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Sabour S, Bantle K, Bhatnagar A, Huang JY, Biggs A, Bodnar J, Dale JL, Gleason R, Klein L, Lasure M, Lee R, Nazarian E, Schneider E, Smith L, Snippes Vagnone P, Therrien M, Tran M, Valley A, Wang C, Young EL, Lutgring JD, Brown AC. Descriptive analysis of targeted carbapenemase genes and antibiotic susceptibility profiles among carbapenem-resistant Acinetobacter baumannii tested in the Antimicrobial Resistance Laboratory Network-United States, 2017-2020. Microbiol Spectr 2024; 12:e0282823. [PMID: 38174931 PMCID: PMC10845962 DOI: 10.1128/spectrum.02828-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Acinetobacter baumannii is a Gram-negative bacillus that can cause severe and difficult-to-treat healthcare-associated infections. A. baumannii can harbor mobile genetic elements carrying genes that produce carbapenemase enzymes, further limiting therapeutic options for infections. In the United States, the Antimicrobial Resistance Laboratory Network (AR Lab Network) conducts sentinel surveillance of carbapenem-resistant Acinetobacter baumannii (CRAB). Participating clinical laboratories sent CRAB isolates to the AR Lab Network for characterization, including antimicrobial susceptibility testing and molecular detection of class A (Klebsiella pneumoniae carbapenemase), class B (Active-on-Imipenem, New Delhi metallo-β-lactamase, and Verona integron-encoded metallo-β-lactamase), and class D (Oxacillinase, blaOXA-23-like, blaOXA-24/40-like, blaOXA-48-like, and blaOXA-58-like) carbapenemase genes. During 2017‒2020, 6,026 CRAB isolates from 45 states were tested for targeted carbapenemase genes; 1% (64 of 5,481) of CRAB tested for targeted class A and class B genes were positive, but 83% (3,351 of 4,041) of CRAB tested for targeted class D genes were positive. The number of CRAB isolates carrying a class A or B gene increased from 2 of 312 (<1%) tested in 2017 to 26 of 1,708 (2%) tested in 2020. Eighty-three percent (2,355 of 2,846) of CRAB with at least one of the targeted carbapenemase genes and 54% (271 of 500) of CRAB without were categorized as extensively drug resistant; 95% (42 of 44) of isolates carrying more than one targeted gene had difficult-to-treat susceptibility profiles. CRAB isolates carrying targeted carbapenemase genes present an emerging public health threat in the United States, and their rapid detection is crucial to improving patient safety.IMPORTANCEThe Centers for Disease Control and Prevention has classified CRAB as an urgent public health threat. In this paper, we used a collection of >6,000 contemporary clinical isolates to evaluate the phenotypic and genotypic properties of CRAB detected in the United States. We describe the frequency of specific carbapenemase genes detected, antimicrobial susceptibility profiles, and the distribution of CRAB isolates categorized as multidrug resistant, extensively drug-resistant, or difficult to treat. We further discuss the proportion of isolates showing susceptibility to Food and Drug Administration-approved agents. Of note, 84% of CRAB tested harbored at least one class A, B, or D carbapenemase genes targeted for detection and 83% of these carbapenemase gene-positive CRAB were categorized as extensively drug resistant. Fifty-four percent of CRAB isolates without any of these carbapenemase genes detected were still extensively drug-resistant, indicating that infections caused by CRAB are highly resistant and pose a significant risk to patient safety regardless of the presence of one of these carbapenemase genes.
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Affiliation(s)
- Sarah Sabour
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Bantle
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y. Huang
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela Biggs
- Maryland Department of Health, Baltimore, Maryland, USA
| | | | | | - Rachel Gleason
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Liore Klein
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Rachel Lee
- Texas Department of State Health Services, Austin, Texas, USA
| | | | - Emily Schneider
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Lori Smith
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | | | | | - Michael Tran
- Washington State Department of Health Public Health Laboratories, Shoreline, Washington, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Chun Wang
- Texas Department of State Health Services, Austin, Texas, USA
| | - Erin L. Young
- Utah Public Health Laboratory, Taylorsville, Utah, USA
| | - Joseph D. Lutgring
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jin L, Xie Z, Lorkiewicz P, Srivastava S, Bhatnagar A, Conklin DJ. Endothelial-dependent relaxation of α-pinene and two metabolites, myrtenol and verbenol, in isolated murine blood vessels. Am J Physiol Heart Circ Physiol 2023; 325:H1446-H1460. [PMID: 37889254 DOI: 10.1152/ajpheart.00380.2023] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
Epidemiological evidence shows that residential proximity to greenspaces is associated with lower risk of all-cause and cardiovascular mortality; however, the mechanism(s) underlying this link remains unclear. Plants emit biogenic volatile organic compounds such as α-pinene that could elicit beneficial cardiovascular effects. To explore the role of α-pinene more directly, we studied the metabolism and the vascular effects of α-pinene. We found that exposure of mice to α-pinene (1 ppm, 6 h) generated two phase I oxidation metabolites, cis- and trans-verbenol [(1R,2R,5R)-verbenol and (1 R,2S,5R)-verbenol)] and myrtenol [(1S,5R)-(+)-myrtenol] that were identified in urine by GC-MS. Precontracted naïve murine male and female aorta and superior mesenteric artery (SMA) were relaxed robustly (60% tension reduction) by increasing concentrations of α-pinene, myrtenol, and verbenol to 0.3 mM, whereas 1 mM α-pinene was vasotoxic. The SMA was six times more sensitive than the aorta to α-pinene. Both myrtenol and verbenol were equally potent and efficacious as parent α-pinene in male and female SMA. The sensitive portion of the α-pinene-, myrtenol-, and verbenol-induced relaxations in male SMA was mediated by 1) endothelium, 2) eNOS-derived NO, and 3) guanylyl cyclase (GC) activity. Moreover, α-pinene activated the transient receptor potential ankyrin-1 (TRPA1) channel whereas the metabolites did not. Endothelial-derived NO regulates blood flow, blood pressure, and thrombosis, and it is plausible that inhaled (and ingested) α-pinene (or its metabolites) augments NO release to mediate the cardiovascular benefits of exposure to greenness.NEW & NOTEWORTHY A common plant-derived biogenic volatile organic compound, α-pinene, and two of its metabolites, myrtenol and verbenol, stimulate vasorelaxation in murine superior mesenteric artery. Both α-pinene- and its metabolites induce vasorelaxation by activation of the endothelium, nitric oxide, and guanylyl cyclase. α-Pinene also activates the transient receptor potential ankyrin-1. Positive associations between greenness exposure and human cardiovascular health may be a result of the vascular action of α-pinene and its metabolites, a novel consideration.
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Affiliation(s)
- L Jin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
| | - Z Xie
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - P Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - S Srivastava
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - D J Conklin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, United States
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Bhatnagar A, Collins B, Collins SP, Jean W, Aulisi E, Harris B, Nayar V, Anaizi A, Watson J, Carrasquilla M, Suy S, Conroy D. Marginless 5-Fraction Robotic Radiosurgery for Unfavorable Nonfunctioning Pituitary Macroadenoma: 5-year Outcomes from a Single Institution Protocol. Int J Radiat Oncol Biol Phys 2023; 117:e165. [PMID: 37784765 DOI: 10.1016/j.ijrobp.2023.06.1000] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Nonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established for single-session radiosurgery, but mature outcomes are lacking for multisession radiosurgery. We report our institution's 5-year efficacy and safety results for unfavorable nonfunctioning pituitary macroadenoma patients treated with marginless 5-fraction robotic radiosurgery. MATERIALS/METHODS Between 2010-2020, patients who completed marginless 5-fraction radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem or pituitary gland). Local control was calculated using the Kaplan-Meier Method. RESULTS Twenty predominately female patients (60%), age from 21-77 (median: 53 years) were included in this study. All underwent primary resection. Indications for radiosurgery included unresectable recurrence (85%) and residual disease progression (70%). Median tumor volume was 3.4 cm3 (range: 0.3-20.8 cm3) and 40% of the tumors were suprasellar. A mean dose of 28.8 Gy (range: 25 Gy-30 Gy), was delivered to a median isodose line of 80% (range: 75%-89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0-25.9 Gy). Toxicity was minimal with 12 patients (40%) developing acute short-lived headaches and 1 patient (5%) developing a brief ipsilateral 6th nerve palsy. There was no radiation induced optic or pituitary dysfunction identified in this cohort. At a median follow up of 5 years local control was 95%. There was 1 in-field failure pathologically confirmed following surgery for pituitary tumor hemorrhage and 2 radiographically confirmed out-of-field failures in patients with large tumors (>20 cc). CONCLUSION The treatment of unfavorable nonfunctioning pituitary macroadenoma with marginless 5-fraction robotic radiosurgery provides excellent local control to date, with minimal toxicity. However, tumors with GTV's greater than 20 cc may require conventionally fractionated treatment with a margin to optimize local control.
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Affiliation(s)
- A Bhatnagar
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | | | - S P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - W Jean
- Lehigh Valley Health Network, Leigh County, PA
| | - E Aulisi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - B Harris
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC
| | - V Nayar
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - A Anaizi
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - J Watson
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - M Carrasquilla
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - S Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - D Conroy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
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Kaur M, Bhatnagar A, Dhillon O, Yadav AS. Genotoxic Effects of Rice-Agrochemicals on Channa punctatus (Bloch) and Cyprinus carpio (Linnaeus) Using Micronucleus Assay and Alkaline Single Cell Gel Electrophoresis. Nat Env Poll Tech 2022. [DOI: 10.46488/nept.2022.v21i04.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rice-cum-fish culture is a cost-effective practice for marginal farmers but the major constraint is the indiscriminate use of agrochemicals. Present work was designed to assess the genotoxic effects of rice agrochemicals in Channa punctatus (Experiment 1 CP1 to CP3) and Cyprinus carpio (Experiment 2 CC1 to CC3); using micronucleus, chromosome aberration, and single cell gel electrophoresis/Comet assay. Two experiments with three treatments (CP1/CC1: without pesticide; CP2/CC2: recommended doses; CP3/CC3: farmers’ dose) were maintained in triplicates. The presence of tail DNA and micronuclei depicted significant DNA damage (P<0.05) in all the treated fish. The mean percent frequency of MN showed significant (P<0.05) differences with respect to the initial. The chromosomal aberrations and mean frequencies of tail DNA (%) were significantly abundant in CP3 and CC3 indicating high a genotoxic effect. Keeping in view the low genotoxic effects, treatment of CP2 and CC2 with recommended doses of pesticides may be disseminated to farmers.
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Ghanem A, Bhatnagar A, Elshaikh M, Burmeister C, Elshaikh M. Recurrence Risk Stratification for Women with FIGO Stage I Uterine Endometrioid Carcinoma Who Underwent Surgical Lymph Node Evaluation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1277] [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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Jones AM, Clode L, Fenton P, Bates A, Bhatnagar A. OA08.05 A Quality Improvement Project Determining if Dietitian Input with the UHS Lung Oncology Team Improved Patient Outcomes. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.046] [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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Holm RH, Nagarkar M, Yeager RA, Talley D, Chaney AC, Rai JP, Mukherjee A, Rai SN, Bhatnagar A, Smith T. Surveillance of RNase P, PMMoV, and CrAssphage in wastewater as indicators of human fecal concentration across urban sewer neighborhoods, Kentucky. FEMS Microbes 2022; 3:1-12. [PMID: 37228897 PMCID: PMC10117713 DOI: 10.1093/femsmc/xtac003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/24/2021] [Accepted: 01/25/2022] [Indexed: 09/03/2023] Open
Abstract
Wastewater surveillance has been widely used as a supplemental method to track the community infection levels of severe acute respiratory syndrome coronavirus 2. A gap exists in standardized reporting for fecal indicator concentrations, which can be used to calibrate the primary outcome concentrations from wastewater monitoring for use in epidemiological models. To address this, measurements of fecal indicator concentration among wastewater samples collected from sewers and treatment centers in four counties of Kentucky (N = 650) were examined. Results from the untransformed wastewater data over 4 months of sampling indicated that the fecal indicator concentration of human ribonuclease P (RNase P) ranged from 5.1 × 101 to 1.15 × 106 copies/ml, pepper mild mottle virus (PMMoV) ranged from 7.23 × 103 to 3.53 × 107 copies/ml, and cross-assembly phage (CrAssphage) ranged from 9.69 × 103 to 1.85 × 108 copies/ml. The results showed both regional and temporal variability. If fecal indicators are used as normalization factors, knowing the daily sewer system flow of the sample location may matter more than rainfall. RNase P, while it may be suitable as an internal amplification and sample adequacy control, has less utility than PMMoV and CrAssphage as a fecal indicator in wastewater samples when working at different sizes of catchment area. The choice of fecal indicator will impact the results of surveillance studies using this indicator to represent fecal load. Our results contribute broadly to an applicable standard normalization factor and assist in interpreting wastewater data in epidemiological modeling and monitoring.
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Affiliation(s)
- R H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
| | - M Nagarkar
- Center for Environmental Solutions and Emergency Response, United States Environmental Protection Agency, Cincinnati, OH 45220, USA
| | - R A Yeager
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA
| | - D Talley
- Louisville/Jefferson County Metropolitan Sewer District, Morris Forman Water Quality Treatment Center, 4522 Algonquin Parkway, Louisville, KY 40211, USA
| | - A C Chaney
- Sanitation District No. 1 of Northern Kentucky, 1045 Eaton Dr., Ft. Wright, Kentucky 41017, USA
| | - J P Rai
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - A Mukherjee
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - S N Rai
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
- Brown Cancer Center, School of Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
- Center for Integrative Environmental Health Sciences, 500 S. Preston St., Suite 1319, Louisville, KY 40202, USA
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
| | - T Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
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Kracalik I, Ham DC, McAllister G, Smith AR, Vowles M, Kauber K, Zambrano M, Rodriguez G, Garner K, Chorbi K, Cassidy PM, McBee S, Stoney RJ, Moser K, Villarino ME, Zazueta OE, Bhatnagar A, Sula E, Stanton RA, Brown AC, Halpin AL, Epstein L, Walters MS. Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018-2019. Emerg Infect Dis 2022; 28:51-61. [PMID: 34932447 PMCID: PMC8714193 DOI: 10.3201/eid2801.211880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.
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Affiliation(s)
| | | | - Gillian McAllister
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Amanda R. Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Maureen Vowles
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kelly Kauber
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Melba Zambrano
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Gretchen Rodriguez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kelley Garner
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kaitlyn Chorbi
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - P. Maureen Cassidy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Shannon McBee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Rhett J. Stoney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Kathleen Moser
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Margarita E. Villarino
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Oscar E. Zazueta
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Amelia Bhatnagar
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Erisa Sula
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Richard A. Stanton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Allison C. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Alison L. Halpin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Lauren Epstein
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - Maroya Spalding Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
| | - for the Verona Integron-Encoded Metallo-β-Lactamase–Producing Carbapenem-Resistant Pseudomonas aeruginosa Medical Tourism Investigation Team2
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters)
- Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber)
- Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez)
- Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner)
- Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi)
- Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy)
- West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee)
- Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
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9
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Al-Ishaq Z, Asif U, Roy M, Sikdar O, Bhatnagar A, Sircar T. Glomus tumour of the nipple in a male patient. Ann R Coll Surg Engl 2021; 104:e60-e63. [PMID: 34821523 DOI: 10.1308/rcsann.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A glomus tumour is a benign mesenchymal tumour. It is extremely rare in the breast. We report a case of glomus tumour of the nipple in a 54-year-old man. To the best of the authors' knowledge, this is the first case report of a glomus tumour of the nipple. We describe the different presenting symptoms, method of diagnosis and treatment.
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Affiliation(s)
| | - U Asif
- The Royal Wolverhampton NHS Trust, UK
| | - M Roy
- Medical School, University of Birmingham, UK
| | - O Sikdar
- Imperial College School of Medicine, UK
| | | | - T Sircar
- The Royal Wolverhampton NHS Trust, UK
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10
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Sabour S, Huang JY, Bhatnagar A, Gilbert SE, Karlsson M, Lonsway D, Lutgring JD, Rasheed JK, Halpin AL, Stanton RA, Gumbis S, Elkins CA, Brown AC. Detection and Characterization of Targeted Carbapenem-Resistant Health Care-Associated Threats: Findings from the Antibiotic Resistance Laboratory Network, 2017 to 2019. Antimicrob Agents Chemother 2021; 65:e0110521. [PMID: 34570648 PMCID: PMC8597727 DOI: 10.1128/aac.01105-21] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Carbapenemase gene-positive (CP) Gram-negative bacilli are of significant clinical and public health concern. Their rapid detection and containment are critical to preventing their spread and additional infections they can cause. To this end, CDC developed the Antibiotic Resistance Laboratory Network (AR Lab Network), in which public health laboratories across all 50 states, several cities, and Puerto Rico characterize clinical isolates of carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), and Acinetobacter baumannii (CRAB) and conduct colonization screens to detect the presence of mobile carbapenemase genes. In its first 3 years, the AR Lab Network tested 76,887 isolates and 31,001 rectal swab colonization screens. Targeted carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaVIM, or blaIMP) were detected by PCR in 35% of CRE, 2% of CRPA, and <1% of CRAB isolates and 8% of colonization screens tested, respectively. blaKPC and blaVIM were the most common genes in CP-CRE and CP-CRPA isolates, respectively, but regional differences in the frequency of carbapenemase genes detected were apparent. In CRE and CRPA isolates tested for carbapenemase production and the presence of the targeted genes, 97% had concordant results; 3% of CRE and 2% of CRPA isolates were carbapenemase production positive but PCR negative for those genes. Isolates harboring blaNDM showed the highest frequency of resistance across the carbapenems tested, and those harboring blaIMP and blaOXA-48-like genes showed the lowest frequency of carbapenem resistance. The AR Lab Network provides a national snapshot of rare and emerging carbapenemase genes, delivering data to inform public health actions to limit the spread of these antibiotic resistance threats.
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Affiliation(s)
- Sarah Sabour
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y. Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E. Gilbert
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph D. Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. Kamile Rasheed
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard A. Stanton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Gumbis
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A. Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C. Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Shugart A, Mahon G, Huang JY, Karlsson M, Valley A, Lasure M, Gross A, Pattee B, Vaeth E, Brooks R, Maruca T, Dominguez CE, Torpey D, Francis D, Bhattarai R, Kainer MA, Chan A, Dubendris H, Greene SR, Blosser SJ, Shannon DJ, Jones K, Brennan B, Hun S, D'Angeli M, Murphy CN, Tierney M, Reese N, Bhatnagar A, Kallen A, Brown AC, Spalding Walters M. Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018. JAC Antimicrob Resist 2021; 3:dlab137. [PMID: 34514407 PMCID: PMC8417453 DOI: 10.1093/jacamr/dlab137] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread. Objectives From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE. Methods State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (blaKPC, blaNDM, blaVIM, blaIMP, or blaOXA-48-like) was detected. Results SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than blaKPC. Conclusions Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
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Affiliation(s)
- Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Garrett Mahon
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Jennifer Y Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | | | | | | | - Richard Brooks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Maryland Department of Health, Baltimore, MD, USA
| | - Tyler Maruca
- Maryland Department of Health, Baltimore, MD, USA
| | | | - David Torpey
- Maryland Department of Health, Baltimore, MD, USA
| | - Drew Francis
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | | | - Allison Chan
- Tennessee Department of Health, Nashville, TN, USA
| | - Heather Dubendris
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Shermalyn R Greene
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Sara J Blosser
- Indiana State Department of Health, Indianapolis, IN, USA
| | - D J Shannon
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Kelly Jones
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Brenda Brennan
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Sopheay Hun
- Washington State Department of Health, Tumwater, WA, USA
| | | | - Caitlin N Murphy
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, NE, USA
| | - Maureen Tierney
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Natashia Reese
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Goldbelt C6 Inc, Juneau, AK, USA
| | - Alex Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
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12
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Jin L, Lorkiewicz P, Xie Z, Bhatnagar A, Srivastava S, Conklin DJ. Acrolein but not its metabolite, 3-Hydroxypropylmercapturic acid (3HPMA), activates vascular transient receptor potential Ankyrin-1 (TRPA1): Physiological to toxicological implications. Toxicol Appl Pharmacol 2021; 426:115647. [PMID: 34271065 PMCID: PMC8343963 DOI: 10.1016/j.taap.2021.115647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
Acrolein, an electrophilic α,β-unsaturated aldehyde, is present in foods and beverages, and is a product of incomplete combustion, and thus, reaches high ppm levels in tobacco smoke and structural fires. Exposure to acrolein is linked with cardiopulmonary toxicity and cardiovascular disease risk. The hypothesis of this study is the direct effects of acrolein in isolated murine blood vessels (aorta and superior mesenteric artery, SMA) are transient receptor potential ankyrin-1 (TRPA1) dependent. Using isometric myography, isolated aorta and SMA were exposed to increasing levels of acrolein. Acrolein inhibited phenylephrine (PE)-induced contractions (approximately 90%) in aorta and SMA of male and female mice in a concentration-dependent (0.01-100 μM) manner. The major metabolite of acrolein, 3-hydroxypropylmercapturic acid (3HPMA), also relaxed PE-precontracted SMA. As the SMA was 20× more sensitive to acrolein than aorta (SMA EC50 0.8 ± 0.2 μM; aorta EC50 > 29.4 ± 4.4 μM), the mechanisms of acrolein-induced relaxation were studied in SMA. The potency of acrolein-induced relaxation was inhibited significantly by: 1) mechanically-impaired endothelium; 2) Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME); 3) guanylyl cyclase (GC) inhibitor (ODQ); and, 4) a TRPA1 antagonist (A967079). TRPA1 positive immunofluorescence was present in the endothelium. Compared with other known TRPA1 agonists, including allyl isothiocyanate (AITC), cinnamaldehyde, crotonaldehyde, and formaldehyde, acrolein stimulated a more potent TRPA1-dependent relaxation. Acrolein, at high concentration [100 μM], induced tension oscillations (spasms) independent of TRPA1 in precontracted SMA but not in aorta. In conclusion, acrolein is vasorelaxant at low levels (physiological) yet vasotoxic at high levels (toxicological).
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Affiliation(s)
- L Jin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA; American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, USA
| | - P Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA; American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, USA
| | - Z Xie
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA; American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, USA; Superfund Research Center, University of Louisville, Louisville, KY, USA
| | - S Srivastava
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA; American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, USA; Superfund Research Center, University of Louisville, Louisville, KY, USA
| | - D J Conklin
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA; Diabetes and Obesity Center, University of Louisville, Louisville, KY, USA; American Heart Association-Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, USA; Superfund Research Center, University of Louisville, Louisville, KY, USA.
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McKay SL, Tobolowsky FA, Moritz ED, Hatfield KM, Bhatnagar A, LaVoie SP, Jackson DA, Lecy KD, Bryant-Genevier J, Campbell D, Freeman B, Gilbert SE, Folster JM, Medrzycki M, Shewmaker PL, Bankamp B, Radford KW, Anderson R, Bowen MD, Negley J, Reddy SC, Jernigan JA, Brown AC, McDonald LC, Kutty PK. Performance Evaluation of Serial SARS-CoV-2 Rapid Antigen Testing During a Nursing Home Outbreak. Ann Intern Med 2021; 174:945-951. [PMID: 33900791 PMCID: PMC8108910 DOI: 10.7326/m21-0422] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To address high COVID-19 burden in U.S. nursing homes, rapid SARS-CoV-2 antigen tests have been widely distributed in those facilities. However, performance data are lacking, especially in asymptomatic people. OBJECTIVE To evaluate the performance of SARS-CoV-2 antigen testing when used for facility-wide testing during a nursing home outbreak. DESIGN A prospective evaluation involving 3 facility-wide rounds of testing where paired respiratory specimens were collected to evaluate the performance of the BinaxNOW antigen test compared with virus culture and real-time reverse transcription polymerase chain reaction (RT-PCR). Early and late infection were defined using changes in RT-PCR cycle threshold values and prior test results. SETTING A nursing home with an ongoing SARS-CoV-2 outbreak. PARTICIPANTS 532 paired specimens collected from 234 available residents and staff. MEASUREMENTS Percentage of positive agreement (PPA) and percentage of negative agreement (PNA) for BinaxNOW compared with RT-PCR and virus culture. RESULTS BinaxNOW PPA with virus culture, used for detection of replication-competent virus, was 95%. However, the overall PPA of antigen testing with RT-PCR was 69%, and PNA was 98%. When only the first positive test result was analyzed for each participant, PPA of antigen testing with RT-PCR was 82% among 45 symptomatic people and 52% among 343 asymptomatic people. Compared with RT-PCR and virus culture, the BinaxNOW test performed well in early infection (86% and 95%, respectively) and poorly in late infection (51% and no recovered virus, respectively). LIMITATION Accurate symptom ascertainment was challenging in nursing home residents; test performance may not be representative of testing done by nonlaboratory staff. CONCLUSION Despite lower positive agreement compared with RT-PCR, antigen test positivity had higher agreement with shedding of replication-competent virus. These results suggest that antigen testing could be a useful tool to rapidly identify contagious people at risk for transmitting SARS-CoV-2 during nascent outbreaks and help reduce COVID-19 burden in nursing homes. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Susannah L McKay
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Farrell A Tobolowsky
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Erin D Moritz
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Kelly M Hatfield
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Amelia Bhatnagar
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Stephen P LaVoie
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - David A Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - K Danielle Lecy
- Centers for Disease Control and Prevention, Anchorage, Alaska (K.D.L.)
| | - Jonathan Bryant-Genevier
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Davina Campbell
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Brandi Freeman
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Sarah E Gilbert
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Jennifer M Folster
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Magdalena Medrzycki
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Patricia L Shewmaker
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Bettina Bankamp
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Kay W Radford
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Raydel Anderson
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Michael D Bowen
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Jeanne Negley
- Georgia Department of Public Health, Atlanta, Georgia (J.N.)
| | - Sujan C Reddy
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - John A Jernigan
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Allison C Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - L Clifford McDonald
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
| | - Preeta K Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.)
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Yeager R, Holm RH, Saurabh K, Fuqua JL, Talley D, Bhatnagar A, Smith T. Wastewater Sample Site Selection to Estimate Geographically Resolved Community Prevalence of COVID-19: A Sampling Protocol Perspective. Geohealth 2021; 5:e2021GH000420. [PMID: 34222738 PMCID: PMC8240399 DOI: 10.1029/2021gh000420] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/10/2021] [Indexed: 05/22/2023]
Abstract
Wastewater monitoring for virus infections within communities can complement conventional clinical surveillance. Currently, most SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) clinical testing is voluntary and inconsistently available, except for a few occupational and educational settings, and therefore likely underrepresents actual population prevalence. Randomized testing on a regular basis to estimate accurate population-level infection rates is prohibitively costly and is hampered by a range of limitations and barriers associated with participation in clinical research. In comparison, community-level fecal monitoring can be performed through wastewater surveillance to effectively surveil communities. However, epidemiologically defined protocols for wastewater sample site selection are lacking. Herein, we describe methods for developing a geographically resolved population-level wastewater sampling approach in Jefferson County, Kentucky, and present preliminary results. Utilizing this site selection protocol, samples (n = 237) were collected from 17 wastewater catchment areas, September 8 to October 30, 2020 from one to four times per week in each area and compared to concurrent clinical data aggregated to wastewater catchment areas and county level. SARS-CoV-2 RNA was consistently present in wastewater during the studied period, and varied by area. Data obtained using the site selection protocol showed variation in geographically resolved wastewater SARS-CoV-2 RNA concentration compared to clinical rates. These findings highlight the importance of neighborhood-equivalent spatial scales and provide a promising approach for viral epidemic surveillance, thus better guiding spatially targeted public health mitigation strategies.
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Affiliation(s)
- R. Yeager
- Christina Lee Brown Enviroment InstituteUniversity of LouisvilleLouisvilleKYUSA
- Department of Environmental and Occupational Health SciencesSchool of Public Health and Information SciencesUniversity of LouisvilleLouisvilleKYUSA
| | - R. H. Holm
- Christina Lee Brown Enviroment InstituteUniversity of LouisvilleLouisvilleKYUSA
| | - K. Saurabh
- James Graham Brown Cancer CenterSchool of MedicineUniversity of LouisvilleLouisvilleKYUSA
- Department of OncologySt. Jude Children's Research HospitalMemphisTNUSA
| | - J. L. Fuqua
- Center for Predictive MedicineUniversity of LouisvilleLouisvilleKYUSA
- Department of Pharmacology and ToxicologyUniversity of LouisvilleLouisvilleKYUSA
| | - D. Talley
- Morris Forman Water Quality Treatment CenterLouisvilleKYUSA
| | - A. Bhatnagar
- Christina Lee Brown Enviroment InstituteUniversity of LouisvilleLouisvilleKYUSA
| | - T. Smith
- Christina Lee Brown Enviroment InstituteUniversity of LouisvilleLouisvilleKYUSA
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15
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Dabas R, Varadaraj G, Sandhu S, Bhatnagar A, Pal R. Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 in an adult: a case report. Br J Dermatol 2021; 185:859-861. [PMID: 34115386 PMCID: PMC9214080 DOI: 10.1111/bjd.20574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/04/2021] [Accepted: 05/30/2021] [Indexed: 12/16/2022]
Affiliation(s)
- R Dabas
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - G Varadaraj
- Department of Medicine, Command Hospital Air Force Bangalore, Bengaluru, India
| | - S Sandhu
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - A Bhatnagar
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
| | - R Pal
- Department of Dermatology, Command Hospital Air Force Bangalore, Bengaluru, India
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Sachdeva KS, Arora N, Solanki R, Singla R, Sarin R, Bhatnagar A, Khanna A, Atahavale A, Shridhar R, Barua SR, Parmar M, Farooq SI, Ramachandran R, Alavadi U, Swamickan R, Tonsing J, Patel Y, Singla N. Strengthened capacity of India´s bedaquiline Conditional Access Programme for introducing new drugs and regimens. Int J Tuberc Lung Dis 2021; 24:1067-1072. [PMID: 33126941 DOI: 10.5588/ijtld.20.0136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Addressing TB in India is critical to meeting global targets. With the scale-up of diagnostic networks and the availability of new TB drugs, India had the opportunity to improve the detection and treatment outcomes in drug-resistant TB (DR-TB).OBJECTIVE: To document how the introduction of new drugs and regimens is helping India improve the care of DR-TB patients.DESIGN: In 2016, India´s National TB Programme (NTP) introduced bedaquiline (BDQ) under a Conditional Access Programme (BDQ-CAP) at six sites after providing extensive training and strengthening laboratory testing, pre-treatment evaluation, active drug safety monitoring and management (aDSM) and follow-up systems.RESULTS: An interim analysis reflected earlier and better culture conversion rates: 83% of the 620 patients converted within a median time of 60 days. However, 248 serious adverse events were reported, including 73 deaths (12%) and 100 cardiotoxicity events (16.3%). Encouraged by the evidence of safety and efficacy of BDQ, the NTP took steps to systematically expand its access to cover the entire population by 2018.CONCLUSION: The cautious yet focused approach used to introduce BDQ under BDQ-CAP paved the way for the rapid introduction of delamanid, as well as the shorter treatment regimen and the all-oral regimen for DR-TB.
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Affiliation(s)
- K S Sachdeva
- Central TB Division, Ministry of Health and Family Welfare, Government of India, New Delhi
| | - N Arora
- International Union Against Tuberculosis and Lung Disease South East Asia, New Delhi
| | - R Solanki
- BJ Medical College and Hospital, Ahmedabad
| | - R Singla
- National Institute for TB and Respiratory Disease, New Delhi
| | - R Sarin
- National Institute for TB and Respiratory Disease, New Delhi
| | - A Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, New Delhi
| | - A Khanna
- Government of National Capital Territory of Delhi, New Delhi
| | - A Atahavale
- King Edward Memorial College & Group of TB Hospital, Mumbai
| | - R Shridhar
- Government Hospital of Thoracic Medicine, Chennai
| | | | - M Parmar
- World Health Organisation, India Country Office, New Delhi
| | - S I Farooq
- International Union Against Tuberculosis and Lung Disease South East Asia, New Delhi
| | - R Ramachandran
- World Health Organisation, India Country Office, New Delhi
| | - U Alavadi
- United States Agency for International Development India, New Delhi, India
| | - R Swamickan
- United States Agency for International Development India, New Delhi, India
| | - J Tonsing
- International Union Against Tuberculosis and Lung Disease South East Asia, New Delhi
| | - Y Patel
- Central TB Division, Ministry of Health and Family Welfare, Government of India, New Delhi
| | - N Singla
- National Institute for TB and Respiratory Disease, New Delhi
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Fuqua JL, Rouchka EC, Waigel S, Sokoloski K, Chung D, Zacharias W, Zhang M, Chariker J, Talley D, Santisteban I, Varsani A, Moyer S, Holm RH, Yeager RA, Smith T, Bhatnagar A. A rapid assessment of wastewater for genomic surveillance of SARS-CoV-2 variants at sewershed scale in Louisville, KY. medRxiv 2021:2021.03.18.21253604. [PMID: 33791725 PMCID: PMC8010757 DOI: 10.1101/2021.03.18.21253604] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this communication, we report on the genomic surveillance of SARS-CoV-2 using wastewater samples in Jefferson County, KY. In February 2021, we analyzed seven wastewater samples for SARS-CoV-2 genomic surveillance. Variants observed in smaller catchment areas, such as neighborhood manhole locations, were not necessarily consistent when compared to associated variant results in downstream treatment plants, suggesting catchment size or population could impact the ability to detect diversity.
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Affiliation(s)
- J L Fuqua
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - E C Rouchka
- Department of Computer Science and Engineering, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
- KY-INBRE Bioinformatics Core, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
| | - S Waigel
- Department of Medicine, University of Louisville, 530 S. Hancock Jackson St., Louisville, KY 40402, United States
| | - K Sokoloski
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Department of Microbiology and Immunology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - D Chung
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Department of Microbiology and Immunology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - W Zacharias
- Department of Medicine, University of Louisville, 530 S. Hancock Jackson St., Louisville, KY 40402, United States
| | - M Zhang
- Department of Neuroscience Training, University of Louisville, 505 S. Hancock St, Louisville, KY 40202
| | - J Chariker
- Department of Computer Science and Engineering, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
- KY-INBRE Bioinformatics Core, University of Louisville, 522 East Gray St., Louisville, KY 40202, United States
| | - D Talley
- Louisville/Jefferson County Metropolitan Sewer District, Morris Forman Water Quality Treatment Center, 4522 Algonquin Parkway, Louisville KY 40211, United States
| | - I Santisteban
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, United States
| | - A Varsani
- The Biodesign Center of Fundamental and Applied Microbiomics, School of Life Sciences, Center for Evolution and Medicine, Arizona State University, Tempe, AZ 85287, United States
| | - S Moyer
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
- Department of Public Health and Wellness, Louisville Metro Government, 400 E. Grays St., Louisville, KY 40202, United States
| | - R H Holm
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - R A Yeager
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
| | - T Smith
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
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Surie D, Huang JY, Brown AC, Gable P, Biedron C, Gilbert SE, Garner K, Bollinger S, Gulley T, Haney T, Lyons AK, Beshearse E, Gregory CJ, Sabour S, Clemmons NS, James AE, Tamin A, Reese N, Perry-Dow KA, Brown R, Harcourt JL, Campbell D, Houston H, Chakravorty R, Paulick A, Whitaker B, Murdoch J, Spicer L, Stumpf MM, Mills L, Coughlin MM, Higdem P, Rasheed MAU, Lonsway D, Bhatnagar A, Kothari A, Anderson K, Thornburg NJ, Breaker E, Adamczyk M, McAllister GA, Halpin AL, Seely KA, Patil N, McDonald LC, Kutty PK. Infectious Period of Severe Acute Respiratory Syndrome Coronavirus 2 in 17 Nursing Home Residents-Arkansas, June-August 2020. Open Forum Infect Dis 2021; 8:ofab048. [PMID: 33723510 PMCID: PMC7928697 DOI: 10.1093/ofid/ofab048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background To estimate the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adults with underlying conditions, we assessed duration of coronavirus disease 2019 (COVID-19) symptoms, reverse-transcription polymerase chain reaction (RT-PCR) positivity, and culture positivity among nursing home residents. Methods We enrolled residents within 15 days of their first positive SARS-CoV-2 test (diagnosis) at an Arkansas facility from July 7 to 15, 2020 and instead them for 42 days. Every 3 days for 21 days and then weekly, we assessed COVID-19 symptoms, collected specimens (oropharyngeal, anterior nares, and saliva), and reviewed medical charts. Blood for serology was collected on days 0, 6, 12, 21, and 42. Infectivity was defined by positive culture. Duration of culture positivity was compared with duration of COVID-19 symptoms and RT-PCR positivity. Data were summarized using measures of central tendency, frequencies, and proportions. Results We enrolled 17 of 39 (44%) eligible residents. Median participant age was 82 years (range, 58–97 years). All had ≥3 underlying conditions. Median duration of RT-PCR positivity was 22 days (interquartile range [IQR], 8–31 days) from diagnosis; median duration of symptoms was 42 days (IQR, 28–49 days). Of 9 (53%) participants with any culture-positive specimens, 1 (11%) severely immunocompromised participant remained culture-positive 19 days from diagnosis; 8 of 9 (89%) were culture-positive ≤8 days from diagnosis. Seroconversion occurred in 12 of 12 (100%) surviving participants with ≥1 blood specimen; all participants were culture-negative before seroconversion. Conclusions Duration of infectivity was considerably shorter than duration of symptoms and RT-PCR positivity. Severe immunocompromise may prolong SARS-CoV-2 infectivity. Seroconversion indicated noninfectivity in this cohort.
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Affiliation(s)
- Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Y Huang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison C Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Biedron
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Gilbert
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Susan Bollinger
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trent Gulley
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Tafarra Haney
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Amanda K Lyons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Beshearse
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher J Gregory
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Sabour
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nakia S Clemmons
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allison E James
- Arkansas Department of Health, Little Rock, Arkansas, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Azaibi Tamin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natashia Reese
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K Allison Perry-Dow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin Brown
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Jennifer L Harcourt
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davina Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Paulick
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brett Whitaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Murdoch
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Lori Spicer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan M Stumpf
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Mills
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa M Coughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pamela Higdem
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | | | - David Lonsway
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Karen Anderson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Breaker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Adamczyk
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian A McAllister
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison L Halpin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - L Clifford McDonald
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Preeta K Kutty
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Bhatnagar A, Sanghvi S, Mathur R, Sarda P. Clinical profile and outcome of patients with congenital heart disease treated with percutaneous transcatheter intervention. Indian Heart J 2020. [DOI: 10.1016/j.ihj.2020.11.057] [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] Open
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20
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Bashir I, Sahu S, Pandita S, Kharbanda M, Sharma R, Bhatnagar A. PO-0813: Total tumor volume as a prognostic factor in head and neck cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00830-6] [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: 10/22/2022]
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21
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McIntyre W, Belley-Côté E, Vadakken M, Rai A, Lengyel A, Rochwerg B, Bhatnagar A, Deif B, Um K, Spence J, Connolly S, Bangdiwala S, Rao-Melacini P, Healey J, Whitlock R. HIGH-SENSITIVITY ESTIMATE OF THE INCIDENCE OF NEW-ONSET ATRIAL FIBRILLATION IN CRITICALLY ILL PATIENTS. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Singh A, Bhatnagar A. Management Of Superficial Partial Thickness Burn With Collagen Sheet Dressing Compared With Paraffin Gauze And Silver Sulfadiazine. Ann Burns Fire Disasters 2020; 33:233-238. [PMID: 33304214 PMCID: PMC7680202] [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] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/22/2020] [Indexed: 06/12/2023]
Abstract
Burn injury is a global problem that equally concerns under-developed and developing countries. An ideal dressing material has to maintain a moist environment, act as a bacterial barrier and as a medium for free exchange of gases, while providing a barrier against toxic contaminants. Sixty-eight consecutive patients with fresh acute superficial partial thickness burns ≤ 15% BSA, registered in two tertiary care teaching hospitals in North India between January 2015 to December 2019, were divided into two groups: a collagen dressing group (group A) and a paraffin gauze (PG) plus silver sulfadiazine (SSD) group (group B). Forty-four patients received collagen dressing and 24 patients received conventional paraffin gauze (PG) plus silver sulfadiazine (SSD) dressing. Patients were followed up for clinical outcome until burn wounds healed. We observed complete healing in 5-7 days for 26 cases (59%) in group A, in 8-12 days for 16 cases (66.66%) in group B. A total of 95.5% of group A patients required analgesia only for ≤ 2days, while 90.90% of group B patients required analgesia for ≥ 6 days. Ninety percent of group A patients required none or a single dressing change with shorter hospital stay. In group B, 22 cases required 3-5 dressing changes. Collagen dressing has proved to be highly advantageous for acute small areas of partial thickness burns (< 15% BSA). It confers better pain relief, and minimal or no dressing change with better rate of wound healing. Pediatric patients preferred collagen sheet dressing. Conventional dressings tend to adhere to the wound surface, and their need for frequent changes traumatises newly epithelialized surfaces and may delay healing.
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Affiliation(s)
- A. Singh
- Dr Ankur Bhatnagar, Additional Professor
Dept. of Plastic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)F-2314, RajajiPuram, Lucknow 226017India+91 9305345897
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23
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Bhatnagar A. Designing health risk assessment report for wellness clinic patients. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.580] [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
Introduction
With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the technical content of test reports, there are very few guidelines on a patient-friendly presentation of such laboratory reports. The complexity of lab test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for them.
Methodology
User feedback was obtained on the Lab Report / medical summaries of a tertiary level hospital based on a pre-tested questionnaire Health Risk Assessment Report was prepared with a view to address patient barriers Functionality enhancements were arrived at for estimating work effort by business analyst of the Customer Relationship Management team.
Results
Patients' health literacy, awareness of inherited diseases, e-health literacy and risk perception were found to be impacting the interpretation of lab results. Based on the user feedback (88% opting for graphical and pictorial presentation), 13 functionality enhancements have been arrived at and submitted to the Customer Relationship Management team for initiating a change management report taking into consideration the training load and cost implications.
Conclusions
Patient friendly systems (CRM) enhance the understanding on the criticality of their health conditions, impacting health seeking behavior. Effective CRMs help hospitals in providing cost effective health care to the community. The enhancements, however, have to be in adherence to the EHR standards of the country.
Key messages
Effective CRMs help hospitals in providing cost effective health care to the community. Patient friendly systems (CRM) enhance the understanding on the criticality of their health conditions, impacting health seeking behavior.
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Affiliation(s)
- A Bhatnagar
- Public Health Administration, National Health Systems Resource Centre, New Delhi, India
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24
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Al-Ishaq Z, Al-Ishaq Z, Sikdar O, Roy M, Bhatnagar A, Sircar T. Lipomodelling of the Breast Following Excision of a Giant Juvenile Fibroadenoma. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Giant juvenile fibroadenomas form 1-8% of breast lesions in the adolescent population. We report a case of
giant fibroadenoma in a 17-year-old girl who underwent simple lump excision through a lateral breast fold
incision followed by lipomodelling to correct the dimpling of the breast. With this dual approach, excellent
cosmetic outcome can be achieved for average-sized giant fibroadenoma without the need for more complex
technique.
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25
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Al-Ishaq Z, Al-Ishaq Z, Roy M, Bickley B, Bhatnagar A, Isgar B, Sircar T. A Rare Case of Metastatic Mucinous Breast Carcinoma as a First Presentation of Colon Cancer in a Male Patient: Case Report and Review of the Literature. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.08.16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The majority of breast tumors are primary; however metastatic tumor to the breast from extramammary sites
has an incidence of 0.5 to 3% and can be misinterpreted clinically as a primary breast tumor. We report a
case of metastatic mucinous breast carcinoma as a first presentation from colon cancer in a male patient
who hasn’t had any bowel symptoms. The immunohistochemical study helped in suspecting the diagnosis,
which was then confirmed by CT scan abdomen and pelvis and endoscopic biopsy of the colonic lesion.
Management of such patients usually by palliative chemotherapy due to the aggressive nature of the disease
however, surgical intervention may be indicated in symptomatic patient or risk of tumor ulceration as in our
patient.
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26
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McAteer J, Derado G, Hughes M, Bhatnagar A, Medalla F, Chatham-Stevens K, Appiah GD, Mintz E. Typhoid Fever in the US Pediatric Population, 1999-2015: Opportunities for Improvement. Clin Infect Dis 2020; 73:e4581-e4589. [PMID: 33247585 DOI: 10.1093/cid/ciaa914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Typhoid fever in the United States is acquired primarily through international travel by unvaccinated travelers. There is currently no typhoid vaccine licensed in the United States for use in children <2 years. METHODS We reviewed Salmonella enterica serotype Typhi infections reported to the Centers for Disease Control and Prevention (CDC) and antimicrobial-resistance data on Typhi isolates in CDC's National Antimicrobial Resistance Monitoring System from 1999 through 2015. RESULTS 5131 cases of typhoid fever were diagnosed and 5004 Typhi isolates tested for antimicrobial susceptibility. Among 1992 pediatric typhoid fever patients, 1616 (81%) had traveled internationally within 30 days of illness onset, 1544 (81%) of 1906 were hospitalized (median duration, 6 days; range, 0-50), and none died. Forty percent (799) were <6 years old; 12% were <2 years old. Based on age and travel destination, 1435 (83%) of 1722 pediatric patients were vaccine-eligible; only 68 (5%) of 1361 were known to be vaccinated. Of 2003 isolates tested for antimicrobial susceptibility, 1216 (61%) were fluoroquinolone-nonsusceptible, of which 272 (22%) were also resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant [MDR]). All were susceptible to ceftriaxone and azithromycin. MDR and fluoroquinolone-nonsusceptible isolates were more common in children than adults (16% vs 9%, P < .001, and 61% vs 54%, P < .001, respectively). Fluoroquinolone nonsusceptibility was more common among travel-associated than domestically acquired cases (70% vs 17%, P < .001). CONCLUSIONS Approximately 95% of currently vaccine-eligible pediatric travelers were unvaccinated, and antimicrobial-resistant infections were common. New public health strategies are needed to improve coverage with currently licensed vaccines. Introduction of an effective pretravel typhoid vaccine for children <2 years could reduce disease burden and prevent drug-resistant infections.
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Affiliation(s)
- Jarred McAteer
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Hughes
- Atlanta Research and Education Foundation, Inc, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Felicita Medalla
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin Chatham-Stevens
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace D Appiah
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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27
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Campbell D, Bowen A, Bhatnagar A, McCullough A, Grass J, Chen J, Folster JP. Identification and characterization of Shigella with decreased susceptibility to azithromycin in the United States, 2005 to 2014. J Glob Antimicrob Resist 2020; 21:417-419. [PMID: 31866575 PMCID: PMC10839632 DOI: 10.1016/j.jgar.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Our objectives were to identify Shigella isolates in the United States with decreased susceptibility to azithromycin (DSA) and characterize the genetic mechanisms responsible for this resistance. METHODS The National Antimicrobial Resistance Monitoring System (NARMS) at the US Centers for Disease Control and Prevention (CDC) collects and conducts broth microdilution antimicrobial susceptibility testing on Shigella to determine minimum inhibitory concentrations (MICs) for up to 15 drugs, including azithromycin. Isolates with decreased susceptibility to azithromycin were subjected to molecular methods (e.g., polymerase chain reaction [PCR], whole-genome sequencing, and plasmid typing/transformation) to identify the genetic mechanisms of resistance. RESULTS A total of 118 isolates with decreased susceptibility to azithromycin were tested-65 (55%) isolates contained only mphA, 1 (<1%) isolate contained only ermB, and 51 (43%) isolates contained both mechanisms. Seven isolates contained IncFII plasmids with mphA, ermB, or mphA and ermB, whereas one isolate contained an IncB/O plasmid with mphA. One (<1%) isolate that contained neither mphA nor ermB contained mutations in rrlH, rplD, and rplV genes and an insertion in rplV, the functions of which are not yet known. CONCLUSION Additional studies are needed to understand the effect on treatment outcomes, epidemiology and possible additional mechanisms responsible for the decreased susceptibility of azithromycin in Shigella.
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Affiliation(s)
- Davina Campbell
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Bowen
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Julian Grass
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jason P Folster
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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28
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Brown AC, Malik S, Huang J, Bhatnagar A, Balbuena R, Reese N, Lonsway D, Karlsson M. 484. Metallo-β-Lactamase-Positive Carbapenem-Resistant Enterobacteriaceae and Pseudomonas aeruginosa in the Antibiotic Resistance Laboratory Network, 2017–2018. Open Forum Infect Dis 2019. [PMCID: PMC6811257 DOI: 10.1093/ofid/ofz360.557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infections with metallo-β-lactamase (MBL)-producing organisms are emerging in the United States. Treatment options for these infections are limited. We describe MBL genes among carbapenemase positive carbapenem-resistant Enterobacteriaceae (CP-CRE) and Pseudomonas aeruginosa (CP-CRPA) isolates tested during the first two years of the Antibiotic Resistance Laboratory Network (AR Lab Network). Methods State and local public health laboratories tested CRE and CRPA isolates for organism identification, antimicrobial susceptibility, and PCR-based detection of blaKPC, blaNDM, blaOXA-48-like, blaVIM, and blaIMP carbapenemase genes. All testing results were sent to CDC at least monthly. Results Since January 2017, the AR Lab Network tested 21,733 CRE and 14,141 CRPA. CP-CRE were detected in 37% of CRE; 2% of CRPA were CP-CRPA. Among CP-CRE, 9% (686/8016) were MBL-producers (NDM, VIM, or IMP). Among MBL-producers, a blaNDM gene was detected most often (81%; 551/686). blaNDM were most common among Klebsiella spp. (47%; 261/551), blaIMP were most common among Providencia spp. (53%; 40/75), blaVIM was most common among Enterobacter spp. (19%; 25/62). Twelve percent (96) of MBL CP-CRE contained more than one carbapenemase gene. Among CP-CRPA, 73% (218/300) were MBL producers and blaVIM was the most common gene (62%; 186). Three (1%) MBL CP-CRPA contained more than one carbapenemase. Conclusion Increased testing of CRE and CRPA isolates through the AR Lab Network has facilitated early and rapid detection of hard-to-treat infections caused by MBL-producing organisms across the United States. The widespread distribution of MBL genes highlights the continued need for containment strategies that help prevent transmission between patients and among healthcare facilities. To support therapeutic decisions for severe infections caused by MBL-producing organisms, the AR Lab Network is now offering rapid susceptibility testing against aztreonam/avibactam, using digital dispenser technology. This testing program aims to close the gap between the availability of new drugs or drug combinations and the availability of commercial AST methods, thereby improving patient safety and antimicrobial stewardship. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | | | | | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
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29
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Stanton RA, McAllister GA, Bhatnagar A, Karlsson M, Brown AC, Rasheed J, Elkins C, Halpin AL. 603. Identification of a Carbapenemase-Producing, Extensively Drug-Resistant Klebsiella pneumoniae Isolate Carrying a blaNDM-1-Bearing, Hypervirulent Plasmid, United States 2017. Open Forum Infect Dis 2019. [PMCID: PMC6810911 DOI: 10.1093/ofid/ofz360.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The recent discovery of carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-HvKP) has signaled the convergence of multidrug resistance and pathogenicity, with the potential for increased mortality. While previous studies of CP-HvKP isolates revealed that most carried carbapenemase genes and hypervirulence elements on separate plasmids, a 2018 report from China confirmed that both could be harbored on a single, hybrid carbapenemase-hypervirulent plasmid. As part of a project sequencing isolates carrying multiple carbapenemase genes identified through CDC’s Antibiotic Resistance Laboratory Network (AR Lab Network), we discovered a blaNDM-1-bearing hypervirulent plasmid found in a KPC- and NDM-positive K. pneumoniae from the United States. Methods Antimicrobial susceptibility testing (AST) was performed by reference broth microdilution against 23 agents. Whole-genome sequencing (WGS) was performed on Illumina MiSeq and PacBio RS II platforms. Results AST results indicated the isolate was extensively drug-resistant, as it was non-susceptible to at least one agent in all but two drug classes; it was susceptible to only tigecycline and tetracycline. Analysis of WGS data showed the isolate was ST11, the same sequence type that caused a fatal outbreak of CP-HvKP in China in 2016. The genome included two plasmids. The smaller one (129kbp) carried seven antibiotic resistance (AR) genes, including the carbapenemase gene blaKPC-2. The larger plasmid (354kbp) harbored 11 AR genes, including the metallo-β-lactamase gene blaNDM-1, as well as virulence factors iucABCD/iutA, peg-344, rmpA, and rmpA2, which comprise four of the five genes previously identified as predictors of hypervirulence in K. pneumoniae. Conclusion This is the first report of a hybrid carbapenemase-hypervirulent plasmid in the United States. The presence of both blaNDM-1 and hypervirulence elements on the same plasmid suggests that the CP-Hv pathotype could spread rapidly through horizontal transfer. This discovery demonstrates the critical role of genomic characterization of emerging resistance and virulence phenotypes by the AR Lab Network as part of US containment efforts. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Alison L Halpin
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Um K, McIntyre W, Mendoza P, Duceppe E, Rochwerg B, Healey J, Koziarz A, Lengyel A, Bhatnagar A, Amit G, Chu V, Belley-Côté E. PRE- AND POST-TREATMENT WITH ANTIARRHYTHMIC DRUGS FOR ELECTRICAL CARDIOVERSION OF ATRIAL FIBRILLATION: A NETWORK META-ANALYSIS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.295] [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] Open
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McIntyre WF, Lengyel AP, Healey JS, Vadakken ME, Rai AS, Rochwerg B, Bhatnagar A, Deif B, Spence J, Bangdiwala SI, Belley-Côté EP, Whitlock RP. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) incidence study. J Electrocardiol 2019; 57:95-99. [PMID: 31629099 DOI: 10.1016/j.jelectrocard.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/27/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is often detected for the first time in patients hospitalized for medical illness or non-cardiovascular surgery. AF occurring transiently with stress (AFOTS) describes this manifestation of AF, which may either be the result of a non-cardiac stressor, or existing paroxysmal AF that was not previously detected. Current estimates of AFOTS incidence are imprecise: ranging from 1 to 44%, owing to the marked heterogeneity in patient populations, identification and methods used to detect AFOTS. METHODS The prospective, two-centre epidemiological AFOTS Incidence study will enroll 250 consecutive participants without a history of AF but with at increased risk of AF (Age ≥ 65 or >50 with one risk factor for AF) admitted to intensive care units (ICUs) for medical illness or non-cardiac surgery. Upon admission, participants will wear an ECG patch monitor that will remain in place for 14 days, or until discharge from hospital. Patients' consent to participation is deferred for up to 72 h after admission. The primary endpoint is the incidence of AF lasting ≥30 s. The study is powered to detect an AF incidence of 17% ± 5%. RESULTS We conducted a vanguard feasibility study, and 55 participants have completed participation. The median duration of monitoring was seven days. AF was detected by the clinical team in 8 participants (14%; 95% Confidence Interval 7-26%). CONCLUSIONS The AFOTS Incidence study will employ a systematic and highly sensitive protocol for detecting AFOTS in medical illness and non-cardiac surgery ICU patients. This study is feasible and will provide a reliable estimate of the true incidence of AFOTS in this population.
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Affiliation(s)
- W F McIntyre
- Population Health Research Institute, McMaster University, Canada.
| | - A P Lengyel
- Population Health Research Institute, McMaster University, Canada
| | - J S Healey
- Population Health Research Institute, McMaster University, Canada
| | - M E Vadakken
- Population Health Research Institute, McMaster University, Canada
| | - A S Rai
- Population Health Research Institute, McMaster University, Canada
| | - B Rochwerg
- Population Health Research Institute, McMaster University, Canada
| | - A Bhatnagar
- Population Health Research Institute, McMaster University, Canada
| | - B Deif
- Population Health Research Institute, McMaster University, Canada
| | - J Spence
- Population Health Research Institute, McMaster University, Canada
| | - S I Bangdiwala
- Population Health Research Institute, McMaster University, Canada
| | - E P Belley-Côté
- Population Health Research Institute, McMaster University, Canada
| | - R P Whitlock
- Population Health Research Institute, McMaster University, Canada
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Jin L, Jagatheesan G, Guo L, Nystoriak M, Malovichko M, Lorkiewicz P, Bhatnagar A, Srivastava S, Conklin DJ. Formaldehyde Induces Mesenteric Artery Relaxation via a Sensitive Transient Receptor Potential Ankyrin-1 (TRPA1) and Endothelium-Dependent Mechanism: Potential Role in Postprandial Hyperemia. Front Physiol 2019; 10:277. [PMID: 30984013 PMCID: PMC6448550 DOI: 10.3389/fphys.2019.00277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022] Open
Abstract
Formaldehyde (FA), the smallest aldehyde, is generated endogenously, and is widespread in the environment in foods, beverages and as a gas phase product of incomplete combustion. The main metabolite of FA, formate, was increased significantly in murine urine (∼3×) after overnight feeding. Because feeding increases mesenteric blood flow, we explored the direct effects of FA in isolated murine superior mesenteric artery (SMA). Over the concentration range of 30–1,200 μM, FA strongly and reversibly relaxed contractions of SMA induced by three different agonists: phenylephrine (PE), thromboxane A2 analog (U46,619) and high potassium (60K, 60 mM K+). Formate (to 1.5 mM) induced a modest relaxation. FA (>1,500 μM) irreversibly depressed vascular function in SMA indicating vasotoxicity. The sensitivity (EC50) but not the efficacy (% relaxation) of FA-induced relaxations was dependent on blood vessel type (SMA << aorta) and contractile agonist (PE, EC50= 52 ± 14 μM; U46,619, EC50= 514 ± 129 μM; 60K, EC50= 1,093 ± 87 μM). The most sensitive component of FA vasorelaxation was within physiological levels (30–150 μM) and was inhibited significantly by: (1) mechanically impaired endothelium; (2) Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME); (3) transient receptor potential ankyrin-1 (TRPA1) antagonist (A967079); (4) guanylyl cyclase (GC) inhibitor (ODQ); and, (5) K+ channel inhibitor (BaCl2). A similar mechanism of SMA vasorelaxation was stimulated by the TRPA1 agonist cinnamaldehyde. Positive TRPA1 immunofluorescent staining and gene-specific sequence were present in SMA but not in aorta. These data indicate FA, but not formate, robustly relaxes SMA via a sensitive TRPA1- and endothelium-dependent mechanism that is absent in aorta. Thus, as FA levels increase with feeding, FA likely contributes to the physiological reflex of post-prandial hyperemia via SMA vasodilatation.
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Affiliation(s)
- L Jin
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, United States
| | - G Jagatheesan
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - L Guo
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - M Nystoriak
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - M Malovichko
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - P Lorkiewicz
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - A Bhatnagar
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, United States.,Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - S Srivastava
- Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
| | - D J Conklin
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, United States.,Envirome Institute, University of Louisville, Louisville, KY, United States.,Diabetes and Obesity Center, University of Louisville, Louisville, KY, United States.,Department of Medicine, University of Louisville, Louisville, KY, United States.,American Heart Association Tobacco Regulation and Addiction Center, University of Louisville, Louisville, KY, United States
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McAteer J, Derado G, Hughes M, Bhatnagar A, Medalla F, Chatham-Stephens K, Appiah GD, Mintz ED. 918. Typhoid Fever in the US Pediatric Population, 1999–2015, and the Potential Benefits of New Vaccines. Open Forum Infect Dis 2018. [PMCID: PMC6252716 DOI: 10.1093/ofid/ofy209.059] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In the United States, typhoid fever is rare. About 300 typhoid cases are reported to CDC annually through the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system. Most are acquired during international travel and while visiting friends and relatives. CDC recommends pretravel vaccination of at-risk children with one of two currently available vaccines: oral (age ≥6 years) or injectable (age ≥2 years). In anticipation of licensure of new protein-conjugate typhoid vaccines that could be administered to children ≥6 months old, we characterized clinical, epidemiologic, and antimicrobial resistance data of pediatric typhoid fever cases reported to CDC. Methods We reviewed laboratory-confirmed Salmonella enterica serotype Typhi infections reported to NTPFS and antimicrobial resistance data on Typhi isolates in the National Antimicrobial Resistance Monitoring System (NARMS) from 1999 to 2015. Results Of 2,051 pediatric (≤18 years) cases of typhoid fever, 80% had traveled internationally within 30 days of illness onset (most frequently to South Asia [82%]), 81% were hospitalized (median duration 6 days; range 0–77 days), and none died. Eight hundred twenty-seven (40%) were <6 years old; 219 (26%) were 6 months–2 years old. While 76% of pediatric cases were vaccine eligible (travelers ≥2 years old), only 6% were known to be vaccinated. Of 2,020 isolates tested for antimicrobial susceptibility, 1,211 (60%) had decreased susceptibility or resistance to ciprofloxacin, of which 277 (23%) were also resistant to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole (multidrug-resistant [MDR]). None were resistant to ceftriaxone or azithromycin. MDR isolates were more likely in children than adults (16% vs. 9%, P < 0.05) and in travel-associated than domestically acquired cases (16% vs. 6%, P < 0.05). Conclusion Among pediatric cases of typhoid fever, 94% of currently vaccine-eligible travelers were unvaccinated. Emphasis on current vaccine indications and an effective pretravel typhoid vaccine for children between 6 months and 2 years old available during routine immunization visits could begin to reduce the burden of disease, and help prevent drug-resistant infections, in this vulnerable age group. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Jarred McAteer
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Hughes
- Atlanta Research and Education Foundation, Inc., Atlanta, Georgia
| | - Amelia Bhatnagar
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention Atlanta, Atlanta, Georgia
| | - Felicita Medalla
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin Chatham-Stephens
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grace D Appiah
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Nishad DK, Rawat HS, Singh T, Bhatnagar A, Mittal G. Decorporation potential of lansoprazole against radiothallium ( 201Tl) in internally contaminated BALB/c mice and New Zealand White rabbits. Hum Exp Toxicol 2018; 38:106-117. [PMID: 29909643 DOI: 10.1177/0960327118781929] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION: This study examined the decorporation potential of lansoprazole (LNP) as radioactivity decorporation agent for radiothallium (201Tl) in internally contaminated BALB/c mice and New Zealand White rabbits using radiometry and gamma scintigraphy. METHODS: Animals were divided into three groups, that is, control, pretreatment-1 (1X LNP), and pretreatment-2 (2X LNP). Mice received LNP intraperitoneally, while in rabbits LNP was given through oral route 0.5 and 1.5 h before radiothallium administration, respectively. Mice and rabbits used in the experiment were administered 1.48 and 11.1 MBq radiothallium (201TlCl) through intravenous and oral route, respectively. Once started as prophylactic, LNP was continued as therapeutic twice a day till the end of study period. Radiometry and gamma scintigraphy were used to monitor radiothallium retention and uptake patterns in animals. Gamma scintigraphic images of rabbits were taken at different time intervals up to 72 h and were analyzed for comparative uptake pattern of 201TlCl in all the groups. RESULTS: LNP treatment significantly increased the 201Tl elimination over untreated control and considerably reduced the retention of 201Tl in various tissues and organs. Decrease in radiothallium uptake up to 40% was observed in LNP-treated mice as compared to untreated control. While in rabbits, whole-body radioactivity burden at 72 h was found to be 31.24%, 26%, and 18.54% in untreated control, 9 and 18 mg/kg LNP-treated groups, respectively. CONCLUSION: LNP exhibited dose-dependent decorporation potential to effectively enhance the elimination of 201Tl in mice and rabbits experimentally contaminated with 201TlCl.
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Affiliation(s)
- D K Nishad
- Department of Nuclear Medicine, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Ministry of Defence, Delhi, India
| | - H S Rawat
- Department of Nuclear Medicine, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Ministry of Defence, Delhi, India
| | - T Singh
- Department of Nuclear Medicine, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Ministry of Defence, Delhi, India
| | - A Bhatnagar
- Department of Nuclear Medicine, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Ministry of Defence, Delhi, India
| | - G Mittal
- Department of Nuclear Medicine, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Ministry of Defence, Delhi, India
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Gulati RK, Bhatnagar P, Bhatnagar A. Antimicrobial Efficacy of Chemical and Herbal Agents against Streptococcus mutans: An in vitro study. Pesqui bras odontopediatria clín integr 2018. [DOI: 10.4034/pboci.2018.181.50] [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: 11/15/2022] Open
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Stone R, Leaper A, Cave J, Bates A, Bhatnagar A, Shaw A, Wood V, Fenton P. Impact of new provision of primary lung SABR: an audit of patient pathways and decisions around treatment modality following initiation of a local SABR service. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30065-5] [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: 10/18/2022]
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Bhardwaj S, Mittholiya K, Bhatnagar A, Bernard R, Dharmadhikari JA, Mathur D, Dharmadhikari AK. Inscription of type I and depressed cladding waveguides in lithium niobate using a femtosecond laser. Appl Opt 2017; 56:5692-5697. [PMID: 29047712 DOI: 10.1364/ao.56.005692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
We describe two types of waveguides (type I and depressed cladding) inscribed in lithium niobate using a variable repetition rate (200 kHz-25 MHz), 270 fs duration fiber laser. The type I modification-based waveguides have propagation losses in the range from 1.2 to 10 dB/cm at 1550 nm, depending on experimental parameters. These waveguides are not permanent; they deteriorate over time. Such deterioration of waveguides can be slowed down from 30 days to 100 days by pre-annealing the samples and by writing at a 720 kHz laser repetition rate. The propagation losses measured at 1550 nm show significant improvement for pre-annealed samples. The depressed cladding-inscribed waveguides are permanent, but the propagation loss depends on the number of damage tracks. A track separation of ∼1 μm between adjacent damage tracks yields the lowest propagation loss of 0.5 dB/cm at 1550 nm for a 40 μm diameter waveguide. We observe multimode guidance for sizes in the range of 20-80 μm in these waveguide structures at 1550 nm. Their crystalline nature is found to remain intact, as inferred from second-harmonic generation within the waveguide region.
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Kaplan A, Rao K, Bhatnagar A, Changkija N, Mullen P. Community Participation in Health: Factors Associated with Active Health
Facility Committees in Nagaland, India. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.036] [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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Tripathy JP, Bhatnagar A, Shewade HD, Kumar AMV, Zachariah R, Harries AD. Ten tips to improve the visibility and dissemination of research for policy makers and practitioners. Public Health Action 2017; 7:10-14. [PMID: 28775937 DOI: 10.5588/pha.16.0090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/07/2016] [Accepted: 12/02/2017] [Indexed: 11/10/2022] Open
Abstract
Effective dissemination of evidence is important in bridging the gap between research and policy. In this paper, we list 10 approaches for improving the visibility of research findings, which in turn will hopefully contribute towards changes in policy. Current approaches include using social media (Facebook, Twitter, LinkedIn); sharing podcasts and other research outputs such as conference papers, posters, presentations, reports, protocols, preprint copy and research data (figshare, Zenodo, Slideshare, Scribd); and using personal blogs and unique author identifiers (ORCID, ResearcherID). Researchers and funders could consider drawing up a systematic plan for dissemination of research during the stage of protocol development.
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Affiliation(s)
- J P Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A Bhatnagar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - R Zachariah
- Médecins Sans Frontières (MSF), Brussels Operational Centre, MSF Luxembourg, Luxembourg
| | - A D Harries
- The Union, Paris, France.,London School of Hygiene & Tropical Medicine, London, United Kingdom
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Syed AMN, Chang H, Schwartzberg B, Bremner A, Boylan S, Lopez-Penalver C, Vito C, Davis M, Dooley W, Chakravarthy AB, Coomer C, Proulx G, Golder S, Ivanov O, Fernandez K, Farha MJ, Gonzalez V, Wengler C, Bhatnagar A, Neuner GA, Kopkash K, Rahman S, Costa P. Abstract P1-10-20: A multi-center trial of intra-operative electronic brachytherapy during breast conservation surgery for early stage breast cancer: Early results of unplanned boost participants. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-10-20] [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: 11/16/2022]
Abstract
Abstract
Objective
To assess the safety and efficacy of single-fraction, intra-operative radiation therapy (IORT) delivered as a boost using the Xoft® Axxent® Electronic Brachytherapy System® (eBx®) immediately following surgical resection for treatment of early stage breast cancer.
Methods
This phase 4, open-label, single-arm, prospective, non-randomized trial is still enrolling participants and is currently being conducted at 26 hospitals in the USA (25) and Portugal (1). 878 participants with biopsy-proven ductal carcinoma in situ (DCIS) or invasive ductal carcinoma who met the inclusion criteria underwent lumpectomy followed by single-fraction IORT to the lumpectomy cavity. Briefly, a small, presterilized lead shield piece was placed on the chest wall to reduce the dose to the ribs, and then a balloon applicator, suitable to the surgical bed, was placed in the lumpectomy cavity and inflated with saline (30-75 cc); skin was temporarily closed over the balloon and ultrasound was used to confirm a balloon surface-to-skin distance ≥ 1.0 cm. The Xoft System was used to deliver the 20 Gy dose at the balloon applicator surface. The balloon was deflated, lead shield and balloon removed and the surgical site sutured. Upon the presence of additional risk factors, 37 participants subsequently received whole breast radiation therapy (WBRT); thus, these participants received an unplanned IORT boost and were removed from the primary analysis but will continue to be followed for the duration of the 10-year study. Cosmesis (Harvard Scale) was assessed in this subset of participants. The primary outcome for the main trial is recurrence of ipsilateral breast tumor at 5 years. Trial Registry: ClinicalTrials.gov; Identifier: NCT01644669.
Early Findings
37 boost participants received WBRT (up to 50 Gy) after IORT (36 received the prescribed 20 Gy dose; one received 14 Gy). Mean follow-up time was 430 days (range 13-1119). Mean age at IORT was 62 years (range 45-78). Boost participants had either DCIS (N=5) or invasive ductal carcinoma (N=32). The DCIS nuclear grade was high (N=3), intermediate (N=1), or low (N=1). Invasive cancers were Grade 1 (N=15), 2 (N=10), 3 (N=6), or unknown (N=1). 29 participants had T1, 3 had T2, and 5 had Tis lesions. Mean tumor size was 13.04 ± 10.26 mm. For the two participants who have reached 3-year follow-up, cosmesis was excellent (N=1) and fair (N=1). For the six participants who have reached 2-year follow-up, cosmesis was excellent (N=4), good (N=1), and fair (N=1). There was one serious adverse event with a Grade 3 for skin necrosis. The most frequent side effects were seroma (10%), edema (9%), pain (9%), erythema (6%), and induration (5%). There have been no deaths, recurrences, or new primary tumors among the boost participants to date.
Conclusions
Early results from this multi-center trial suggest that IORT as a tumor-bed boost using the Xoft Axxent eBx System at the time of breast conservation surgery is safe and has low morbidity. To date, the majority of participants receiving an unplanned IORT boost have had excellent to good cosmetic results and the majority of adverse events have been low-grade.
Funding
Funded by Xoft, Inc., a subsidiary of iCAD, Inc.
Citation Format: Syed AMN, Chang H, Schwartzberg B, Bremner A, Boylan S, Lopez-Penalver C, Vito C, Davis M, Dooley W, Chakravarthy AB, Coomer C, Proulx G, Golder S, Ivanov O, Fernandez K, Farha MJ, Gonzalez V, Wengler C, Bhatnagar A, Neuner GA, Kopkash K, Rahman S, Costa P. A multi-center trial of intra-operative electronic brachytherapy during breast conservation surgery for early stage breast cancer: Early results of unplanned boost participants [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-20.
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Affiliation(s)
- AMN Syed
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - H Chang
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - B Schwartzberg
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - A Bremner
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - S Boylan
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - C Lopez-Penalver
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - C Vito
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - M Davis
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - W Dooley
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - AB Chakravarthy
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - C Coomer
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - G Proulx
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - S Golder
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - O Ivanov
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - K Fernandez
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - MJ Farha
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - V Gonzalez
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - C Wengler
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - A Bhatnagar
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - GA Neuner
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - K Kopkash
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - S Rahman
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
| | - P Costa
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Revlon/UCLA Breast Center, Long Beach, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Sentara Northern Virginia, Woodbridge, VA; Doctors Hospital, Miami, FL; City of Hope National Medical Center, Duarte, CA; Swedish Medical Center, Englewood, CO; Oklahoma University, Oklahoma City, OK; Vanderbilt University, Nashville, TN; Staten Island University Hospital, Staten Island, NY; Exeter Hospital, Exeter, NH; Sarah Cannon at Parkridge Medical Center, Chattanooga, TN; Florida Hospital Department of Surgery, Orlando, FL; Medstar Franklin Square Medical Center, Baltimore, MD; Medstar Union Memorial Hospital, Baltimore, MD; University of Arizona, Tucson, AZ; Martin Health System, Stuart, FL; 21st Century Oncology, Casa Grande, AZ; Greater Baltimore Medical Center, Baltimore, MD; Rush University Medical Center, Chicago, IL; Diablo Valley Oncology Hematol
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Bhatnagar A, Sinha AA, Chaudhary S, Manuja N, Kaur H, Chaitra TR. Accuracy and evaluation of a new regression equation in predicting the width of unerupted permanent canines and premolar teeth. Eur Arch Paediatr Dent 2017; 18:31-37. [PMID: 28110423 DOI: 10.1007/s40368-016-0263-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
AIM To assess the applicability of two regression equations based on mixed dentition analysis and to propose and evaluate a new regression equation using the mandibular incisors and first permanent molars as predictors in calculating the size of unerupted permanent canines and premolar teeth in school children. METHODS Dental study casts of 100 children (50 males and 50 females) aged 11-14 years from schools situated in Moradabad, Uttar Pradesh, India were used. The analysis of Tanaka Johnston, Bernabe Flores-Mir and the proposed equation were tested on the casts. RESULTS The analysis of Tanaka Johnston and Bernabe Flores-Mir tended to overestimate the mesio-distal width of the canines and premolars. The proposed equation also overestimated but the mean difference showed a closer approximation with the actual measured values compared to the other two equations. CONCLUSION Validating studies with a similar population must be conducted to confirm the applicability and precision of the proposed equation.
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Affiliation(s)
- A Bhatnagar
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India.
| | - A A Sinha
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India
| | - S Chaudhary
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India
| | - N Manuja
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India
| | - H Kaur
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India
| | - T R Chaitra
- Department of Paedodontics and Preventive Dentistry, Kothiwal Dental College and Research Centre, Moradabad, UP, 244001, India
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Bhatnagar A, Chaudhary S, Sinha AA. Evaluation of Three Different Regression Equations Based Mixed Dentition Analysis in Children of Moradabad City, India. Pesqui bras odontopediatria clín integr 2017. [DOI: 10.4034/pboci.2017.171.32] [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] Open
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Dhir V, Sandhu A, Bhatnagar A, Dhawan V, Kaur J, Sood A, Sharma A, Sharma S. FRI0103 Erythrocyte Methotrexate Polyglutamate Levels Do Not Determine Efficacy and Tolerability of Methotrexate in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2342] [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: 11/03/2022]
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Dua B, Chufal K, Jadhav G, Thakwani A, Bhatnagar A. EP-1094: Total tumour volume predicts response in head and neck cancer: regression tree analysis and models. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Costa P, Syed A, Chang H, Schwartzberg B, Bremner A, Boylan S, Lopez-Penalver C, Vito C, Davis M, Dooley W, Chakravarthy A, Coomer C, Proulx G, Golder S, Ivanov O, Fernandex K, Farha M, Gonzalez V, Bhatnagar A, Neuner G, Kopkash K, Rahman S, Corn C. PO-0954: Early results of a multi-center trial of IORT using electronic brachytherapy for breast cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32204-6] [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: 11/27/2022]
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Dua B, Chufal K, Jadhav G, Thakwani A, Bhatnagar A. EP-1091: Stratifying patients of head and neck cancer into risk groups for local control: predictive models. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32341-6] [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: 11/30/2022]
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Syed AMN, Chang H, Schwartzberg BS, Bremner AK, Lopez-Penalver C, Coomer C, Boylan S, Chakravarthy A, Vito CA, Bhatnagar A, Proulx GM, Dooley WC, Davis M, Golder SL, Ivanov O, Fernandez K, Rahman S. Abstract P3-12-11: One-year follow-up results of a multi-center trial of intra-operative radiation therapy using electronic brachytherapy at the time of breast conservation surgery for early stage breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-12-11] [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: 11/16/2022]
Abstract
Abstract
Objectives: To describe observations of one-year follow-up of subjects treated on a multi-center, non-randomized study with a single fraction of intra-operative radiation therapy (IORT) using the Xoft® Axxent® Electronic Brachytherapy System® (eBx®) immediately following surgical resection of early stage breast cancer.
Methods: Two-hundred forty three (243) subjects were treated at seventeen (17) US hospitals. Upon meeting the inclusion/exclusion criteria, patients underwent partial mastectomy, placement of a balloon applicator suitable to the surgical bed in the lumpectomy cavity and inflated with saline (30 – 75 cc). The skin was temporarily closed over the balloon and ultrasound examination performed to confirm that the balloon surface-to-skin distance was > 1.0 cm. A single fraction of intra-operative radiation therapy was delivered to the lumpectomy cavity using the Xoft System. The prescribed dose was 20 Gy at the balloon applicator surface, and the mean treatment time was 10.2 minutes. After treatment, the balloon was deflated and removed, and skin sutured.
Results: Two-hundred forty two (242) subjects received the prescribed dose of 20 Gy; one subject received 21 Gy. Eighteen (18) subjects were removed from the primary analysis post-IORT due to positive surgical margins (N=2), positive sentinel lymph nodes (N=13), or balloon surface-to-skin distance < 1 cm (N=3). However, these eighteen subjects will continue to be followed for the duration of this 10-year study. The mean follow-up for the two-hundred twenty five evaluable subjects is 494 days (range 300-465 days). The mean patient age was 65 years (41-89). Forty-nine subjects (21.8%) had ductal carcinoma in situ, one-hundred seventy one (76%) had invasive ductal carcinoma, and five (2.2%) had unknown histology. The DCIS nuclear grade was evenly distributed between high (N=18) and low/intermediate (N=23); 5 were unknown. Invasive cancer was Grade 1-2 in 142/171 cases. Two-hundred twelve subjects (94.2%) had T1 lesions, eight (3.6%) had T2 lesions, and five (2.2%) were unknown. The mean tumor size was 10.6 mm ± 6.4 mm. At the time of the last subject visit, 49/318 reported adverse events were Grade 2 or higher, and only 1/100 had serious side effects, i.e. infection. One patient died of aortic aneurism and two developed secondary malignancies, i.e. ovarian cancer and chronic lymphocytic leukemia. The most frequent side effects were seroma (12.5%), erythema (9.1%), and induration (7.5%). Cosmesis was excellent to good in 95% of cases.
Conclusions: IORT using the Xoft System as part of the conservative treatment of breast cancer is safe, with low morbidity. Early results from this multi-center trial demonstrate this short, convenient course of radiation therapy for select patients with early stage breast cancer has excellent-to-good cosmetic results and a low rate of low-grade adverse events.
Citation Format: Syed AMN, Chang H, Schwartzberg BS, Bremner AK, Lopez-Penalver C, Coomer C, Boylan S, Chakravarthy A, Vito CA, Bhatnagar A, Proulx GM, Dooley WC, Davis M, Golder SL, Ivanov O, Fernandez K, Rahman S. One-year follow-up results of a multi-center trial of intra-operative radiation therapy using electronic brachytherapy at the time of breast conservation surgery for early stage breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-11.
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Affiliation(s)
- AMN Syed
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - H Chang
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - BS Schwartzberg
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - AK Bremner
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - C Lopez-Penalver
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - C Coomer
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - S Boylan
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - A Chakravarthy
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - CA Vito
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - A Bhatnagar
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - GM Proulx
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - WC Dooley
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - M Davis
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - SL Golder
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - O Ivanov
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - K Fernandez
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
| | - S Rahman
- Todd Cancer Institute, Long Beach Memorial Medical Center, Long Beach, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA; Sarah Cancer Research Institute at Rose Medical Center, Denver, CO; Breastlink, Murietta, CA; Doctors Hospital, Miami, FL; Staten Island University Hospital, Staten Island, NY; Sentara Northern Virginia, Woodbridge, VA; Vanderbilt University, Nashville, TN; City of Hope National Medical Center, Duarte, CA; Cancer Treatment Services, Casa Grande, AZ; Exeter Hospital, Exeter, NH; Oklahoma University, Oklahoma City, OK; Swedish Medical Center, Englewood, CO; Shannon Cannon Cancer Center at Parkridge Medical Center, Chattanooga, TN; Florida Hospital, Orlando, FL; MedStar Health, Baltimore, MD; Diablo Valley Oncology Hematology Medical Group, Pleasant Hill, CA
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Pannu D, Malik S, Shamsunder S, Bhatnagar A. Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis. JNMA J Nepal Med Assoc 2016; 54:36-39. [PMID: 27935910] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However, ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month.
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Affiliation(s)
- D Pannu
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - S Malik
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - S Shamsunder
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - A Bhatnagar
- Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi, India
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Syed N, Chang H, Schwartzberg B, Bremner A, Bhatnagar A, Lopez-Penalver C, Vito C, Ivanov O, Rahman S, Golder S, Proulx G, Ellenhorn J, Boylan S. Feasibility and Early Outcomes of a Multicenter Trial of Intraoperative Radiation Therapy Using Electronic Brachytherapy at the Time of Breast Conservation Surgery for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2039] [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]
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Bhatnagar A. Electronic Brachytherapy for the Treatment of Non Melanoma Skin Cancer: Results Up to 5 Years. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2174] [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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