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Kelly KR, Ailawadhi S, Siegel DS, Heffner LT, Somlo G, Jagannath S, Zimmerman TM, Munshi NC, Madan S, Chanan-Khan A, Lonial S, Chandwani S, Minasyan A, Ruehle M, Barmaki-Rad F, Abdolzade-Bavil A, Rharbaoui F, Herrmann-Keiner E, Haeder T, Wartenberg-Demand A, Anderson KC. Indatuximab ravtansine plus dexamethasone with lenalidomide or pomalidomide in relapsed or refractory multiple myeloma: a multicentre, phase 1/2a study. Lancet Haematol 2021; 8:e794-e807. [PMID: 34529955 DOI: 10.1016/s2352-3026(21)00208-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Indatuximab ravtansine (BT062) is an antibody-drug conjugate that binds to CD138 and synergistically enhances the antitumor activity of lenalidomide in preclinical models of multiple myeloma. This phase 1/2a study was done to determine the safety, activity, and pharmacokinetics of indatuximab ravtansine in combination with immunomodulatory drugs in patients with relapsed or refractory multiple myeloma. METHODS This open-label, phase 1/2a study took place at nine hospital sites in the USA. Eligible patients were aged 18 years or older, had relapsed or refractory multiple myeloma, and ECOG performance status or Zubrod score of 2 or below. Patients who received indatuximab ravtansine with lenalidomide and dexamethasone (indatuximab ravtansine plus lenalidomide) had failure of at least one previous therapy. Patients treated with indatuximab ravtansine with pomalidomide and dexamethasone (indatuximab ravtansine plus pomalidomide) had failure of at least two previous therapies (including lenalidomide and bortezomib) and had progressive disease on or within 60 days of completion of their last treatment. In phase 1, patients received indatuximab ravtansine intravenously on days 1, 8, and 15 of each 28-day cycle in escalating dose levels of 80 mg/m2, 100 mg/m2, and 120 mg/m2, with lenalidomide (25 mg; days 1 to 21 every 28 days orally) and dexamethasone (20-40 mg; days 1, 8, 15, and 22 every 28 days). In phase 2, the recommended phase 2 dose of indatuximab ravtansine was given to an expanded cohort of patients in combination with lenalidomide and dexamethasone. The protocol was amended to allow additional patients to be treated with indatuximab ravtansine plus pomalidomide (4 mg; days 1 to 21 every 28 days orally) and dexamethasone, in a more heavily pretreated patient population than in the indatuximab ravtansine plus lenalidomide group. The phase 1 primary endpoint was to determine the dose-limiting toxicities and the maximum tolerated dose (recommended phase 2 dose) of indatuximab ravtansine, and the phase 2 primary endpoint was to describe the objective response rate (ORR; partial response or better) and clinical benefit response (ORR plus minor response). All patients were analysed for safety and all patients with post-treatment response assessments were analysed for activity. This study is registered with ClinicalTrials.gov, number NCT01638936, and is complete. FINDINGS 64 (86%) of 74 screened patients were enrolled between July 3, 2012, and June 30, 2015. 47 (73%) patients received indatuximab ravtansine plus lenalidomide (median follow-up 24·2 months [IQR 19·9-45·4]) and 17 (27%) received indatuximab ravtansine plus pomalidomide (24·1 months [17·7-36·7]). The maximum tolerated dose of indatuximab ravtansine plus lenalidomide was 100 mg/m2, and defined as the recommended phase 2 dose for indatuximab ravtansine plus pomalidomide. An objective response for indatuximab ravtansine plus lenalidomide was observed in 33 (71·7%) of 46 patients and in 12 (70·6%) of 17 patients in the indatuximab ravtansine plus pomalidomide group. The clinical benefit response for indatuximab ravtansine plus lenalidomide was 85% (39 of 46 patients) and for indatuximab ravtansine plus pomalidomide it was 88% (15 of 17 patients). The most common grade 3-4 adverse events in both groups were neutropenia (14 [22%] of 64 patients), anaemia (10 [16%]), and thrombocytopenia (seven [11%]). Treatment-emergent adverse events (TEAEs) that led to discontinuation occurred in 35 (55%) of the 64 patients. Five (8%) patients with a TEAE had a fatal outcome; none was reported as related to indatuximab ravtansine. INTERPRETATION Indatuximab ravtansine in combination with immunomodulatory drugs shows preliminary antitumor activity, is tolerated, and could be further evaluated in patients with relapsed or refractory multiple myeloma. FUNDING Biotest AG.
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Affiliation(s)
- Kevin R Kelly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | - David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, Atlanta, GA, USA
| | - George Somlo
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | | | - Nikhil C Munshi
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sumit Madan
- Banner MD Anderson Cancer Center, Phoenix, AZ, USA
| | | | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, Atlanta, GA, USA
| | - Suraj Chandwani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashot Minasyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Jansen G, Ebeling N, Latka E, Krüger S, Scholz SS, Trapp S, Granneman JJ, Thaemel D, Chandwani S, Sauzet O, Rehberg SW, Borgstedt R. Impact of COVID-19 adapted guidelines on resuscitation quality in out-of-hospital-cardiac-arrest: a manikin study. Minerva Anestesiol 2021; 87:1320-1329. [PMID: 34263582 DOI: 10.23736/s0375-9393.21.15621-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the effects of European Resuscitation Council (ERC) COVID-19-guidelines on resuscitation quality emphasizing advanced airway management in out-of-hospital-cardiacarrest. METHODS In a manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), COVID-19-guidelines as suggested with minimum staff (COVID-19-minimal-personnel); COVID-19-guidelines with paramedics and an emergency physician (COVID-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean±standard deviation. RESULTS Thirty resuscitation scenarios were completed. No-flow-time was markedly prolonged in COVID-19-minimal-personnel [113±37sec] compared to Control [55±9sec] and COVID-19-advanced-airway-manager [76±38sec](p<0.001 each). In both COVID-19-groups chest compressions started later [COVID-19-minimal-personnel:32±6sec; COVID-19-advancedairway-manager:37±7sec; each p<0.001 vs. Control (21±5sec)], but oxygen supply [COVID-19-minimal-personnel:29±5sec; COVID-19-advanced-airway-manager:34±7sec; each p<0.001 vs. Control (77±19sec)] and first intubation attempt [COVID-19-minimalpersonnel: 111±14sec; COVID-19-advanced-airway-manager:131±20sec; each p<0.001 vs. Control (178±44sec)] were performed earlier. However, time interval to successful intubation was similar [Control:198±48sec; COVID-19-minimal-personnel:181±42sec; COVID-19-advanced-airway-manager:130±25sec] due to a longer intubation time in COVID-19-minimalpersonnel [61±35sec] compared to COVID-19-advanced-airway-manager (p=0.002) and control [19±6sec;p<0.001]. Time to first rhythm analysis was more than doubled in COVID-19-minimal-personnel [138±96sec] compared to control [50±12sec;p<0.001]. CONCLUSIONS Delayed chest compressions and prolonged no-flow-time markedly reduced the quality of resuscitation. These negative effects were attenuated by increasing the number of staff and by adding an experienced airway manager. The use of endotracheal intubation for reducing aerosol release during resuscitation should be discussed critically as its priorization is associated with an increase in no-flow-time.
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Affiliation(s)
- Gerrit Jansen
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany -
| | - Nicole Ebeling
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Eugen Latka
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Stefan Krüger
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Sean S Scholz
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Simon Trapp
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Julia J Granneman
- Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain therapy, Bielefeld Municipal Hospital, Bielefeld, Germany
| | - Daniel Thaemel
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Suraj Chandwani
- Clinic for Internal Medicine and Gastroenterology, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Odile Sauzet
- Epidemiology and International Public Health, Bielefeld School of Public Health & Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
| | - Rainer Borgstedt
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Bielefeld, Germany
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Jansen G, Fischer AK, Chandwani S, Rehberg S. Tension enterothorax: a rare differential diagnosis of progressive dyspnea. Intensive Care Med 2020; 46:1911. [DOI: 10.1007/s00134-020-06116-0] [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] [Received: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 12/01/2022]
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Chirovsky D, Liu Z, Baxi S, Chandwani S, Joo S, Ramakrishnan K. Real World Treatment Patterns and Time On Treatment in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (R/M HNSCC) Previously Treated with Platinum-Containing Chemotherapy in United States (US). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Altini M, Massa I, Balzi W, Gentili N, Foca F, Danesi V, Manunta S, Ejzykowicz F, Chandwani S, Burgio M, Cravero P, Verlicchi A, Bronte G, Crino L, Delmonte A. EP1.16-04 Real World Clinical Outcomes for Metastatic Non-Small Cell Lung Cancer (mNSCLC) at IRST Italy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2369] [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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Velcheti V, Chandwani S, Chen X, Piperdi B, Burke T. P2.16-41 Pembrolizumab for Previously Treated, PD-L1–Expressing Advanced NSCLC: Real-World Time on Treatment and Overall Survival. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Velcheti V, Chandwani S, Chen X, Piperdi B, Burke T. P1.16-42 Real-World Trends in Systemic Anticancer Therapy (SACT) for Squamous Advanced NSCLC (aNSCLC) in the US, 2011–2018. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shi Q, Williams L, El Ferjani B, Hirschmann M, Ponce D, Dibaj S, Chandwani S, Roarty E, Rinsurongkawong W, Lewis J, Burke T, Cleeland C, Lee J, Roth J, Swisher S, Heymach J, Zhang J, Simon G. P1.16-31 Body Mass Index Relating to Patient-Reported Symptoms in First-Line Treatment of Metastatic Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Altini M, Massa I, Balzi W, Gentili N, Foca F, Danesi V, Manunta S, Burgio M, Cravero P, Ejzykowicz F, Chandwani S, Delmonte A. Real-world treatment patterns for metastatic non-small cell lung cancer at IRST Italy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.074] [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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Velcheti V, Chandwani S, Chen X, Pietanza M, Burke T. First-line pembrolizumab monotherapy in metastatic PD-L1 positive non-small cell lung cancer: A real-world analysis of time on treatment in US community oncology practices. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy486.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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11
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Vaghani V, Chandwani S, Hirschmann M, Dibaj S, Landry L, Roarty E, Zhang J, Rinsurnogkawong W, Lewis J, Lee J, Roth JJA, Swisher S, Heymach J, Burke T, Simon G. P3.01-91 Computing the Impact of Immunotherapy on the Non-Small Cell Lung Cancer (NSCLC) Therapeutic Landscape. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1651] [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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Huang M, Pietanza M, Samkari A, Pellissier J, Burke T, Chandwani S, Kong F, Pickard A. Q-TWiST analysis to assess benefit-risk of pembrolizumab in patients with PD-L1-positive advanced or metastatic NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.095] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tan W, Huang M, Chandwani S, Hsu T, Tan S, Tan D. P1.16-07 Cost-Effectiveness of Pembrolizumab as 1st Line Treatment for Metastatic NSCLC Patients with High PD-L1 Expression in Singapore. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chandwani S, Vaghani V, Hirschmann M, Lacerda Landry L, Roarty E, Zhang J, Shi Q, Rinsurnogkawong W, Lewis J, Williams L, Cleeland C, Burke T, Lee J, Roth J, Swisher S, Heymach J, Simon G. P2.04-014 Computing the Impact of Immunotherapy on NSCLC Landscape: The Advanced Non-Small Cell Lung Cancer Holistic Registry (ANCHoR). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Loong H, Huang M, Wong C, Leung L, Burke T, Chandwani S, Law A, Tan S. P1.01-050 Cost-Effectiveness of PDL1 Based Test-And-Treat Strategy with Pembrolizumab as the 1st Line Treatment for NSCLC in Hong Kong. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.704] [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: 10/18/2022]
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Winkler M, Pratschke J, Schulz U, Zheng S, Zhang M, Li W, Lu M, Sgarabotto D, Sganga G, Kaskel P, Chandwani S, Ma L, Petrovic J, Shivaprakash M. Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study. Transpl Infect Dis 2010; 12:230-7. [PMID: 20070619 PMCID: PMC2904899 DOI: 10.1111/j.1399-3062.2009.00490.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
M. Winkler, J. Pratschke, U. Schulz, S. Zheng, M. Zhang, W. Li, M. Lu, D. Sgarabotto, G. Sganga, P. Kaskel, S. Chandwani, L. Ma, J. Petrovic, M. Shivaprakash. Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study. Transpl Infect Dis 2010: 12: 230–237. All rights reserved
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Affiliation(s)
- M Winkler
- Medizinische Hochschule Hannover, Klinik für Allgemein-, Viszeral- und Transplanationschirurgie, Hannover, Germany.
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Essajee SM, Kim M, Gonzalez C, Rigaud M, Kaul A, Chandwani S, Hoover W, Lawrence R, Spiegel H, Pollack H, Krasinski K, Borkowsky W. Immunologic and virologic responses to HAART in severely immunocompromised HIV-1-infected children. AIDS 1999; 13:2523-32. [PMID: 10630521 DOI: 10.1097/00002030-199912240-00005] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the long-term immunologic and virologic effects of highly active antiretroviral therapy (HAART) in children with AIDS. DESIGN A prospective observational study. SETTING Two pediatric HIV clinics. PARTICIPANTS Twenty-five protease-inhibitor naive HIV-infected children (aged 2-18 years) with advanced disease (CD4 < or =6%). INTERVENTION HAART (one protease inhibitor and one or more nucleoside analogs). Diphtheria and tetanus immunization in six patients after 18 months of therapy. MAIN OUTCOME MEASURES Changes in percentage of CD4 cells and plasma HIV-1 RNA levels; post-treatment assays of lymphoproliferative responses to recall antigens; CD4 cell memory phenotype. RESULTS Median duration of follow-up was 18.8 months (range, 7.5-28 months). At baseline the CD4 cell percentage was 2% (range, 0-6%), this increased significantly to 16% (range, 3-48%) above baseline at 12 months (P = 0.002). The mean maximum CD4 cell increase was 20.7% (range 4-48%) which corresponds to 657x10(6) cells/l (range, 30-2240x10(6) cells/l) above baseline. By contrast, the median viral load was not significantly lower at 12 months than at baseline (P = 0.34), and only 25% of the patients had sustained undetectable viral load. Of the reconstituted CD4 cells 70% were naive, and none of the subjects had lymphoproliferative responses to tetanus and diphtheria although 40% did develop responses to Candida, an environmental antigen. A single immunization with diphtheria and tetanus toxoid produced lymphoproliferative responses to tetanus in three out of six patients. CONCLUSIONS HAART was associated with sustained increases in CD4 cell counts, despite a high incidence of 'virologic failure'. CD4 counts and the proportion of naive cells were higher than have been reported in adults, which may be a reflection of greater thymic activity in children. Memory cell clones for antigens encountered in the past which are not prevalent before therapy could not be expanded without additional antigenic exposure.
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Affiliation(s)
- S M Essajee
- Department of Pediatrics, New York University Medical Center/Bellevue Hospital, New York 10016, USA
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Abstract
Permanent neurologic disabilities are seen in up to a quarter of survivors of bacterial meningitis despite major improvements in therapy. Experimental studies have demonstrated that most of the pathology in meningitis is mediated by inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-1 (IL-1), which are produced by host cells in response to bacterial invasion of the meninges. Dexamethasone has been used in a number of clinical trials to moderate the host response and to improve neurologic outcome of meningitis. Results of six randomized, placebo controlled trials are summarized in this review. Dexamethasone treatment did not lower mortality. Only a moderate, but not a significant reduction in the neurologic and audiologic sequelae was seen in dexamethasone recipients when Haemophilus influenzae type b (Hib) was the causative agent of meningitis. Following routine use of Hib vaccine, meningitis caused by this agent has virtually disappeared in the USA. Hence, findings from these trials may no longer be applicable in countries with high rates of immunization against Hib. Presently, there is little or no evidence showing a benefit of dexamethasone therapy in meningitis caused by S. pneumoniae or N. meningitidis. Global emergence of penicillin and cephalosporin resistant S. pneumoniae has raised new concerns about the use of dexamethasone in pneumococcal meningitis. Since dexamethasone significantly decreases the penetration and concentration of vancomycin and ceftriaxone in the CSF and delays CSF sterilization, adjunctive dexamethasone therapy may increase the risk of treatment failure in meningitis caused by antibiotic resistant pneumococci. An antibiotic combination should be used in the treatment of meningitis caused by antibiotic resistant pneumococci, particularly if dexamethasone is also being administered concurrently.
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Affiliation(s)
- A Kaul
- Department of Pediatrics, New York University School of Medicine, USA
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Chandwani S, Kaul A, Bebenroth D, Kim M, John DD, Fidelia A, Hassel A, Borkowsky W, Krasinski K. Cytomegalovirus infection in human immunodeficiency virus type 1-infected children. Pediatr Infect Dis J 1996; 15:310-4. [PMID: 8866799 DOI: 10.1097/00006454-199604000-00006] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a frequent opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected children. The interactions of CMV and HIV-1 in coinfected children are not well-characterized. OBJECTIVE To evaluate the prevalence of asymptomatic CMV infection and symptomatic CMV disease and to assess the influence of CMV on clinical and laboratory markers of HIV disease progression in CMV-coinfected children. METHODS Serial urine CMV cultures were performed on 500 children (131 HIV-1-infected (HIV+), 129 seroreverters born to HIV-infected mothers, and 240 HIV-uninfected (HIV-)). The clinical, immunologic and virologic data of 131 HIV+ children were analyzed. RESULTS CMV was recovered in 40 of 131 HIV+ (31%), 22 of 129 seroreverters (17%) and 30 of 240 HIV- (13%) children. Of the 40 HIV+ children with CMV coinfection, 7 developed symptomatic CMV disease (17.5%) including chorioretinitis (3), colitis (2) and pneumonitis (2). The HIV+ children with symptomatic CMV disease had significantly lower mean CD4+ T lymphocyte proportions (17% vs. 26%; age-adjusted P = 0.013) and greater HIV p24 antigen concentrations (329 pg/ml vs. 57 pg/ml; age-adjusted P = 0.13) than HIV+ children with asymptomatic CMV infection. In a subset of children coinfected with CMV before 6 months of age (n = 11), 5 (45%) developed symptomatic CMV disease, and 4 of these 5 children died within 10 months of diagnosis of CMV disease. At the time of the first positive CMV culture in these children, mean CD4+ T lymphocyte proportions did not differ according to the presence or absence of CMV-related symptoms (symptomatic CMV+, 21% vs. asymptomatic CMV = 38%; P = 0.14). In HIV+ children with symptomatic CMV disease, p24 antigen concentrations were greater than in those with asymptomatic CMV infection (461 vs. 190 pg/ml, P = 0.06). CONCLUSIONS Symptomatic CMV disease occurred in young CMV-coinfected children with low CD4+ lymphocytes and elevated HIV p24 antigen concentrations. Whether progressive immunodeficiency allows the emergence of CMV disease or CMV infection causes more rapidly progressive HIV-1 disease or whether there is a more complex relationship remains to be determined.
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Affiliation(s)
- S Chandwani
- Department of Pediatrics, New York University Medical Center, NY 10016, USA
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Pandya AK, Chandwani S, Das TK, Pandya KD. Serum calcium, magnesium and inorganic phosphorous levels during various phases of menstrual cycle. Indian J Physiol Pharmacol 1995; 39:411-4. [PMID: 8582757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Serum Calcium (Ca), Magnesium (Mg) and Inorganic phosphorous (Pi) were investigated serially during menstrual, follicular, ovulatory and luteal phases of menstrual cycle in 25 healthy medical student volunteers. The result shows significant cyclic variations within physiological limits in all parameters. Ca level was highest during ovulation (P < 0.001) and lowest during luteal phase (P < 0.001) compared to other phases. Exactly opposite result was observed for Ca level. It is lowest during ovulation (P < 0.001) and highest during the luteal phase (P < 0.001). However, the highest level of Pi was seen during menstrual phase (P < 0.001) and lowest during the luteal phase (P < 0.001). These changes are probably brought about under the influence of cyclic variations of the ovarian hormones.
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Affiliation(s)
- A K Pandya
- Department of Physiology, Medical College, Baroda
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Chandwani S, Kaul A. Molecular techniques in biomedical sciences: a new era in diagnosis of infectious diseases. Indian J Pediatr 1995; 62:41-53. [PMID: 10829843 DOI: 10.1007/bf02752182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S Chandwani
- Department of Pediatrics, New York University Medical Center, New York, USA
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22
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Kaul A, Chandwani S. Infants born to HIV-1 infected women: lessons from the past decade. Indian J Pediatr 1995; 62:17-24. [PMID: 10829840 DOI: 10.1007/bf02752178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A Kaul
- Department of Pediatrics, New York University Medical Center, NY 10016, USA
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Gesner M, Desiderio D, Kim M, Kaul A, Lawrence R, Chandwani S, Pollack H, Rigaud M, Krasinski K, Borkowsky W. Streptococcus pneumoniae in human immunodeficiency virus type 1-infected children. Pediatr Infect Dis J 1994; 13:697-703. [PMID: 7970969 DOI: 10.1097/00006454-199408000-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to characterize systemic Streptococcus pneumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infected children. All cases of bacteremia and meningitis caused by S. pneumoniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993. There were 31 bouts of systemic S. pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 bouts in 113 children not known to be HIV-1-infected. Four of the 19 HIV-1-infected children had multiple episodes of S. pneumoniae bacteremia as compared with 3 of 113 in the general population (P = 0.008). The frequency of serotypes and distribution of infections by season of the year did not differ between the 2 groups. The median ages at the time of the S. pneumoniae infection were 1.8 and 1.1 years for the HIV-1-infected children and the general population of children, respectively, when those children with multiple episodes were included for their initial episode only (P = 0.06). In the HIV-1-infected patients, 10 episodes were associated with pneumonia, 5 with pneumonia and otitis media, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with meningitis only and 1 with periorbital cellulitis; 5 had no apparent focus of infection. One episode of pneumonia was complicated by lung abscess and there were 2 deaths. Most HIV-1-infected patients recovered without significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healthy children.
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Affiliation(s)
- M Gesner
- Division of Infectious Disease and Immunology, New York University Medical Center, NY
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Persaud D, Bangaru B, Greco MA, Nachman S, Mittal K, Chandwani S, Krasinski K, Borkowsky W, Kaul A. Cholestatic hepatitis in children infected with the human immunodeficiency virus. Pediatr Infect Dis J 1993; 12:492-8. [PMID: 8102198 DOI: 10.1097/00006454-199306000-00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A distinct clinical syndrome of cholestasis and hepatitis occurred during early infancy in seven infants with perinatally acquired human immunodeficiency virus 1 infection. In five infants hepatitis was the first manifestation of human immunodeficiency virus 1 infection. The median age of onset of hepatitis was 7 months (range, 5 to 10 months). The mean total bilirubin concentration at presentation was 7.4 mg/dl (range, 3.9 to 11 mg/dl), the mean aspartate aminotransferase was 1512 IU/liter (range, 782 to 2960 IU/liter) and the mean alanine amino-transferase 512 IU/liter (range, 92 to 1247 IU/liter). The absolute CD4 count at the time of onset of hepatitis ranged from 191 to 2298 cells/mm3 (mean, 766 cells/mm3). Six of the seven children died within 12 weeks of onset of hepatitis, three as a result of complications of Pneumocystis carinii pneumonia, and two died of complications secondary to cytomegalovirus. In only one infant was the cause of death the direct consequence of liver failure. The seventh infant died 17 months after the onset of hepatitis of dilated cardiomyopathy. No specific etiologic agent has been identified as the cause of cholestatic hepatitis in these infants. In situ hybridization studies to detect human immunodeficiency virus 1 messenger RNA was negative in the liver tissue obtained at biopsy and autopsy in five of the samples tested.
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Affiliation(s)
- D Persaud
- Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, New York 10016
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Chandwani S, Moore T, Kaul A, Krasinski K, Borkowsky W. Early diagnosis of human immunodeficiency virus type 1-infected infants by plasma p24 antigen assay after immune complex dissociation. Pediatr Infect Dis J 1993; 12:96-7. [PMID: 8417434 DOI: 10.1097/00006454-199301000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S Chandwani
- Department of Pediatrics, New York University Medical Center, NY
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Persaud D, Chandwani S, Rigaud M, Leibovitz E, Kaul A, Lawrence R, Pollack H, DiJohn D, Krasinski K, Borkowsky W. Delayed recognition of human immunodeficiency virus infection in preadolescent children. Pediatrics 1992; 90:688-91. [PMID: 1408540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Thirty-two (18%) of 181 children cared for at our institution who were infected with the human immunodeficiency virus type 1 (HIV-1) were first seen, and HIV was diagnosed, when they were 4 years of age and older. Initial complaints or diagnoses for these children included the following: hematologic disorders (5) (3 idiopathic thrombocytopenic purpura, 1 neutropenia, 1 anemia); recurrent bacterial infections (10); Pneumocystis carinii pneumonia (3); developmental delay (1); skin disorders (2) (1 genital wart, 1 chronic zoster); weight loss (3); malignancy (1); and nephropathy (1). Eight children were referred for evaluation because of maternal HIV-1 infection. The risk factors for HIV-1 infection included maternal/perinatal exposure (22), perinatal blood transfusion (6), blood transfusion during infancy (2), and sexual abuse (2). Ten (31%) of the 32 children have subsequently died. The longest survival from perinatal infection was 12 years. HIV-1 infection in children can result in a prolonged clinical latency and can masquerade as other pathologic conditions. The absence of clinical symptoms in older children at risk for HIV-1 infection should not deter HIV testing.
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Affiliation(s)
- D Persaud
- Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, New York, NY 10016
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27
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Leibovitz E, Rigaud M, Chandwani S, Kaul A, Greco MA, Pollack H, Lawrence R, Di John D, Hanna B, Krasinski K. Disseminated fungal infections in children infected with human immunodeficiency virus. Pediatr Infect Dis J 1991; 10:888-94. [PMID: 1766703 DOI: 10.1097/00006454-199112000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A retrospective review of charts of 156 human immunodeficiency virus-infected children cared for during a 7.5-year period revealed 11 episodes of disseminateed candidiasis (DC) occurring in 11 patients (7%). All 11 patients developed the fungal infection in the context of advanced human immunodeficiency virus infection. All but one were hospital-acquired, occurring at a mean of 2.3 months after admission. Ten patients had been febrile for more than 14 days before diagnosis. Previous oral thrush and central venous catheters (73 and 82% of patients) represented major predisposing factors for development of DC. Neutropenia (2 of 11 patients) did not represent a major risk factor for DC. Candida albicans was isolated in 9 patients, Rhodotorula minuta in 1 patient and 1 fungal isolate could not be identified. Sources of isolation were blood (8 of 11 patients), central venous catheters (3 of 11) and urine (2 of 11). Lungs (6 of 11 patients), esophagus (5 of 11) and brain, heart and kidneys (3 patients each) were the organs most often involved in DC. Antemortem diagnosis was achieved in only 7 (64%) patients; none of the 4 patients with DC diagnosed postmortem had been treated before death. Seven patients were treated with amphotericin B; 6 of them died but only 3 were treated for more than 7 days of therapy. The overall mortality was 90% (10 of 11 patients). In all 20% of the 50 human immunodeficiency virus-infected children who died at our hospital during the study period had an episode of DC in close proximity to their death. DC was considered the direct cause of death in 4 of 10 children.
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Affiliation(s)
- E Leibovitz
- Department of Pediatrics, New York University Medical Center/Bellevue Hospital Center, NY 10016
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Chandwani S, Greco MA, Mittal K, Antoine C, Krasinski K, Borkowsky W. Pathology and human immunodeficiency virus expression in placentas of seropositive women. J Infect Dis 1991; 163:1134-8. [PMID: 1902246 DOI: 10.1093/infdis/163.5.1134] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The pathology of term placentas from seropositive human immunodeficiency virus (HIV)-infected and seronegative women was investigated by routine histologic, immunocytochemical, and in situ hybridization techniques. Placentas were evaluated for evidence of villitis, chorioamnionitis, and funisitis. Membranes, trophoblast, and decidua were also examined by immunohistochemistry using monoclonal HIV p24 antibody. Twenty placentas were evaluated by combined immunochemical and in situ hybridization techniques, using a 35S-labeled RNA probe complementary to the 3' long terminal repeat and envelope region of HIV-1. HIV-seropositive placentas did not show significant villitis; however, the incidence of chorioamnionitis increased (P less than .01). HIV antigens and nucleic acids were identified in the trophoblast of 10% of the placentas that also showed chorionitis. Term HIV-positive placentas may show histologic changes that may or may not be directly related to the virus. Analysis of tissues from earlier gestational placentas may prove more informative in clarifying the mechanism of maternal-fetal HIV transmission.
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Affiliation(s)
- S Chandwani
- Department of Pediatrics, New York University Medical Center, New York
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Leibovitz E, Rigaud M, Pollack H, Lawrence R, Chandwani S, Krasinski K, Borkowsky W. Pneumocystis carinii pneumonia in infants infected with the human immunodeficiency virus with more than 450 CD4 T lymphocytes per cubic millimeter. N Engl J Med 1990; 323:531-3. [PMID: 1974030 DOI: 10.1056/nejm199008233230807] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- E Leibovitz
- Department of Pediatrics, New York University Medical Center, NY 10016
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30
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Affiliation(s)
- S Chandwani
- Department of Pediatrics, New York University Medical Center, New York 10016
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Anderson VM, Greco MA, Recalde AL, Chandwani S, Church JA, Krasinski K. Intestinal cytomegalovirus ganglioneuronitis in children with human immunodeficiency virus infection. Pediatr Pathol 1990; 10:167-74. [PMID: 2156244 DOI: 10.3109/15513819009067105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cytomegalovirus in children with human immunodeficiency virus (HIV) infection can result in widespread involvement of enteric ganglion cells. Intestinal ganglioneuronitis, as noted in the two infants cited, expands the spectrum of neurologic lesions in children with acquired immunodeficiency syndrome (AIDS).
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Affiliation(s)
- V M Anderson
- New York City Department of Health, Bureau of Child Health, New York 10013
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Abstract
Human immunodeficiency virus type 1 (HIV-1) core antigen was assayed in the plasma of children at risk for infection with HIV to determine its usefulness in the diagnosis of infection and to correlate it with the clinical stage of disease. Antigen was detected in the plasma of all children less than 15 months of age with acquired immunodeficiency syndrome (AIDS). Two thirds of children with AIDS-related illnesses and half of children with asymptomatic infection had antigen. Although 53% of plasma specimens originating from HIV-infected children younger than 6 months of age contained antigen, only 25% of plasma specimens from children younger than 6 months who had no symptoms and none of the 10 specimens from HIV-infected newborn infants contained antigen. Half of the specimens containing core antigen also contained anticore antibody. Quantitative mean antigen levels were more likely to be elevated in children with AIDS (516 pg/ml) than in children with AIDS-related illnesses (295 pg/ml) or in those who had no symptoms (70 pg/ml). Antigen levels tended to increase over time in children with advancing clinical illness, but they tended to decrease over time after a diagnosis of AIDS was made. Antigen was detected in the plasma of 4 of 14 children without symptoms who subsequently reverted to an HIV seronegative state. We conclude that the detection of core antigen occurs with high frequency in children, even young infants, with symptomatic HIV infection. Plasma core antigen was less frequent in children without symptoms and was not detected in 10 infected children when they were tested at birth.
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Affiliation(s)
- W Borkowsky
- Department of Pediatrics, New York University Medical Center, NY 10016
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Abstract
Fifty-six volunteer medical students participated in three groups balanced for number of subjects, performance at last examination, and hypnotizability. The hypnosis and waking groups attended eight group sessions once a week with general ego-strengthening and specific suggestions for study habits, with a ninth session of age progression and mental rehearsal. Subjects in these two groups practiced self-suggestions (in self-hypnosis or waking respectively) daily for the study period of 9 weeks. The control group experienced sessions of passive relaxation induced by light reading for the same period of time. The hypnosis group improved significantly in coping with examination stress, but there was no significant change in performance on examinations by any of the groups.
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Borkowsky W, Krasinski K, Paul D, Moore T, Bebenroth D, Chandwani S. Human-immunodeficiency-virus infections in infants negative for anti-HIV by enzyme-linked immunoassay. Lancet 1987; 1:1168-71. [PMID: 2883490 DOI: 10.1016/s0140-6736(87)92143-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Of 85 children with human-immuno-deficiency-virus (HIV) infection based on clinical (opportunistic infection), epidemiological (mother a drug addict or known to be HIV infected), and immunological (helper-T-cell deficiency and impaired proliferative response to pokeweed mitogen) features, 9 were found to lack antibody to HIV as measured by a commercial enzyme-linked immunoassay (ELISA). All 9 children had detectable levels of HIV antigen in simultaneous plasma specimens, measured by a sensitive antigen-capture ELISA. The use of the western blot assay and an ELISA with recombinant HIV antigens was able to identify HIV infection in 4 of the 9 children.
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Dadlani AG, Chandwani S, Desai CA, Pandya KD. Serum electrolytes during various phases of menstrual cycle. Indian J Physiol Pharmacol 1982; 26:302-6. [PMID: 7152639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The corollary follow up study carried presents variation in electrolyte content of serum during menstrual, follicular, ovulatory and luteal phases of menstrual cycle. Variation in sodium, potassium and chloride were found to be parallel with each other. Their level increase significantly from follicular to ovulatory phase and falls significantly during luteal phase. Bicarbonate levels are higher in follicular and luteal phases while they are lower in menstrual and ovulatory phases.
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