1
|
Mellen PL, Obeid A, Wibbelsman TD, Hsu J, Konkoly MA, Velez MR, Calem DB, Sioufi K, Jenkins TL, Xu D, Chiang A, Gupta OP, Spirn M, Regillo CD, Ho AC, Klufas MA. Clinical Outcomes of Eyes With Diabetic Macular Edema Switched From Aflibercept to Ranibizumab Therapy. Ophthalmic Surg Lasers Imaging Retina 2020; 51:691-697. [PMID: 33339050 DOI: 10.3928/23258160-20201202-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE In 2018, cases of inflammation were reported after intravitreal aflibercept (IVA), which resulted in switches to intravitreal ranibizumab (IVR). The authors' purpose was to evaluate outcomes after switching from IVA to IVR in diabetic macular edema (DME). PATIENTS AND METHODS Retrospective cohort study. Eyes switched from IVA to IVR for treating DME were included. Data were gathered from three visits before to three visits post-switch. Outcome measures included central subfoveal thickness (CFT) and Snellen visual acuity (VA). RESULTS There was a statistically significant increase in CFT at the first visit (325 μm ± 234 μm; P = .006) compared to the switch visit, but no difference later visits (268 μm ± 103 μm; P = .32; 284 μm ± 118 μm; P = .11; n = 54). There was no statistically significant change in mean logarithm of the minimum angle of resolution VA between the switch and later visits (0.43 ± 0.38, P = .95; 0.38 ± 0.30, P = .12; 0.41 ± 0.37, P = .69). CONCLUSIONS The authors observed transient worsening of macular edema in eyes treated for DME when switched from aflibercept to ranibizumab. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:691-697.].
Collapse
|
2
|
Orsinelli DA, Orsinelli MH, Velez MR. Radiation Exposure of Cardiac Sonographers. J Am Soc Echocardiogr 2018; 31:1366. [PMID: 30522607 DOI: 10.1016/j.echo.2018.09.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- David A Orsinelli
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | | | | |
Collapse
|
3
|
Milks MW, Velez MR, Mehta N, Ishola A, Van Houten T, Yildiz VO, Reinbolt R, Lustberg M, Smith SA, Orsinelli DA. Usefulness of Integrating Heart Failure Risk Factors Into Impairment of Global Longitudinal Strain to Predict Anthracycline-Related Cardiac Dysfunction. Am J Cardiol 2018; 121:867-873. [PMID: 29454478 DOI: 10.1016/j.amjcard.2017.12.022] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022]
Abstract
The prediction of cancer therapeutics-related cardiac dysfunction (CTRCD) is an essential aspect of care for individuals who receive potentially cardiotoxic oncologic treatments. Certain clinical risk factors have been described for incident CTRCD, and measurement of left ventricular (LV) longitudinal strain by speckle tracking 2-dimensional echocardiography (2DE) is the best-validated myocardial mechanical imaging assessment to detect subtle changes in LV function during cancer treatment. However, the direct integration of clinical and imaging risk factors to predict CTRCD has not yet been extensively examined. This was a retrospective study of 183 women with breast cancer aged 50.9 ± 10.8 years who received treatment with anthracyclines (doxorubicin dose of 422 ± 69 mg/m2, with 41.2% of subjects also receiving trastuzumab) and underwent 2DE at clinically determined intervals. CTRCD was diagnosed when LV ejection fraction dropped ≥10% to a subnormal (<53%) value by 2DE. Left ventricular global longitudinal strain (LV-GLS) was assessed offline. The risk prediction tool based only on clinical factors previously described by Ezaz et al was applied to our cohort and accurately stratified these subjects into low-, intermediate-, and high-risk groups, with incident CTRCD in 7.4%, 26.9%, and 54.6%, respectively (chi-square = 20.7, p <0.0001). We developed novel multivariate models to predict CTRCD using (1) demographic variables only (c = 0.8674), (2) echocardiographic (peak LV-GLS) variables only (c = 0.8440), or (3) a combination of demographic and echocardiographic variables, with the combined model exhibiting superior receiver-operating characteristics (c = 0.9629). In conclusion, estimation of CTRCD risk should integrate all available data, including both clinical variables and an imaging assessment.
Collapse
Affiliation(s)
- M Wesley Milks
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Michael R Velez
- Columbus Cardiology Consultants, Mount Carmel Health System, Columbus, Ohio
| | - Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Abiodun Ishola
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Thomas Van Houten
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vedat O Yildiz
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Raquel Reinbolt
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sakima A Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David A Orsinelli
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
4
|
Velez MR, Orsinelli MH, Orsinelli DA. Radiation exposure of cardiac sonographers working in an academic noninvasive cardiovascular imaging laboratory. Echocardiography 2017; 35:4-8. [DOI: 10.1111/echo.13718] [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: 11/29/2022] Open
Affiliation(s)
- Michael R. Velez
- Division of Cardiovascular Medicine; Davis Heart and Lung Research Institute; The Ohio State University Wexner Medical Center; Columbus OH USA
- Mt. Carmel Health System; Columbus OH USA
| | - Maryellen H. Orsinelli
- The Richard M. Ross Heart Hospital; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - David A. Orsinelli
- Division of Cardiovascular Medicine; Davis Heart and Lung Research Institute; The Ohio State University Wexner Medical Center; Columbus OH USA
| |
Collapse
|
6
|
Abstract
BACKGROUND The prototype for the cardiovascular imager has evolved to necessitate some degree of competency in multimodality imaging (MMI)-defined as expertise in at least 2 of the 4 modalities (echocardiography [ECHO], nuclear cardiology [NUC], cardiovascular computed tomography [CCT], and magnetic resonance [CMR]). Uncertainty exists about the effects of this change. METHODS Information detailing the current totals of board-certified practitioners in MMI was collected and organized into groups of 1, 2, and 3 modalities. A randomized stratified sample of names was obtained to identify a representative 10% of each group. Those names were cross-referenced online with information from state medical boards, faculty rosters of academic medical centers, and physician tracking Websites. RESULTS There are a total of 2209 board-certified MMI practitioners (2 modalities = 1885, 3 modalities = 324) and 6450 single-modality imagers in the United States. Of those sampled, 98.9% were cardiologists, 31.3% were at academic medical centers and mean time from medical school graduation was 17.75 years. MMI practitioners were more likely to have graduated from medical school more recently (P < 0.0001) and to be trained cardiologists (P = 0.003) than those who practice in a single modality. There was a nonsignificant trend toward MMI being practiced more commonly in an academic setting (P = 0.38). CONCLUSION Board-certified specialists in MMI tend to be younger cardiologists than those engaged in single-modality cardiac imaging. There are few advanced (3 modality) MMI practitioners in the United States.
Collapse
Affiliation(s)
- Michael R Velez
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | |
Collapse
|
7
|
Essa E, Velez MR, Smith S, Giri S, Raman SV, Gumina RJ. Cardiovascular magnetic resonance in wet beriberi. J Cardiovasc Magn Reson 2011; 13:41. [PMID: 21838901 PMCID: PMC3175447 DOI: 10.1186/1532-429x-13-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/12/2011] [Indexed: 11/23/2022] Open
Abstract
The clinical presentation of beriberi can be quite varied. In the extreme form, profound cardiovascular involvement leads to circulatory collapse and death. This case report is of a 72 year-old male who was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He subsequently developed pulmonary edema and high output cardiac failure requiring intubation and blood pressure support. With the constellation of peripheral neuropathy, encephalopathy, ophthalmoplegia, unexplained heart failure, and lactic acidosis, thiamine deficiency was suspected. He was empirically initiated on thiamine replacement therapy and his thiamine level pre-therapy was found to be 23 nmol/L (Normal: 80-150 nmol/L), consistent with the diagnosis of beriberi. Cardiovascular magnetic resonance (CMR) showed severe left ventricular systolic dysfunction, markedly increased myocardial T2, and minimal late gadolinium enhancement (LGE). After 5 days of daily 100 mg IV thiamine and supportive care, the hypotension resolved and the patient was extubated and was released from the hospital 3 weeks later. Our case shows via CMR profound myocardial edema associated with wet beriberi.
Collapse
Affiliation(s)
- Essa Essa
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Michael R Velez
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Sakima Smith
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Shivraman Giri
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Richard J Gumina
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| |
Collapse
|
8
|
Sidhom MB, Velez MR. Monitoring the effect of triamterene and hydrochlorothiazide on dihydrofolate reductase activity using a new spectrophotometric method. J Pharm Biomed Anal 1989; 7:1551-7. [PMID: 2490542 DOI: 10.1016/0731-7085(89)80164-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A new spectrophotometric method is developed and applied for the study of the inhibitory effect of triamterene, hydrochlorothiazide and their combinations on the in vitro activity of dihydrofolate reductase enzyme. The method is based on incubating the drug (0.1-1.0 microM) or a buffer control with a solution containing reduced nicotinamide adenine dinucleotide phosphate (0.5 mM), magnesium chloride (1.29 mM), and folic acid as a substrate (0.01-0.1 mM) with the dihydrofolate reductase (0.25 unit). The resulting tetrahydrofolic acid is determined by first hydrolysing it by a methanol-hydrochloric acid mixture to produce p-aminobenzoyl glutamic acid, then adding p-dimethylaminocinnamic aldehyde reagent to form a stable pink coloured product. The colour is found to develop within 5 min and is stable over 12 h, with a maximum absorption at 545 nm. A linear calibration curve is formed by using standard solutions of tetrahydrofolic acid. The presence of the studied drugs did not interfere with the determination. Lineweaver-Burk plots of the reaction kinetics, in the presence of triamterene and/or hydrochlorothiazide showed a competitive inhibition of the dihydrofolate reductase in the presence of triamterene with or without hydrochlorothiazide. A 100% inhibition is obtained by 1 microM solution of triamterene at a folic acid concentration of 0.01 mM. No measurable effect of hydrochlorothiazide at the studied concentration range is demonstrated.
Collapse
Affiliation(s)
- M B Sidhom
- College of Pharmacy, University of Puerto Rico, San Juan 00936
| | | |
Collapse
|