and Masses in Patients with Known or Suspected Extra-Pulmonary Malignancies. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jain D, Jangra K, Malik PS, Arulselvi S, Madan K, Mathur S, Sharma MC. Anaplastic lymphoma kinase immunohistochemistry in lung adenocarcinomas: Evaluation of performance of standard manual method using D5F3 antibody. Indian J Cancer 2018; 54:209-213. [PMID: 29199692 DOI: 10.4103/0019-509x.219588] [Citation(s) in RCA: 1] [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
OBJECTIVE Immunohistochemistry (IHC) with anaplastic lymphoma kinase (ALK) antibodies is considered as an economical screening method in lung adenocarcinomas. Automated Ventana D5F3-IHC is approved by US Food and Drug Administration for targeted therapy; however, the automated IHC apparatus are not widely used in most laboratories. We evaluated the performance of ALK IHC using the manual semiquantitative method to assess the concordance with Ventana ALK IHC assay. MATERIALS AND METHODS We tested 156 cases of primary lung adenocarcinomas for ALK protein expression by D5F3-IHC. The intensity of cytoplasmic staining was classified as 0 or 1+/2+/3+ (weak/medium/strong). Binary score of positive and negative was used for Ventana assay. A comparison analysis and clinicopathological features were recorded. RESULTS ALK IHC was positive in 25 (16.02%) cases, of which 18 were men and mostly nonsmokers. The mean age for all patients was 55 years, and for ALK IHC-positive cases was 48 years. Nine of 25 (36%) ALK IHC-positive cases showed signet ring cell and mucinous morphology. On comparison, all, but one, cases positive by manual method showed positive results by automated assay. IHC negative cases by manual method were negative by Ventana assay. CONCLUSION Manual IHC is equally effective in the detection of ALK-rearranged cases as automated methods. It can be easily integrated as a screening method into routine practice thus reducing the cost of automated systems. However, equivocal cases should be tested by approved methods.
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Affiliation(s)
- D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K Jangra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Arulselvi
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine and Sleep Disorder, All India Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Hari S, Paul SB, Vidyasagar R, Dhamija E, Adarsh AD, Thulkar S, Mathur S, Sreenivas V, Sharma S, Srivastava A, Seenu V, Prashad R. Breast mass characterization using shear wave elastography and ultrasound. Diagn Interv Imaging 2018; 99:699-707. [PMID: 30006125 DOI: 10.1016/j.diii.2018.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the role of SWE in characterizing breast masses and ascertain whether additional use of SWE to ultrasound for evaluating BI-RADS 3 and 4a masses could help reduce long-term follow-up and unnecessary biopsies of these suspicious breast masses. MATERIALS AND METHODS This prospective, cross-sectional study was performed between June 2013 and November 2014. All enrolled patients underwent clinical breast examination, ultrasound, SWE and ultrasound-guided core biopsy of the breast mass. Breast Imaging Reporting and Data System (BI-RAD) categories were assigned to breast masses. For qualitative and quantitative variables of SWE, cut-off values for differentiation between benign and malignant breast masses were estimated. Modified BIRADS' (up/downgrading of BIRADS category) was done for BI-RADS 3/4a masses by combining individual SWE parameters and ultrasound findings. Sensitivity, specificity, positive and negative predictive value of modified BI-RADS' and ultrasound BI-RADS were compared. RESULTS A total of 119 women (mean age, 42.3±13.6 [SD] years; range: 13-87 years) with a single breast mass each were enrolled. Histopathologically, 57/119 (48%) breast masses were benign and 62 (52%) were malignant. On ultrasound, 42 breast masses were BI-RADS3 and 77 were BI-RADS 4 (4a, n=10; 4b, n=24; 4c, n=43) leading to 96.8% sensitivity and 70.2% specificity. On SWE, benign breast masses were oval/round, homogenous/reasonably homogenous, blue/green with lower elasticity values and malignant breast masses were irregular, inhomogeneous, red/orange with high elasticity values. On modified BI-RADS' using E-color and E-mean/E-max, specificity improved to 78.9% and 75.4% respectively. CONCLUSION Addition of SWE to ultrasound improves characterization of BI-RADS 3 and 4a masses. E-max, E-mean and E-color are the most useful SWE parameters to differentiate between malignant and benign breast masses.
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Affiliation(s)
- S Hari
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S B Paul
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India.
| | - R Vidyasagar
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - E Dhamija
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - A D Adarsh
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Thulkar
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Mathur
- Departments of Pathology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - V Sreenivas
- Departments of Biostatistics, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - S Sharma
- Department of Radiology, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - A Srivastava
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - V Seenu
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - R Prashad
- Departments of Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
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Kataria K, Srivastava A, Ranjan P, Mathur S. Radical resection of Phyllodes Tumour: A guarantee against recurrence. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tiwari A, Gogia A, Deo S, Shukla NK, Mathur S, Sharma DN. Retrospective study of efficacy and safety of neoadjuvant docetaxel, carboplatin, and trastuzumab in HER2-positive locally advanced and oligometastatic breast cancer: An Indian experience. Indian J Cancer 2017; 54:343-346. [PMID: 29199719 DOI: 10.4103/ijc.ijc_152_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
BACKGROUND The neoadjuvant chemotherapy in HER2-positive breast cancer consists of a chemotherapy backbone and HER2-directed therapy. The increase in cardiotoxicity by the use of trastuzumab with an anthracycline-based regimen has led to the use of nonanthracycline-based alternative regimens. The docetaxel, carboplatin, and trastuzumab (TCH) are one such regimen. The efficacy and toxicity of this regimen have not been widely studied in Indian patients. AIMS This retrospective study aims to evaluate the efficacy and toxicity of neoadjuvant TCH regimen in locally advanced and oligometastatic HER2-positive breast cancer in Indian patients. METHODOLOGY The hospital records between January 2014 and December 2016 were reviewed to identify patients with locally advanced and oligometastatic HER2-positive breast cancer treated with uniform 3-weekly neoadjuvant chemotherapy protocol-containing docetaxel (75 mg/m2), carboplatin (AUC = 6), and trastuzumab (8 mg/kg loading followed by 6 mg/kg) (TCH). The primary outcome was the pathologic complete response (pCR), which was defined as an absence of invasive and noninvasive cancer in breast or lymphnode. RESULTS Thirty-two patients with mean age 46 years met our inclusion criteria, of these 24 patients had locally advanced breast cancer, and eight patients had oligometastatic breast cancer. 13 (40.6%) patients had hormone-positive breast cancer. The objective response rate as assessed clinically was 100%, and pCR rate was 36.3%. The patients with oligometastatic breast cancer also showed a good response to chemotherapy with three patients showing pCR and four patients showing resolution disease at metastatic sites. The patients experienced very few Grade III/IV toxicities, and no patient had clinical congestive heart failure. CONCLUSION The TCH protocol is an efficacious neoadjuvant chemotherapy regimen for locally advanced and oligometastatic breast cancer and is safe and well tolerated in this population.
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Affiliation(s)
- A Tiwari
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - A Gogia
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiotherapy, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Cunha DNQ, del Rio CL, Youngblood BL, Ferris EL, Geist GE, Ueyama Y, Franz LC, Mathur S, Hamlin RL. Efficacy of a mephentermine-based product as a vasopressor and a cardiac performance enhancer when given intramuscularly to cattle. J Vet Pharmacol Ther 2017; 41:274-280. [DOI: 10.1111/jvp.12444] [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] [Received: 02/15/2017] [Accepted: 07/11/2017] [Indexed: 12/01/2022]
Affiliation(s)
- D. N. Q. Cunha
- Rua Luiz Fernando Rodriguez; Veterinary Medicine Research and Development; Zoetis; Campinas Brazil
| | | | | | | | | | | | - L. C. Franz
- Rua Luiz Fernando Rodriguez; Veterinary Medicine Research and Development; Zoetis; Campinas Brazil
| | - S. Mathur
- Rua Luiz Fernando Rodriguez; Veterinary Medicine Research and Development; Zoetis; Campinas Brazil
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Nwachokor J, Tawfik O, Danley M, Mathur S, House J, Sharma P, Christenson LK, Bansal A. Quantitation of spatial and temporal variability of biomarkers for Barrett's Esophagus. Dis Esophagus 2017; 30:1-8. [PMID: 28859356 PMCID: PMC6036660 DOI: 10.1093/dote/dox023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/03/2017] [Indexed: 12/11/2022]
Abstract
Chemoprevention and risk-stratification studies in Barrett's esophagus (BE) rely on biomarkers but the variability in their temporal and spatial expression is unknown. If such variability exists, it will impact sampling techniques and sample size calculations. Specimens from three levels of biopsies over two serial endoscopies in nondysplastic BE patients were analyzed for aneuploidy, proliferation markers (Ki67, Mcm2), and cell cycle markers (cyclin A and cyclin D1). A modification of the image cytometry technique, where cytokeratin staining automatically distinguished epithelial and stromal cells, measured aneuploidy on whole tissue sections. Other biomarkers were studied by immunohistochemistry. Coefficient of variability (SD/mean) was calculated; a value <10% indicated low variability. A total of 120 specimens (20 subjects each with three biopsy levels at two time points) from nondysplastic BE patients (71 ± 8.8 years, all Caucasian, 90% males, C5.1M7.5 ± 3.4 cm) were analyzed. The mean interval between endoscopies was 32.8 ± 8.4 months. Aneuploidy had a spatial variability of 6.8% at visit 1 (mean diploid index: 1.1 ± 0.09) and 7.9% at visit 2 (mean diploid index: 1.1 ± 0.06) and a temporal variability of 7.0-8.1% for the three levels. For other biomarkers, the spatial variability ranged from ∼5 to 30% at visit 1 and 11-92% at visit 2 and the temporal variability ranged from 0 to 77%. To conclude, of all the biomarkers, only aneuploidy had both spatial and temporal variability of <10%. Spatial and temporal variability were biomarker dependent and could be as high as 90% even without progression. These data will be useful to design chemoprevention and risk-stratification studies in BE.
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Affiliation(s)
| | - O. Tawfik
- Pathology and Laboratory Medicine, the University of Kansas School of Medicine,The Kansas Cancer Institute, Kansas City, KS
| | - M. Danley
- Pathology and Laboratory Medicine, the University of Kansas School of Medicine
| | - S. Mathur
- Pathology and Laboratory Medicine, the University of Kansas School of Medicine,Department of Pathology and Laboratory Medicine, the Veterans Affairs Medical Center
| | - J. House
- Department of Biostatistics, Saint Lukes Mid-America Heart Institute
| | - P. Sharma
- The Kansas Cancer Institute, Kansas City, KS,Department of Gastroenterology and Hepatology, the Veterans Affairs Medical Center, Kansas City, MO,Departments of Gastroenterology and Hepatology
| | - L. K. Christenson
- Molecular and Integrative Physiology, the University of Kansas Medical Center, Kansas City, KS
| | - A. Bansal
- The Kansas Cancer Institute, Kansas City, KS,Department of Gastroenterology and Hepatology, the Veterans Affairs Medical Center, Kansas City, MO,Departments of Gastroenterology and Hepatology
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Neuwelt AJ, Mathur S, Johnson AT, Kessler ER, Bowles DW. Cabozantinib use in renal cell carcinoma. Drugs Today (Barc) 2017. [PMID: 28650002 DOI: 10.1358/dot.2017.53.5.2623107] [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] [Indexed: 10/19/2022]
Abstract
In the last several years, many new drugs have been approved to treat metastatic renal cell carcinoma (RCC). Cabozantinib is a novel multikinase inhibitor with activity against vascular endothelial growth factor receptor (VEGFR), proto-oncogene tyrosine-protein kinase receptor Ret and other kinases that recently joined this impressive list of approved agents. Cabozantinib is an active agent in the preclinical and clinical setting, having recently demonstrated superiority over everolimus in a blinded, randomized phase III study of patients with progressive RCC after at least one prior line of antiangiogenic therapy. This agent's toxicity profile is similar to those of other multikinase inhibitors approved to treat RCC. This review will explore cabozantinib's pharmacologic and safety profile and its preclinical and clinical activity in RCC.
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Affiliation(s)
- A J Neuwelt
- University of Colorado School of Medicine, Division of Medical Oncology, Aurora, Colorado, USA
| | - S Mathur
- University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, Colorado, USA
| | - A T Johnson
- University of Colorado School of Medicine, Division of Medical Oncology, Aurora, Colorado, USA
| | - E R Kessler
- University of Colorado School of Medicine, Division of Medical Oncology, Aurora, Colorado, USA
| | - D W Bowles
- University of Colorado School of Medicine, Division of Medical Oncology, Aurora, Colorado, USA.
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Chan O, Moore L, Lai B, Jeong E, Nelson L, Malik F, Sykes J, Mathur S, Wu K. WS04.5 Predicting six-minute walk distance in adults with cystic fibrosis during hospitalisation. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramteke P, Seenu V, Prashad R, Gupta SD, Iyer V, Deo S, Gogia A, Mathur S. Alteration in steroid hormone and Her-2/neu receptor status following neoadjuvant chemotherapy in locally advanced breast cancer: Experience at a tertiary care centre in India. Indian J Cancer 2017; 53:366-371. [PMID: 28244460 DOI: 10.4103/0019-509x.200669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Use of neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC) enables tumor reduction and conservative surgery. It is proposed in some studies that there may be an alteration in the hormonal receptor (HR) status and human epidermal growth factor receptor 2 (Her-2)/neu immune-expression following NACT. AIMS To study the status of estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu receptor before and after NACT in LABC. MATERIALS AND METHODS HR and Her-2/neu status were evaluated by immunohistochemistry on 100 core needle biopsy of primary tumors and surgical specimens after receiving NACT (NACT group); fifty patients without NACT served as non-NACT group, and discordance was compared between the two groups. RESULTS In the NACT group, discordance of 17%, 13%, and 11% was noted in ER, PR, and Her-2/neu status, while in non-NACT group, discordance seen in ER, PR, and Her-2/neu was 8%, 8%, and 4%, respectively. CONCLUSIONS There was a significant alteration in ER and Her-2/neu status from the core biopsy to the treated resected tumor in the study group. As these changes may impact treatment, HR and Her-2/neu expression reanalysis in final surgical specimens is recommended.
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Affiliation(s)
- P Ramteke
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - V Seenu
- Department of Surgery, All Institute of Medical Sciences, New Delhi, India
| | - R Prashad
- Department of Surgery, All Institute of Medical Sciences, New Delhi, India
| | - S D Gupta
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - V Iyer
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, Dr. B.R.A Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - A Gogia
- Department of Medical Oncology, Dr. B.R.A Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
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Ramteke P, Mallick S, Mathur S, Jain D, Iyer VK. Fine needle aspiration cytology from a postauricular swelling. Cytopathology 2017; 28:246-247. [PMID: 28198060 DOI: 10.1111/cyt.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Ramteke
- Department of Pathology, India Institute of Medical Sciences, New Delhi, India
| | - S Mallick
- Department of Pathology, India Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pathology, India Institute of Medical Sciences, New Delhi, India
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Bhoriwal S, Deo S, Shukla N, Garg P, Kumar R, Gogia A, Sharma D, Thulkar S, Mathur S. 18 FDG PET-CT–SUV correlation with molecular subtypes in locally advanced/recurrent breast carcinoma. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30152-1] [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: 11/29/2022]
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Matthews J, Sanfilippo F, Lopez D, Knuiman M, Hobbs M, Hung J, Mathur S, Beilby J, Briffa T, Nedkoff L. Long-Term Trends in Inpatient Hospital Admission Rates for Unspecified Chest Pain in Western Australia, 1998-2013. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mathur S, Serrano-Linares A, Turnbull A, Stevens C, Mincher D. A novel legumain-targeted fluorogenic theranostic prodrug. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Das C, Gogia A, Shukla N, Deo S, Mathur S, Sharma D. 121P Prognostic significance of the derived neutrophil lymphocyte ratio in metastatic breast cancer: A tertiary cancer care center analysis from India. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw577.005] [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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Boardman J, Hilditch C, Roberts G, Raffalli-Ebezant H, Sonwalker H, Wuppalapati S, Mathur S, Emsley H. FOREIGN MATERIAL CEREBRAL EMBOLI FOLLOWING ENDOVASCULAR COILING. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Das C, Gogia A, Shukla N, Deo S, Mathur S, Sharma D. 121P Prognostic significance of the derived neutrophil lymphocyte ratio in metastatic breast cancer: A tertiary cancer care center analysis from India. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mathur S, Symons SP, Huynh TJ, Muthusami P, Montanera W, Bharatha A. First-Pass Contrast-Enhanced MRA for Pretherapeutic Diagnosis of Spinal Epidural Arteriovenous Fistulas with Intradural Venous Reflux. AJNR Am J Neuroradiol 2016; 38:195-199. [PMID: 27884880 DOI: 10.3174/ajnr.a5008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal epidural AVFs are rare spinal vascular malformations. When there is associated intradural venous reflux, they may mimic the more common spinal dural AVFs. Correct diagnosis and localization before conventional angiography is beneficial to facilitate treatment. We hypothesize that first-pass contrast-enhanced MRA can diagnose and localize spinal epidural AVFs with intradural venous reflux and distinguish them from other spinal AVFs. MATERIALS AND METHODS Forty-two consecutive patients with a clinical and/or radiologic suspicion of spinal AVF underwent MR imaging, first-pass contrast-enhanced MRA, and DSA at a single institute (2000-2015). MR imaging/MRA and DSA studies were reviewed by 2 independent blinded observers. DSA was used as the reference standard. RESULTS On MRA, all 7 spinal epidural AVFs with intradural venous reflux were correctly diagnosed and localized with no interobserver disagreement. The key diagnostic feature was arterialized filling of an epidural venous pouch with a refluxing radicular vein arising from the arterialized epidural venous system. CONCLUSIONS First-pass contrast-enhanced MRA is a reliable and useful technique for the initial diagnosis and localization of spinal epidural AVFs with intradural venous reflux and can distinguish these lesions from other spinal AVFs.
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Affiliation(s)
- S Mathur
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.)
| | - S P Symons
- Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.).,Department of Otolaryngology-Head and Neck Surgery (S.P.S.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T J Huynh
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Department of Medical Imaging (S.M., S.P.S., T.J.H.)
| | - P Muthusami
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - W Montanera
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A Bharatha
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., P.M., W.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Mathur S, Symons SP, Huynh TJ, Marotta TR, Aviv RI, Bharatha A. First-Pass Contrast-Enhanced MR Angiography in Evaluation of Treated Spinal Arteriovenous Fistulas: Is Catheter Angiography Necessary? AJNR Am J Neuroradiol 2016; 38:200-205. [PMID: 27811131 DOI: 10.3174/ajnr.a4971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Catheter angiography is typically used for follow-up of treated spinal AVFs. The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA. MATERIALS AND METHODS A retrospective review was performed of all patients at our tertiary referral hospital (from January 2000 to April 2015) who underwent spine MR imaging, first-pass contrast-enhanced MRA, and DSA after surgical and/or endovascular treatment of a spinal AVF. Presence of recurrent or residual fistula on MRA, including vertebral level of the recurrent/residual fistula, was evaluated by 2 experienced neuroradiologists blinded to DSA findings. Posttreatment conventional MR imaging findings were also evaluated, including presence of intramedullary T2 hyperintensity, perimedullary serpentine flow voids, and cord enhancement. The performance of MRA and MR imaging findings for diagnosis of recurrent/residual fistula was determined by using DSA as the criterion standard. RESULTS In total, 28 posttreatment paired MR imaging/MRA and DSA studies were evaluated in 22 patients with prior spinal AVF and 1 patient with intracranial AVF with prior cervical perimedullary venous drainage. Six image sets of 5 patients demonstrated recurrent/residual disease at DSA. MRA correctly identified all cases with recurrent/residual disease with 1 false-positive (sensitivity, 100%; specificity 95%; P < .001), with correct localization in all cases without interobserver disagreement. Conventional MR imaging parameters were not significantly associated with recurrent/residual spinal AVF. CONCLUSIONS First-pass MRA demonstrates high sensitivity and specificity for identifying recurrent/residual spinal AVFs and may potentially substitute for DSA in the posttreatment follow-up of patients with spinal AVFs.
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Affiliation(s)
- S Mathur
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., T.R.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.)
| | - S P Symons
- Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.).,Department of Otolaryngology-Head and Neck Surgery (S.P.S.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T J Huynh
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., T.R.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.)
| | - T R Marotta
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., T.R.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - R I Aviv
- Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.)
| | - A Bharatha
- From the Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., T.J.H., T.R.M., A.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Mathur S, Bharatha A, Huynh TJ, Aviv RI, Symons SP. Comparison of Time-Resolved and First-Pass Contrast-Enhanced MR Angiography in Pretherapeutic Evaluation of Spinal Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2016; 38:206-212. [PMID: 27811132 DOI: 10.3174/ajnr.a4962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Different MRA techniques used to evaluate spinal dural arteriovenous fistulas offer unique advantages and limitations with regards to temporal and spatial resolution. The purpose of this study was to compare the efficacy and interobserver agreement of 2 commonly used contrast-enhanced spinal MRA techniques, multiphase time-resolved MRA and single-phase first-pass MRA, in assessment of spinal dural arteriovenous fistulas. MATERIALS AND METHODS Retrospective review of 15 time-resolved and 31 first-pass MRA studies in patients with clinical suspicion of spinal dural arteriovenous fistula was performed by 2 independent, blinded observers. DSA was used as the reference standard to compare the diagnostic performance of the 2 techniques. RESULTS There were 10 cases of spinal dural arteriovenous fistula in the time-resolved MRA group and 20 in the first-pass MRA group. Time-resolved MRA detected spinal dural arteriovenous fistulas with sensitivity and specificity of 100% and 80%, respectively, with 100% correct-level localization rate. First-pass MRA detected spinal dural arteriovenous fistulas with sensitivity and specificity of 100% and 82%, respectively, with 87% correct-level localization rate. Interobserver agreement for localization was excellent for both techniques; however, it was higher for time-resolved MRA. In 5 cases, the site of fistula was not included in the FOV, but a prominent intradural radicular vein was observed at the edge of the FOV. CONCLUSIONS Multiphase time-resolved MRA and single-phase first-pass MRA were comparable in diagnosis and localization of spinal dural arteriovenous fistulas and demonstrated excellent interobserver agreement, though there were more instances of ambiguity in fistula localization on first-pass MRA.
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Affiliation(s)
- S Mathur
- From the Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.).,Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., A.B., T.J.H.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - A Bharatha
- Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., A.B., T.J.H.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - T J Huynh
- From the Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.).,Division of Diagnostic and Interventional Neuroradiology, Department of Medical Imaging (S.M., A.B., T.J.H.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - R I Aviv
- From the Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.)
| | - S P Symons
- From the Division of Neuroradiology, Department of Medical Imaging (S.M., T.J.H., R.I.A., S.P.S.) .,Department of Otolaryngology-Head and Neck Surgery (S.P.S.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Das C, Gogia A, Deo S, Shukla N, Mathur S, Sreenivas V, Sharma D. Prognostic significance of the derived neutrophil-lymphocyte ratio in non-metastatic breast cancer: An institutional analysis from a tertiary care center in India. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.70] [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: 11/14/2022] Open
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Erlandson M, Lorbergs A, Mathur S, Cheung A. Muscle analysis using pQCT, DXA and MRI. Eur J Radiol 2016; 85:1505-11. [DOI: 10.1016/j.ejrad.2016.03.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 12/22/2022]
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