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Gavazzi LM, Nair M, Suydam R, Usip S, Thewissen JGM, Cooper LN. Protein signaling and morphological development of the tail fluke in the embryonic beluga whale (Delphinapterus leucas). Dev Dyn 2024. [PMID: 38494595 DOI: 10.1002/dvdy.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND During the land-to-sea transition of cetaceans (whales, dolphins, and porpoises), the hindlimbs were lost and replaced by an elaborate tail fluke that evolved 32 Ma. All modern cetaceans utilize flukes for lift-based propulsion, and nothing is known of this organ's molecular origins during embryonic development. This study utilizes immunohistochemistry to identify the spatiotemporal location of protein signals known to drive appendage outgrowth in other vertebrates (e.g., Sonic Hedgehog [SHH], GREMLIN [GREM], wingless-type family member 7a [WNT], and fibroblast growth factors [FGFs]) and to test the hypothesis that signals associated with outgrowth and patterning of the tail fluke are similar to a tetrapod limb. Specifically, this study utilizes an embryo of a beluga whale (Delphinapterus leucas) as a case study. RESULTS Results showed epidermal signals of WNT and FGFs, and mesenchymal/epidermal signals of SHH and GREM. These patterns are most consistent with vertebrate limb development. Overall, these data are most consistent with the hypothesis that outgrowth of tail flukes in cetaceans employs a signaling pattern that suggests genes essential for limb outgrowth and patterning shape this evolutionarily novel appendage. CONCLUSIONS While these data add insights into the molecular signals potentially driving the evolution and development of tail flukes in cetaceans, further exploration of the molecular drivers of fluke development is required.
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Affiliation(s)
- L M Gavazzi
- School of Biomedical Sciences, Kent State University, Kent, Ohio, USA
- Musculoskeletal Research Focus Area, Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - M Nair
- Wright State University, Dayton, Ohio, USA
| | - R Suydam
- Department of Wildlife Management, North Slope Borough, Utqiaġvik, Alaska, USA
| | - S Usip
- Musculoskeletal Research Focus Area, Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - J G M Thewissen
- Musculoskeletal Research Focus Area, Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - L N Cooper
- Musculoskeletal Research Focus Area, Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Jose B, Gopinath S, Vijayanatha Kurup A, Nair M, Pillai A, Kumar A, Parasuram H. Improving the accuracy of epileptogenic zone localization in stereo EEG with machine learning algorithms. Brain Res 2023; 1820:148546. [PMID: 37633355 DOI: 10.1016/j.brainres.2023.148546] [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: 06/01/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
The precise identification of the epileptogenic zone (EZ) is paramount in the presurgical evaluation of epilepsy patients to ensure successful surgical outcomes. The analysis of Stereo EEG, an instrumental tool for EZ localization, poses considerable challenges even for experienced epileptologists. Consequently, the development of machine learning (ML)-based computational tools for enhanced EZ localization is imperative. In this investigation, we developed ML models utilizing Stereo EEG from 15 patients, who remained seizure-free (Engel 1 a-d) following EZ resection, over an average follow-up period of 44.4 months. Utilizing Delphos and MNI detectors, spikes and High Frequency Oscillations (HFOs) were identified from Stereo EEG in Resected Zone (RZ) and non-Resected Zone (non-RZ). Linear and non-linear features were estimated from each modality using MATLAB. A total of 27,744 spikes, 7,790 ripples, and 7,632 fast ripples, along with their combinations, were employed to train the ML models. The Gradient Boosting classifier demonstrated the highest prediction accuracy of 98.5% for EZ localization in Mesial Temporal Lobe Epilepsy (MTLE) when trained with features derived from the spike-ripple combination. In the case of Neocortical Epilepsy (NE), the Extra Trees classifier achieved an accuracy of 87.6% when utilizing features from fast ripples. The Random Forest, Extra Trees, and Gradient Boosting algorithms were the most effective for predicting the RZ. Linear features outperformed non-linear features in predicting epileptogenic zones within the epileptic brain. Our study establishes the capability of ML methodologies in localizing epileptogenic zones with high accuracy. Future studies that focus on increasing the training sample size and incorporating more advanced machine learning (ML) algorithms have the potential to significantly improve the accuracy of these models in pinpointing epileptogenic networks. Additionally, implementing this ML approach across multiple research centers would contribute to the broader validation and generalizability of this technique.
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Affiliation(s)
- Bijoy Jose
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Siby Gopinath
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Arjun Vijayanatha Kurup
- Department of Computer Science and Applications, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Manjusha Nair
- Department of Computer Science and Applications, Amrita Vishwa Vidyapeetham, Amritapuri, India
| | - Ashok Pillai
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; Department of Neurosurgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anand Kumar
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Harilal Parasuram
- Amrita Advanced Centre for Epilepsy (AACE), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
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Trivedi M, Thankamony P, Nair M, Rajeswari B, Guruprasad CS, Prasanth VR, Nair RA, Jagathnath Krishna KM. Clinical profile and outcome of children with anaplastic large cell lymphoma treated with short-course chemotherapy - ten years experience from a tertiary care center in a LMIC. Pediatr Hematol Oncol 2023:1-12. [PMID: 37477212 DOI: 10.1080/08880018.2023.2212710] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Anaplastic large-cell lymphoma (ALCL) constitutes 10-15% of non-Hodgkin lymphoma in children. With short-course chemotherapy, outcome has improved up-to 90% in developed-countries. There is limited-data on outcome of pediatric ALCL treated with ALCL99 protocol from low-middle income countries. Children ≤14 years, diagnosed with ALCL between 1st January 2007 and 31st December 2016 were analyzed. Details regarding clinical-presentation and treatment were recorded and outcome was analyzed. Fourteen-children were diagnosed. Median-age was 114 months (range 24 - 162 months). Male:female ratio was 3.6:1. Stage-I, II and III disease was seen in three (21.4%), three (21.4%), and eight (57.1%) children, respectively. Low, standard and high-risk disease was seen in two (14.2%), six (42.9%) and six (42.9%), respectively. All children were treated using ALCL99 protocol. Three (21.4%) children had disease-progression/relapse and five (35.7%) died (three from treatment-related mortality, and two from disease). At median follow-up of 54-months, four-year EFS and OS were 64.3% and 64.3%, respectively. Log-rank test demonstrated female gender (p = 0.005), stage-III disease (p < 0.001), visceral-organ involvement (p = 0.035), high-risk disease (p = 0.016) and, serum albumin ≤3.5 g/dL (p = 0.031) associated with significantly worse 4-year EFS. Cox-regression analysis demonstrated female gender associated with poor EFS (p = 0.02) and female gender and visceral-organ involvement associated with poor OS (p = 0.02, p = 0.011, respectively). Good survival could be achieved for children with ALCL using uniform treatment protocol in a resource-limited setting, especially among low and standard-risk children. Female-sex, high-risk disease, stage-III disease, visceral organ involvement and low albumin levels were associated with poor outcome, however these findings need to be corroborated in larger studies.
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Affiliation(s)
- Maharshi Trivedi
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Priyakumari Thankamony
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - C S Guruprasad
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - V R Prasanth
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rekha A Nair
- Department of Medical and Pediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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Nair M, Ghoshal A. Hospice Care in India-A Pediatrician's Perspective. South Asian J Cancer 2023; 12:303-308. [PMID: 38047051 PMCID: PMC10691903 DOI: 10.1055/s-0043-1771407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Manjusha NairHospice care plays a vital role in providing compassionate and holistic support to terminally ill patients and their families. While hospice care has gained recognition and acceptance globally, its implementation and understanding in the context of pediatric patients in India remain limited. This article aims to explore the pediatrician's perspective on hospice care in India, highlighting the challenges and opportunities for enhancing end-of-life care for children. By understanding the unique needs of pediatric patients and their families, healthcare professionals can contribute to the development and improvement in hospice care services across the country.
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Affiliation(s)
- Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Arun Ghoshal
- Division of Palliative Care, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Rajendran PV, Thankamony P, Rajeswari B, Sojamani GC, Nair M, Parukuttyamma K, Krishna Km J. Loss of protective anti-HBs titers and seroconversion to hepatitis B vaccination in children during chemotherapy for acute lymphoblastic leukemia. Pediatr Blood Cancer 2023; 70:e30154. [PMID: 36545908 DOI: 10.1002/pbc.30154] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to evaluate loss of protective anti-hepatitis B (HBs) titers and seroconversion to hepatitis B vaccine (HBV) during chemotherapy in children with acute lymphoblastic leukemia (ALL). METHODS Anti-HBs titers were done at diagnosis. Patients were divided into two groups. Group I (protective titers >10 mIU/ml) received single double dose of HBV as booster. Titers were repeated at three time points: end of phase 1b, beginning of re-induction, and start of maintenance chemotherapy. Group II (nonprotective titers <10 mIU/L) received hepatitis B immunoglobulin (HBIG), prior to start of chemotherapy, followed by three double doses of HBV as booster. Titers were repeated at two time points: prior to first dose, and 4 weeks after third dose of vaccine. RESULTS Total 125 patients were included: 88 in group I; 37 in group II. Among group I patients, 98.7%, 90%, and 84% retained protective titers at the three points, respectively. Subgroup analysis showed that those with initial titers greater than 100 mIU/L retained protective titers better than those with titers between 11 and 100 mIU/L (p = .0001). Among group II patients, 62% and 64% attained protective titers at the two points, respectively. CONCLUSIONS HBV boosters helped maintain protective titers during intensive ALL chemotherapy in immunized children having titers more than 10 mIU/L, and more so if titer was more than 100 mIU/L. Therefore, we propose that cut off for protective anti-HBs titers be changed to greater than or equal to 100 mIU/L. Titers between 11 and 100 mIU/L may require combined active and passive immunization. Around one-third of group II patients who fail to attain protective titers may need frequent doses of HBIG.
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Affiliation(s)
| | - Priyakumari Thankamony
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Jagathnath Krishna Km
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Rajeswari B, Guruprasad CS, Nair M, Prasanth VR, Sugath BS, Thankamony P. High dose methotrexate containing regimen in pediatric non-metastatic extremity osteosarcoma patients: experience from a tertiary cancer center in India. Pediatr Hematol Oncol 2022; 39:225-232. [PMID: 34378476 DOI: 10.1080/08880018.2021.1963021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Methotrexate containing chemotherapy is less commonly used for treatment of osteosarcoma in resource limited settings. We present our experience with the administration of high dose methotrexate (HDMTX) containing chemotherapy over a period of three years. Children between 1 and 14 years of age with newly diagnosed nonmetastatic extremity osteosarcoma, registered in Pediatric Oncology Department of a tertiary care cancer center in South India between 1st January 2016 and 31st December 2018 and receiving MAP chemotherapy were included. Patients in this study received HDMTX at 12 g/m2. Twenty two patients were included. After neoadjuvant chemotherapy, 20 patients underwent surgery (limb salvage surgery in 16, amputation in 4). The median time from initiation of chemotherapy to surgery was 97.5 days. Eighteen of 22 patients (81.8%) completed planned chemotherapy in our cohort, one patient was lost to follow up after progression and three patients required change of chemotherapy due to toxicities. Of a total of 227 cycles of HDMTX infusions in 22 patients, delayed clearance occurred in 22 cycles (9.7%). Major toxicities were myelosuppression (30 episodes in 17 patients), blood stream infections (24 episodes in 15 patients) and mucositis (15 episodes in 10 patients). Hearing loss was documented in 7 patients. There was no treatment related mortality. Chemotherapy was completed in a median duration of 38.5 weeks. Administration of high dose methotrexate containing chemotherapy is feasible in pediatric patients with osteosarcoma, even in resource limited settings, if there are facilities for hydration, determination of methotrexate levels and good supportive care.
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Affiliation(s)
- Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | | | - Priyakumari Thankamony
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Nair M, Zeegers MP, Varghese GM, Burza S. India's National Action Plan on Antimicrobial Resistance: a critical perspective. J Glob Antimicrob Resist 2021; 27:236-238. [PMID: 34695609 DOI: 10.1016/j.jgar.2021.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
Antimicrobial resistance (AMR) is widely recognised as a global health threat, which is projected to account for more deaths than cancer by 2050. The Government of India has formulated a National Action Plan to tackle AMR (NAP-AMR), largely modelled on the World Health Organization's Global Action Plan on AMR. While the NAP-AMR successfully mirrors the Global Action Plan and lays out ambitious goals, we find that the lack of financial allocation across states, poor enforcement and inadequate multisectoral co-ordination have hampered progress. A broader focus on improving infrastructure for water and sanitation, linking the issue of AMR to existing vertical health programmes for human immunodeficiency virus (HIV) and tuberculosis (TB), prioritising infection prevention and control, strengthening the frontline healthcare workforce in rural and peri-urban settings to reduce reliance on antibiotics, leveraging point-of-care testing and mobile app-based health interventions for diagnosis and surveillance, and adopting a socioecological approach to health and development would help to create an enabling environment for concrete action on AMR in India.
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Affiliation(s)
- M Nair
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - M P Zeegers
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - S Burza
- Médecins Sans Frontières, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK
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Fellmeth G, Kishore MT, Verma A, Desai G, Bharti O, Kanwar P, Singh S, Thippeswamy H, Chandra PS, Kurinczuk JJ, Nair M, Alderdice F. Perinatal mental health in India: protocol for a validation and cohort study. J Public Health (Oxf) 2021; 43:ii35-ii42. [PMID: 34622290 PMCID: PMC8498097 DOI: 10.1093/pubmed/fdab162] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh). METHODS The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively. CONCLUSION Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.
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Affiliation(s)
- G Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - G Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - O Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, India
| | - P Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - S Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - H Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - P S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - F Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Rajeswari B, Sukumaran Nair RK, Guruprasad CS, Nair M, Thankamony P, Parukutty K. Infections during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia – Profile and Outcomes: Experience from a Cancer Center in South India. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_95_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Objective:The objective of this study is to describe the incidence, clinical, laboratory and microbiological profile, treatment, and outcome of infections during induction chemotherapy in children with acute lymphoblastic leukemia (ALL). Materials and Methods: This was prospective, observational study. All children aged 1–14 years, newly diagnosed to have ALL and attending the Pediatric oncology division at our center were included. Induction chemotherapy was administered as per a modified Berlin-Frankfurt-Münster protocol. The study period was from January 2014 to June 2015. Results: Two hundred and twenty-seven patients with ALL were included in the study. One hundred and fifty episodes of infection occurred among 117 patients. Major sites of infection were lung (n = 35) and gastrointestinal tract (n = 30). Blood cultures were positive in 45 episodes (30.6%) with Gram negative organisms being the predominant isolates. The most common organisms isolated were Pseudomonas aeruginosa and Klebsiella spp. The response to antibiotics was good with only 18% of episodes requiring a third-line antibiotic. One hundred and thirty-six (90.6%) episodes resolved without sequelae. Overall induction mortality (12 out of 227-5.3%) was mainly accounted for by infections. Conclusions: Infections are the major cause of mortality and morbidity in patients with ALL on induction chemotherapy. The outcomes are good for the majority of patients if they receive adequate antibiotics early in the course of infection.
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Affiliation(s)
- Binitha Rajeswari
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
| | - Reghu K Sukumaran Nair
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
| | - C S Guruprasad
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
| | - Manjusha Nair
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
| | - Priyakumari Thankamony
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
| | - Kusumakumary Parukutty
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala State, India
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11
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Han L, White H, Bosch K, Nair M. 708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.474] [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: 11/14/2022]
Abstract
Abstract
Introduction
Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG).
Method
Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines.
Results
We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations.
Conclusions
Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.
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Affiliation(s)
- L Han
- North Middlesex University Hospital, London, United Kingdom
| | - H White
- North Middlesex University Hospital, London, United Kingdom
| | - K Bosch
- North Middlesex University Hospital, London, United Kingdom
| | - M Nair
- North Middlesex University Hospital, London, United Kingdom
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12
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Prabhu JS, Patil S, Rajarajan S, Ce A, Nair M, Alexander A, Ramesh R, Bs S, Sridhar T. Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis. Ann Oncol 2021; 32. [PMID: 34220400 DOI: 10.1016/j.annonc.2021.03.052] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance. Methods Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis. Results Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC. Conclusions Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.
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Affiliation(s)
- J S Prabhu
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Patil
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Rajarajan
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Ce
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - M Nair
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Alexander
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - R Ramesh
- Department of Surgical Oncology, St Johns Medical College Hospital, Bangalore, India
| | - S Bs
- Department of Surgical Oncology, Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - T Sridhar
- Molecular Medicine, St Johns Research Institute, Bangalore, India
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13
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Seetharam S, Thankamony P, Gopakumar KG, Nair RA, Jacob PM, Jagathnath Krishna KM, Rajeswari B, Nair M, Guruprasad CS, Prasanth VR. Outcomes of pediatric mixed phenotype acute leukemia treated with lymphoid directed therapy: Analysis of an institutional series from India. Pediatr Hematol Oncol 2021; 38:358-366. [PMID: 33635170 DOI: 10.1080/08880018.2020.1871453] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is limited data regarding pediatric mixed phenotype acute leukemia (MPAL) and there is no global consensus on its management yet. In this retrospective study, we analyzed the outcomes of children diagnosed with MPAL at our institute. This study included children ≤ 14 years with MPAL who presented to a tertiary cancer center in India from January 1st 2009 to December 31st 2015. Over a seven-year period, 1390 patients with leukemia presented to our institute of which 22 patients (1.5%) had MPAL. Sixteen patients (72.7%) had B/myeloid leukemia, while 4 (18.1%) and 2 (9%) patients had T/myeloid and B/T leukemia respectively. Twenty-one patients were treated with a modified BFM ALL 95 protocol. 76.1% (n = 16) of patients had a good prednisolone response (GPR) on day 8 and end-of-induction (EOI) marrow was in remission in 90.5% (n = 19). A poor prednisolone response (PPR) on day 8 correlated with an inferior relapse-free survival (25% vs 79.5%, P=.025). The 4-year event-free survival (EFS) and overall survival (OS) for the entire group was 60.8% and 64.9% respectively while the EFS for patients who had a GPR and remission at the EOI (n = 15) was 80% as compared to 16.7% in patients with PPR or induction failure. Lymphoid directed chemotherapy is seen to have good survival outcomes in pediatric MPAL. However, a PPR on day 8 or a positive EOI marrow may be an indication for more aggressive treatment.
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Affiliation(s)
- Shwetha Seetharam
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | | | | | | | - Priya Mary Jacob
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| | - K M Jagathnath Krishna
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, India
| | - Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - C S Guruprasad
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
| | - V R Prasanth
- Department of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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14
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Patel M, Nair M, Pirozzoli E, Cienfuegos MC, Aitken E. 18 Socio-Demographic Associations of COVID Antibody in Multi-Ethnic Healthcare Workers. Age Ageing 2021. [PMCID: PMC7989648 DOI: 10.1093/ageing/afab028.18] [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: 11/15/2022] Open
Abstract
Introduction Healthcare workers are particularly susceptible to developing COVID-19 owing to close and frequent contact with COVID-19 patients. This study aimed to describe prevalence of SARS-COV-2 antibodies amongst healthcare workers within a hospital trust and examine factors associated with increased prevalence of this antibody. Methods Data was obtained over a 4-week period in 2020 from a cross-sectional prospective survey of healthcare workers serving a multi-ethnic inner-city population who had IgG SARS-COV-2 antibody. Multiple, overlapping sources of notification were implemented to promote the availability of the test. Anonymised socio-demographic data about staff members were cross referenced with data of the antibody tests. Results Of 7,013,6,212 (89%) staff undertook the antibody test during the study period. The overall detection rate of IgG SARS COV-2 antibody was 26%(1584/6212). Univariate analyses reveal that there were no differences in the prevalence rates in terms of gender or age. Compared to white staff members (18%), prevalence of the antibody was significantly greater in Black(38%) and Asian(27%) staff members. The combined prevalence for all BAME staff members was 32%. The prevalence rates of staff in general wards (43%) were significantly higher other areas of the trust. For staff in emergency medicine, intensive care and anaesthetics, prevalence was 23%, whereas for other clinical teams it was 21%. In terms of professional groups, prevalence rates were highest amongst nursing and allied clinical services (28%), followed by doctors (23%), whereas, it was lower for non-clinical staff(19%). Discussion This large multi-ethnic hospital-based study has described the prevalence of recent exposure to SARS-COV-2 infection amongst healthcare workers and determined socio-demographic associations of this prevalence including ethnicity, professional healthcare groups, and geographical areas of work in healthcare settings. The study provides information that may be useful in future COVID studies examining the role of antibody testing both in general populations as well as in healthcare settings.
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Affiliation(s)
- M Patel
- Lewisham & Greenwich NHS Trust, London SE13 6LH
| | - M Nair
- Lewisham & Greenwich NHS Trust, London SE13 6LH
| | - E Pirozzoli
- Lewisham & Greenwich NHS Trust, London SE13 6LH
| | | | - E Aitken
- Lewisham & Greenwich NHS Trust, London SE13 6LH
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15
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Cyriac M, Gireeshkumar TR, Furtado CM, Fathin KPF, Shameem K, Shaik A, Vignesh ER, Nair M, Kocherla M, Balachandran KK. Distribution, contamination status and bioavailability of trace metals in surface sediments along the southwest coast of India. Mar Pollut Bull 2021; 164:112042. [PMID: 33524831 DOI: 10.1016/j.marpolbul.2021.112042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
This study investigates the influence of upwelling induced seasonal hypoxia in the sediment-water interface on the distribution, bioavailability and geochemical partitioning of selected trace metals in surficial sediments along the southwest coast of India based on two successive cruises. The first cruise was during the southwest monsoon (SWM) season when coastal waters exhibited intermittent bottom hypoxia due to upwelling. The second cruise during the northeast monsoon (NEM) season was characterised by a uniformly warm and well-oxygenated water column in the study region. The results showed that grain size, organic carbon and Fe are the major factors influencing the distribution of trace metals in the surface sediments. Based on the geochemical indices (contamination factor, enrichment factor and geo-accumulation factor), the study region appears to be moderately contaminated by Ni, Cr, and Pb. Based on the ecological risk assessment criteria, the enrichment of Pb, Cr and Ni may cause adverse effects on the benthic organisms. The fractionation studies demonstrated that the major pathway of metal deposition in the sediment is lithogenic. The data also showed that labile and organic fractions are the second dominant forms, while other fractions (exchangeable and carbonate) are insignificant. The consistency in the reactive Fe concentrations during SWM and NEM could be due to the absence of Fe dissolution in sediments under mild reducing condition (intermittent hypoxia). In addition to the above, an enrichment of organic matter also leads to increased deposition of trace metals in sediments. Conversely, the secondary phase enrichment factor and risk assessment code calculated based on the metal fractionation data indicated low risk and contamination along the southwest coast of India except for Zn that showed moderate contamination in some transects. The study provides the need for regular geochemical assessment to control metal pollution in the coastal environment, which is a major resource of the fishery.
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Affiliation(s)
- M Cyriac
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
| | - T R Gireeshkumar
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India.
| | - C M Furtado
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
| | - K P Fahad Fathin
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
| | - K Shameem
- Inter University Centre for Development of Marine Biotechnology, School of Marine Sciences, Cochin University of Science and Technology, Kochi 682016, India
| | - Adnan Shaik
- CSIR - National Institute of Oceanography, Dona Paula, Goa 400 003, India
| | - E R Vignesh
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
| | - M Nair
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
| | - M Kocherla
- CSIR - National Institute of Oceanography, Dona Paula, Goa 400 003, India
| | - K K Balachandran
- CSIR - National Institute of Oceanography, Regional Centre, Kochi 682 018, India
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16
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Nirmal G, Thankamony P, Chellapam Sojamani G, Nair M, Rajeswari B, Varikkattu Rajendran P, Krishna K M J. Prevalence and Risk Factors for Metabolic Syndrome Among Childhood Acute Lymphoblastic Leukemia Survivors: Experience From South India. J Pediatr Hematol Oncol 2021; 43:e154-e158. [PMID: 32516199 DOI: 10.1097/mph.0000000000001856] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Improved survival of childhood acute lymphoblastic leukemia (ALL) has diverted attention to the long-term consequences of the treatment; metabolic abnormalities being one of the most important issues. METHODS Children diagnosed with ALL at age 14 years and younger at Regional Cancer Centre in South India who completed treatment and who were on follow-up for >2 years were enrolled in the study between April 1, 2018 and March 31, 2019. They were prospectively evaluated for the presence of metabolic syndrome (MS) and associated risk factors. RESULTS AND DISCUSSION A total of 277 survivors of pediatric ALL were recruited during the study period. MS was present in 8.3% (n=23) and 6% (n=13) survivors by National Cholesterol Education Programme Adult Treatment Panel III (NCEPATP III) and International Diabetes Federation (IDF) criteria, respectively. The prevalence of overweight and obesity in the survivors was 9% and 13%. The prevalence of increased waist circumference, low high-density lipoprotein cholesterol, elevated triglycerides, elevated fasting glucose, and increased blood pressure were 10.5%, 28.9%, 24.9%, 2.5%, and 9%, respectively. Overweight/obese survivors were at an increased risk for developing MS (odds ratio=17.66; 95% confidence interval=6.2-50.16, P=0.001). Survivors who received cranial radiotherapy were at an elevated risk for having low high-density lipoprotein cholesterol (P=0.001). CONCLUSIONS In our study, the prevalence of MS was higher in childhood ALL survivors, as compared with the general population. The study points to the need for regular screening of pediatric ALL survivors for early detection of MS, along with lifestyle modification in those with metabolic abnormalities, to curb the growing incidence of coronary artery disease.
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Affiliation(s)
| | | | | | | | | | | | - Jagathnath Krishna K M
- Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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17
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Caobi A, Andre M, Miles J, Tomitaka A, Nikkhah-Moshaie R, Hernandez A, Nair M, Raymond AD. Magnetic Nanoparticle and Exosomal Therapeutic (M-NEXT) Effects on HIV-Associated Neurotoxicity. Crit Rev Biomed Eng 2021; 48:189-198. [PMID: 33389896 DOI: 10.1615/critrevbiomedeng.2020034629] [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]
Abstract
The human immunodeficiency virus (HIV) envelope glycoprotein protein 120 (gp120) induces neurotoxicity associated with HIV-associated neurocognitive disorders (HAND). Mechanism of Gp120-mediated neurotoxicity is primarily apoptosis. Currently, there are no therapeutics that address gp120 neurotoxicity. A biocompatible, efficacious therapeutic that easily crosses the blood-brain barrier (BBB) is needed to treat neuronal toxicity observed in HIV-infected individuals. Magnetic nanoparticles (MNPs) have successfully delivered anti-HIV agents across in vitro BBB transwell model. However, MNPs at high doses may damage cells. Exosomal extracellular vesicles (xEVs) are endogenous nanocarriers capable of crossing the BBB. Unlike MNPs, xEVs interact with cells in a paracrine or juxtracrine manner, lacking long-range site specificity. Here we investigated the efficacy of an MNP and xEV-coupled therapeutic (M-NEXT) as a nanocarrier for targeted delivery of anti-HIV fusion agent across the BBB to inhibit HIV-gp120 associated neuropathology. M-NEXT consisting of MNPs encapsulated within xEV carrying T20 peptide on the surface was synthesized and characterized via zeta potential, dynamic light scattering, and TEM imaging. Preliminary efficacy studies using SH-SY5Y cocultured with the in vitro BBB model showed that the M-NEXT-T20-fusion peptide protected neurons from HIV gp120-mediated neurotoxicity. Additionally, BBB integrity and permeability assessed via trans-endothelial resistance (TEER) and a Dextran-FITC transport assay was unaffected. SH-SY5Y viability measured by XTT assay was not significantly modulated by M-NEXT. In summary, preliminary findings support M-NEXT as effective nanocarriers for delivery of anti-HIV gp120 associated neurotoxicity agents.
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Affiliation(s)
- A Caobi
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - M Andre
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - J Miles
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - Asahi Tomitaka
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA; Advanced Materials Engineering Research Institute, College of Engineering and Computing, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - R Nikkhah-Moshaie
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - A Hernandez
- Advanced Materials Engineering Research Institute, College of Engineering and Computing, Florida International University 11200 SW 8th Street Miami, Florida 33199, USA
| | - M Nair
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - Andrea D Raymond
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
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Alsharqi M, Arnold L, Dockerill C, Baigent C, Leeson P, Nair M. A novel approach using hand-held echocardiography to guide the diagnosis of heart failure in pregnant women in a low-resource setting; Maternal and Perinatal Health Research Collaboration. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Point of care imaging devices are promising tools for cardiovascular imaging in low-resource settings.
Purpose
Our aim was to determine whether hand-held echocardiography scans performed by obstetricians can help to identify the cardiac phenotypes in pregnant women with heart failure in India.
Methods
In November 2018, eighteen obstetricians from 10 hospitals across the states of Assam, Meghalaya and Uttar Pradesh were given 2 days of hands-on training in image acquisition using Philips Lumify devices. Obstetricians were asked to follow a simplified protocol of image acquisition and optimisation designed by the Oxford Cardiovascular Clinical Research Facility team. The protocol includes 3 key echocardiography views; parasternal long axis, parasternal short axis, and apical four chamber. Remote supervision and constructive feedback on performance was provided to improve image quality. Echocardiographic images of 269 pregnant women (with and without suspected heart failure) were acquired by the trained obstetricians, between February 2018 and January 2020. The first 147 scans were transferred with end-to-end encryption to the University of Oxford Research Echocardiography Core Laboratory (ORECL). Image interpretation and formal quality assessment was performed by 2 experienced echocardiographers.
Results
Parasternal long axis image quality was assessed as good in 78.3%, and was superior to both the parasternal short axis view (76.5%) and the apical 4-chamber view (61.9%). Image depth and gain optimisation was the main reason for loss of quality. The acquisition quality was related to reported clinical disease severity, and advanced pregnancy status. Left ventricular systolic function was impaired in 32 participants (21.9%), and 23.3% of the cohort had a dilated left atrium. Rheumatic heart disease was found in 12 participants (8.3%), in which the mitral valve was stenotic; 10 severe and 1 moderate. Mitral regurgitation was reported in 29 cases (20.8%); 6 severe, 7 moderate and 16 mild. Tricuspid and aortic valve abnormalities were also detected. Pericardial effusion was reported in 45 participants (30.8%).
Conclusion
Obstetricians with supervised training, using hand-held echocardiography have demonstrated acceptable image acquisition quality which could be assessed through core laboratory analysis to detect cardiac abnormalities. Such an approach could be useful to guide the diagnosis of heart failure in pregnant women in low-resource settings. Further training for the obstetricians and image quality assurance have been implemented in the ongoing MaatHRI study with plans to conduct a validation analysis.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Medical Research Council (MRC), UK Fellowship for M Nair.
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Affiliation(s)
- M Alsharqi
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom
| | - L Arnold
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom
| | - C Dockerill
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom
| | - C Baigent
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - P Leeson
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom
| | - M Nair
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
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Varma TH, Thankamony P, Nair M, Rajeswari B, Guruprasad C, Prasanth V. Evaluation of the toxicity profile and clearance of high dose methotrexate in children with acute lymphoblastic leukemia from a tertiary cancer centre of South India. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.082] [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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20
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Gopakumar K, Thankamony P, Nair M, Rajeswari B, Guruprasad C, Prasanth V, jagathnath Krishna K. Survival with “7+3” induction and high dose cytosine arabinoside consolidation in pediatric AML; A prospective observational study of real world scenario. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Rajeswari B, Prasanth V, Priyakumari T, Nair M, CS G, Sankar A, Sugath S, Krishna J, P K. Ewing sarcoma in children – A five year retrospective analysis. Pediatric Hematology Oncology Journal 2020. [DOI: 10.1016/j.phoj.2021.04.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Liquid or blood-based biopsy is a less invasive and more efficient method in which to clinicians can identify diagnostic, prognostic, and therapeutic responsive biomarkers in cancer patients. Circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), RNAs, proteins, metabolites, and extracellular vesicles (EVs) are all potential biomarkers found in liquid biopsies. All nucleated cells including healthy, virally infected, and cancer cells release EVs. Since the early 1980s, evidence has mounted to support the pathophysiological role of EVs in cancer. Here we focus on the smallest of the EV, the exosome, and their clinical relevance as nanotherapeutics for cancers. Exosomes obtained from tumors have been reported to promote and/or facilitate malignancy of cancers especially in terms of metastatic potential. Exosomal EVs have also contributed to the development of therapeutic resistance. Recent studies demonstrate that intrinsic and bioengineered exosomes can serve as effective therapeutic agents that disrupt cancer progression. Here we review the current literature regarding the utilization of bioengineered exosomes for therapeutics to treat prevalent cancers such as melanoma, glioma, breast, pancreatic, hepatic, cervical, prostate, and colon cancers. Overall, studies reviewed show that bioengineered exosomes are effective and promising for targeted cancer therapy.
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Affiliation(s)
- J. Miles
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - M. Andre
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - A. Caobi
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - M. Ruiz
- Department of Human and Health Services, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
- Miami Cancer Institute, Bone Marrow Transplant and CART T-Cell Therapy Department, Baptist Health South Florida, 8900 N Kendall Dr., Miami, FL 33176, USA
| | - M. Nair
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
| | - A.D. Raymond
- Department of Immunology and NanoMedicine, Herbert Wertheim College of Medicine, Florida International University 11200 SW 8th Street Miami, FL 33199, USA
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O’Donovan J, Nair M. Perceptions of Junior Doctors in the United Kingdom Regarding a Career in Interventional Radiology. Hong Kong Journal of Radiology 2019. [DOI: 10.12809/hkjr1917045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J O’Donovan
- Department of Education, The University of Oxford, Oxford, United Kingdom
| | - M Nair
- Acute Medical Unit, Arrowe Park Hospital, Birkenhead, United Kingdom
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Chinnapaiyan S, Dutta RK, Nair M, Chand HS, Rahman I, Unwalla HJ. TGF-β1 increases viral burden and promotes HIV-1 latency in primary differentiated human bronchial epithelial cells. Sci Rep 2019; 9:12552. [PMID: 31467373 PMCID: PMC6715689 DOI: 10.1038/s41598-019-49056-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/15/2019] [Indexed: 12/28/2022] Open
Abstract
Combination antiretroviral therapy (cART) has increased the life expectancy of HIV patients. However, the incidence of non-AIDS associated lung comorbidities, such as COPD and asthma, and that of opportunistic lung infections have become more common among this population. HIV proteins secreted by the anatomical HIV reservoirs can have both autocrine and paracrine effects contributing to the HIV-associated comorbidities. HIV has been recovered from cell-free bronchoalveolar lavage fluid, alveolar macrophages, and intrapulmonary lymphocytes. We have recently shown that ex-vivo cultured primary bronchial epithelial cells and the bronchial brushings from human subjects express canonical HIV receptors CD4, CCR5 and CXCR4 and can be infected with HIV. Together these studies suggest that the lung tissue can serve as an important reservoir for HIV. In this report, we show that TGF-β1 promotes HIV latency by upregulating a transcriptional repressor BLIMP-1. Furthermore, we identify miR-9-5p as an important intermediate in TGF-β-mediated BLIMP-1 upregulation and consequent HIV latency. The transcriptionally suppressed HIV can be reactivated by common latency reactivating agents. Together our data suggest that in patients with chronic airway diseases, TGF-β can elevate the HIV viral reservoir load that could further exacerbate the HIV associated lung comorbidities.
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Affiliation(s)
- S Chinnapaiyan
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - R K Dutta
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - M Nair
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - H S Chand
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - I Rahman
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - H J Unwalla
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
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Abstract
Imatinib is a preferred drug for pediatric Chronic Myeloid Leukemia (CML). Long-term use has inhibitory effects on other tyrosine kinase pathways causing off-target complications such as growth impairment. Our aim was to evaluate impact of long-term use on longitudinal growth in children with CML in Kerala. We hypothesized that the impact would be lesser compared to Northern India as Kerala has the lowest rates of underweight and stunting, with a high literacy rate and per capita income. Children ≤14 years of age, diagnosed with CML and received imatinib for at least 1 year were included. Girls >9 years of age and boys >11 years were considered pubertal. Height Z scores were derived using WHO AnthroPlus. Paired t test compared difference of Z scores in prepubertal and postpubertal age groups. Height Z scores were compared with mid-parental height and sibling height Z scores. Thirty-six children were included (M = 21; F = 15). Median duration of imatinib exposure was 84 months. Decrease in longitudinal growth affected children in both prepubertal and postpubertal age groups. Decrease in height Z scores was more in prepubertal age group when imatinib therapy was initiated (p = .0018). Of 10 patients currently above 19 years (of whom 8 were in pubertal age and 2 in prepubertal age at start of imatinib) none are stunted. Patient's height Z scores was lesser compared to sibling height Z scores (p = .027). Children on continuous imatinib showed a significant stunting when treatment was initiated during prepubertal age. There is a catch-up of growth as the final height reached is within normal limits of WHO reference values.
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Affiliation(s)
- Deepthi Boddu
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Priyakumari Thankamony
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - C S Guruprasad
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Manjusha Nair
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Binitha Rajeswari
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
| | - Shwetha Seetharam
- a Department of Pediatric Oncology, Regional Cancer Centre , Thiruvananthapuram , Kerala, India
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Gopakumar KG, Seetharam S, Km JK, Nair M, Rajeswari B, Cs G, Vr P, Thankamony P. Risk-based management strategy and outcomes of tumor lysis syndrome in children with leukemia/lymphoma: Analysis from a resource-limited setting. Pediatr Blood Cancer 2018; 65:e27401. [PMID: 30101454 DOI: 10.1002/pbc.27401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Data from low- and middle-income countries on tumor lysis syndrome (TLS) in the pediatric population are limited. This study aims to analyze the clinical and biochemical characteristics and treatment outcomes of TLS in children with leukemia/lymphomas in a resource-limited setting. PROCEDURE Children with intermediate risk (IRD) and high risk (HRD) for developing TLS were retrospectively studied at a tertiary cancer center in India. RESULTS Over a three-year period, 224 children with acute leukemia/lymphoma having IRD (21.8%, n = 49) and HRD (78.1%, n = 175) were identified. TLS developed in 53.6% (n = 120) cases, of which 75% (n = 90) had laboratory TLS alone. Thirteen children had clinical TLS (C-TLS) at presentation while 17 patients progressed to develop C-TLS. TLS developed in 51% (n = 25) and 54.5% (n = 95) of children with IRD and HRD, respectively. Rasburicase was used in 8.5% (n = 19) cases and five children required hemodialysis. Two children (0.8%) expired during the course of TLS management. Multivariate analysis identified the presence of hyperuricemia as the single significant risk factor for developing TLS. When children in whom a 25% change in biochemical values from the baseline that falls within the normal range were excluded, 21.4% (48/224) cases were identified to have clinically relevant TLS (8% in IRD and 25% in HRD). CONCLUSION With hydration, supportive care and judicious use of rasburicase, it is feasible to manage TLS efficiently in resource-limited settings. A modification of the TLS definition criteria would help to identify clinically relevant TLS.
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Affiliation(s)
| | - Shwetha Seetharam
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Jagathnath Krishna Km
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Manjusha Nair
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Binitha Rajeswari
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Guruprasad Cs
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Prasanth Vr
- Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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Nair M, Kuttath V, Nair AR, Rajeswari B, Chellappan G, Thankamony P, Parukkutty K. Iron Overload in Children with Leukemia Receiving Multiple Blood Transfusions. Indian Pediatr 2018; 55:962-965. [PMID: 30587644] [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: 06/09/2023]
Abstract
OBJECTIVE To find out prevalence of iron overload in children with leukemia at the end of treatment, and to identify factors affecting iron overload. METHODS Children (age-1-14 y) treated for Leukemia of our center who completed treatment between January and August 2016 were included in the study. Serum ferritin and iron were measured at completion of treatment and total blood transfusion received throughout treatment was quantified. Serum ferritin >1000 ng/mL was considered as marker of transfusional iron overload. RESULTS Out of 66 participants, 55 (83.3%) received red cell transfusions. Average transfused volume was 48 mL/kg, and patients with high-risk leukemia received more transfusions than standard-risk patients. 16 patients (24.2%) demonstrated transfusional iron overload. Total transfused volume and treatment intensity were significant factors associated with iron overload, and total transfused volume of >100 mL/kg (approximately 10 transfusions) was the most important determinant of transfusional iron burden. CONCLUSIONS One-fourth of pediatric leukemia patients demonstrated iron overload at the end of treatment. These patients need to be monitored and followed-up after treatment to assess need for later chelation therapy.
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Affiliation(s)
- Manjusha Nair
- Department of Pediatrics, Regional Cancer Center, Trivandrum, Kerala, India. Correspondence to: Dr Manjusha Nair, PRA-19, Prasanth, Pathirappally Road, Poojappura PO, Trivandrum, Kerala, India.
| | - Vijayalakshmi Kuttath
- Department of Transfusion Medicine, Regional Cancer Center, Trivandrum, Kerala, India
| | | | - Binitha Rajeswari
- Department of Pediatrics, Regional Cancer Center, Trivandrum, Kerala, India
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Rajarajan S, Prabhu J, Korlimarla A, Nair M, Alexander A, Kaluve R, Ps H, Raja U, Ramesh R, Patil S, Bs S, Ts S. MicroRNA based immune response signature identifies poor prognostic subgroup within ER negative breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy428.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chandar R, Seetharam S, Gopakumar KG, Appanraj P, Cs G, Rajeswari B, Nair M, Thankamony P. Paraneoplastic Demyelinating Sensorimotor Neuropathy Delaying the Diagnosis of an Underlying Acute Lymphoblastic Leukemia in a Child. J Oncol Pract 2018; 14:629-631. [PMID: 30133345 DOI: 10.1200/jop.18.00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nair M, Manchan Kannimoola J, Jayaraman B, Nair B, Diwakar S. Temporal constrained objects for modelling neuronal dynamics. PeerJ Comput Sci 2018; 4:e159. [PMID: 33816812 PMCID: PMC7924700 DOI: 10.7717/peerj-cs.159] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/26/2018] [Indexed: 06/12/2023]
Abstract
BACKGROUND Several new programming languages and technologies have emerged in the past few decades in order to ease the task of modelling complex systems. Modelling the dynamics of complex systems requires various levels of abstractions and reductive measures in representing the underlying behaviour. This also often requires making a trade-off between how realistic a model should be in order to address the scientific questions of interest and the computational tractability of the model. METHODS In this paper, we propose a novel programming paradigm, called temporal constrained objects, which facilitates a principled approach to modelling complex dynamical systems. Temporal constrained objects are an extension of constrained objects with a focus on the analysis and prediction of the dynamic behaviour of a system. The structural aspects of a neuronal system are represented using objects, as in object-oriented languages, while the dynamic behaviour of neurons and synapses are modelled using declarative temporal constraints. Computation in this paradigm is a process of constraint satisfaction within a time-based simulation. RESULTS We identified the feasibility and practicality in automatically mapping different kinds of neuron and synapse models to the constraints of temporal constrained objects. Simple neuronal networks were modelled by composing circuit components, implicitly satisfying the internal constraints of each component and interface constraints of the composition. Simulations show that temporal constrained objects provide significant conciseness in the formulation of these models. The underlying computational engine employed here automatically finds the solutions to the problems stated, reducing the code for modelling and simulation control. All examples reported in this paper have been programmed and successfully tested using the prototype language called TCOB. The code along with the programming environment are available at http://github.com/compneuro/TCOB_Neuron. DISCUSSION Temporal constrained objects provide powerful capabilities for modelling the structural and dynamic aspects of neural systems. Capabilities of the constraint programming paradigm, such as declarative specification, the ability to express partial information and non-directionality, and capabilities of the object-oriented paradigm especially aggregation and inheritance, make this paradigm the right candidate for complex systems and computational modelling studies. With the advent of multi-core parallel computer architectures and techniques or parallel constraint-solving, the paradigm of temporal constrained objects lends itself to highly efficient execution which is necessary for modelling and simulation of large brain circuits.
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Affiliation(s)
- Manjusha Nair
- Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
- Department of Computer Science and Applications, Amritapuri Campus, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
| | - Jinesh Manchan Kannimoola
- Center for Cybersecurity Systems and Networks, Amritapuri Campus, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
| | - Bharat Jayaraman
- Department of Computer Science & Engineering, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bipin Nair
- Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
| | - Shyam Diwakar
- Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
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Chinnapaiyan S, Dutta R, Bala J, Parira T, Agudelo M, Nair M, Unwalla HJ. Cigarette smoke promotes HIV infection of primary bronchial epithelium and additively suppresses CFTR function. Sci Rep 2018; 8:7984. [PMID: 29789655 PMCID: PMC5964097 DOI: 10.1038/s41598-018-26095-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/04/2018] [Indexed: 02/07/2023] Open
Abstract
Recurrent lung infections are a common cause of morbidity and mortality in people living with HIV and this is exacerbated in smokers even when administered combination antiretroviral therapy (cART). The incidence of pneumonia is increased with smoking and treatment interruption and is directly dependent on viral load in patients when adjusted for CD4 counts. CFTR dysfunction plays an important role in aberrant airway innate immunity as it is pivotal in regulating mucociliary clearance (MCC) rates and other antibacterial mechanisms of the airway. In our earlier work, we have demonstrated that bronchial epithelium expresses canonical HIV receptors CD4, CCR5 and CXCR4 and can be infected with HIV. HIV Tat suppresses CFTR mRNA and function via TGF-β signaling. In the present study, we demonstrate that cigarette smoke (CS) potentiates HIV infection of bronchial epithelial cells by upregulating CD4 and CCR5 expression. HIV and CS individually and additively suppress CFTR biogenesis and function, possibly explaining the increased incidence of lung infections in HIV patients and its exacerbation in HIV smokers.
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Affiliation(s)
- S Chinnapaiyan
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - R Dutta
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - J Bala
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - T Parira
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - M Agudelo
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - M Nair
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - H J Unwalla
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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Lommerse K, Knight M, Nair M, Deneux‐Tharaux C, Akker T. The impact of reclassifying suicides in pregnancy and in the postnatal period on maternal mortality ratios. BJOG 2018. [DOI: 10.1111/1471-0528.15215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Lommerse
- Department of Psychiatry Haaglanden Medical Centre The Hague the Netherlands
| | - M Knight
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
| | - M Nair
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
| | - C Deneux‐Tharaux
- INSERMU1153 Obstetric, Perinatal, and Paediatric Epidemiology Research Team Centre for Epidemiology and Statistics Sorbonne Paris Cité Paris Descartes University Paris France
| | - T Akker
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
- Department of Obstetrics Leiden University Medical Centre Leiden the Netherlands
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Abstract
The unregulated market for e-cigarettes continues to grow, with debates on their efficacy and impact on global public health. E-cigarettes, or electronic nicotine delivery systems (ENDs), are marketed as a 'safe' alternative to tobacco products and a tool for 'harm reduction'. Some public health experts are calling it a 'game changer' and favour the 'harm reduction' strategy, while others dispute this claim. In our opinion, the debate needs to be broadened to encompass other related concerns and effects on non-users and affected stakeholders. As with tobacco control, a holistic approach is needed to build a raft of policies that effectively address the issue from all angles and look beyond the direct health implications of e-cigarette use to explore the social, economic, political and environmental aspects of this debate, putting 'harm reduction' in context.
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Affiliation(s)
- E Latif
- Department of Tobacco Control, International Union Against Tuberculosis and Lung Disease, Edinburgh, UK
| | - M Nair
- Department of Tobacco Control, International Union Against Tuberculosis and Lung Disease, Edinburgh, UK
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Nair M, Rajeswari B, S GC, T P. Trend over time in epidemiology and outcome of pediatric neuroblastoma – experience from a Regional Cancer Centre in India. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.146] [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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Gopakumar KG, Priyakumari T, Nair M, Kusumakumary P. Jehovah's Witness and consent for blood transfusion in a child: The Indian scenario. Asian J Transfus Sci 2018; 12:78-80. [PMID: 29563681 PMCID: PMC5850703 DOI: 10.4103/ajts.ajts_50_17] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In India, the clinical guidelines and laws governing consent for blood transfusion in a minor are meager and vague. In an elective situation, whether the parents can make a decision for the child on his/her behalf or whether the doctor has the right to make the decision in the best interests of the child is not clear. We present the case scenario of a child belonging to Jehovah's Witness denomination diagnosed with Burkitt lymphoma. His parents were in a dilemma whether to opt for blood transfusion or not. In the absence of laws and guidelines in this context, and considering the complications that he developed during the treatment period, it was very challenging for us to manage the situation both medically and medico-legally. This situation highlights the need for framing consensus guidelines/laws regarding elective blood transfusion in a minor to make health-care delivery, smooth, transparent and flawless.
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Rajeswari B, Guruprasad C, Nair M, Sugath S, Priyakumari T. Feasibility Of Administration And Toxicity Profile Of Map Chemotherapy In Pediatric Non-Metastatic Osteosarcoma Patients - Experience From A Tertiary Cancer Centre In India. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.148] [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: 10/27/2022] Open
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Sagar V, Pilakka-Kanthikeel S, Martinez PC, Atluri VSR, Nair M. Common gene-network signature of different neurological disorders and their potential implications to neuroAIDS. PLoS One 2017; 12:e0181642. [PMID: 28792504 PMCID: PMC5549695 DOI: 10.1371/journal.pone.0181642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
The neurological complications of AIDS (neuroAIDS) during the infection of human immunodeficiency virus (HIV) are symptomized by non-specific, multifaceted neurological conditions and therefore, defining a specific diagnosis/treatment mechanism(s) for this neuro-complexity at the molecular level remains elusive. Using an in silico based integrated gene network analysis we discovered that HIV infection shares convergent gene networks with each of twelve neurological disorders selected in this study. Importantly, a common gene network was identified among HIV infection, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and age macular degeneration. An mRNA microarray analysis in HIV-infected monocytes showed significant changes in the expression of several genes of this in silico derived common pathway which suggests the possible physiological relevance of this gene-circuit in driving neuroAIDS condition. Further, this unique gene network was compared with another in silico derived novel, convergent gene network which is shared by seven major neurological disorders (Alzheimer's disease, Parkinson's disease, Multiple Sclerosis, Age Macular Degeneration, Amyotrophic Lateral Sclerosis, Vascular Dementia, and Restless Leg Syndrome). These networks differed in their gene circuits; however, in large, they involved innate immunity signaling pathways, which suggests commonalities in the immunological basis of different neuropathogenesis. The common gene circuits reported here can provide a prospective platform to understand how gene-circuits belonging to other neuro-disorders may be convoluted during real-time neuroAIDS condition and it may elucidate the underlying-and so far unknown-genetic overlap between HIV infection and neuroAIDS risk. Also, it may lead to a new paradigm in understanding disease progression, identifying biomarkers, and developing therapies.
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Affiliation(s)
- Vidya Sagar
- Institute of Neuroimmune Pharmacology/Center for Personalized Nanomedicine, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - S. Pilakka-Kanthikeel
- Institute of Neuroimmune Pharmacology/Center for Personalized Nanomedicine, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Paola C. Martinez
- Institute of Neuroimmune Pharmacology/Center for Personalized Nanomedicine, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - V. S. R. Atluri
- Institute of Neuroimmune Pharmacology/Center for Personalized Nanomedicine, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - M. Nair
- Institute of Neuroimmune Pharmacology/Center for Personalized Nanomedicine, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
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Abstract
OBJECTIVES To describe clinical characteristics and preoperative management of a national cohort of infants with Hirschsprung's disease (HD). DESIGN Population-based cohort study of all live-born infants with HD born in the UK and Ireland from October 2010 to September 2012. SETTING All 28 paediatric surgical centres in the UK and Ireland. PARTICIPANTS 305 infants presenting before 6 months of age with histologically proven HD. MAIN OUTCOME MEASURES Incidence, clinical characteristics including gestational age, birth weight, gender, associated anomalies; age and clinical features at presentation; and use of rectal washouts or stoma. RESULTS The incidence of HD in the UK and Ireland was 1.8 per 10 000 live births (95% CI 1.5 to 1.9). Male to female ratio was 3.3:1. An associated anomaly was identified in 23% (69), with 15% (47) having a recognisable syndrome. The proportion of infants who presented and were diagnosed in the neonatal period was 91.5% (279) and 83.9% (256), respectively. 23.9% (73) and 44.2% (135) passed meconium within 24 and 48 hours of birth. 81% (246) first presented to a hospital without tertiary paediatric surgical services, necessitating interhospital transfer. Initial colonic decompression was by rectal washouts in 86.2% (263) and by defunctioning stoma in 12.8% (39). Subsequently, 27.4% (72) of infants failed management with rectal washouts and required a delayed stoma, resulting in 36.4% (111) of infants having a stoma. CONCLUSIONS In this population-based cohort, presentation outside the neonatal period was rare. Nearly half of the infants with HD passed meconium within 48 hours of birth and over one third were managed with a stoma.
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Affiliation(s)
- T J Bradnock
- Department of Paediatric Surgery, The Royal Hospital for Children, Glasgow, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - S Kenny
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G M Walker
- Department of Paediatric Surgery, The Royal Hospital for Children, Glasgow, UK
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Abstract
OBJECTIVE This study aimed to examine the factors associated with maternal mortality among women aged ≥35 years. DESIGN Unmatched population based case-control study. SETTING United Kingdom. POPULATION Between 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE-UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005-2012). METHODS Risk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis. MAIN OUTCOME MEASURES Odds ratios and 95% confidence intervals associated with maternal death. RESULTS Five factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13-3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79-63.45), medical co-morbidities (aOR 5.92, 95% CI 3.56-9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23-3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02-1.22). CONCLUSION Age was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age. TWEETABLE ABSTRACT Smoking is a risk factor for maternal death for those aged over 35 years.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Nair
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Rajeswari B, Nair M, Ninan A, Parukuttyamma K. Ovarian tumors in children: 10-year experience from a tertiary care center in South India. Indian J Cancer 2017; 53:292-295. [PMID: 28071630 DOI: 10.4103/0019-509x.197726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ovarian tumors are uncommon in childhood and constitute around 1% of childhood malignancies. Two thirds of pediatric ovarian tumors are germ cell tumors. Epithelial ovarian tumors and stromal tumors are less frequent. We share our experience in childhood ovarian cancers, analyzing a series of cases with respect to the clinical profile, treatment and survival. METHODS All newly diagnosed ovarian tumors in children up to 14 years of age, registered in our Pediatric Oncology Division between January 2000 and December 2009 were retrospectively reviewed. OBSERVATIONS There were 47 patients with newly diagnosed ovarian tumors. The mean age at presentation was 10.0 ± 3.4 years. The most common symptoms at presentation were acute abdominal pain (48.9%) and abdominal mass (40.4%). Precocious puberty was uncommon (6.3%). Histology was germ cell tumors in 44 cases and nongerm cell tumors in three cases. The benign teratomas (mature and immature grade 1 and 2; n=9) underwent complete surgical resection alone; none had recurrence on follow up. Of the remaining 35 GCTs, 31 patients were given chemotherapy and 4 refused treatment.26 out of the 31 patients completed chemotherapy with BEP (bleomycin, etoposide, cisplatin) regimen with acceptable toxicities. 5 children i.e.; (19.2%) developed recurrence. At a median follow up of 80 months, 10 year disease free survival was 80.8 ± 7.7% and 10 year overall survival was 92.7 ± 4.9%. CONCLUSION Germ cell tumors are the most common ovarian malignancy in children. With surgery and chemotherapy using BEP, good outcome can be expected in these patients.
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Affiliation(s)
- B Rajeswari
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - M Nair
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - A Ninan
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K Parukuttyamma
- Division of Pediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Chinnapaiyan S, Parira T, Dutta R, Agudelo M, Morris A, Nair M, Unwalla HJ. HIV Infects Bronchial Epithelium and Suppresses Components of the Mucociliary Clearance Apparatus. PLoS One 2017; 12:e0169161. [PMID: 28060951 PMCID: PMC5217953 DOI: 10.1371/journal.pone.0169161] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022] Open
Abstract
Recurrent lung infections and pneumonia are emerging as significant comorbidities in the HIV-infected population in the era of combination antiretroviral therapy (cART). HIV infection has been reported to suppress nasal mucociliary clearance (MCC). Since the primary components driving nasal MCC and bronchial MCC are identical, it is possible that bronchial MCC is affected as well. Effective MCC requires optimal ciliary beating which depends on the maintenance of the airway surface liquid (ASL), a function of cystic fibrosis transmembrane conductance regulator (CFTR) activity and the integrity of the signaling mechanism that regulates ciliary beating and fluid secretion. Impairment of either component of the MCC apparatus can compromise its efficacy and promote microbial colonization. We demonstrate that primary bronchial epithelium expresses HIV receptor CD4 and co-receptors CCR5 and CXCR4 and can be infected by both R5 and X4 tropic strains of HIV. We show that HIV Tat suppresses CFTR biogenesis and function in primary bronchial epithelial cells by a pathway involving TGF-β signaling. HIV infection also interferes with bronchial epithelial cell differentiation and suppresses ciliogenesis. These findings suggest that HIV infection suppresses tracheobronchial mucociliary clearance and this may predispose HIV-infected patients to recurrent lung infections, pneumonia and chronic bronchitis.
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Affiliation(s)
- S. Chinnapaiyan
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
| | - T. Parira
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
| | - R. Dutta
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
| | - M. Agudelo
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
| | - A. Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - M. Nair
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
| | - H. J. Unwalla
- Department of Immunology, Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University. Miami, Florida, United States of America
- * E-mail:
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Mullanfiroze K, Boddu D, Chandar R, Nair M, Priya Kumari T. Severity of clinical manifestations of dengue infection in pediatric oncology during maximum immunosuppression: Does it change the clinical course? Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.11.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cai K, Desai M, Shao W, Chen X, Campbell YL, Nair M, Suman SP, Schilling MW. Quality Characteristics of Normal and Woody Breast Meat. Meat and Muscle Biology 2017. [DOI: 10.22175/rmc2016.073] [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] Open
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Nair M, Paul LT, Latha PT, Parukkutty K. Parents' Knowledge and Attitude Regarding Their Child's Cancer and Effectiveness of Initial Disease Counseling in Pediatric Oncology Patients. Indian J Palliat Care 2017; 23:393-398. [PMID: 29123344 PMCID: PMC5661340 DOI: 10.4103/ijpc.ijpc_83_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To examine parent's knowledge, attitude and psychosocial response regarding their child's cancer and treatment after initial disease counseling by doctor. Materials and Methods: Structured questionnaire based study of 43 mothers of newly diagnosed pediatric cancer patients undergoing treatment in pediatric oncology division. Mothers received initial counseling regarding their child's cancer and treatment from the doctor. Questionnaire was administered 2-6 months after initial counseling and mothers self-reported their responses. Results: 83% mothers had school level education only and 84% belonged to lower and middle socio-economic status. More than 80% mothers knew the name of their child's cancer, type of treatment received by child and approximate duration of treatment. 93% knew regarding painful procedures and 84% mothers reported knowledge about chemotherapy side effects. Hope of cure and satisfaction with treatment were reported by 90% mothers. 81% mothers reported high levels of anxiety and 66% worried regarding painful procedures. As high as 60% of parents were afraid to send their child outside to play and 40% were afraid to send their child to school. 40% mothers wanted more information regarding child's higher education, married life & fertility. On statistical analysis, mother's age, educational status or family background did not influence their knowledge and attitude. Conclusion: Relevant information about child's cancer and treatment can be imparted effectively even to mothers with school level education. This knowledge helps to instill hopeful attitude, confidence and satisfaction in parents. Anxiety and fear related to cancer persists in mothers even after the initial stress period is over. Pain related to injections and procedures is a major concern in parents. Involvement of counselor in the treating team is desirable to overcome these problems.
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Affiliation(s)
- Manjusha Nair
- Regional Cancer Centre, Division of Pediatric Oncology, Trivandrum, Kerala, India
| | - Lidiya T Paul
- Regional Cancer Centre, Division of Pediatric Oncology, Trivandrum, Kerala, India
| | - P T Latha
- Regional Cancer Centre, Division of Cancer Epidemiology, Trivandrum, Kerala, India
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45
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Desai M, Jackson V, Zhai W, Suman S, Nair M, Beach C, Schilling W. Proteome Basis of Pale, Soft, and Exudative Broiler Breast (Pectoralis Major) Meat. Meat and Muscle Biology 2017. [DOI: 10.22175/rmc2016.080] [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] Open
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46
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Sagar V, Atluri VSR, Tomitaka A, Shah P, Nagasetti A, Pilakka-Kanthikeel S, El-Hage N, McGoron A, Takemura Y, Nair M. Coupling of transient near infrared photonic with magnetic nanoparticle for potential dissipation-free biomedical application in brain. Sci Rep 2016; 6:29792. [PMID: 27465276 PMCID: PMC4964614 DOI: 10.1038/srep29792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/21/2016] [Indexed: 01/05/2023] Open
Abstract
Combined treatment strategies based on magnetic nanoparticles (MNPs) with near infrared ray (NIR) biophotonic possess tremendous potential for non-invasive therapeutic approach. Nonetheless, investigations in this direction have been limited to peripheral body region and little is known about the potential biomedical application of this approach for brain. Here we report that transient NIR exposure is dissipation-free and has no adverse effect on the viability and plasticity of major brain cells in the presence or absence superparamagnetic nanoparticles. The 808 nm NIR laser module with thermocouple was employed for functional studies upon NIR exposure to brain cells. Magnetic nanoparticles were characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), dynamic laser scattering (DLS), and vibrating sample magnetometer (VSM). Brain cells viability and plasticity were analyzed using electric cell-substrate impedance sensing system, cytotoxicity evaluation, and confocal microscopy. When efficacious non-invasive photobiomodulation and neuro-therapeutical targeting and monitoring to brain remain a formidable task, the discovery of this dissipation-free, transient NIR photonic approach for brain cells possesses remarkable potential to add new dimension.
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Affiliation(s)
- Vidya Sagar
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
| | - V. S. R. Atluri
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
| | - A. Tomitaka
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
| | - P. Shah
- Department of Biomedical engineering, College of Engineering and Computing, Florida International University, Miami, 33174 Florida, USA
| | - A. Nagasetti
- Department of Biomedical engineering, College of Engineering and Computing, Florida International University, Miami, 33174 Florida, USA
| | - S. Pilakka-Kanthikeel
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
| | - N. El-Hage
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
| | - A. McGoron
- Department of Biomedical engineering, College of Engineering and Computing, Florida International University, Miami, 33174 Florida, USA
| | - Y. Takemura
- Department of Electrical and Computer Engineering, Yokohama National University, Yokohama 240-8501, Japan
| | - M. Nair
- Center for Personalized Nanomedicine/Institute of Neuroimmune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida 33199, USA
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Vora A, Kapoor A, Nair M, Lokhandwala Y, Narsimhan C, Ravikishore AG, Dwivedi SK, Namboodiri N, Hygriv R, Saxena A, Nabar A, Garg S, Bardoloi N, Yadav R, Nambiar A, Pandurangi U, Jhala D, Naik A, Nagmallesh, Rajagopal S, Selvaraj R, Arora V, Thachil A, Thomas J, Panicker G. Clinical presentation, management, and outcomes in the Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF) registry. Indian Heart J 2016; 69:43-47. [PMID: 28228305 PMCID: PMC5319007 DOI: 10.1016/j.ihj.2016.06.006] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/22/2016] [Accepted: 06/10/2016] [Indexed: 11/08/2022] Open
Abstract
Aim A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. Methods A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed. Results The average age of Indian AF patients was 54.7 years. There was a marginal female preponderance – 51.5% females and 48.5% males. At baseline, 20.4% had paroxysmal AF; 33% had persistent AF; 35.1% had permanent AF and 11% had first AF episode. At one-year follow-up, 45.6% patients had permanent AF. Rheumatic valvular heart disease (RHD) was present in 47.6% of patients. Hypertension, heart failure, coronary artery disease, and diabetes were seen in 31.4%, 18.7%, 16.2%, and 16.1%, respectively. Rate control was the strategy used in 75.2% patients, digoxin and beta-blockers being the most frequently prescribed rate-control drugs. Oral anticoagulation (OAC) drugs were used in 70% of patients. The annual mortality was 6.5%, hospitalization 8%, and incidence of stroke 1%. Conclusions In India, AF patients are younger and RHD is still the most frequent etiology. Almost two-third of the patients have persistent/permanent AF. At one-year follow-up, there is a significant mortality and morbidity in AF patients in India.
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Affiliation(s)
- A Vora
- Arrhythmia Associates, Mumbai, India.
| | - A Kapoor
- Department of Cardiology, Sanjay Gandhi Post-Graduate Institute, Lucknow, India
| | - M Nair
- Holy Family Hospital, New Delhi, India
| | | | - C Narsimhan
- Division of Electrophysiology, Care Hospital, Hyderabad, India
| | | | - S K Dwivedi
- Department of Cardiology, King George Medical University, Lucknow, India
| | - N Namboodiri
- Department of Cardiology, Sri Chitra Trinumal Hospital, Trivandrum, India
| | - R Hygriv
- KIMS Hospitals, Hyderabad, India
| | - A Saxena
- Cardiac Pacing & Electrophysiology, Fortis Escorts Hospital, New Delhi, India
| | - A Nabar
- Department of Cardiology, KEM Hospital, Mumbai, India
| | - S Garg
- Maulana Azad Medical College, New Delhi, India
| | - N Bardoloi
- Cardiology Department, Apollo Hospital, Guwahati, India
| | - R Yadav
- Department of Cardiology, AIIMS Hospital, New Delhi, India
| | - A Nambiar
- Cardiology, Baby Memorial Hospital, Kozhikode, India
| | | | - D Jhala
- Lilavati Hospital, Mumbai, India
| | - A Naik
- Division of Electrophysiology, CIMS Hospital, Ahmedabad, India
| | - Nagmallesh
- M.S. Ramaiah Memorial Hospital, Bengaluru, India
| | - S Rajagopal
- Department of Cardiology, Railway Hospital, Chennai, India
| | - R Selvaraj
- Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - V Arora
- Division of Electrophysiology, Max Superspeciality Hospital, Delhi, India
| | - A Thachil
- Division of Electrophysiology, Lisie Hospital, Kochi, India
| | - J Thomas
- Frontier Lifeline Hospital, Chennai, India
| | - G Panicker
- Quintiles Cardiac Safety Services, Mumbai, India
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Uttarilli A, Ranganath P, Matta D, Md Nurul Jain J, Prasad K, Babu AS, Girisha KM, Verma IC, Phadke SR, Mandal K, Puri RD, Aggarwal S, Danda S, Sankar VH, Kapoor S, Bhat M, Gowrishankar K, Hasan AQ, Nair M, Nampoothiri S, Dalal A. Identification and characterization of 20 novel pathogenic variants in 60 unrelated Indian patients with mucopolysaccharidoses type I and type II. Clin Genet 2016; 90:496-508. [PMID: 27146977 DOI: 10.1111/cge.12795] [Citation(s) in RCA: 21] [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: 01/11/2016] [Revised: 04/23/2016] [Accepted: 05/01/2016] [Indexed: 11/30/2022]
Abstract
Mucopolysaccharidoses (MPS), a subgroup of lysosomal storage disorders, are caused due to deficiency of specific lysosomal enzyme involved in catabolism of glycosaminoglycans. To date more than 200 pathogenic variants in the alpha-l-iduronidase (IDUA) for MPS I and ∼500 pathogenic variants in the iduronate-2-sulphatase (IDS) for MPS II have been reported worldwide. The mutation spectrum of MPS type I and MPS type II disorders in Indian population is not characterized yet. In this study, we carried out clinical, biochemical, molecular and in silico analyses to establish the mutation spectrum of MPS I and MPS II in the Indian population. We conducted molecular analysis for 60 MPS-affected patients [MPS I (n = 30) (Hurler syndrome = 17, Hurler-Scheie syndrome = 13), and MPS II (n = 30) (severe = 18, attenuated = 12)] and identified a total of 44 [MPS I (n = 22) and MPS II (n = 22)] different pathogenic variants comprising missense, nonsense, frameshift, gross deletions and splice site variants. A total of 20 [MPS I (n = 14), and MPS II (n = 6)] novel pathogenic sequence variants were identified in our patient cohort. We found that 32% of pathogenic variants detected in IDUA were recurrent and 25% in MPS II. This is the first study revealing the mutation spectrum of MPS I and MPS II patients in the Indian population.
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Affiliation(s)
- A Uttarilli
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Graduate Studies, Manipal University, Manipal, India
| | - P Ranganath
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - D Matta
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - J Md Nurul Jain
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - K Prasad
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - A S Babu
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - K M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, India
| | - I C Verma
- Center of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India
| | - S R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - K Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R D Puri
- Center of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India
| | - S Aggarwal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - S Danda
- Department of Clinical Genetics, Christian Medical College and Hospital, Vellore, India
| | - V H Sankar
- Genetics Clinic, Department of Pediatrics, SAT Hospital, Government Medical College, Trivandrum, India
| | - S Kapoor
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - M Bhat
- Centre for Human Genetics, Bengaluru, India
| | | | - A Q Hasan
- Department of Genetics, Kamineni Hospital, Hyderabad, India
| | - M Nair
- Additional Professor in Pediatrics, Government Medical College, Manjeri, India
| | - S Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences, Kochi, India
| | - A Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
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Nair M, Knight M, Kurinczuk JJ. Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case-control study. BJOG 2016; 123:1654-62. [PMID: 26969482 PMCID: PMC5021205 DOI: 10.1111/1471-0528.13978] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
Objectives To identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK. Design Unmatched case–control analysis. Setting All hospitals caring for pregnant women in the UK. Population Comprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life‐threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS). Methods Multivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths. Outcomes Odds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk. Results Seven factors, of 13 examined, were independently associated with increased odds of maternal death: pre‐existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29–11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14–11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33–2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61–111.94), substance misuse (aOR 12.21; 95% CI 2.33–63.98), unemployment (aOR 1.81; 95% CI 1.08–3.04) and maternal age (aOR 1.06; 95% CI 1.04–1.09). There was a four‐fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died. Conclusion This study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio‐economic inequalities in maternal death in the UK. Tweetable abstract Medical comorbidities and socio‐economic inequalities are important risk factors for maternal death in the UK. Medical comorbidities and socio‐economic inequalities are important risk factors for maternal death in the UK.
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Affiliation(s)
- M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Affiliation(s)
- RD Jayant
- Center of Personalized Nanomedicine, Institute of Neuro Immune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL-33199, USA
| | - M Nair
- Center of Personalized Nanomedicine, Institute of Neuro Immune Pharmacology, Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL-33199, USA
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