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Savoldo B, Grover N, Dotti G. CAR T cells for hematological malignancies. J Clin Invest 2024; 134:e177160. [PMID: 38226627 PMCID: PMC10786683 DOI: 10.1172/jci177160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
- Barbara Savoldo
- Lineberger Comprehensive Cancer Center
- Department of Pediatrics
| | - Natalie Grover
- Lineberger Comprehensive Cancer Center
- Department of Medicine, and
| | - Gianpietro Dotti
- Lineberger Comprehensive Cancer Center
- Department of Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Jena A, Grover N, Bhatia P, Singh M, Lad D, Prasad KK, Singh H, Dutta U, Sharma V. ITPA polymorphisms do not predict additional risk beyond TPMT and NUDT15 for thiopurine-induced cytopenia in inflammatory bowel disease. Rev Gastroenterol Mex (Engl Ed) 2024; 89:25-30. [PMID: 36707393 DOI: 10.1016/j.rgmxen.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND AIM Thiopurine-related leukopenia is associated with polymorphisms in the thiopurine methyltransferase (TPMT) and nucleoside diphosphate-linked moiety X type motif 15 (NUDT15) genes. However, those polymorphisms explain only a fraction of thiopurine-related leukopenia. Our aim was to study the role of an inosine triphosphate pyrophosphatase (ITPA) polymorphism in patients with inflammatory bowel disease (IBD) and thiopurine-related leukopenia that was unexplained by the TPMT and NUDT15 polymorphisms. MATERIAL AND METHODS We enrolled consecutive IBD patients on thiopurines (azathioprine or 6-mercaptopurine) from January 2019-March 2020, at a tertiary care center in North India. The presence of the ITPA (C.94C > A) polymorphism was evaluated in all patients, along with its association with thiopurine-related leukopenia. RESULTS Of the 33 patients (from a total of 119 patients) that developed leukopenia, 8 had the TPMT (n = 1) or NUDT15 (n = 7) polymorphism. Of the remaining 111 patients, their mean age was 36.36 ± 13.54 years and 57 (51.3%) were males. Twenty-five (21.01%) had unexplained leukopenia. The ITPA polymorphism was detected in 4 (16%) patients in the unexplained leukopenia group and 24 (27.9%) patients in the non-leukopenia group (p = 0.228). The odds ratio for predicting leukopenia with the ITPA polymorphism was 0.4921 (95% CI 0.1520-1.5830, p = 0.234). CONCLUSION The ITPA (C.94C > A) polymorphism was frequently detected in the study population but was not predictive for leukopenia in patients with IBD on thiopurine therapy.
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Affiliation(s)
- A Jena
- Departamento de Gastroenterología, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - N Grover
- Departamento de Medicina Interna, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - P Bhatia
- Departamento de Hemato-Oncología Pediátrica, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - M Singh
- Departamento de Hemato-Oncología Pediátrica, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - D Lad
- Departamento de Hematología Clínica, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - K K Prasad
- Departamento de Gastroenterología, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - H Singh
- Departamento de Gastroenterología Quirúrgica, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - U Dutta
- Departamento de Gastroenterología, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India
| | - V Sharma
- Departamento de Gastroenterología, Instituto de Posgrado de Educación e Investigación Médica, Chandigarh, India.
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Schorr C, Forindez J, Espinoza-Gutarra M, Mehta R, Grover N, Perna F. Thrombotic Events Are Unusual Toxicities of Chimeric Antigen Receptor T-Cell Therapies. Int J Mol Sci 2023; 24:8349. [PMID: 37176053 PMCID: PMC10179014 DOI: 10.3390/ijms24098349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has greatly transformed the treatment and prognosis of B-cell hematological malignancies. As CAR T-cell therapy continues to be more readily adopted and indications increase, the field's recognition of emerging toxicities will continue to grow. Among the adverse events associated with CAR T-cell therapy, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are the most common toxicities, while thrombotic events represent an under-reported, life-endangering complication. To determine thrombosis incidence post CAR T-cell therapy, we performed a multi-center, retrospective study on CAR T-cell therapy adult patients (N = 140) from Indiana University Simon Cancer Center and the University of North Carolina Medical Center treated from 2017 to 2022 for relapsed and refractory B-cell acute lymphoblastic leukemia (B-ALL, N = 3), diffuse large B-cell lymphoma (DLBCL, N = 92), follicular lymphoma (FL, N = 9), mantle cell lymphoma (MCL, N = 2), and multiple myeloma (MM, N = 34). We report 10 (7.14%) thrombotic events related to CAR T-cell therapy (DLBCL: N = 8, FL: N = 1, MM: N = 1) including 9 primary venous events and 1 arterial event that occurred with median time of 23.5 days post CAR T-cell infusion. In search of parameters associated with such events, we performed multivariate analyses of coagulation parameters (i.e., PT, PTT, and D-Dimer), scoring for adverse events (Padua Score and ISTH DIC Score) and grading for CAR T-cell toxicity severity (CRS grade and ICANS grade) and found that D-Dimer peak elevation and ICANS grade were significantly associated with post-CAR T-cell infusion thrombosis. While the pathophysiology of CAR T-cell associated coagulopathy remains unknown, our study serves to develop awareness of these emerging and unusual complications.
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Affiliation(s)
- Christopher Schorr
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.S.)
- Department of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Jorge Forindez
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Rakesh Mehta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.S.)
| | - Natalie Grover
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Fabiana Perna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (C.S.)
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Dittus C, Grover N, Sethi T, Cohen JB, Voloschin A, Rabadey J, Tan X, Beaven A, Park SI. A multicenter, real-world analysis of primary central nervous system lymphoma in those with and without human immunodeficiency virus. EJHaem 2022; 3:734-738. [PMID: 36051081 PMCID: PMC9421958 DOI: 10.1002/jha2.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Christopher Dittus
- Division of HematologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Natalie Grover
- Division of HematologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tarsheen Sethi
- Division of HematologyYale UniversityNew HavenConnecticutUSA
| | - Jonathon B. Cohen
- Department of Hematology and Medical OncologyEmory University‐Winship Cancer InstituteAtlantaGeorgiaUSA
| | - Alfredo Voloschin
- Department of Hematology and Medical OncologyEmory University‐Winship Cancer InstituteAtlantaGeorgiaUSA
| | - Janhvi Rabadey
- Division of HematologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Xianming Tan
- Division of HematologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anne Beaven
- Division of HematologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Steven I. Park
- Atrium Health Levine Cancer InstituteCharlotteNorth CarolinaUSA
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Jena A, Grover N, Bhatia P, Singh M, Lad D, Prasad K, Singh H, Dutta U, Sharma V. Los polimorfismos de ITPA no predicen un riesgo adicional más allá de TPMT y NUDT15 para citopenia inducida por tiopurina en la enfermedad inflamatoria intestinal. Revista de Gastroenterología de México 2022. [DOI: 10.1016/j.rgmx.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
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Abdou Y, Yuan Y, Ueno N, Dees E, Chao J, Grover N, Angelos M, Barton D, Swaby R, Ronczka A, Cushing D, Abramson S, Condamine T, Klichinsky M, Reiss K. Hematopoietic Stem/Progenitor Cells and Engineering: A PHASE 1, FIRST IN HUMAN (FIH) STUDY OF ADENOVIRALLY TRANSDUCED AUTOLOGOUS MACROPHAGES ENGINEERED TO CONTAIN AN ANTI-HER2 CHIMERIC ANTIGEN RECEPTOR (CAR) IN SUBJECTS WITH HER2 OVEREXPRESSING SOLID TUMORS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Forster M, Fedoriw Y, Tuchman S, Grover N. Epstein–Barr virus mucocutaneous ulcer followed by Hodgkin lymphoma in multiple myeloma patient. Clin Case Rep 2022; 10:e05528. [PMID: 35280097 PMCID: PMC8894576 DOI: 10.1002/ccr3.5528] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022] Open
Abstract
Epstein–Barr virus mucocutaneous ulcers (EBV MCU) are B‐cell lymphoproliferative disorders associated with immunosuppression. We report EBV MCU in a multiple myeloma patient on lenalidomide maintenance after stem cell transplant that resolved with decreased immunosuppression. Furthermore, the subsequent development of classical Hodgkin lymphoma suggests an underlying predisposition to EBV‐driven lymphoproliferative disorders.
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Affiliation(s)
- Moriah Forster
- Department of Internal Medicine University of North Carolina Chapel Hill North Carolina USA
| | - Yuri Fedoriw
- Department of Pathology and Lab Medicine University of North Carolina Chapel Hill North Carolina USA
| | - Sascha Tuchman
- Lineberger Comprehensive Cancer Center Department of Hematology University of North Carolina Chapel Hill North Carolina USA
| | - Natalie Grover
- Lineberger Comprehensive Cancer Center Department of Hematology University of North Carolina Chapel Hill North Carolina USA
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Scordo M, Wang TP, Ahn KW, Chen Y, Ahmed S, Awan FT, Beitinjaneh A, Chen A, Chow VA, Dholaria B, Epperla N, Farooq U, Ghosh N, Grover N, Hamad N, Hildebrandt GC, Holmberg L, Hong S, Inwards DJ, Jimenez-Jimenez A, Karmali R, Kenkre VP, Khimani F, Klyuchnikov E, Krem MM, Munshi PN, Nieto Y, Prestidge T, Ramakrishnan Geethakumari P, Rezvani AR, Riedell PA, Seo S, Shah NN, Solh M, Yared JA, Kharfan-Dabaja MA, Herrera A, Hamadani M, Sauter CS. Outcomes Associated With Thiotepa-Based Conditioning in Patients With Primary Central Nervous System Lymphoma After Autologous Hematopoietic Cell Transplant. JAMA Oncol 2021; 7:993-1003. [PMID: 33956047 DOI: 10.1001/jamaoncol.2021.1074] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Primary central nervous system lymphoma (PCNSL) requires induction and consolidation to achieve potential cure. High-dose therapy and autologous hematopoietic cell transplant (AHCT) is an accepted and effective consolidation strategy for PCNSL, but no consensus exists on the optimal conditioning regimens. Objective To assess the outcomes in patients with PCNSL undergoing AHCT with the 3 most commonly used conditioning regimens: thiotepa/busulfan/cyclophosphamide (TBC), thiotepa/carmustine (TT-BCNU), and carmustine/etoposide/cytarabine/melphalan (BEAM). Design, Setting, and Participants This observational cohort study used registry data from the Center for International Blood and Marrow Transplant Research registry. The Center is a working group of more than 380 transplantation centers worldwide that contributed detailed data on HCT to a statistical center at the Medical College of Wisconsin, Milwaukee. The participant data were from 603 adult patients with PCNSL who underwent AHCT as initial, or subsequent, consolidation between January 2010 and December 2018. Patients were excluded if they had a non-Hodgkin lymphoma subtype other than diffuse large B-cell lymphoma, systemic non-Hodgkin lymphoma, or HIV; received an uncommon conditioning regimen; or were not in partial remission or complete remission prior to AHCT. Statistical analysis was performed from July 5, 2020, to March 1, 2021. Interventions Patients received 1 of 3 conditioning regimens: TBC (n = 263), TT-BCNU (n = 275), and BEAM (n = 65). Main Outcomes and Measures The primary outcome was progression-free survival. Secondary outcomes included hematopoietic recovery, incidence of relapse, nonrelapse mortality, and overall survival. Results Of 603 patients, the mean age was 57 (range, 19-77) years and 318 (53%) were male. The 3-year adjusted progression-free survival rates were higher in the TBC cohort (75%) and TT-BCNU cohort (76%) compared with the BEAM cohort (58%) (P = .03) owing to a higher relapse risk in the BEAM cohort (hazard ratio [HR], 4.34; 95% CI, 2.45-7.70; P < .001). In a multivariable regression analysis, compared with the TBC cohort, patients who received TT-BCNU had a higher relapse risk (HR, 1.79; 95% CI, 1.07-2.98; P = .03), lower risk of nonrelapse mortality (NRM) (HR, 0.50; 95% CI, 0.29-0.87; P = .01), and similar risk of all-cause mortality more than 6 months after HCT (HR, 1.54; 95% CI, 0.93-2.55; P = .10). Age of 60 years or older, Karnofsky performance status less than 90, and an HCT-comorbidity index greater than or equal to 3 were associated with lower rates of survival across all 3 cohorts. Subgroup analyses demonstrated that patients aged 60 years and older had considerably higher NRM with TBC. Conclusions and Relevance In this cohort study, thiotepa-based conditioning regimen was associated with higher rates of survival compared with BEAM, despite higher rates of early toxic effects and NRM; these findings may assist clinicians in choosing between TBC or TT-BCNU based on patient and disease characteristics.
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Affiliation(s)
- Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Trent P Wang
- Division of Transplantation and Cellular Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee.,Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Yue Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farrukh T Awan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Andy Chen
- Department of Medicine, Oregon Health and Science University, Portland
| | - Victor A Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Narendranath Epperla
- The James Cancer Hospital and Solove Research Institute, Division of Hematology, Department of Medicine, The Ohio State University, Columbus
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City
| | - Nilanjan Ghosh
- Levine Cancer Institute, Department of Hematologic Oncology and Blood Disorders, Atrium Health, Charlotte, North Carolina
| | - Natalie Grover
- Department of Medicine, University of North Carolina Hospitals, Chapel Hill
| | - Nada Hamad
- St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | - Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sanghee Hong
- Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | | | - Antonio Jimenez-Jimenez
- Division of Transplantation and Cellular Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Reem Karmali
- Department of Medicine, Northwestern University, Chicago, Illinois
| | | | - Farhad Khimani
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Evgeny Klyuchnikov
- Department for Stem Cell Transplantation, University Cancer Center, Hamburg, Germany
| | | | - Pashna N Munshi
- Department of Medicine, Georgetown University Hospital, Washington, DC
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | | | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation, Stanford University, Stanford, California
| | - Peter A Riedell
- Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Nirav N Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Melhem Solh
- The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Greenebaum Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of Maryland, Baltimore
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
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Grover N, Barton D, Ronczka A, Bauml J. Abstract OT-28-06: A phase 1, first in human study of adenovirally transduced autologous macrophages engineered to contain an anti-HER2 chimeric antigen receptor in subjects with HER2 overexpressing solid tumors. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-28-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Adoptive T cell therapies have led to remarkable advances among patients with hematologic malignancies, but not in those with solid tumors. Macrophages are actively recruited into and more abundantly present in the tumor microenvironment (TME) as compared to T cells. Tumor- associated macrophages (TAMs), typically evince immunosuppressive behavior, but when engineered to be proinflammatory, may be an ideal vector to administer adoptive cellular therapy in solid tumors. Furthermore, insertion of a CAR confers on the macrophages the ability to selectively recognize and phagocytose antigen overexpressing cancer cells. CAR macrophages can also potentially interact with, stimulate, and present neoantigens to T cells. Human Epidermal Growth Factor Receptor 2 (HER2) is overexpressed in many cancers, including but not limited to breast and gastroesophageal cancers (Table 1). CT-0508 is a cell product comprised of autologous monocyte-derived pro-inflammatory macrophages expressing an anti-HER2 CAR. In vitro and in vivo studies have shown that CT-0508 leads to cancer cell phagocytosis sparing normal cells, decreased tumor burden and prolonged survival. CT-0508 cells were safe in a semi-immunocompetent mouse model of human HER2 overexpressing ovarian cancer. This is a FIH Phase 1 study to evaluate safety, tolerability, cell manufacturing feasibility, trafficking, and preliminary evidence of efficacy of investigational product CT-0508 on approximately 18 subjects with locally advanced (unresectable) or metastatic solid tumors overexpressing HER2 who have failed available therapies including anti-HER2 therapies when indicated.Filgrastim, will be used to mobilize autologous hematopoietic progenitor cells for monocyte collection by apheresis. CT-0508 cell product will be manufactured, prepared and cryopreserved. Group 1 will receive CT-0508 infusion split over D1, 3 and 5. Subjects will be continually assessed for acute and cumulative toxicity. Dose limiting toxicities will be observed and addressed by a Safety Review Committee. Group 2 will receive the full CT-0508 infusion on D1. Pre and post treatment biopsies and blood samples will be collected to investigate correlates of trafficking, persistence, TME modulation, immune response and safety.
Citation Format: Natalie Grover, Debora Barton, Amy Ronczka, Joshua Bauml. A phase 1, first in human study of adenovirally transduced autologous macrophages engineered to contain an anti-HER2 chimeric antigen receptor in subjects with HER2 overexpressing solid tumors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-28-06.
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Voorhees TJ, Kannan KK, Galeotti J, Grover N, Vaidya R, Moore DT, Montgomery ND, Beaven AW, Dittus C. Identification of high-risk monomorphic post-transplant lymphoproliferative disorder following solid organ transplantation. Leuk Lymphoma 2020; 62:86-94. [PMID: 32933363 DOI: 10.1080/10428194.2020.1821006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Monomorphic post-transplant lymphoproliferative disorder (M-PTLD) occurring after solid organ transplant histologically resembles aggressive non-Hodgkin lymphomas, with diffuse large B-cell lymphoma being the most common. In a cohort of 40 patients with DLBCL-type M-PTLD, inferior progression free survival (PFS) was observed for Revised International Prognostic Index (R-IPI) >2 (p = 0.01) and high-risk pathologic features (p = 0.02), defined by double expressor lymphoma, MYC rearrangement, or increased copy number of either MYC or BCL2. Overall survival (OS) was inferior in R-IPI >2 (p = 0.002) and high-risk pathologic features (p = 0.003). Combining both R-IPI >2 and high-risk pathologic features resulted in well-delineated good, intermediate, and poor risk groups of DLBCL-type M-PTLD with respect to both PFS and OS (p < 0.001). Our results demonstrate a prognostic role for both the R-IPI score and presence of high-risk pathologic features in DLBCL-type M-PTLD.
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Affiliation(s)
- Timothy J Voorhees
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kavya K Kannan
- Division of Hematology and Oncology, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Natalie Grover
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rakhee Vaidya
- Division of Hematology and Oncology, Department of Internal Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Dominic T Moore
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Anne W Beaven
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Dittus
- Division of Hematology and Oncology, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
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Malpica L, Mufuka B, Galeotti J, Tan X, Grover N, Clark SM, Beaven A, Muss H, Dittus C. A retrospective study on prephase therapy prior to definitive multiagent chemotherapy in aggressive lymphomas. Leuk Lymphoma 2020; 61:1508-1511. [PMID: 32037934 DOI: 10.1080/10428194.2020.1725505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Luis Malpica
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Bolanle Mufuka
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jonathan Galeotti
- Department of Pathology, University of North Carolina, Chapel Hill, NC, USA
| | - Xianming Tan
- Department of Biostatistics Shared Resource, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Natalie Grover
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen M Clark
- Department of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Anne Beaven
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hyman Muss
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher Dittus
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Bond D, Switchenko J, Maddocks K, Churnetski M, Goyal S, Shanmugasundaram K, Calzada O, Kolla B, Bachanova V, Gerson J, Barta S, Hill B, Salwaha Y, Martin P, Maldonado E, Gordon M, Danilov A, Grover N, Mathews S, Burkart M, Karmali R, Ghosh N, Park S, Epperla N, Badar T, Guo J, Hamadani M, Fenske T, Malecek M, Kahl B, Flowers C, Blum K, Cohen J. OUTCOMES FOR PATIENTS WITH MANTLE CELL LYMPHOMA EXPERIENCING FRONTLINE TREATMENT FAILURE: A MULTICENTER RETROSPECTIVE STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.77_2631] [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: 11/12/2022]
Affiliation(s)
- D.A. Bond
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - J. Switchenko
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Maddocks
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - M. Churnetski
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - S. Goyal
- Department of Biostatistics and Bioinformatics; Rollins School of Public Health, Emory University; Atlanta United States
| | - K. Shanmugasundaram
- Department of Internal Medicine; Emory University School of Medicine; Atlanta United States
| | - O. Calzada
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - B. Kolla
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - V. Bachanova
- Department of Hematology; University of Minnesota; Minneapolis United States
| | - J. Gerson
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - S. Barta
- Hematology; Abramson Cancer Center, University of Pennsylvania; Pennsylvania United States
| | - B. Hill
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - Y. Salwaha
- Hematology and Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - P. Martin
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - E. Maldonado
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - M. Gordon
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - A. Danilov
- Hematology and Oncology; Oregon Health and Science University, Knight Cancer Institute; Portland United States
| | - N. Grover
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - S. Mathews
- Hematology and Oncology; University of North Carolina Lineberger Comprehensive Cancer Center; Chapel Hill United States
| | - M. Burkart
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - R. Karmali
- Hematology and Oncology; Northwestern University, Feinberg School of Medicine; Chicago United States
| | - N. Ghosh
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - S. Park
- Hematology and Oncology; Atrium Health; Charlotte United States
| | - N. Epperla
- Division of Hematology; Ohio State University Comprehensive Cancer Center; Columbus United States
| | - T. Badar
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - J. Guo
- Department of Medicine; Weil Cornell Medicine; New York United States
| | - M. Hamadani
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - T. Fenske
- Hematology and Oncology; Medical College of Wisconsin; Milwaukee United States
| | - M. Malecek
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - B. Kahl
- Hematology and Oncology; Siteman Cancer Center, Washington University; St. Louis United States
| | - C. Flowers
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - K. Blum
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
| | - J. Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute; Atlanta United States
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Calzada O, Switchenko JM, Maly JJ, Blum KA, Grover N, Mathews S, Park SI, Gordon M, Danilov A, Epperla N, Fenske TS, Hamadani M, Flowers CR, Cohen JB. Deferred treatment is a safe and viable option for selected patients with mantle cell lymphoma. Leuk Lymphoma 2018; 59:2862-2870. [PMID: 29912594 DOI: 10.1080/10428194.2018.1455973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Prospective identification of candidates for deferred therapy is not standardized and many patients receive immediate therapy regardless of risk. We conducted a retrospective, multi-center cohort analysis of MCL patients with comprehensive clinical data to examine the use and safety of deferred therapy for newly diagnosed patients. Previously untreated patients ≥18 years-old with MCL diagnosed in 1993-2015 at five academic sites were included. Of 395 patients, 72 (18%) received deferred therapy (defined as receipt of first treatment >90 days following initial diagnosis). Patients receiving deferred therapy were more likely to have an ECOG performance status of 0 (67 versus 44% p = .001), have no B symptoms (83 versus 65% p = .003) and have normal LDH levels at diagnosis (87 versus 55% p < .001). In multivariable analysis, deferred therapy was not associated with a significant difference in OS (HR 0.64: 95% CI 0.22-1.84, p = .407).
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Affiliation(s)
- Oscar Calzada
- a Department of Hematology and Medical Oncology , Emory University - Winship Cancer Institute , Atlanta , GA , USA
| | - Jeffrey M Switchenko
- b Department of Biostatistics and Bioinformatics , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Joseph J Maly
- c The Ohio State University - James Comprehensive Cancer Center , Columbus , OH , USA
| | - Kristie A Blum
- c The Ohio State University - James Comprehensive Cancer Center , Columbus , OH , USA
| | - Natalie Grover
- d Lineberger Cancer Center - University of North Carolina , Chapel Hill , NC , USA
| | - Stephanie Mathews
- d Lineberger Cancer Center - University of North Carolina , Chapel Hill , NC , USA
| | - Steven I Park
- d Lineberger Cancer Center - University of North Carolina , Chapel Hill , NC , USA
| | - Max Gordon
- e Oregon Health Sciences University , Portland , OR , USA
| | - Alexey Danilov
- e Oregon Health Sciences University , Portland , OR , USA
| | - Narendranath Epperla
- f Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Timothy S Fenske
- f Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Mehdi Hamadani
- f Division of Hematology and Oncology , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Christopher R Flowers
- a Department of Hematology and Medical Oncology , Emory University - Winship Cancer Institute , Atlanta , GA , USA
| | - Jonathon B Cohen
- a Department of Hematology and Medical Oncology , Emory University - Winship Cancer Institute , Atlanta , GA , USA
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Lyttle Schumacher B, Grover N, Mesen T, Steiner A, Mersereau J. Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy. Hum Reprod 2018; 32:2049-2055. [PMID: 28938728 DOI: 10.1093/humrep/dex257] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/22/2017] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION What is the live-birth rate (LBR) and cost-effectiveness of fertility preservation with oocyte cryopreservation (FP-OC) compared to expectant management in cancer patients age 25-40 based on estimated gonadotoxicity of treatments 5 years after cancer diagnosis? SUMMARY ANSWER Oocyte cryopreservation prior to cancer treatment is more costly, yet more effective (producing more live births), than not undergoing oocyte cryopreservation but it is most beneficial for patients undergoing high-risk chemotherapy (HRC). WHAT IS KNOWN ALREADY The decision to undergo FP prior to treatment is multifactorial and can be costly and delay treatment. Not all treatments carry the same gonadotoxicity and patients may choose to undergo FP-OC based on the probability of premature ovarian insufficiency, predicted outcomes and cost. A comprehensive model that incorporates age at diagnosis and toxicity of treatment to help guide patients in the decision to undergo FP-OC does not yet exist. STUDY DESIGN, SIZE DURATION This study used a Decision Analysis Model to estimate effectiveness and cost of FP for cancer patients. PARTICIPANTS/MATERIALS, SETTING, METHODS Age-based estimates of LBR and cost per live birth were calculated for ages 25-40 years based on gonadotoxicity of treatment. A decision analysis model was constructed using Treeage Pro 2015 with case base probabilities derived from national registries, practice guidelines and medical records from a national network of infertility practices (IntegraMed). MAIN RESULTS AND THE ROLE OF CHANCE Compared to no FP-OC, FP-OC improved LBRs for women of all ages undergoing either low-risk chemotherapy (LRC) or HRC; however, it was most cost effective for women undergoing LRC at older ages or HRC at younger ages. Although FP-OC results in higher LBRs, it was always more costly. Using donor oocyte IVF can be a successful alternative to autologous FP-OC. LIMITATIONS REASONS FOR CAUTION Decision tree results reflect probabilities of certain events and are compiled from multiple reputable sources but are not directly derived from a recruited cohort of patients. Outcomes are based on United States estimates and should be interpreted in the broader context of individual patient diagnoses, treatment care plans and country of origin. WIDER IMPLICATIONS OF THE FINDINGS The development of this analytic model will help guide practitioners in their counseling of women from age 25 to 40 years, who are considering FP-OC at the time of cancer diagnosis. It provides a realistic pathway from diagnosis to LB and accounts for the majority of costs and outcome possibilities. STUDY FUNDING/COMPETING INTEREST(s) This study was partially funded by a grant from National Institute of Health (NIH)/National Institute of Child Health and Human Development (NICHD) (R01 HD67683) to A.Z.S. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Lyttle Schumacher
- Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - N Grover
- Hematology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - T Mesen
- Carolinas Fertility Institute, 2614 E 7th St. Suite C, Charlotte, NC 28205, USA
| | - A Steiner
- Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - J Mersereau
- Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of North Carolina, Chapel Hill, NC 27599, USA
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Dittus C, Grover N, Ellsworth S, Tan X, Park SI. Bortezomib in combination with dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) induces long-term survival in patients with plasmablastic lymphoma: a retrospective analysis. Leuk Lymphoma 2018; 59:2121-2127. [PMID: 29303024 DOI: 10.1080/10428194.2017.1416365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive form of B-cell non-Hodgkin lymphoma. This subtype of lymphoma has a post-germinal center cell-of-origin called the plasmablast, and the immunophenotype is more consistent with that of a plasma cell than a lymphocyte. Because of these unique features, PBL is notoriously difficult to treat. Case reports and small reviews have evaluated the addition of agents directed against plasma cell disorders in combination with traditional lymphoma-directed regimens. We describe the largest case series to date, with the longest follow-up, evaluating bortezomib in combination with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (V-EPOCH) for the treatment of PBL. Our results show that this is a safe and effective regimen with an overall and complete response rate of 100% and 2-year overall survival of 50%.
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Affiliation(s)
- Christopher Dittus
- a Division of Hematology and Oncology Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Natalie Grover
- b Division of Hematology and Oncology Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Steven Ellsworth
- c Division of Pathology and Cytopathology , Louisiana State University , Shreveport , LA , USA
| | - Xianming Tan
- d Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Steven I Park
- e Levine Cancer Institute, Carolinas Healthcare System , Charlotte , NC , USA
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Greenwell IB, Valla K, Caulfield S, Switchenko JM, Staton A, Flowers C, Maly J, Blum KA, Grover N, Mathews S, Park SI, Gordon M, Danilov AV, Epperla N, Fenske TS, Hamadani M, Cohen JB. Outcomes in Mantle Cell Lymphoma for Elderly Patients Undergoing Autologous Stem Cell Transplant in CR1. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.429] [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: 10/20/2022]
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Khajuria A, Praharaj AK, Grover N, Kumar M. Emergence of VIM-2 metallo-beta-lactamase producing Ralstonia pickettii clinical isolate in India. Indian J Med Microbiol 2014; 32:191-3. [PMID: 24713914 DOI: 10.4103/0255-0857.129831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A multidrug-resistant clinical isolate of Ralstonia pickettii from a woman was analysed. Modified Hodge test was positive for carbapenemase production. Conjugation experiment revealed the presence of conjugative plasmid of >140 Kb size typed as IncN type. This is the first report of emergence blaVIM-2 in R. pickettii in India.
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Affiliation(s)
- A Khajuria
- Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India
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Chaudhari CN, Tandel K, Grover N, Bhatt P, Sahni AK, Sen S, Prahraj AK. In vitro vancomycin susceptibility amongst methicillin resistant Staphylococcus aureus. Med J Armed Forces India 2014; 70:215-9. [PMID: 25378772 DOI: 10.1016/j.mjafi.2013.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/23/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vancomycin is drug of choice for treatment of Methicillin Resistant Staphylococcus aureus (MRSA) infections. S. aureus with reduced vancomycin susceptibility (SA-RVS) is on rise. Current guidelines of detection of SA-RVS are based on MIC (Minimum Inhibitory Concentration) by broth or agar dilution methods. Vancomycin MIC by E test (Epsilometer Test) is an alternative. A study was undertaken to know the prevalence of SA-RVS and compare vancomycin MIC by agar dilution and E test. METHODS A prospective study was undertaken at tertiary care hospital; 232 clinical MRSA isolates were included. Vancomycin MIC was undertaken by agar dilution method and E test. RESULTS All isolates were sensitive to Linezolid. Two MRSA isolates had vancomycin MIC ≥4 μg/ml; vancomycin MIC50 and MIC90 of MRSA isolates was 0.5 and 0.2 μg/ml respectively by agar dilution method. There was agreement over 93.5% isolates in vancomycin susceptibility by agar dilution and E test. E test had sensitivity and positive predictive value of 1.0 (CI - 0.34-1.0) and 0.5 (CI - 0.17-0.83) respectively compare to agar dilution method. CONCLUSIONS MRSA isolates continues to be susceptible to vancomycin and Linezolid. E test was found equally suitable in initial screening for vancomycin susceptibility. Due to geographic variation in prevalence, there is need of ongoing surveillance of SA-RVC.
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Affiliation(s)
- C N Chaudhari
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - K Tandel
- Medical Officer (Microbiology), Military Hospital Gwalior, India
| | - N Grover
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - P Bhatt
- Resident, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - A K Sahni
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - S Sen
- Senior Advisor (Pathology, Microbiology & Virology), Army Hospital (R&R), Delhi Cantt 10, India
| | - A K Prahraj
- Professor & Head (Microbiology), AIIMS, Bhubaneswar, Orissa, India
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Nair V, Sharma A, DAS S, Sharma S, Grover N, Kaur J. Allogeneic haematopoietic stem cell transplantation: the Army hospital experience. Natl Med J India 2013; 26:6-11. [PMID: 24066986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND We analysed the results of allogeneic haematopoietic stem cell transplantation (HSCT) in various genetic disorders, bone marrow failures and haematological malignancies done from 2002 to 2010 at the Army Hospital, Research and Referral, Delhi. METHODS A total of 119 matched-related allogeneic- HSCTs (allo-HSCTs) were done in 114 patients (men 76, women 38) aged between 2 and 60 years. Peripheral blood stem cells (n=75) and bone marrow (n=43) were used as the source of stem cells. RESULTS The overall survival was 62.3% (71/114) at a median follow-up of 34 months. Graft versus host disease (GVHD) was seen in 42 (36.8%) patients; grade III/IV acute GVHD in 17 (15%) and chronic GVHD in 24 (21%) patients. There were 4 (3.5%) graft rejections and one nonengraftment. The overall mortality was 37.7% (n=43) and the main causes of death were GVHD (32%), infections (26%), relapse (23%) and regimen-related toxicity (11%). CONCLUSION Our results are comparable to published data in most disease conditions. With improvements in GVHD prophylaxis and better supportive care, we need to further reduce our mortality and morbidity.
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Affiliation(s)
- V Nair
- Armed Forces Medical College, Pune 411040, Maharashtra, India. Department of Medicine and Clinical Haematology
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Grover N, Beudekker W, Young RS, Nicholls PJ. Differences in species response to hyperactivity induced by lipopolysaccharide (LPS) from Escherichia coli. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1998.tb02273.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- N Grover
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
| | - W Beudekker
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
| | - R S Young
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
| | - P J Nicholls
- Welsh School of Pharmacy, Cardiff University, Cathays Park Cardiff CF1 3XF
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Grover N, Amen F, Savy L, Brookes G. West J Med 2010; 340:c2081-c2081. [DOI: 10.1136/bmj.c2081] [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: 11/04/2022]
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Grover N, Nawange SR, Naidu J, Singh SM, Sharma A. Ecological niche of Cryptococcus neoformans var. grubii and Cryptococcus gattii in decaying wood of trunk hollows of living trees in Jabalpur City of Central India. Mycopathologia 2009. [DOI: 10.1007/s11046-009-9203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grover N, Nawange SR, Naidu J, Singh SM, Sharma A. Ecological niche of Cryptococcus neoformans var. grubii and Cryptococcus gattii in decaying wood of trunk hollows of living trees in Jabalpur City of Central India. Mycopathologia 2007; 164:159-70. [PMID: 17661160 DOI: 10.1007/s11046-007-9039-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 06/28/2007] [Indexed: 10/23/2022]
Abstract
Cryptococcus neoformans var. grubii and C. gattii were repeatedly isolated from decaying wood of trunk hollows in living trees growing in Jabalpur City in Central India. The isolation of C. gattii has been reported from decayed wood inside trunk hollow of Tamarindus indica (15.6%), Mangifera indica (2.2%), Pithecolobium dulce (12.5%), Syzygium cumini (14%), and one from bark of S. cumini. C. n. var. grubii was isolated from decaying wood debris of T. indica (4.4%), M. indica (13.3%), Terminalia arjuna (25%), S. cumini (2%), Cassia fistula (4.5%), and two from bark of S. cumini. The two species [corrected] never co-occurred in the same hollow. C. gattii [corrected] isolates belonged to serotype B. [corrected] The data strongly supported the colonization of the pathogen in decaying wood hollow of all six-tree species. Evidence of this was found by repeated isolation up to 820 days. P. dulce is being reported for the first time as natural habitat of C. gattii and T. arjuna and C. fistula as natural habitat for C. n. var. grubii. M. indica is being reported for the second time as the natural habitat of both species [corrected] (C. n. var. grubii and C. gattii). The population density of these pathogens from decaying wood debris of various tree species ranged between 0.5 x 10(3) cells/g and 6 x 10(5) cells/g. The seasonal variation has been seen in isolation of these pathogens. [corrected] Our result further reinforce the recently emerging evidence that the natural habitat of C. n. var. grubii and C. gattii is more generalized.
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Affiliation(s)
- N Grover
- Medical Mycology Research Laboratory, Department of Biological Science, Rani Durgavati University, Jabalpur, MP, India
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Nair V, Sharma A, Ratheesh J, Das S, Mishra DK, Kale R, Grover N, Mohan C. Severe intravascular haemolysis following minor group mismatched peripheral blood stem cell transplantation. Bone Marrow Transplant 2007; 39:805-6. [PMID: 17417657 DOI: 10.1038/sj.bmt.1705674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grover N, Sankhyan N, Bisht JP. A five year review of clinical profile in HSP. JNMA J Nepal Med Assoc 2007; 46:62-65. [PMID: 18094739] [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: 05/25/2023] Open
Abstract
To study the clinical profile of Henoch Schönlein Purpura [HSP] in children. A retrospective case series of 30 consecutive children with a diagnosis of HSP, with special focus on clinical manifestations. Two cases with unusual features are described in detail. Data of 19 boys and 11 girls with a mean age of 10.55 years was reviewed. Overall skin was involved in 100%, joints in 86.7%, GIT in 80% and renal system in 30% Two-thirds had palpable purpura at presentation. The mean duration of appearance of skin lesions after preceding joint and gastrointestinal symptoms was 8.6 days and 6.6 days respectively. Abdominal pain was the most common gastrointestinal symptom. Knee and ankle involvement occurred in more than 3/4th of the patients with arthritis. Vesciculobullous lesions were seen in two patients while one patient had rheumatic fever. Most children with HSP will have classical manifestation of the disease but diagnostic confusion can occur in those with atypical or absent cutaneous features at the onset.
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Affiliation(s)
- N Grover
- Dept. of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
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Grover N, Kumaraiah V, Prasadrao PSDV, D'souza G. Cognitive behavioural intervention in bronchial asthma. J Assoc Physicians India 2002; 50:896-900. [PMID: 12126343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE The aim of the present study was to find out the efficacy of cognitive behaviour therapy, as an adjunct to standard pharmacotherapy in bronchial asthma. DESIGN An experimental design with pre- and post-therapy assessments was adopted. SETTING The Medicine Out-patient Department of St. John's Medical College and Hospital, and Department of Clinical Psychology, NIMHANS, Bangalore. PATIENTS Ten asthma patients who fulfilled the inclusion and exclusion criteria, matched for use of drugs, were sequentially allotted to two groups: a) experimental group, who were exposed to cognitive behaviour therapy along with standard pharmacotherapy, b) control group, who were exposed to standard pharmacotherapy alone. INTERVENTION Cognitive behaviour therapy included 15 individual sessions consisting of asthma education, Jacobson progressive muscle relaxation (JPMR), behavioural techniques, cognitive restructuring, cognitive coping skills and behavioural counseling to significant others. MEASUREMENTS The measures used for pre- and post-therapy assessments were--Asthma symptom checklist, asthma diary, state trait anxiety inventory-Y1 and Y2, Beck depression inventory, asthma quality of life questionnaire and peak expiratory flow rate. RESULTS There was significant decrease in asthma symptoms, anxiety and depression; and significant increase in quality of life in the experimental group (p < 0.05) at the post-assessment. The control group did not show any significant change at the post-assessment. CONCLUSION Cognitive behaviour therapy helps in improving the management of asthma.
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Affiliation(s)
- N Grover
- Department of Clinical Psychology, NIMHANS, Bangalore
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Caspi E, Wittstruck TA, Grover N. Nuclear Magnetic Resonance Spectra of Heterocyclic Compounds. II. Abnormal Products from the Ketalization of Cortisone1. J Org Chem 2002. [DOI: 10.1021/jo01038a041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grover N. ILO recommends workers' compensation AIDS guidelines. AIDS Policy Law 2001; 16:7. [PMID: 11548477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Grover N, Rao NN, Kotian MS. Evaluation of immunoglobulin G synthesizing plasma cells in periapical granuloma and cyst. Indian J Dent Res 2001; 12:35-9. [PMID: 11441800] [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: 02/20/2023] Open
Abstract
Immunoglobulin synthesizing plasma cells for IgG were quantitated in 20 periapical granulomas and 20 periapical cysts, using unlabelled antibody peroxidase-antiperoxidase complex method. Result showed that immunoglobulin G producing plasma cells were predominant in periapical cyst as compared with periapical granuloma. A statistical significant relation was observed between these two lesions.
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Affiliation(s)
- N Grover
- Departments of Oral Pathology and Community Medicine, College of Dental Surgery, Manipal and K.M.C. Mangalore, India
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Abstract
Two cases of trichobezoar with unusual presentation in rural female children are described. The first one in a healthy asymptomatic child with no abnormal psychological behaviour and other one in an emotionally disturbed child with history of trichotillomania. Both were treated surgically with no recurrence. A physical sign of indentibility is discussed and literature is also reviewed.
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Affiliation(s)
- A K Sood
- Department of Paediatrics, Indira Gandhi Medical College, Shimla
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Abstract
Congenital malformations were studied over a period of five years in 10,100 consecutive births including still births at Indira Gandhi Medical College, Shimla. Out of these, 180 babies had one or the other congenital malformations and the overall incidence was 1.78%. Amongst the 311 still born babies 47 had congenital malformations indicating that the incidence of congenital malformations was much higher in still born babies (15.1%) as compared to the live born babies (1.3%). The malformations involving the central nervous system were the commonest (40%) followed by musculoskeletal system (23.8%) while genitourinary system malformations were the least common and accounted for 3.8% of the cases. Incidence of congenital malformations was the highest in mothers over 35 years of age and gravida four and more. The incidence was 2.8% in both the groups; the incidence of congenital malformation was more in babies weighing < 2500 gms and was 2.6%.
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Affiliation(s)
- N Grover
- Department of Pediatrics, Indira Gandhi Medical College, Shimla
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Abstract
During the study period there were 2063 live births. Of these 573 (27.8%) were low birth weight (LBW), 277 (13.4%) preterm and 148 (7.1%) small for date (SFD) babies. In all, 263 (12.7%) newborns suffered from one or the other morbidity. Birth asphyxia of varying severity developed in 130 (6.3%) babies [88 LBW and 42 normal birth weight (NBW) (p < 0.001)]. Respiratory distress syndrome was diagnosed in 82 (3.9%) babies, most being due to hyaline membrane diseases (31.7%), which affected 26 (9.4%) of preterm babies. Deep infections were seen in 109 (5.3%) newborns [60 LBW and 49 NBW, (p < 0.001)] and superficial infections were seen in 79 (3.8%) babies [46 LBW and 33 NBW, (p < 0.001)]. Hyperbilirubinemia was detected in 78 (3.8%) babies. In one fifth of the babies, the cause of hyperbilirubinemia remained unidentified even after detailed investigations. Hypothermia was observed in 59 (2.9%) newborns [48 LBW and 11 NBW, (p < 0.001] and congenital malformations were seen in 24 (1.7%) babies. Morbidity was found to be high amongst LBW and preterm babies. The incidence of deep infections and hypothermia was high in our study.
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Affiliation(s)
- S Kaushik
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, H.P
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Kaushik SL, Parmar VR, Grover N, Grover PS, Kaushik R. Neonatal sepsis in hospital born babies. J Commun Dis 1998; 30:147-52. [PMID: 10093419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Incidence of neonatal sepsis in a study carried out among hospital born babies was found to be 5.3 per cent significantly high (10.9%) amongst low birth weight compared to (3.1%) normal birth weight babies. Sepsis related mortality also exceeded significantly in low birth weight babies. Positive cultures were obtained in 36.7 per cent of babies with sepsis. The organisms identified were Staphylococcus pyogenes (40%), E. coli (27.5%), Klebsiella spp. (15%), Staphylococcus epidermidis (10%) and Enterobacter spp. (7.5%). Gram negative bacilli predominated in early onset (< 72 hrs. of life) and gram positive cocci in late onset. Mortality with early onset culture positive neonatal sepsis was significantly high compared to late onset. The bacterial isolates obtained were found to be resistant to routinely used antibiotics (penicillin, ampicillin and gentamycin). Third generation cephalosporins and aminoglycosides (netilmycin) were found to be effective in treatment of neonatal sepsis.
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35
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Behl L, Grover N, Kaushik SL. Perinatal and neonatal mortality--a hospital based study. Indian Pediatr 1998; 35:683-4. [PMID: 10216684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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36
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Kaushik SL, Grover N, Parmar VR, Kaushik R, Gupta AK. Hypothermia in newborns at Shimla. Indian Pediatr 1998; 35:652-6. [PMID: 10216676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- S L Kaushik
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, India
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37
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Abstract
A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p < 0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p < 0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.
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Affiliation(s)
- S L Kaushik
- Department of Pediatrics, Indira Gandhi Medical College, Shimla
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Affiliation(s)
- N Grover
- Division of Gastroenterology, Scripps Clinic and Research Foundation, La Jolla, California 92037, USA
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Parmar VR, Grover N, Randhawa I, Bahl L, Kaushal RK. Perinatal mortality in Shimla (Himachal Pradesh). Indian Pediatr 1994; 31:833-6. [PMID: 7890347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- V R Parmar
- Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh
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40
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Dogra J, Grover N, Kumar P, Aneja N. Indigenous free radical scavenger MAK 4 and 5 in angina pectoris. Is it only a placebo? J Assoc Physicians India 1994; 42:466-7. [PMID: 7852231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Thirty patients were evaluated to study the effect of Maharishi Amrit Kalsh (MAK) 4 & 5 on Angina pectoris. The mean angina frequency per month was 8.87. Twelve lead ECG, computerized TMT and echo studies were done initially, at 6 months, and after 2 years in all cases. Ten grams of MAK 4 paste was given daily in two divided doses, each followed by a MAK 5 tablet, for six months. Vasodilator and antihypertensive drugs were continued on ethical grounds. Twenty-four patients (80%) out of the total 30 reported a significant improvement after 6 months of therapy. The mean angina frequency per month improved from 8.87 to 3.03. All patients reported a sense of well being. Five out of 11 hypertensive patients reported a fall in systolic blood pressure. Lipid profile showed a rise in HDL which was statistically insignificant. Improved exercise tolerance was observed in 10 cases (33.33%) after 6 months of therapy and this effect was sustained even at 2 years. ECG and echo studies were inconclusive. No side effects or drug interactions were seen. This beneficial effect observed is probably as a result of free radical scavenging property of MAK on 'Reactive Oxygen Species' or an inhibitory effect on lipid peroxidation; or by its inhibitory action on platelet aggregation or all these in synergism.
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Affiliation(s)
- J Dogra
- Department of Medicine, C.G.H.S., Jaipur, India
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41
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Lazar EJ, Frishman WH, Grover N. Medical therapy of the hypertensive patient with concomitant angina pectoris. Cardiol Clin 1991; 9:167-76. [PMID: 1674226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic hypertension and symptomatic ischemic heart disease are two common disorders that coexist in the same patient. A medical approach to the patient with both systemic hypertension and angina pectoris is presented in this article, and different treatment modalities are considered.
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Affiliation(s)
- E J Lazar
- Medical Service, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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May JY, Margaliot EJ, Laufer HN, Zuckerman Z, Grover N, Ovadia J. Human spermatozoa penetration to zona-free hamster ova and the volume of sperm cells. Arch Androl 1986; 16:131-3. [PMID: 3741024 DOI: 10.3109/01485018608986932] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thirty-five infertile men were divided into two groups: those with normal spermograms (15 cases) and those with oligospermia (20 cases). Each semen sample was examined by its penetration into zona-free hamster ova and by an improved Coulter counter apparatus for measuring the volume of spermatozoal head. Both groups were further divided into two subgroups: those with normal (above 15%) and those with abnormal penetration assay (0-10%). The relationship between sperm modal size and sperm cell penetration into hamster ova in both groups--the oligospermic and the normospermic--was calculated and was found to be nonsignificant (correlation index: -0.154). It appears that the inability of some human sperm cells to penetrate the zona-free hamster ova cannot be attributed to the spermatozoal size.
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Halperin D, Reuben C, Ben-Efraim S, Grover N, Weiss DW. Effects of the methanol extraction residue (MER) tubercle bacillus fraction on the production of antibodies in vitro. III. Consequence of prior sensitization to MER. Cell Immunol 1985; 92:404-13. [PMID: 3922630 DOI: 10.1016/0008-8749(85)90021-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mice repeatedly immunized with the methanol extraction residue fraction of tubercle bacilli (MER) in incomplete Freund's adjuvant produced high titers of circulating antibodies against MER, as assessed by the enzyme-linked immunosorbent assay (ELISA) method. Spleen cells derived from these animals failed to respond to the usual nonspecific immunopotentiating influence of MER on the primary production of antibodies (generation of specific plaque-forming cells) in vitro to sheep red blood cells. The defect was expressed by B lymphocytes and splenic macrophages, but not by splenic T lymphocytes or peritoneal exudate macrophagic cells. Impaired responsiveness by spleen cells from MER-immunized animals to nonspecific immunostimulation was also expressed with regard to another, unrelated biological response modifier, lipopolysaccharide. There was no impairment of responsiveness to polyclonal mitogenic stimulation. Possible mechanisms of the effects described are discussed.
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Ben-Efraim S, Sarir C, Dar O, Barbash G, Grover N, Weiss DW. Effects of the MER tubercle bacillus fraction on the production of antibodies in vitro. I. Effect on the primary response. Cell Immunol 1980; 50:314-26. [PMID: 6986996 DOI: 10.1016/0008-8749(80)90286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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45
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Abstract
In familial dysautonomia there are malfunctions of motor, sensory and autonomic systems. The sural nerve has reduced transverse fascicular area, diminished numbers of myelinated axons (particularly those of small diameter) and very few non-myelinated axons. Catecholamine containing endings are not found in accompanying arteries. These changes are compatible with reduced neuronal populations described in sympathetic and sensory ganglia. The observed pathology accounts for many of the clinical features of the disease and suggests an abnormality in intrauterine development.
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