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Nikhil KG, Jayakumar KT, Shiny PJ, Ramya NK, Kumar JS. Neutrophil lymphocyte ratio and heart type fatty acid binding protein as a prognostic marker in Myocardial infarction within 48 h of admission. Egypt Heart J 2024; 76:59. [PMID: 38771512 DOI: 10.1186/s43044-024-00489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The neutrophil to lymphocyte ratio (NLR) is a measure of systemic inflammation, whereas Heart type fatty acid protein (HFABP) is a cytosolic protein released early after acute coronary syndrome (ACS). The aim of this research study is to determine whether NLR and H-FAB are useful in predicting the prognosis in patients with ST segment elevation myocardial infarction (STEMI) 48 h after admission. This is a prospective observational study conducted on 97 patients who had been admitted to emergency room with ST-elevation myocardial infarction in their ECG in a tertiary care centre of south India. The neutrophil-lymphocyte ratio was measured at the time of admission, 24th hour and 48th hour, and then compared with the outcome. To determine their significance in the MI episode, troponin-I and H-FABP were also measured. RESULTS A significant correlation was found in the final outcomes of patients and the NLR at the time of admission and at 48 h (p = 0.01). Additionally, a substantial correlation between NLR and various degrees of LV dysfunction was also observed (p = 0.01). H-FABP was found to be positive in all 97 of the patients examined, whereas Troponin-I was only found to be positive in 56.7%. CONCLUSION The study's findings, indicated strong correlations between NLR and LVEF, indicated that NLR might serve as an early predictor of cardiac events which could be either poor prognosis or higher mortality. This research found that H-FABP may serve as an early MI diagnostic marker.
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Affiliation(s)
- K G Nikhil
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - K T Jayakumar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - P J Shiny
- Department of Medical Research, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu, 603209, India
| | - N K Ramya
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - J S Kumar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India.
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Rajakumar I, Vidya TA, Ramachandran K, Hussain A, Aarthi J, Poovitha M, Madhavan K, Kumar JS. Platelet indices as prognostic markers of ischemic stroke and their correlation with lipid profile. Clin Neurol Neurosurg 2024; 237:108119. [PMID: 38295481 DOI: 10.1016/j.clineuro.2024.108119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Stroke is the cause of one in eight deaths and adds a dreadful burden of disability for the patients. Ischemic stroke is caused by a loss of blood supply to brain due to sudden occlusion of the arterial system, caused by an emboli or thrombus. Our aim was to correlate platelet indices, total cholesterol ratio, and various comorbidities with stroke. METHODS A cross-sectional study was performed from 2020-2022 with 132 stroke patients admitted to the SRM Medical College Hospital and Research Center, India. Detailed clinical examination was performed. Venous blood samples were drawn at the time of admission to estimate platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT). Overnight fasting serum samples were obtained for lipid profiling. RESULTS Among the participants in our study, maximum belonged to the age group 50 to 59 years (34.1%) and majority were males (79.5%). In terms of comorbidities, 85.6% of the participants had diabetes, 42.4% had hypertension and 22% had dyslipaedemia. All platelet and lipid parameters were found to be similar between patients with and without comorbidities. While all platelet indices increased with the increase in severity of stroke, we found that PDW is most reliable in predicting stroke with an area under the receiver operator curve of 0.942, with a sensitivity and specificity of 92.1% at cut-off value 14. All platelet parameters also significantly increased in patients with severe lipid dysfuction, establishing a correlation between lipid profile, platelet indices and stroke. CONCULSION We found a significant relationship between all platelet parameters and stroke. Thus, we believe that patients with risk factors for atherosclerosis should have their platelet indices assessed periodically before the development of cerebrovascular events. Furthermore, dyslipidemia if properly treated, is a modifiable risk factor for stroke, which can decrease morbidity and mortality leading to a healthier society.
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Affiliation(s)
- Ilakyaa Rajakumar
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - T A Vidya
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - Krithika Ramachandran
- Department of Medical Research, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - Aamina Hussain
- Department of Community Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - J Aarthi
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - M Poovitha
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - K Madhavan
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India
| | - J S Kumar
- Department of General Medicine, SRM Medical college Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu 603209, India.
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Fisher DG, Sharifi KA, Ulutas EZ, Kumar JS, Kalani MYS, Miller GW, Price RJ, Tvrdik P. Magnetic Resonance Imaging of Mouse Cerebral Cavernomas Reveal Differential Lesion Progression and Variable Permeability to Gadolinium. Arterioscler Thromb Vasc Biol 2023; 43:958-970. [PMID: 37078284 PMCID: PMC10257814 DOI: 10.1161/atvbaha.122.318938] [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: 12/23/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Cerebral cavernous malformations, also known as cavernous angiomas, are blood vessel abnormalities comprised of clusters of grossly enlarged and hemorrhage-prone capillaries. The prevalence in the general population, including asymptomatic cases, is estimated to be 0.5%. Some patients develop severe symptoms, including seizures and focal neurological deficits, whereas others remain asymptomatic. The causes of this remarkable presentation heterogeneity within a primarily monogenic disease remain poorly understood. METHODS We established a chronic mouse model of cerebral cavernous malformations, induced by postnatal ablation of Krit1 with Pdgfb-CreERT2, and examined lesion progression in these mice with T2-weighted 7T magnetic resonance imaging (MRI). We also established a modified protocol for dynamic contrast-enhanced MRI and produced quantitative maps of gadolinium tracer gadobenate dimeglumine. After terminal imaging, brain slices were stained with antibodies against microglia, astrocytes, and endothelial cells. RESULTS These mice develop cerebral cavernous malformations lesions gradually over 4 to 5 months of age throughout the brain. Precise volumetric analysis of individual lesions revealed nonmonotonous behavior, with some lesions temporarily growing smaller. However, the cumulative lesional volume invariably increased over time and after about 2 months followed a power trend. Using dynamic contrast-enhanced MRI, we produced quantitative maps of gadolinium in the lesions, indicating a high degree of heterogeneity in lesional permeability. MRI properties of the lesions were correlated with cellular markers for endothelial cells, astrocytes, and microglia. Multivariate comparisons of MRI properties of the lesions with cellular markers for endothelial and glial cells revealed that increased cell density surrounding lesions correlates with stability, whereas denser vasculature within and surrounding the lesions may correlate with high permeability. CONCLUSIONS Our results lay a foundation for better understanding individual lesion properties and provide a comprehensive preclinical platform for testing new drug and gene therapies for controlling cerebral cavernous malformations.
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Affiliation(s)
- Delaney G. Fisher
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA
| | - Khadijeh A. Sharifi
- Department of Neuroscience, University of Virginia, Charlottesville, VA
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - E. Zeynep Ulutas
- Department of Neuroscience, Georgia Institute of Technology, Atlanta, GA
| | - Jeyan S. Kumar
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | | | - G. Wilson Miller
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA
| | - Richard J. Price
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA
| | - Petr Tvrdik
- Department of Neuroscience, University of Virginia, Charlottesville, VA
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
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4
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Norat P, Sokolowski JD, Gorick CM, Soldozy S, Kumar JS, Chae Y, Yagmurlu K, Nilak J, Sharifi KA, Walker M, Levitt MR, Klibanov AL, Yan Z, Price RJ, Tvrdik P, Kalani MYS. Intraarterial Transplantation of Mitochondria After Ischemic Stroke Reduces Cerebral Infarction. Stroke Vasc Interv Neurol 2023; 3:e000644. [PMID: 37545759 PMCID: PMC10399028 DOI: 10.1161/svin.122.000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/03/2023] [Indexed: 08/08/2023]
Abstract
Background- Transplantation of autologous mitochondria into ischemic tissue may mitigate injury caused by ischemia and reperfusion. Methods- Using murine stroke models of middle cerebral artery occlusion, we sought to evaluate feasibility of delivery of viable mitochondria to ischemic brain parenchyma. We evaluated the effects of concurrent focused ultrasound activation of microbubbles, which serves to open the blood-brain barrier, on efficacy of delivery of mitochondria. Results- Following intra-arterial delivery, mitochondria distribute through the stroked hemisphere and integrate into neural and glial cells in the brain parenchyma. Consistent with functional integration in the ischemic tissue, the transplanted mitochondria elevate concentration of adenosine triphosphate in the stroked hemisphere, reduce infarct volume and increase cell viability. Additional of focused ultrasound leads to improved blood brain barrier opening without hemorrhagic complications. Conclusions- Our results have implications for the development of interventional strategies after ischemic stroke and suggest a novel potential modality of therapy after mechanical thrombectomy.
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Affiliation(s)
- Pedro Norat
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jennifer D. Sokolowski
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Catherine M. Gorick
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jeyan S. Kumar
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Youngrok Chae
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Joelle Nilak
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Khadijeh A. Sharifi
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Michael R. Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Alexander L. Klibanov
- Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Zhen Yan
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Richard J. Price
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
| | - M. Yashar S. Kalani
- St. John’s Neuroscience Institute and the University of Oklahoma School of Medicine, Tulsa, Oklahoma
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Ironside N, Patrie J, Ng S, Ding D, Rizvi T, Kumar JS, Mastorakos P, Hussein MZ, Naamani KE, Abbas R, Harrison Snyder M, Zhuang Y, Kearns KN, Doan KT, Shabo LM, Marfatiah S, Roh D, Lignelli-Dipple A, Claassen J, Worrall BB, Johnston KC, Jabbour P, Park MS, Sander Connolly E, Mukherjee S, Southerland AM, Chen CJ. Quantification of hematoma and perihematomal edema volumes in intracerebral hemorrhage study: Design considerations in an artificial intelligence validation (QUANTUM) study. Clin Trials 2022; 19:534-544. [PMID: 35786006 DOI: 10.1177/17407745221105886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hematoma and perihematomal edema volumes are important radiographic markers in spontaneous intracerebral hemorrhage. Accurate, reliable, and efficient quantification of these volumes will be paramount to their utility as measures of treatment effect in future clinical studies. Both manual and semi-automated quantification methods of hematoma and perihematomal edema volumetry are time-consuming and susceptible to inter-rater variability. Efforts are now underway to develop a fully automated algorithm that can replace them. A (QUANTUM) study to establish inter-quantification method measurement equivalency, which deviates from the traditional use of measures of agreement and a comparison hypothesis testing paradigm to indirectly infer quantification method measurement equivalence, is described in this article. The Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study aims to determine whether a fully automated quantification method and a semi-automated quantification method for quantification of hematoma and perihematomal edema volumes are equivalent to the hematoma and perihematomal edema volumes of the manual quantification method. METHODS/DESIGN Hematoma and perihematomal edema volumes of supratentorial intracerebral hemorrhage on 252 computed tomography scans will be prospectively quantified in random order by six raters using the fully automated, semi-automated, and manual quantification methods. Primary outcome measures for hematoma and perihematomal edema volumes will be quantified via computed tomography scan on admission (<24 h from symptom onset) and on day 3 (72 ± 12 h from symptom onset), respectively. Equivalence hypothesis testing will be conducted to determine if the hematoma and perihematomal edema volume measurements of the fully automated and semi-automated quantification methods are within 7.5% of the hematoma and perihematomal edema volume measurements of the manual quantification reference method. DISCUSSION By allowing direct equivalence hypothesis testing, the Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study offers advantages over radiology validation studies which utilize measures of agreement to indirectly infer measurement equivalence and studies which mistakenly try to infer measurement equivalence based on the failure of a comparison two-sided null hypothesis test to reach the significance level for rejection. The equivalence hypothesis testing paradigm applied to artificial intelligence application validation is relatively uncharted and warrants further investigation. The challenges encountered in the design of this study may influence future studies seeking to translate artificial intelligence medical technology into clinical practice.
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Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sherman Ng
- Department of Software Engineering, Microsoft Corporation, Redmond, WA, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mohamed Z Hussein
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Yan Zhuang
- Department of Biomedical Engineering and Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kevin T Doan
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leah M Shabo
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Saurabh Marfatiah
- Department of Radiology, Columbia University School of Medicine, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | | | - Jan Claassen
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | - Bradford B Worrall
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen C Johnston
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - E Sander Connolly
- Department of Neurosurgery, Columbia University School of Medicine, New York, NY, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andrew M Southerland
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA
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6
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Snyder MH, Ironside N, Kumar JS, Doan KT, Kellogg RT, Provencio JJ, Starke RM, Park MS, Ding D, Chen CJ. Antiplatelet therapy and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg 2022; 137:95-107. [PMID: 34740185 DOI: 10.3171/2021.7.jns211239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Delayed cerebral ischemia (DCI) is a potentially preventable cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The authors performed a meta-analysis to assess the effect of antiplatelet therapy (APT) on DCI in patients with aSAH. METHODS A systematic review of the PubMed and MEDLINE databases was performed. Study inclusion criteria were 1) ≥ 5 aSAH patients; 2) direct comparison between aSAH management with APT and without APT; and 3) reporting of DCI, angiographic, or symptomatic vasospasm rates for patients treated with versus without APT. The primary efficacy outcome was DCI. The outcomes of the APT versus no-APT cohorts were compared. Bias was assessed using the Downs and Black checklist. RESULTS The overall cohort comprised 2039 patients from 15 studies. DCI occurred less commonly in the APT compared with the no-APT cohort (pooled = 15.9% vs 28.6%; OR 0.47, p < 0.01). Angiographic (pooled = 51.6% vs 68.7%; OR 0.46, p < 0.01) and symptomatic (pooled = 23.6% vs 37.7%; OR 0.51, p = 0.01) vasospasm rates were lower in the APT cohort. In-hospital mortality (pooled = 1.7% vs 4.1%; OR 0.53, p = 0.01) and functional dependence (pooled = 21.0% vs 35.7%; OR 0.53, p < 0.01) rates were also lower in the APT cohort. Bleeding event rates were comparable between the two cohorts. Subgroup analysis of cilostazol monotherapy compared with no APT demonstrated a lower DCI rate in the cilostazol cohort (pooled = 10.6% vs 28.1%; OR 0.31, p < 0.01). Subgroup analysis of surgically treated aneurysms demonstrated a lower DCI rate for the APT cohort (pooled = 18.4% vs 33.9%; OR 0.43, p = 0.02). CONCLUSIONS APT is associated with improved outcomes in aSAH without an increased risk of bleeding events, particularly in patients who underwent surgical aneurysm repair and those treated with cilostazol. Although study heterogeneity is the most significant limitation of the analysis, the findings suggest that APT is worth exploring in patients with aSAH, particularly in a randomized controlled trial setting.
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Affiliation(s)
- M Harrison Snyder
- 1Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Natasha Ironside
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jeyan S Kumar
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kevin T Doan
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ryan T Kellogg
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - J Javier Provencio
- 3Department of Neurology, University of Virginia Health System, Charlottesville, Virginia
| | - Robert M Starke
- 4Department of Neurosurgery, University of Miami, Miami, Florida
| | - Min S Park
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 5Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky; and
| | - Ching-Jen Chen
- 6Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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7
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Chen CJ, Ding D, Kumar JS, Kearns KN, Ironside N, Yang HC, Ogino A, Kano H, Liscak R, May J, Williams BJ, Gigliotti MJ, Cockroft K, McInerney J, Simon S, Lee CC, Sheehan JP. Hemorrhage and Recurrence of Obliterated Brain Arteriovenous Malformations Treated With Stereotactic Radiosurgery. Stroke 2022; 53:e363-e368. [PMID: 35616021 DOI: 10.1161/strokeaha.122.039213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
BACKGROUND Although complete nidal obliteration of brain arteriovenous malformations (AVM) is generally presumed to represent durable cure, postobliteration hemorrhage, and AVM recurrence have become increasingly recognized phenomena. The goal of the study was to define hemorrhage and nidal recurrence risks of obliterated AVMs treated with stereotactic radiosurgery (SRS). METHODS This is a retrospective cohort study from the International Radiosurgery Research Foundation comprising AVM patients treated between 1987 and 2020. Patients with AVM obliteration on digital subtraction angiography (DSA) were included. Outcomes were (1) hemorrhage and (2) AVM recurrence. Follow-up duration began at the time of AVM obliteration and was censored at subsequent hemorrhage, AVM recurrence, additional AVM treatment, or loss to follow-up. Annualized risk and survival analyses were performed. A sensitivity analysis comprising patients with AVM obliteration on magnetic resonance imaging or DSA was also performed for postobliteration hemorrhage. RESULTS The study cohort comprised 1632 SRS-treated patients with AVM obliteration on DSA. Pediatric patients comprised 15% of the cohort, and 42% of AVMs were previously ruptured. The mean imaging follow-up after AVM obliteration was 22 months. Among 1607 patients with DSA-confirmed AVM obliteration, 16 hemorrhages (1.0%) occurred over 2223 patient-years of follow-up (0.72%/y). Of the 1543 patients with DSA-confirmed AVM obliteration, 5 AVM recurrences (0.32%) occurred over 2071 patient-years of follow-up (0.24%/y). Of the 16 patients with postobliteration hemorrhage, AVM recurrence was identified in 2 (12.5%). In the sensitivity analysis comprising 1939 patients with post-SRS AVM obliteration on magnetic resonance imaging or DSA, 16 hemorrhages (0.83%) occurred over 2560 patient-years of follow-up (0.63%/y). CONCLUSIONS Intracranial hemorrhage and recurrent arteriovenous shunting after complete nidal obliteration are rare in AVM patients treated with SRS, and each phenomenon harbors an annual risk of <1%. Although routine postobliteration DSA cannot be recommended to SRS-treated AVM patients, long-term neuroimaging may be advisable in these patients.
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Affiliation(s)
- Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center at Houston (C.-J.C.)
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, KY (D.D., B.J.W.)
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (H.-C.Y., C.-C.L.).,School of Medicine, National Yang-Ming University, Taipei, Taiwan (H.-C.Y., C.-C.L.)
| | - Akiyoshi Ogino
- Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.O., H.K.)
| | - Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.O., H.K.)
| | - Roman Liscak
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J. May)
| | - Jaromir May
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J. May)
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, KY (D.D., B.J.W.)
| | - Michael J Gigliotti
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Kevin Cockroft
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - James McInerney
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Scott Simon
- Department of Neurosurgery, Penn State Health-Hershey Medical Center, Hershey, PA (M.J.G., K.C., J. McInerney, S.S.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan (H.-C.Y., C.-C.L.).,School of Medicine, National Yang-Ming University, Taipei, Taiwan (H.-C.Y., C.-C.L.)
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville (J.S.K., K.N.K., N.I., J.P.S.)
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Chen CJ, Chalhoub R, Ding D, Kumar JS, Ironside N, Kellogg RT, Worrall BB, Southerland AM, Jabbour P, Wolfe SQ, Arthur AS, Goyal N, Fragata I, Maier I, Matouk C, Grossberg JA, Kan P, Schirmer CM, Crowley RW, Ares WJ, Ogilvy CS, Rai AT, Levitt MR, Mokin M, Guerrero WR, Mascitelli JR, Yoo AJ, Williamson R, Grande AW, Crosa RJ, Webb S, Psychogios MN, Starke RM, Spiotta AM, Park MS. Is a picture-perfect thrombectomy necessary in acute ischemic stroke? J Neurointerv Surg 2022; 14:111-116. [PMID: 33593800 PMCID: PMC10947782 DOI: 10.1136/neurintsurg-2020-017193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/10/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3. METHODS This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage. RESULTS The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041). CONCLUSIONS Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.
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Affiliation(s)
- Ching-Jen Chen
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Reda Chalhoub
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dale Ding
- Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Jeyan S Kumar
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Natasha Ironside
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ryan T Kellogg
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Bradford B Worrall
- Neurology, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stacey Q Wolfe
- Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Adam S Arthur
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ilko Maier
- Neurology, University Medicine Goettingen, Goettingen, NS, Germany
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Jonathan A Grossberg
- Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | | | - William J Ares
- Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | | | - Ansaar T Rai
- Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | | | - Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Albert J Yoo
- Neurointerventional Radiology, Texas Stroke Institute, Plano, Texas, USA
| | - Richard Williamson
- Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Andrew Walker Grande
- Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA
| | | | - Sharon Webb
- Neurosurgery, Bon Secours, Greenville, South Carolina, USA
| | - Marios N Psychogios
- Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Robert M Starke
- Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Min S Park
- Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Norat P, Soldozy S, Sokolowski JD, Gorick CM, Kumar JS, Chae Y, Yağmurlu K, Prada F, Walker M, Levitt MR, Price RJ, Tvrdik P, Kalani MYS. Author Correction: Mitochondrial dysfunction in neurological disorders: exploring mitochondrial transplantation. NPJ Regen Med 2021; 6:13. [PMID: 33654099 PMCID: PMC7925516 DOI: 10.1038/s41536-021-00125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Catherine M Gorick
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Youngrok Chae
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.,Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Melanie Walker
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R Levitt
- Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Richard J Price
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. .,Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA. .,St. John's Neuroscience Institute, Tulsa, OK, 74119, USA.
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Desai B, Soldozy S, Desai H, Kumar JS, Shah SP, Raper D, Park MS. Evaluating the Safety and Efficacy of Various Endovascular Approaches for the Treatment of Infectious Intracranial Aneurysms. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_346] [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: 11/12/2022] Open
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Sundaram CS, Kumar JS, Kumar SS, Ramesh PLN, Zin T, Rao USM. Antibacterial and anticancer potential of Brassica oleracea var acephala using biosynthesised copper nanoparticles. Med J Malaysia 2020; 75:677-684. [PMID: 33219177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Brassica oleracea var acephala was studied for preliminary phytochemical screening. The results showed that the ethanolic crude extract of the leaf contain high phytochemical activity hence B.oleracea var acephala is rich in flavonoids, phenolic compounds, carbohydrates and phytosterols. MATERIALS AND METHODS The ethanolic extract was used to synthesise copper nanoparticles. The copper nanoparticles were successfully synthesised from copper sulphate solution which was identified by the colour change from dark green colour of the extract. Thus the B.oleracea var acephala is a good source to synthesis copper nanoparticles. The synthesised copper nanoparticles were characterised using Scanning Electron Microscope (SEM) analysis. The SEM image displayed the high-density nanoparticles synthesised by leaf extracts and that the nanoparticles were crystals in shape. RESULTS The copper nanoparticles (CNP) bind to the leaf extract. B.oleracea var acephala also has shown the antimicrobial and antioxidant activity. A comparative study was done between ethanolic its crude extract and nanoparticles. Both extracts exhibited zone of inhibition and better antioxidant potential but the CuNPs shows major zone of inhibition and showed more antioxidant activity. Anticancer activity of B.oleracea var acephala against Cervical HeLa cell line was confirmed using ethanolic crude extract and CNP. The results showed that HeLa cells proliferation was inhibited with increasing concentration of ethanolic crude extract and copper nanoparticles. From the results, it was seen that percentage viability of the cancer cells decreased with increased concentration of the samples whereas cytotoxicity against HeLa cell lines increased with the increased concentration of the samples. CONCLUSION Thus B.oleracea var acephala possesses anticancer activity against HeLa cell lines.
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Affiliation(s)
- C S Sundaram
- PG & Research Department of Microbiology, Hindustan College of Arts & Science, Padur, Chennai, India
| | - J S Kumar
- PG & Research Department of Biotechnology, Hindustan College of Arts & Science, Padur, Chennai, India
| | - S S Kumar
- Universiti Putra Malaysia, Department of Medical Microbiology and Parasitology, UPM Serdang Selangor, Malaysia
| | | | - T Zin
- Universiti Sultan Zainal Abidin, Faculty of Medicine, Terengganu, Malaysia
| | - U S M Rao
- Universiti Sultan Zainal Abidin, Faculty of Medicine, Terengganu, Malaysia.
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Abstract
In the last forty years, the field of medicine has experienced dramatic shifts in technology-enhanced surgical procedures - from its initial use in 1985 for neurosurgical biopsies to current implementation of systems such as magnetic-guided catheters for endovascular procedures. Systems such as the Niobe Magnetic Navigation system and CorPath GRX have allowed for utilization of a fully integrated surgical robotic systems for perioperative manipulation, as well as tele-controlled manipulation systems for telemedicine. These robotic systems hold tremendous potential for future implementation in cerebrovascular procedures, but lack of relevant clinical experience and uncharted ethical and legal territory for real-life tele-robotics have stalled their adoption for neurovascular surgery, and might present significant challenges for future development and widespread implementation. Yet, the promise that these technologies hold for dramatically improving the quality and accessibility of cerebrovascular procedures such as thrombectomy for acute stroke, drives the research and development of surgical robotics. These technologies, coupled with artificial intelligence (AI) capabilities such as machine learning, deep-learning, and outcome-based analyses and modifications, have the capability to uncover new dimensions within the realm of cerebrovascular surgery.
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Affiliation(s)
- Emily P Rabinovich
- University of Virginia School of Medicine, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Stepan Capek
- Department of Neurological Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908, USA; 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908, USA.
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Soldozy S, Young S, Kumar JS, Capek S, Felbaum DR, Jean WC, Park MS, Syed HR. A systematic review of endovascular stent-electrode arrays, a minimally invasive approach to brain-machine interfaces. Neurosurg Focus 2020; 49:E3. [PMID: 32610291 DOI: 10.3171/2020.4.focus20186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to systematically review the feasibility and safety of minimally invasive neurovascular approaches to brain-machine interfaces (BMIs). METHODS A systematic literature review was performed using the PubMed database for studies published between 1986 and 2019. All studies assessing endovascular neural interfaces were included. Additional studies were selected based on review of references of selected articles and review articles. RESULTS Of the 53 total articles identified in the original literature search, 12 studies were ultimately selected. An additional 10 articles were included from other sources, resulting in a total of 22 studies included in this systematic review. This includes primarily preclinical studies comparing endovascular electrode recordings with subdural and epidural electrodes, as well as studies evaluating stent-electrode gauge and material type. In addition, several clinical studies are also included. CONCLUSIONS Endovascular stent-electrode arrays provide a minimally invasive approach to BMIs. Stent-electrode placement has been shown to be both efficacious and safe, although further data are necessary to draw comparisons between subdural and epidural electrode measurements given the heterogeneity of the studies included. Greater access to deep-seated brain regions is now more feasible with stent-electrode arrays; however, further validation is needed in large clinical trials to optimize this neural interface. This includes the determination of ideal electrode material type, venous versus arterial approaches, the feasibility of deep brain stimulation, and more streamlined computational decoding techniques.
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Affiliation(s)
- Sauson Soldozy
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Steven Young
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jeyan S Kumar
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Stepan Capek
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel R Felbaum
- 2Department of Neurosurgery, Georgetown University, Washington, DC; and
| | - Walter C Jean
- 3Department of Neurosurgery, George Washington University, Washington, DC
| | - Min S Park
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hasan R Syed
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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14
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Ironside N, Buell TJ, Chen CJ, Kumar JS, Paisan GM, Sokolowski JD, Liu KC, Ding D. High-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors of Functional Outcome. World Neurosurg 2019; 125:e723-e728. [PMID: 30735864 DOI: 10.1016/j.wneu.2019.01.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/29/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV-V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. METHODS We retrospectively evaluated consecutive patients with aSAH admitted to a single institution from January 2000 to April 2015. Adult (age ≥18 years) patients with WFNS grade IV-V aSAH were included for analysis. Patients without sufficient baseline data, those who died before discharge, and those without follow-up data were excluded. Univariable and multivariable logistic regression analyses were used to identify factors associated with functional independence, defined as a modified Rankin Scale score of 0-2, at last follow-up. RESULTS Of the 260 patients with a WFNS grade IV-V aSAH during the study period, 139 met the inclusion criteria. After a mean follow-up of 6.3 months, functional independence was achieved in 73% of high-grade aSAH survivors (101/139 patients) and in 39% of all high-grade aSAH cases (101/260 patients). Only a lack of cerebrospinal fluid shunt placement was found to be an independent predictor of functional independence in the multivariable analysis (odds ratio 0.28 [0.109-0.722]; P = 0.008). CONCLUSIONS Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.
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Affiliation(s)
- Natasha Ironside
- Department of Neurosurgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gabriella M Paisan
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth C Liu
- Department of Neurosurgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
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15
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Kumar JS, Karthickeyan K, Patel B, Haroon Meeran KI, Karishma G, Raveendran V. Study on glycaemic control by canagliflozin and its effect on insulin resistance and plasma ketone in type 2 diabetes mellitus patients. J Diabetol 2019. [DOI: 10.4103/jod.jod_11_18] [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: 11/04/2022] Open
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16
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Vinodhini VM, Keerthi K, Kumar JS, Subramaniyam G. Assessment of Remnant Lipoprotein Cholesterol (RLP-C) Levels and its Correlation with Carotid Intima Media Thickness in Insulin Resistant Type 2 Diabetes Mellitus Patients. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/40984.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Ironside N, Chen CJ, Ding D, Ilyas A, Kumar JS, Buell TJ, Taylor D, Lee CC, Sheehan JP. Seizure Outcomes After Radiosurgery for Cerebral Arteriovenous Malformations: An Updated Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:550-562.e3. [DOI: 10.1016/j.wneu.2018.08.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
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18
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Chen CJ, Turnage C, Sokolowski JD, Kumar JS, Kalani MY, Park MS. Dangers of outpatient nimodipine use after spontaneous subarachnoid hemorrhage in accordance with the Comprehensive Stroke Center guidelines. J Clin Neurosci 2018; 52:151-152. [DOI: 10.1016/j.jocn.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
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Pal V, Saxena A, Singh S, Goel AK, Kumar JS, Parida MM, Rai GP. Development of a real-time loop-mediated isothermal amplification assay for detection of Burkholderia mallei. Transbound Emerg Dis 2017. [PMID: 28649808 DOI: 10.1111/tbed.12665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Burkholderia mallei is the aetiological agent of glanders, a highly contagious and re-emerging zoonotic disease. Early diagnosis of glanders is critically important to ensure timely treatment with appropriate antibiotics in humans, and to prevent spread of infection in animals. Molecular detection of B. mallei has always been troublesome because of its genetic similarity with Burkholderia pseudomallei, the causative agent of melioidosis. In present investigation, a set of six B. mallei-specific primers were designed and a simple, rapid, specific and sensitive real-time loop-mediated isothermal amplification (LAMP) assay was developed for detection of B. mallei. The LAMP assay could detect as low as 1 pg of B. mallei genomic DNA and 5.5 × 103 CFU/ml of B. mallei in spiked human blood. The assay was highly specific for B. mallei as it did not cross-react with other bacterial strains used in the study. The established LAMP assay is field adaptable and can be a better and viable alternative to PCR-based techniques for detection of B. mallei in glanders endemic areas with resource-limited settings.
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Affiliation(s)
- V Pal
- Microbiology Division, Defence Research and Development Establishment, Gwalior, India
| | - A Saxena
- Microbiology Division, Defence Research and Development Establishment, Gwalior, India
| | - S Singh
- Microbiology Division, Defence Research and Development Establishment, Gwalior, India
| | - A K Goel
- Biotechnology Division, Defence Research and Development Establishment, Gwalior, India
| | - J S Kumar
- Virology Division, Defence Research and Development Establishment, Gwalior, India
| | - M M Parida
- Virology Division, Defence Research and Development Establishment, Gwalior, India
| | - G P Rai
- Microbiology Division, Defence Research and Development Establishment, Gwalior, India
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Mohan V, Kalra S, Kesavadev J, Singh AK, Kumar A, Unnikrishnan AG, Chawla R, Mukherjee JJ, Sahay RK, Kumar JS, Bhoraskar A, Asirvatham AJ, Panda JK, Zargar AH, Das AK. Consensus on Initiation and Intensification of Premix Insulin in Type 2 Diabetes Management. J Assoc Physicians India 2017; 65:59-73. [PMID: 28527166 DOI: pmid/28527166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Premix insulin is the most commonly used insulin preparation in India. The first Indian premix guidelines were developed in 2009 and thereafter were updated in 2013. There is a need to revisit the Indian premix insulin guidelines, in view of emerging evidence and introduction of newer co-formulations. OBJECTIVE The present consensus has been developed to evaluate available premix formulations, examine existing evidence related to premix formulations, and evolve consensus statement of recommendations on the topic. METHODS A meeting of experts from across India was conducted at Chennai in July 2016. The expert committee evaluated each premix insulin regimen with reference to 1) Current recommendations by various guidelines, 2) Approved pack inserts and 3) Published scientific literature. The information was debated and discussed within the expert group committee, to arrive at seven consensus-based recommendations for initiation and intensification with premix insulin. RESULTS Recommendations based on consensus on initiation and intensification of premix insulin in type 2 diabetes mellitus (T2DM) management were developed for the following situations. 1) Initiation of premix insulin co-formulation at diagnosis, 2) Initiation of once daily (OD) premix insulin/co-formulation, 3) Initiation of twice daily (BID) premix insulin/co-formulation 4) Intensification with BID and thrice daily (TID) premix insulin/co-formulation. Three recommendations pertained to the use of premix insulin in other forms of diabetes, or in specific situations: 5) Use of premix insulin in gestational diabetes mellitus 6) Use of premix insulin in type 1 Diabetes Mellitus (T1DM) 7) Premix insulin use during Ramadan. CONCLUSIONS In the setting of high carbohydrate consumption in India, or in patients with predominant post prandial hyperglycemia, premix insulin/co-formulation can offer effective and convenient glycemic control. This paper will help healthcare practitioners initiate and intensify premix insulin effectively.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana
| | - Jothydev Kesavadev
- Chairman and Managing Director at Jothydev's Diabetes Research Centre, Trivandrum, Kerala
| | - Awadhesh Kumar Singh
- Consultant Endocrinologist, GD Hospital and Diabetes Institute, Kolkata, and Sun Valley Diabetes Research Center, Guwahati, Assam
| | - Ajay Kumar
- Diabetes Care and Research Centre, Near Overbridge, Kankarbagh, Patna, Bihar
| | | | - Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre and Department of Medicine, Maharaja Agrasen Hospital, New Delhi
| | | | | | - J S Kumar
- Consultant Diabetologist, Apollo Sugar Clinic and Professor, Department of Medicine, SRM Medical College and Research Institute, Kattankulathur, Chennai, Tamil Nadu
| | - Anil Bhoraskar
- Diabetes Care Mumbai, Maharashtra and SL Raheja Hospital (Fortis Associate Hospital) Mumbai, Maharashtra
| | | | - Jayanta Kumar Panda
- Wellbeing, Cuttack, Orissa; SCB Medical College, Cuttack, Orissa and SARP Multispeciality Hospital, Cuttack, Orissa
| | - Abdul Hamid Zargar
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
| | - Ashok Kumar Das
- Professor of Medicine and Professor and Head of Endocrinology, Pondicherry Institute of Medical Sciences, Dhanvantri Nagar, Gorimedu, Puducherry
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Kumar JS, Miller Jenkins LM, Gottesman MM, Hall MD. The Drug Excipient Cyclodextrin Interacts With d-Luciferin and Interferes With Bioluminescence Imaging. Mol Imaging 2016; 15:15/0/1536012115625225. [PMID: 27030398 PMCID: PMC4982550 DOI: 10.1177/1536012115625225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 08/14/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022] Open
Abstract
Cyclodextrins are well-characterized, barrel-shaped molecules that can solubilize organic small molecules in aqueous solution via host–guest interactions. As such, cyclodextrins are used as excipients for experimental therapeutics in vivo. We observed unanticipated modifications to bioluminescence imaging (BLI) signal intensity when 2-hydroxy-propyl-β-cyclodextrin (HPCD) was coinjected as an excipient. We hypothesized that HPCD binds d-luciferin and interferes with the BLI signal. Using luciferase-expressing cell lines, we showed that HPCD lowers the BLI signal in a concentration-dependent manner. Flow cytometry revealed that HPCD resulted in reduced cellular accumulation of d-luciferin, and mass spectrometry revealed d-luciferin HPCD species, confirming a direct interaction. In vivo imaging using a luciferase mouse model demonstrated that HPCD reduced luciferin-mediated BLI compared to luciferin alone. The implications of using HPCD as an excipient in BLI studies are discussed.
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Affiliation(s)
- Jeyan S Kumar
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa M Miller Jenkins
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael M Gottesman
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew D Hall
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA NCATS Chemical Genomics Center, National Institutes of Health, Rockville, MD, USA
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Weidner LD, Fung KL, Kannan P, Moen JK, Kumar JS, Mulder J, Innis RB, Gottesman MM, Hall MD. Tariquidar Is an Inhibitor and Not a Substrate of Human and Mouse P-glycoprotein. ACTA ACUST UNITED AC 2015; 44:275-82. [PMID: 26658428 DOI: 10.1124/dmd.115.067785] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/08/2015] [Indexed: 01/15/2023]
Abstract
Since its development, tariquidar (TQR; XR9576; N-[2-[[4-[2-(6,7-Dimethoxy-3,4-dihydro-1H-isoquinolin-2-yl)ethyl]phenyl]carbamoyl]-4,5-dimethoxyphenyl]quinoline-3-carboxamide) has been widely regarded as one of the more potent inhibitors of P-glycoprotein (P-gp), an efflux transporter of the ATP-binding cassette (ABC) transporter family. A third-generation inhibitor, TQR exhibits high affinity for P-gp, although it is also a substrate of another ABC transporter, breast cancer resistance protein (BCRP). Recently, several studies have questioned the mechanism by which TQR interfaces with P-gp, suggesting that TQR is a substrate for P-gp instead of a noncompetitive inhibitor. We investigated TQR and its interaction with human and mouse P-gp to determine if TQR is a substrate of P-gp in vitro. To address these questions, we used multiple in vitro transporter assays, including cytotoxicity, flow cytometry, accumulation, ATPase, and transwell assays. A newly generated BCRP cell line was used as a positive control that demonstrates TQR-mediated transport. Based on our results, we conclude that TQR is a potent inhibitor of both human and mouse P-gp and shows no signs of being a substrate at the concentrations tested. These in vitro data further support our position that the in vivo uptake of [(11)C]TQR into the brain can be explained by its high-affinity binding to P-gp and by it being a substrate of BCRP, followed by amplification of the brain signal by ionic trapping in acidic lysosomes.
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Affiliation(s)
- Lora D Weidner
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - King Leung Fung
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Pavitra Kannan
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Janna K Moen
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Jeyan S Kumar
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Jan Mulder
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Robert B Innis
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Michael M Gottesman
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
| | - Matthew D Hall
- Molecular Imaging Branch, National Institute of Mental Health, Bethesda, Maryland (L.D.W., P.K., R.B.I.); Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.L.F., J.K.M., J.S.K., M.M.G., M.D.H.); and Karolinska Institutet, Department of Neuroscience, Stockholm, Sweden (L.D.W., J.M.)
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Raja S, Mohapatra S, Kumar JS, Rani RJ. Prescription patterns of hypolipidaemic drugs in a tertiary care teaching hospital of southern India. J Clin Diagn Res 2014; 8:HC01-3. [PMID: 24959461 DOI: 10.7860/jcdr/2014/8010.4206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. MATERIALS AND METHODS A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. RESULTS While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. CONCLUSION This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs.
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Affiliation(s)
- Sangeetha Raja
- Postgraduate Student, Department of Pharmacology, SRM Medical College Hospital and Research Centre , Potheri, Tamilnadu, India
| | - Satyajit Mohapatra
- Assistant Professor, Department of Pharmacology, SRM Medical College Hospital and Research Centre , Potheri, Tamilnadu, India
| | - J S Kumar
- Professor, Department of General Medicine, SRM Medical College Hospital and Research Centre , Potheri, Tamilnadu, India
| | - R Jamuna Rani
- Professor and Head, Department of Pharmacology, SRM Medical College Hospital and Research Centre , Potheri, Tamilnadu, India
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Kumar JS, Subramanian VS, Kapadia R, Kashyap ML, Said HM. Mammalian colonocytes possess a carrier-mediated mechanism for uptake of vitamin B3 (niacin): studies utilizing human and mouse colonic preparations. Am J Physiol Gastrointest Liver Physiol 2013; 305:G207-13. [PMID: 23744738 PMCID: PMC3742858 DOI: 10.1152/ajpgi.00148.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Niacin (vitamin B3; nicotinic acid) plays an important role in maintaining redox state of cells and is obtained from endogenous and exogenous sources. The latter source has generally been assumed to be the dietary niacin, but another exogenous source that has been ignored is the niacin that is produced by the normal microflora of the large intestine. For this source of niacin to be bioavailable, it needs to be absorbed, but little is known about the ability of the large intestine to absorb niacin and the mechanism involved. Here we addressed these issues using the nontransformed human colonic epithelial NCM460 cells, native human colonic apical membrane vesicles (AMV) isolated from organ donors, and mouse colonic loops in vivo as models. Uptake of ³H-nicotinic acid by NCM460 cells was: 1) acidic pH (but not Na⁺) dependent; 2) saturable (apparent Km = 2.5 ± 0.8 μM); 3) inhibited by unlabeled nicotinic acid, nicotinamide, and probenecid; 4) neither affected by other bacterially produced monocarboxylates, monocarboxylate transport inhibitor, or by substrates of the human organic anion transporter-10; 5) affected by modulators of the intracellular protein tyrosine kinase- and Ca²⁺-calmodulin-regulatory pathways; and 6) adaptively regulated by extracellular nicotinate level. Uptake of nicotinic acid by human colonic AMV in vitro and by mouse colonic loops in vivo was also carrier mediated. These findings report, for the first time, that mammalian colonocytes possess a high-affinity carrier-mediated mechanism for nicotinate uptake and show that the process is affected by intracellular and extracellular factors.
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Affiliation(s)
- Jeyan S. Kumar
- 1Departments of Medicine, Physiology and Biophysics, University of California, Irvine; ,2Department of Medical Research, Veterans Affairs Medical Center, Long Beach, California
| | - Veedamali S. Subramanian
- 1Departments of Medicine, Physiology and Biophysics, University of California, Irvine; ,2Department of Medical Research, Veterans Affairs Medical Center, Long Beach, California
| | - Rubina Kapadia
- 1Departments of Medicine, Physiology and Biophysics, University of California, Irvine; ,2Department of Medical Research, Veterans Affairs Medical Center, Long Beach, California
| | - Moti L. Kashyap
- 2Department of Medical Research, Veterans Affairs Medical Center, Long Beach, California
| | - Hamid M. Said
- 1Departments of Medicine, Physiology and Biophysics, University of California, Irvine; ,2Department of Medical Research, Veterans Affairs Medical Center, Long Beach, California
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Kuzhandai velu V, Jyothirmayi B, Kumar JS. Insulin resistance and alanine amino transaminase (ALT) levels in first degree relatives of type 2 diabetes mellitus. Diabetes Metab Syndr 2011; 5:143-147. [PMID: 22813567 DOI: 10.1016/j.dsx.2012.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Insulin resistance is established as an independent predictor of a range of disorders such as obesity, hypertension, dyslipidemia, type 2 diabetes mellitus and atherosclerotic cardiovascular diseases. There is an association of hyperinsulinemia with hypertriglycerdemia, low level of HDL and high level of LDL. In nonalcoholic fatty liver disease, there is an elevation of ALT, raising the possibility that the prospective relationship between ALT and type 2 diabetes may reflect cross-sectional associations with insulin resistance or obesity. AIM AND OBJECTIVE To find the significance of insulin resistance and alanine aminotransferase level in first degree relatives of type 2 diabetes mellitus. MATERIALS AND METHODS The study included 50 first degree relatives of type 2 diabetes (25 men and 25 women) aged 20-60 years and 30 control of similar age. All cases were taken from SRM Medical College Hospital and Research Centre, Chennai. All the cases were analyzed for HOMA(IR), QUICKI, IR ratio, fasting glucose, insulin (ELISA), lipid profile and alanine aminotransferase. Student's 't' test was applied for statistical analysis. RESULT The data show the significance of insulin resistance (HOMA(IR)) (2.76±1.46, 1.35±0.8, p<0.001) in the first degree relatives of type 2 diabetes mellitus when compared with controls respectively and increased level fasting plasma insulin (12.28±6.16, 6.12±3.04, p<0.001). In the lipid profile the total cholesterol and TAG are significant. No statistical significance was found in ALT (24.8±9.84, 20.08±11.02). CONCLUSION Results of the study conclude that there is a high prevalence of insulin resistance in the first degree relatives of type 2 diabetes mellitus. ALT levels in the first degree relatives of type 2 diabetes mellitus had increased levels of insulin resistance, the pathogenesis suggesting increase in ALT levels as seen in insulin resistance condition. In our study, ALT was not statistically significant.
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Affiliation(s)
- V Kuzhandai velu
- Department of Biochemistry, Mahamata Gandhi Medical College and Research Institute, Pillaiyarkupam, Puducherry, India.
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Subramanya SB, Subramanian VS, Kumar JS, Hoiness R, Said HM. Inhibition of intestinal biotin absorption by chronic alcohol feeding: cellular and molecular mechanisms. Am J Physiol Gastrointest Liver Physiol 2011; 300:G494-501. [PMID: 21148397 PMCID: PMC3064116 DOI: 10.1152/ajpgi.00465.2010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The water-soluble vitamin biotin is essential for normal cellular functions and its deficiency leads to a variety of clinical abnormalities. Mammals obtain biotin from exogenous sources via intestinal absorption, a process mediated by the sodium-dependent multivitamin transporter (SMVT). Chronic alcohol use in humans is associated with a significant reduction in plasma biotin levels, and animal studies have shown inhibition in intestinal biotin absorption by chronic alcohol feeding. Little, however, is known about the cellular and molecular mechanisms involved in the inhibition in intestinal biotin transport by chronic alcohol use. These mechanisms were investigated in this study by using rats and transgenic mice carrying the human full-length SLC5A6 5'-regulatory region chronically fed alcohol liquid diets; human intestinal epithelial Caco-2 cells chronically exposed to alcohol were also used as models. The results showed chronic alcohol feeding of rats to lead to a significant inhibition in carrier-mediated biotin transport events across jejunal brush border and basolateral membrane domains. This inhibition was associated with a significant reduction in level of expression of the SMVT protein, mRNA, and heterogenous nuclear RNA. Chronic alcohol feeding also inhibited carrier-mediated biotin uptake in rat colon. Studies with transgenic mice confirmed the above findings and further showed chronic alcohol feeding significantly inhibited the activity of SLC5A6 5'-regulatory region. Finally, chronic exposure of Caco-2 cells to alcohol led to a significant decrease in the activity of both promoters P1 and P2 of the human SLC5A6 gene. These studies identify for the first time the cellular and molecular parameters of the intestinal biotin absorptive processes that are affected by chronic alcohol feeding.
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Affiliation(s)
- Sandeep B. Subramanya
- Departments of Medicine and Physiology/Biophysics, University of California, Irvine; and Department of Veterans Affairs Medical Center, Long Beach, California
| | - Veedamali S. Subramanian
- Departments of Medicine and Physiology/Biophysics, University of California, Irvine; and Department of Veterans Affairs Medical Center, Long Beach, California
| | - Jeyan S. Kumar
- Departments of Medicine and Physiology/Biophysics, University of California, Irvine; and Department of Veterans Affairs Medical Center, Long Beach, California
| | - Robert Hoiness
- Departments of Medicine and Physiology/Biophysics, University of California, Irvine; and Department of Veterans Affairs Medical Center, Long Beach, California
| | - Hamid M. Said
- Departments of Medicine and Physiology/Biophysics, University of California, Irvine; and Department of Veterans Affairs Medical Center, Long Beach, California
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Ashokkumar B, Kumar JS, Hecht GA, Said HM. Enteropathogenic Escherichia coli inhibits intestinal vitamin B1 (thiamin) uptake: studies with human-derived intestinal epithelial Caco-2 cells. Am J Physiol Gastrointest Liver Physiol 2009; 297:G825-33. [PMID: 19628653 PMCID: PMC2763801 DOI: 10.1152/ajpgi.00250.2009] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/20/2009] [Indexed: 01/31/2023]
Abstract
Infection with the gram-negative enteropathogenic Escherichia coli (EPEC), a food-borne pathogen, represents a significant risk to human health. Whereas diarrhea is a major consequence of this infection, malnutrition also occurs especially in severe and prolonged cases, which may aggravate the health status of the infected hosts. Here we examined the effect of EPEC infection on the intestinal uptake of the water-soluble vitamin B1 (thiamin) using an established human intestinal epithelial Caco-2 cell model. The results showed that infecting Caco-2 cells with wild-type EPEC (but not with nonpathogenic E. coli, killed EPEC, or filtered supernatant) leads to a significant (P < 0.01) inhibition in thiamin uptake. Kinetic parameters of both the nanomolar (mediated by THTR-2) and the micromolar (mediated by THTR-1) saturable thiamin uptake processes were affected by EPEC infection. Cell surface expression of hTHTR-1 and -2 proteins, (determined by the biotinylation method) showed a significantly (P < 0.01) lower expression in EPEC-treated cells compared with controls. EPEC infection also affected the steady-state mRNA levels as well as promoter activity of the SLC19A2 and SLC19A3 genes. Infecting Caco-2 cells with EPEC mutants that harbor mutations in the escN gene (which encodes a putative ATPase for the EPEC type III secretion system, TTSS) or the espA, espB, or espD genes (which encode structural components of the TTSS) did not affect thiamin uptake. On the other hand, mutations in espF and espH genes (which encode effector proteins) exhibited partial inhibition in thiamin uptake. These results demonstrate for the first time that EPEC infection of human intestinal epithelial cells leads to inhibition in thiamin uptake via effects on physiological and molecular parameters of hTHTR-1 and -2. Furthermore, the inhibition appears to be dependent on a functional TTSS of EPEC.
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Affiliation(s)
- Balasubramaniem Ashokkumar
- Department of Medical Research, Veterans Administration Medical Center, Long Beach, California 90822, USA
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Abstract
Efficient synthesis of two novel analogues of some known protease inhibitors, via the isosteric replacement of oxirane/aziridine moiety of the parent compounds by cyclopropane ring, is described.
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Affiliation(s)
- J S Kumar
- Organic III, Indian Institute of Chemical Technology, Hyderabad
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Abstract
The effects of diabetes on levels of lipid peroxides and glycolipids in brain were studied in alloxan (18 mg/100 g body weight) diabetic rats. Free fatty acid (FFA) and malondialdehyde (MDA) levels were increased in the brains of diabetic animals. On the other hand, activities of the antioxidative enzymes catalase and superoxide dismutase (SOD) were decreased. The study also showed elevated levels of most of the glycolipid fractions except gangliosides, which were found to decrease in diabetic brain. Administration of insulin to diabetic animals results in the restoration of these parameters to normal levels. These changes observed in diabetic brain may be responsible for the increased frequency of stroke in diabetes.
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Affiliation(s)
- J S Kumar
- Department of Biochemistry, University of Kerala, Thiruvananthapuram, India
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Kumar JS, Menon VP. Peroxidative changes in experimental diabetes mellitus. Indian J Med Res 1992; 96:176-81. [PMID: 1512041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Changes in the levels of lipid peroxides and antioxidant enzymes were studied in male albino rats with experimental diabetes mellitus. Diabetes was induced by single subcutaneous injection of alloxan (19 mg/100 g body weight). The concentration of malondialdehyde (MDA) showed an increase both in the liver (P less than 0.01) and kidney (0 less than 0.05), while in the heart, there was a decrease (P less than 0.01), as compared to control values. A similar pattern of change was observed in the level of hydroperoxides in the liver and heart. The conjugated dienes showed an elevation during diabetes in all tissues (P less than 0.01). Glutathione levels in heart (P less than 0.01) and kidney were found to be decreased (P less than 0.05) while the liver showed an elevation during long-term diabetes (P less than 0.01). Serum ceruloplasmin showed an increase (P less than 0.05) in diabetes. Antioxidant enzymes superoxide dismutase and catalase decreased in all tissues (P less than 0.01) while the activity of glutathione s-transferase increased in heart, but no change in other tissues. The studies thus show that lipid peroxidation is activated in liver and kidney while heart tissues show some resistance towards lipid peroxidation.
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Affiliation(s)
- J S Kumar
- Department of Biochemistry, University of Kerala, Thiruvananthapuram
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Kumar JS, Menon VP. Changes in levels of lipid peroxides and activity of superoxide dismutase and catalase in diabetes associated with myocardial infarction. Indian J Exp Biol 1992; 30:122-7. [PMID: 1521861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Studies were carried out on the metabolism of lipid peroxides and antioxidative enzymes during diabetes and diabetes superimposed with myocardial infarction. Diabetes was induced using alloxan and myocardial infarction was induced by isoproterenol. In the case of diabetic animals there was a decrease in the levels of lipid peroxides in the heart while in the case of diabetes associated with myocardial infarction it was slightly elevated. The activity of superoxide dismutase and catalase showed a decrease in both the groups. Glutathione showed a fall in the case of diabetes and diabetes associated with myocardial infarction while taurine in heart and ceruloplasmin in the serum was elevated. Histopathological changes in the heart tissue showed some focal changes in the case of both diabetes and diabetes associated with myocardial infarction, but the degree of necrosis was much less than in the case of myocardial infarction.
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Affiliation(s)
- J S Kumar
- Department of Biochemistry, University of Kerala, Trivandrum, India
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Sushamakumari S, Jayadeep A, Kumar JS, Menon VP. Effect of carnitine on malondialdehyde, taurine and glutathione levels in heart of rats subjected to myocardial stress by isoproterenol. Indian J Exp Biol 1989; 27:134-7. [PMID: 2807405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effect of carnitine on free fatty acid, malondialdehyde, taurine and glutathione levels in myocardium was studied in rats administered isoproterenol to induce a stress in the myocardium resulting in myocardial ischaemia. Carnitine decreased the levels of free fatty acid and malondialdehyde (an index of lipid peroxidation) when compared to control rats given isoproterenol alone. Taurine and glutathione also registered a fall in the carnitine treated animals when compared to rats treated with isoproterenol alone. The results indicate that carnitine by decreasing the levels of these parameters helps the myocardium to survive from the stress induced by isoproterenol.
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