1
|
Asghar A, Priya A, Prasad N, Patra A, Agrawal D. Variations in morphology of cystic artery: systematic review and meta-analysis. Clin Ter 2024; 175:184-192. [PMID: 38767077 DOI: 10.7417/ct.2024.5061] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Variations in cystic artery anatomy are not unusual in occurrence, hence considerably crucial during hepatobiliary surgical planning and execution. This systematic review and meta-analysis of the anatomical variations of cystic artery (CA) was undertaken to emphasize their significance in surgical practice. Methods The PICO model was adopted, both MeSH term and free keywords were utilized for the search strategy. The risk of bias in each study was calculated by the anatomy quality assurance (AQUA) tool. Result The search strategy identified 8204 records, extracted 5529 studies, and evaluated 117 abstracts. Out of these 117 studies, 53 met the eligibility criteria. The CA was absent in 2% of instances (95% CI: 0.01-0.04), indicating that 98% of cases had the CA. In 10071 participants from 29 investigations, double cystic arteries were found in 13% (95% CI: 11-16%), with significant heterogeneity (I2 = 91%). In 46 studies with a total of 9928 participants, 89% of the individuals had CA originating from RHA (95% CI: 85%-92%) with significant heterogeneity (I2=94.3%) and a predictive range of 43%-99%. Conclusion The cystic artery is primarily derived from the right hepatic artery, followed by aberrant, proper, and left hepatic arteries. It is located anterior to common hepatic ducts and cystic ducts. The mean length and diameter of CA were 20.77 mm and 1.91 mm Short cystic arteries are common (20%) Congenital anomalies like absent and double cystic arteries have low prevalence but must be conside-red during surgery.
Collapse
Affiliation(s)
- A Asghar
- All India Institute of Medical Sciences, Patna, India
| | - A Priya
- Rajendra Institute of Medical Sciences, Ranchi, India
| | - N Prasad
- All India Institute of Medical Sciences, Patna, India
| | - A Patra
- All India Institute of Medical Sciences, Bathinda, India
| | - D Agrawal
- All India Institute of Medical Sciences, Jodhpur, India
| |
Collapse
|
2
|
Ruddy S, Bapna M, Karnik K, Yung L, Rodriguez G, Urban C, Yoon J, Prasad N, Segal-Maurer S, Turett G. Novel case of combination antibiotic therapy for treatment of a complicated polymicrobial urinary tract infection with one organism harboring a metallo-β-lactamase (MBL) in a pregnant patient. IDCases 2024; 36:e01946. [PMID: 38646598 PMCID: PMC11031789 DOI: 10.1016/j.idcr.2024.e01946] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/23/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024] Open
Abstract
Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.
Collapse
Affiliation(s)
- S. Ruddy
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - M. Bapna
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - K. Karnik
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| | - L. Yung
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - G. Rodriguez
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Columbia University School of Nursing, New York, NY, 10032, United States of America
| | - C. Urban
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - J. Yoon
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - N. Prasad
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - S. Segal-Maurer
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- Weill Cornell Medicine, Cornell University, New York, NY 10065, United States of America
| | - G. Turett
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, NY 11355, United States of America
| |
Collapse
|
3
|
Mahmoud M, Huang Y, Garimella K, Audano PA, Wan W, Prasad N, Handsaker RE, Hall S, Pionzio A, Schatz MC, Talkowski ME, Eichler EE, Levy SE, Sedlazeck FJ. Utility of long-read sequencing for All of Us. Nat Commun 2024; 15:837. [PMID: 38281971 PMCID: PMC10822842 DOI: 10.1038/s41467-024-44804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
The All of Us (AoU) initiative aims to sequence the genomes of over one million Americans from diverse ethnic backgrounds to improve personalized medical care. In a recent technical pilot, we compare the performance of traditional short-read sequencing with long-read sequencing in a small cohort of samples from the HapMap project and two AoU control samples representing eight datasets. Our analysis reveals substantial differences in the ability of these technologies to accurately sequence complex medically relevant genes, particularly in terms of gene coverage and pathogenic variant identification. We also consider the advantages and challenges of using low coverage sequencing to increase sample numbers in large cohort analysis. Our results show that HiFi reads produce the most accurate results for both small and large variants. Further, we present a cloud-based pipeline to optimize SNV, indel and SV calling at scale for long-reads analysis. These results lead to widespread improvements across AoU.
Collapse
Affiliation(s)
- M Mahmoud
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Y Huang
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, 02141, USA
| | - K Garimella
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, 02141, USA
| | - P A Audano
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, 06032, USA
| | - W Wan
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, 02141, USA
| | - N Prasad
- Discovery Life Sciences, Huntsville, AL, 35806, USA
| | - R E Handsaker
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, 02141, USA
| | - S Hall
- Discovery Life Sciences, Huntsville, AL, 35806, USA
| | - A Pionzio
- Discovery Life Sciences, Huntsville, AL, 35806, USA
| | - M C Schatz
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - M E Talkowski
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, 02141, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - E E Eichler
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, WA, USA
| | - S E Levy
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, 35806, USA
| | - F J Sedlazeck
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA.
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
- Department of Computer Science, Rice University, Houston, TX, USA.
| |
Collapse
|
4
|
Ford P, Kreuter M, Brown KK, Wuyts WA, Wijsenbeek M, Israël-Biet D, Hubbard R, Nathan SD, Nunes H, Penninckx B, Prasad N, Seghers I, Spagnolo P, Verbruggen N, Hirani N, Behr J, Kaner RJ, Maher TM. An adjudication algorithm for respiratory-related hospitalisation in idiopathic pulmonary fibrosis. ERJ Open Res 2024; 10:00636-2023. [PMID: 38288082 PMCID: PMC10823372 DOI: 10.1183/23120541.00636-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024] Open
Abstract
Background There is no standard definition of respiratory-related hospitalisation, a common end-point in idiopathic pulmonary fibrosis (IPF) clinical trials. As diverse aetiologies and complicating comorbidities can present similarly, external adjudication is sometimes employed to achieve standardisation of these events. Methods An algorithm for respiratory-related hospitalisation was developed through a literature review of IPF clinical trials with respiratory-related hospitalisation as an end-point. Experts reviewed the algorithm until a consensus was reached. The algorithm was validated using data from the phase 3 ISABELA trials (clinicaltrials.gov identifiers NCT03711162 and NCT03733444), by assessing concordance between nonadjudicated, investigator-defined, respiratory-related hospitalisations and those defined by the adjudication committee using the algorithm. Results The algorithm classifies respiratory-related hospitalisation according to cause: extraparenchymal (worsening respiratory symptoms due to left heart failure, volume overload, pulmonary embolism, pneumothorax or trauma); other (respiratory tract infection, right heart failure or exacerbation of COPD); "definite" acute exacerbation of IPF (AEIPF) (worsening respiratory symptoms within 1 month, with radiological or histological evidence of diffuse alveolar damage); or "suspected" AEIPF (as for "definite" AEIPF, but with no radiological or histological evidence of diffuse alveolar damage). Exacerbations ("definite" or "suspected") with identified triggers (infective, post-procedural or traumatic, drug toxicity- or aspiration-related) are classed as "known AEIPF"; "idiopathic AEIPF" refers to exacerbations with no identified trigger. In the ISABELA programme, there was 94% concordance between investigator- and adjudication committee-determined causes of respiratory-related hospitalisation. Conclusion The algorithm could help to ensure consistency in the reporting of respiratory-related hospitalisation in IPF trials, optimising its utility as an end-point.
Collapse
Affiliation(s)
| | - Michael Kreuter
- Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care and Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Kevin K. Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Wim A. Wuyts
- Unit for Interstitial Lung Diseases, Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marlies Wijsenbeek
- Centre for Interstitial Lung Disease and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Richard Hubbard
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Steven D. Nathan
- Inova Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Hilario Nunes
- Department of Pneumology, Centre de Référence des Maladies Pulmonaires Rares, Assistance Publique–Hôpitaux de Paris, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France
| | | | | | | | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Nik Hirani
- Edinburgh Lung Fibrosis Clinic, Royal Infirmary Edinburgh and Centre for Inflammation Research, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Juergen Behr
- Department of Medicine V, LMU University Hospital, Ludwig Maximilian University Munich, Comprehensive Pneumology Center (member of the German Center for Lung Research), Munich, Germany
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine and Department of Genetic Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Keck Medicine of University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Maher TM, Ford P, Brown KK, Costabel U, Cottin V, Danoff SK, Groenveld I, Helmer E, Jenkins RG, Milner J, Molenberghs G, Penninckx B, Randall MJ, Van Den Blink B, Fieuw A, Vandenrijn C, Rocak S, Seghers I, Shao L, Taneja A, Jentsch G, Watkins TR, Wuyts WA, Kreuter M, Verbruggen N, Prasad N, Wijsenbeek MS. Ziritaxestat, a Novel Autotaxin Inhibitor, and Lung Function in Idiopathic Pulmonary Fibrosis: The ISABELA 1 and 2 Randomized Clinical Trials. JAMA 2023; 329:1567-1578. [PMID: 37159034 PMCID: PMC10170340 DOI: 10.1001/jama.2023.5355] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 09/21/2022] [Accepted: 03/20/2023] [Indexed: 05/10/2023]
Abstract
Importance There is a major need for effective, well-tolerated treatments for idiopathic pulmonary fibrosis (IPF). Objective To assess the efficacy and safety of the autotaxin inhibitor ziritaxestat in patients with IPF. Design, Setting, and Participants The 2 identically designed, phase 3, randomized clinical trials, ISABELA 1 and ISABELA 2, were conducted in Africa, Asia-Pacific region, Europe, Latin America, the Middle East, and North America (26 countries). A total of 1306 patients with IPF were randomized (525 patients at 106 sites in ISABELA 1 and 781 patients at 121 sites in ISABELA 2). Enrollment began in November 2018 in both trials and follow-up was completed early due to study termination on April 12, 2021, for ISABELA 1 and on March 30, 2021, for ISABELA 2. Interventions Patients were randomized 1:1:1 to receive 600 mg of oral ziritaxestat, 200 mg of ziritaxestat, or placebo once daily in addition to local standard of care (pirfenidone, nintedanib, or neither) for at least 52 weeks. Main Outcomes and Measures The primary outcome was the annual rate of decline for forced vital capacity (FVC) at week 52. The key secondary outcomes were disease progression, time to first respiratory-related hospitalization, and change from baseline in St George's Respiratory Questionnaire total score (range, 0 to 100; higher scores indicate poorer health-related quality of life). Results At the time of study termination, 525 patients were randomized in ISABELA 1 and 781 patients in ISABELA 2 (mean age: 70.0 [SD, 7.2] years in ISABELA 1 and 69.8 [SD, 7.1] years in ISABELA 2; male: 82.4% and 81.2%, respectively). The trials were terminated early after an independent data and safety monitoring committee concluded that the benefit to risk profile of ziritaxestat no longer supported their continuation. Ziritaxestat did not improve the annual rate of FVC decline vs placebo in either study. In ISABELA 1, the least-squares mean annual rate of FVC decline was -124.6 mL (95% CI, -178.0 to -71.2 mL) with 600 mg of ziritaxestat vs -147.3 mL (95% CI, -199.8 to -94.7 mL) with placebo (between-group difference, 22.7 mL [95% CI, -52.3 to 97.6 mL]), and -173.9 mL (95% CI, -225.7 to -122.2 mL) with 200 mg of ziritaxestat (between-group difference vs placebo, -26.7 mL [95% CI, -100.5 to 47.1 mL]). In ISABELA 2, the least-squares mean annual rate of FVC decline was -173.8 mL (95% CI, -209.2 to -138.4 mL) with 600 mg of ziritaxestat vs -176.6 mL (95% CI, -211.4 to -141.8 mL) with placebo (between-group difference, 2.8 mL [95% CI, -46.9 to 52.4 mL]) and -174.9 mL (95% CI, -209.5 to -140.2 mL) with 200 mg of ziritaxestat (between-group difference vs placebo, 1.7 mL [95% CI, -47.4 to 50.8 mL]). There was no benefit with ziritaxestat vs placebo for the key secondary outcomes. In ISABELA 1, all-cause mortality was 8.0% with 600 mg of ziritaxestat, 4.6% with 200 mg of ziritaxestat, and 6.3% with placebo; in ISABELA 2, it was 9.3% with 600 mg of ziritaxestat, 8.5% with 200 mg of ziritaxestat, and 4.7% with placebo. Conclusions and Relevance Ziritaxestat did not improve clinical outcomes compared with placebo in patients with IPF receiving standard of care treatment with pirfenidone or nintedanib or in those not receiving standard of care treatment. Trial Registration ClinicalTrials.gov Identifiers: NCT03711162 and NCT03733444.
Collapse
Affiliation(s)
- Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, England
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | | | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Vincent Cottin
- Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel, Hospices Civils de Lyon, and IVPC, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Sonye K. Danoff
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Irene Groenveld
- Galapagos NV, Leiden, the Netherlands
- CellPoint BV, Oegstgeest, the Netherlands
| | - Eric Helmer
- Galapagos Biotech Ltd, Cambridge, England
- Exscientia, Oxford, England
| | - R. Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, England
| | - Julie Milner
- Gilead Sciences, Inc, Foster City, California
- Alnylam, Maidenhead, England
| | | | | | | | | | | | | | | | - Ineke Seghers
- Galapagos NV, Mechelen, Belgium
- Argenx, Gent, Belgium
| | - Lixin Shao
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | - Wim A. Wuyts
- Department of Respiratory Medicine, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Lung Research, Heidelberg, Germany
- Center for Pulmonary Medicine, Department of Pneumology, Mainz University Medical Center, Mainz, Germany
- Department of Pulmonary, Critical Care, and Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | | | - Niyati Prasad
- Galapagos NV, Mechelen, Belgium
- Enterprise Therapeutics, Brighton, England
| | - Marlies S. Wijsenbeek
- Centre for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
6
|
KHURANA M, Prasad N. WCN23-1145 A COMPARATIVE LONG TERM OUTCOME STUDY OF DIFFUSE CRESCENTIC IMMUNOGLOBULIN A NEPHROPATHY AND ANCA ASSOCIATED PAUCIMMUNE CRESCENTIC GLOMERULONEPHRITIS. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.185] [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: 03/22/2023] Open
|
7
|
VEERANKI V, Prasad N, Meyyappan J, Bhadauria D, Kaul A, Patel M, Kushwaha R, Behera M, Yachha M. WCN23-1143 DOES THE CHANGING EPIDEMIOLOGY AND THE THERAPEUTICS HAVE INFLUENCE ON THE SPECTRUM OF RENAL DISEASES IN PATIENTS WITH DIABETES MELLITUS? Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.457] [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: 03/22/2023] Open
|
8
|
Yadav B, Prasad N, Agrawal V, Jain M, Agarwal V. WCN23-0779 Inflammatory interstitial fibrosis and tubular atrophy is associated with intragraft Granzyme-B+ immune cell infiltration and phosphoSMAD-3+ mediated signaling in renal transplant recipients. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.903] [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: 03/22/2023] Open
|
9
|
KAMTHAN S, Agrawal V, Singh S, Prasad N, Agarwal V. WCN23-1127 CIRCULATING MICROPARTICLES, URINARY SOLUBLE CD163 AND CD163+ M2 MACROPHAGE TISSUE INFILTRATION IN ANTIBODY-MEDIATED RENAL ALLOGRAFT REJECTION. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.929] [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: 03/22/2023] Open
|
10
|
Khanna D, Denton CP, Furst DE, Mayes MD, Matucci-Cerinic M, Smith V, de Vries D, Ford P, Bauer Y, Randall MJ, Ebrahimpoor M, Kupcsik L, Stiers PJ, Deberdt L, Prasad N, Lim S, Pujuguet P, Ahmed S. A 24-Week, Phase IIa, Randomized, Double-blind, Placebo-controlled Study of Ziritaxestat in Early Diffuse Cutaneous Systemic Sclerosis (NOVESA). Arthritis Rheumatol 2023. [PMID: 36787101 DOI: 10.1002/art.42477] [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] [Received: 06/09/2022] [Revised: 12/14/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE NOVESA explored the efficacy, safety, and tolerability of ziritaxestat, a selective autotaxin inhibitor, in patients with early diffuse cutaneous systemic sclerosis (dcSSc). METHODS NOVESA was a 24-week, Phase IIa, double-blind, placebo-controlled study. Adults with dcSSc were randomized to oral ziritaxestat 600 mg once daily or matching placebo. The primary efficacy endpoint was change from baseline in modified Rodnan skin score (mRSS) at Week 24. Secondary endpoints assessed safety and tolerability; other endpoints included assessment of skin and blood biomarkers. Patients in NOVESA could enter a 104-week open-label extension (OLE). RESULTS Patients were randomized to ziritaxestat (n = 21) or placebo (n = 12). Reduction in mRSS was significantly greater in the ziritaxestat versus placebo group (-8.9 vs. -6.0 units; P = 0.0411). Placebo patients switching to ziritaxestat in the OLE showed similar reductions in mRSS to those observed for ziritaxestat patients in the parent study. Ziritaxestat was well tolerated; the most frequent treatment-related treatment-emergent adverse events were headache and diarrhea. Circulating lysophosphatidic acid (LPA) C18:2 was significantly reduced, demonstrating ziritaxestat target engagement; levels of fibrosis biomarkers were reduced in the blood. No differentially expressed genes were identified in skin biopsies. Significant changes in 109 genes were identified in blood samples. CONCLUSION Ziritaxestat resulted in significantly greater reductions in mRSS at Week 24 than placebo; no new safety signals emerged. Biomarker analysis suggests ziritaxestat may reduce fibrosis. Modulation of the autotaxin/LPA pathway could improve skin involvement in patients with dcSSc. A plain language summary is available in the Supplement.
Collapse
Affiliation(s)
- Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan, USA
| | | | - Daniel E Furst
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - Maureen D Mayes
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of Rheumatology, AOUC, Florence, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | | | | | | | | | | | | | | | | | | | - Sharlene Lim
- Gilead Sciences, Inc., Foster City, California, USA
| | | | | |
Collapse
|
11
|
Kalia S, Dhiman V, Tekou Carol T. T, Basandrai D, Prasad N. Antibacterial activities of Bi-Ag co-doped cobalt ferrite and their ZnO/Ag nanocomposite/s. INORG CHEM COMMUN 2023. [DOI: 10.1016/j.inoche.2022.110382] [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: 01/29/2023]
|
12
|
Sangha J, Edroos S, Glancy J, Prasad N. Lipoprotein(a) in progressive coronary artery disease: beyond classical cardiovascular risk parameters. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2358] [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
Introduction
Classical primary preventive cardiovascular disease (CVD) risk algorithms, such as the Framingham risk score and the widely used QRISK score in the UK, predate large-scale deep-phenotyped biomedical research resources. There is therefore the opportunity to identify novel predictors. In addition, whilst CVD risk profiling is well studied in the context of primary prevention, there is a paucity of data examining risk in regard to secondary prevention.
Purpose
To identify independent predictors of repeat coronary artery revascularisation, following index coronary angioplasty.
Methods
The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37–73 years at entry between 2006–2010. Data are derived from an array of physical measurements, self-reported measures and biological samples, together with longitudinal linkage to hospital inpatient records and death registries. Procedural codes were used to identify patients who had undergone first coronary angioplasty from 2006 onwards. Repeat revascularisation (RR) was defined as angioplasty or bypass grafting occurring at least 9 months after the index angioplasty, in order to preclude instances of staged revascularisation and in-stent restenosis. Data were censored at January 2021 or date of death as appropriate.
Results
A total of 12,853 participants underwent a first coronary angioplasty during the study period, with 1,394 (10.8%) requiring RR over a median follow-up of 6.5 years. The average age was 64 years in the RR cohort and 1117 (80%) were male. Univariate analyses confirmed a number of established associations with RR, including for example diabetes mellitus and hypertension. Median lipoprotein(a) concentrations were 27.6 vs. 30.3nmol/L in the RR group, p=0.066. Cox regression analyses (n=7,216) incorporating 21 biometric and clinical parameters demonstrated that lipoprotein(a) >80nmol/L was one of six independent predictors of time to RR (HR 1.24, p=0.006), independent of other lipids. The strength and significance of this association persisted when the number of covariates was reduced to include only other lipids and classical cardiovascular risk parameters. LDL, HDL, and triglyceride levels were not significant predictors in this model.
Conclusions
Lipoprotein(a) is identified as a major independent driver of RR. However current European Society of Cardiology guidance does not recommend measurement of Lipoprotein(a) in the context of progressive coronary artery disease. Furthermore, it is known that strategies such as lifestyle advice and statins – recommended in all patients with established coronary artery disease - do no reduce lipoprotein(a), whilst niacin and PCSK9 inhibitors do have a significant effect. Indications for lipoprotein(a) measurement must therefore be broadened, so that specific treatments to lower it can be instituted in order to reduce the burden of progressive coronary artery disease.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Herefordshire Heart Fund
Collapse
Affiliation(s)
- J Sangha
- Luton and Dunstable University Hospital , Luton , United Kingdom
| | - S Edroos
- Luton and Dunstable University Hospital , Luton , United Kingdom
| | - J Glancy
- Hereford County Hospital, Wye Valley NHS Trust , Hereford , United Kingdom
| | - N Prasad
- Hereford County Hospital, Wye Valley NHS Trust , Hereford , United Kingdom
| |
Collapse
|
13
|
Prasad N, Gupta N. POS-054 TRIAD OF "FEVER, LIVER AND KIDNEY INJURY(FLIKI)": ETIOLOGY AND OUTCOMES IN NORTHERN INDIAN SETTINGS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.071] [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: 10/14/2022] Open
|
14
|
Shenoy R, Prasad N, Kaul A, Bhadauria D. POS-106 PROFILE OF CRYPTOCOCCAL INFECTIONS IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
15
|
Shinde R, Kaul A, Bhadauria D, Behera M, Yachha M, Kushwah R, Patel M, Gala R, Prasad N. POS-108 POST-TRANSPLANT INFECTIONS AND LONG TERM OUTCOMES IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.126] [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: 10/14/2022] Open
|
16
|
Sharma H, George R, Prasad N, Kaul A, Bahaduria D, Patel M, Behera M, Kushwaha R, Yaccha M. POS-107 LONG TERM OUTCOMES OF RENAL TRANSPLANTATION WITH PRE- AND POST-TRANSPLANT TUBERCULOSIS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.125] [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: 10/14/2022] Open
|
17
|
Patil A, Kaul A, Bhadauria D, Umair M, Jha G, Prasad N. POS-105 EXPERIENCE OF TUNNELED CUFFED CATHETERS AS VASCULAR ACCESS IN A TERTIARY CARE HOSPITAL. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
18
|
Mathews T, Pushkar D, Bhaduaria D, Kaul A, Prasad N, Patel M, Behera M, Yachha M, Kushwaha R, Srivastava A. Early versus late acute graft pyelonephritis: A retrospective analysis of graft and patient outcomes. Transpl Immunol 2022; 75:101657. [PMID: 35787934 DOI: 10.1016/j.trim.2022.101657] [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: 04/09/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Acute graft pyelonephritis (AGPN) is thought to affect graft and patient survival among renal transplant recipients. The objective was to compare outcomes among early AGPN (<6 months from transplant) versus late AGPN (>6 months from transplant). METHODS This retrospective study analysed 150 patients with AGPN dividing them into early and late AGPN from 2008 to 2016. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analysed using Kaplan-Meyer survival plots. RESULTS 55.3% (n = 83) had early AGPN and 44.7% (n = 67) had late AGPN. In an early AGPN group, 13.3% had CMV disease on the follow-up, compared to only 3% in the late AGPN group (p > 0.05). Furthermore, 38.6% had prolonged DJ stent in-situ (> 2 weeks) following transplant surgery in the early AGPN compared to only 19.4% in the late AGPN group (p < 0.05). Recurrent GPN was more common in the late AGPN group - (35.8% versus 18.1%). The presence of renal abscess was predictive of graft loss in Univariate analysis (HR-6.12, p < 0.004). There was decreased death-censored graft survival in the early AGPN group (p = 0.035), without a significant difference in the patient survival among the two groups. CONCLUSION The occurrence of early AGPN had a significant impact on long-term graft survival in renal transplant recipients, with no significant effect on patient survival. This study underlines the paramount importance of the prevention of urinary tract infection (UTI) in renal transplant recipients.
Collapse
Affiliation(s)
- T Mathews
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Pushkar
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Bhaduaria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - N Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Behera
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Yachha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Srivastava
- Department of Urology Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
19
|
Kaul A, Bhaduaria D, Behera MR, Kushwaha R, Prasad N, Yachha M, Patel M, Kalitha J. Psycho-social health and quality of life among kidney donors following transplantation. Transpl Immunol 2022; 74:101649. [PMID: 35777614 DOI: 10.1016/j.trim.2022.101649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Living kidney donation is a complex psychological experience for donors. The present study examined the psychosocial impact of kidney donation on donors. METHODS The retrospective study included 506 donors who donated a kidney between 2010 and 2018 at a transplant centre in India. These donors responded via a donor insight questionnaire about their hospital anxiety, and their possible level of depression. The information included socio-demographic form with multiple information. The health survey was used periodically evaluate the psychosocial impact among donors following donation, including the transplant outcomes. RESULTS The majority of donors were females (79.4%). There was a significant improvement in the quality of life among donors (SF-36) following the donation of a kidney, especially among those donors who maintained good graft functions themselves as well as those who were informed about good kidney function in transplanted recipients. These donors showed a lesser degree of depressive and anxiety scores (HAD score 3.5 and BDI II 4.8) than donors who had problems themselves and/or whose donated kidneys did not function well. Most living donors (89.1%) felt that the act of donation had a positive impact on their lives and those donors would encourage others to donate a kidney. Overall, the graft outcomes impacted the donor's state of mind. CONCLUSION The study showed a very positive impact of the acknowledgment of the donor by the recipient, especially those donors whose kidney transplants were well functioning. The state of depression, anxiety, and psycho-social outcomes correlated with the graft outcomes. Donors showed positive insight towards donation, with inner conscience still conclusively willing to donate and encourage others.
Collapse
Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India.
| | - D Bhaduaria
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Ranjan Behera
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Yachha
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Patel
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - J Kalitha
- Department of Neurology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| |
Collapse
|
20
|
Prasad N, Lynggaard P. LoRaWan Sensitivity Analysis and Prevention Strategies Against Wireless DoS Attacks. Wirel Pers Commun 2022; 126:3663-3675. [PMID: 35756171 PMCID: PMC9209830 DOI: 10.1007/s11277-022-09884-8] [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] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
New wireless IoT technology provides smart pseudo intelligent solutions that will have a big impact on the infrastructures and the society in the future to come. In the last decade, many new low power longrange wireless technologies have emerged to support these wireless IoT based solutions. One of the most promising and commonly accepted technologies is LoRaWAN. Unfortunately, the introduction and deployment of a new wireless technology provides new risks and new security challenges. Some of these challenges can be categorized as "critical", which means that if they fail, this will have major consequences for the society's critical infrastructure and the society as a hole. In this paper one of these critical challenges is analyzed in terms of wireless jamming attacks that cause fatale denial-of-services on the LoRaWAN wireless infrastructure and connectivity. This analysis is based on a mathematical simulation model which is described and elaborated. By using this model on a selected societal critical service example, a sensitivity analysis in terms of jamming and DoS attacks is performed, provided, and elaborated. Finally, some selected prevention strategies to avoid and counter-fight these attacks are presented, discussed, and elaborated.
Collapse
Affiliation(s)
- N. Prasad
- CTIF Global Capsule (CGC), School of Business and Social Sciences, Aarhus University, Herning, Denmark
| | - P. Lynggaard
- Technical University of Denmark, Ballerup, Denmark
| |
Collapse
|
21
|
Tromp J, Bauer DN, Claggett BL, Frost M, Iversen MB, Prasad N, Petrie M, Larson MG, Ezekowitz JA, Solomon SD. A prospective validation of a deep learning-based automated workflow for the interpretation of the echocardiogram. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.002] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Us2.ai
Background. Deep learning can automate the interpretation of medical imaging tests. This study aimed to prospectively assess the interchangeability of deep learning algorithms with expert human measurements for interpreting echocardiographic studies, the primary method for assessing cardiac structure and function.
Methods. We compared a deep learning interpretation of 23 echocardiographic parameters—including cardiac volumes, ejection fraction, and Doppler measurements—with three repeated measurements by core lab human experts in a prospective study for submission to the United States Food and Drug Administration (FDA). The primary outcome metric was the individual equivalence coefficient (IEC), which compares the disagreement between deep learning and human readers relative to the disagreement among human readers. The pre-determined non-inferiority criterion was 0.25 for the upper bound of the 95% confidence interval (CI). Secondary outcomes included measures of agreement, including the mean absolute deviation.
Results. We included 602 studies from 600 participants (421 with heart failure, 179 controls, 69% women) with a mean age of 57 ± 16 years. The point estimates of IEC were all <0, indicating that the disagreement between the deep learning and human measures were lower than the disagreement among three core lab readers, and the upper bound of the 95% CI of IECs fell below the prespecified success criterion of 0.25. Secondary endpoints showed good agreement of automated with human expert measurements (Figure), with comparable or lower mean absolute deviations between automated and human experts relative to the mean absolute deviation among human experts.
Conclusion. This prospective validation study demonstrated excellent agreement between deep learning and expert human interpretation for a wide range of echocardiographic measurements. These results highlight the potential of deep learning algorithms to improve efficiency and reduce costs of echocardiography. Abstract Figure.
Collapse
Affiliation(s)
- J Tromp
- National University Health System, Singapore, Singapore
| | - DN Bauer
- Brigham And Women"S Hospital, Harvard Medical School, Cardiovascular division, Boston, United States of America
| | - BL Claggett
- Brigham And Women"S Hospital, Harvard Medical School, Cardiovascular division, Boston, United States of America
| | - M Frost
- Us2.ai, Singapore, Singapore
| | | | - N Prasad
- Brigham And Women"S Hospital, Harvard Medical School, Cardiovascular division, Boston, United States of America
| | - M Petrie
- BHF Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom of Great Britain & Northern Ireland
| | - MG Larson
- Boston University, Boston, United States of America
| | - JA Ezekowitz
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - SD Solomon
- Brigham And Women"S Hospital, Harvard Medical School, Cardiovascular division, Boston, United States of America
| |
Collapse
|
22
|
SHARMA H, Prasad N, Kaul A, Bahaduria Singh D, Patel Ranjan M, Behera Ranjan M, Yaccha M, Kushwaha Singh R. POS-812 FACTORS PREDICTING POST RENAL TRANSPLANT TUBERCULOSIS: A TERTIARY CARE CENTRE EXPERIENCE. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.848] [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: 11/26/2022] Open
|
23
|
S S, Bhadauria D, Prasad N, Kaul A, Patel M, Behera M, Yachha M, Kushwaha R. POS-807 THE DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN COEXISTING BKV NEPHROPATHY WITH ACUTE REJECTION - A SINGLE CENTRE EXPERIENCE FROM NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
24
|
Prasad N, Agarwal V, Patel M, Yadav B. POS-804 Donor vascular endothelial growth factor gene polymorphism association with acute allograft rejection in live related renal transplant recipient patients. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
25
|
S S, Prasad N, Kaul A, Bhadauria D, Patel M, Kushwaha R, Behera M, Yachha M. POS-808 "Renal allograft cortical necrosis" - Disappearing entity in live renal transplant over two decades - A Single centre experience. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.844] [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: 10/19/2022] Open
|
26
|
Sangha J, Dewji A, Glancy J, Prasad N. Repeat revascularisation following PCI in the UK Biobank prospective cohort study: incidence, independent predictors and prognostic impact. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2164] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Data from the SYNTAX and EXCEL trials have previously demonstrated increased morbidity and mortality following repeat revascularisation (RR). However real-world RR rates following index PCI are poorly defined, particularly in the 'late' context of restenosis of bystander disease and de novo lesions.
Purpose
To identify independent predictors of RR and evaluate its prognostic impact in an unselected cohort of patients following first PCI.
Methods
The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37–73 years at entry between 2006–2010. Data are derived from an array of physical measurements, self-reported measures and biological samples, together with longitudinal linkage to hospital inpatient records and death registries. Procedural codes (OPCS-4) were used to identify patients who had undergone first PCI from 2006 onwards. RR was defined as PCI or CABG occurring at least 9 months after the index PCI, in order to preclude instances of staged revascularisation and in-stent restenosis. Data were censored at January 2021 or date of death as appropriate. Non-parametric tests are used throughout.
Results
A total of 12,853 participants underwent a first PCI during the study period, with 1,394 (10.8%) requiring RR over a median follow-up of 6.5 years. Of these, 1188 underwent PCI whilst 206 were elected to CABG. The average age was 64 years in the RR cohort and 1117 (80%) were male. Univariate analyses confirmed a number of established associations with RR, including for example diabetes mellitus and hypertension. Median lipoprotein(a) concentrations were 27.6 vs. 30.3nmol/L in the RR group, p=0.066. Cox regression analyses incorporating 21 biometric and clinical parameters demonstrated that lipoprotein(a) was an independent predictor of time to RR, independent of other lipids (Table 1). The strength of this association persisted when the number of covariates was reduced to include only other lipids and classical cardiovascular risk parameters. In Kaplan-Meier analyses, RR was associated with lower all-cause mortality (Figure 1). Further multivariate time-to-event analyses confirmed this association (HR 0.59, 95% CI 0.47–0.75, p<0.001). In separate models examining PCI and CABG as distinct modalities of RR, both were independently associated with prognostic benefit (HR 0.61, p<0.001 and HR 0.48, p<0.05 respectively).
Conclusions
Lipoprotein(a) is identified as a major independent driver of RR. In contrast to recent trial data focussing on left main stem and multivessel disease, unselected patients undergoing RR 9 or more months following index PCI attain prognostic benefit as assessed in multivariate analyses. The findings support an invasive approach, whether with PCI or CABG, in progressive coronary artery disease following initial PCI.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): 1. The Herefordshire Heart Fund, UK. 2. Postgraduate Medical Bursary, Wye Valley NHS Trust, UK. Table 1Figure 1
Collapse
Affiliation(s)
- J Sangha
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, United Kingdom
| | - A Dewji
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, United Kingdom
| | - J Glancy
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, United Kingdom
| | - N Prasad
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, United Kingdom
| |
Collapse
|
27
|
Pham K, Wu Y, Turett G, Prasad N, Yung L, Rodriguez GD, Segal-Maurer S, Urban C, Yoon J. Edwardsiella tarda, a rare human pathogen isolated from a perihepatic abscess: Implications of transient versus long term colonization of the gastrointestinal tract. IDCases 2021; 26:e01283. [PMID: 34527514 PMCID: PMC8433271 DOI: 10.1016/j.idcr.2021.e01283] [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: 07/13/2021] [Revised: 09/05/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022] Open
Abstract
Although gastroenteritis is the most commonly described manifestation of Edwardsiella tarda infection, the pathogenesis and transient or long-term colonization of the gastrointestinal tract of this organism in human disease is not clear. We describe a rare manifestation of E. tarda infection in a perihepatic abscess in the setting of a patient with perforated cholecystitis and its successful eradication following antibiotic treatment.
Collapse
Affiliation(s)
- K Pham
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Y Wu
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - G Turett
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - N Prasad
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - L Yung
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - G D Rodriguez
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,Columbia University School of Nursing, Columbia University, NY 10032, USA
| | - S Segal-Maurer
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,Weill Cornell Medicine, Cornell University, NY 10065, USA
| | - C Urban
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,Weill Cornell Medicine, Cornell University, NY 10065, USA
| | - J Yoon
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| |
Collapse
|
28
|
SINGH M, Prasad N, Rai M, Behera M, jaiswal A, Agarwal V, Misra D. POS-771 ROLE OF INTERLUKIN-6 AMPLIFIER LOOP (IL-6+IL-17) IN CHRONIC ANTIBODY MEDIATED REJECTION IN RENAL ALLOGRAFT RECIPIENT. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.803] [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: 10/21/2022] Open
|
29
|
Prasad N, Yadav A, Ghosh A, Kumar V, Kundu M, Gautam S, Jha V, CKD Study Investigators I. POS-362 PRESCRIPTION PATTERN OF MEDICINE IN EARLY CKD STAGES IN ICKD COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.379] [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
|
30
|
Saikumar Doradla LP, Lal H, Kaul A, Bhaduaria D, Jain M, Prasad N, Thammishetti V, Gupta A, Patel M, Sharma RK. Clinical profile and outcomes of De novo posttransplant thrombotic microangiopathy. Saudi J Kidney Dis Transpl 2021; 31:160-168. [PMID: 32129209 DOI: 10.4103/1319-2442.279936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Thrombotic microangiopathy (TMA) after kidney transplant is rather uncommon but an important reversible cause of graft loss. This retrospective study of biopsy-proven posttransplant TMA was done to identify the important etiological factors, clinical features, and outcomes of post transplant TMA in a tertiary care referral hospital in northern India. This retrospective study was conducted among all renal transplant recipients who presented with graft dysfunction between 1989 and 2015. All the cases were looked for their etiology, clinical course, treatment modalities, and renal outcomes. The study was conducted in accord with prevailing ethical principles and reviewed by our own institutional review board. Seventeen patients out of 2000 (0.008%) transplants done during the study period had posttransplant TMA, out of which all the patients had de novo TMA, and the median time of presentation after transplantation was four months. Systemic TMA was noted in only four patients. Biopsy revealed associated rejection in five patients and associated calcineurin inhibitor (CNI) toxicity in 12 patients. Patients with TMA due to CNI toxicity were managed with CNI reduction or switching to alternate CNI or mammalian target of rapamycin inhibitors. In addition, antithymocyte globulin and plasma exchange were used in rejection-associated TMA. While four out of 12 patients (33%) in CNI-related TMA developed end-stage renal disease (ESRD), all patients in rejection-associated TMA developed ESRD. The overall one-year graft survival was 47%, whereas five- and 10-year survival was 35%. There was no significant difference in graft survival between localized and systemic TMAs (P = 0.4). Posttransplant TMA should be suspected even if there are no systemic features of hemolysis and early graft biopsy and prompt action is needed. The occurrence of TMA in the setting of rejection is associated with grave prognosis.
Collapse
Affiliation(s)
- L P Saikumar Doradla
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - H Lal
- Departmenta of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anupma Kaul
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhaduaria
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M Jain
- Departmenta of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - N Prasad
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V Thammishetti
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M Patel
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Departmenta of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
31
|
SINGH PhD H, Prasad N, Jaiswal A, Misra D, Agarwal V. SAT-468 Can steroid responsiveness be regulated epigenetically in childhood nephrotic syndrome? Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.498] [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: 10/24/2022] Open
|
32
|
Prasad N. TF1 A Tool for Faculty Preceptors to Guide Emergency Departments Learners in Constructing Focused Assessments of Common Presenting Complaints. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.353] [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]
|
33
|
Siddiqui M, Rodriguez C, Balakumar A, Prasad N, Naples R, Papanagnou D, Zhang X. TF6 How Do You Listen? A Workshop for Medical Students to Reflect on Their Listening Styles. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Kumar V, Gang S, Modi G, Parameswaran S, Singh S, Sircar D, Prasad N, Varughese S, Sahay M, Jha V. SAT-251 DIFFERENCES IN PATIENTS BETWEEN CKD – CAUSE UNKNOWN AND THOSE WITH KNOWN CAUSES OF CKD: A COMPARISON FROM THE INDIAN CHRONIC KIDNEY DISEASE COHORT. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
35
|
jaiswal PhD A, Chaturvedi S, Singh H, Agarwal V, Prasad N. MON-212 COMPLETE ABROGATION OF ALPHA SMOOTH MUSCLE ACTIN ON DUAL INHIBITION OF PHOSPHODIESTERASE 5 AND 5-HT2B INHIBITORS IN HUMAN PERITONEAL FIBROBLASTS ISOLATED FROM CAPD PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
36
|
Prasad N, Prakash S, Khan A, Bhadauria D, Gupta A. SUN-201 GENOME WIDE ANALYSIS STUDY TO EVALUATE POTENTIAL GENETIC RISKS AND IMMUNOLOGICAL PATHWAYS ASSOCIATED WITH CHRONIC KIDNEY DISEASE OF UNKNOWN ETIOLOGY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
37
|
CHATURVEDI S, Prasad N, Singh H, Agarwal V, Misra D. SUN-146 5-HT2 AND 5-HT2B RECEPTOR INHIBITION ATTENUATE PERITONEAL FIBROSIS BY TARGETING NON-CANONICAL SIGNALING PATHWAYS INCLUDING STAT3. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.547] [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
|
38
|
jaiswal PhD A, Prasad N, Agarwal V. SAT-005 PLA2R+VE MEMBRANOUS GLOMERULONEPHRITIS PATIENTS SHOWS POOR RESPONSE TO TACROLIMUS PLUS PREDNISOLONE THERAPY COMPARED TO PLA2R-VE PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.025] [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
|
39
|
Kaul A, Prasad P, Kumari N, Bhaduaria D, Sharma RK, Prasad N, Gupta A, Krishnani N. G6PD deficiency is not an uncommon cause of pigment nephropathy. Saudi J Kidney Dis Transpl 2018; 29:1371-1375. [PMID: 30588969 DOI: 10.4103/1319-2442.248316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute kidney injury (AKI) with evidence of hemolysis is associated with tropical infections. However, pigment-induced AKI can happen with relatively uncommon genetic causes of hemolytic anemia, i.e., glucose 6-phosphate deficiency (G6PD). We share our experience of three such patients whose clinical presentation was similar to jaundice, AKI with hemolysis with suspicion of thrombotic microangiopathy. On evaluation, all had a history of usage of anti-malarial and with G6PD estimation revealing deficient status even during the episode while other tests such as Coomb's test and bone marrow biopsy was normal in all three patients. The kidney biopsy revealed acute tubular necrosis with red blood cell casts and pigments in all the cases. All patients were managed conservatively and showed complete recovery. Thus in tropical countries G6PD deficiency although is not common, should be considered among patients who have received antimalarial drugs presenting as AKI and a detailed hemolytic work-up needs to be carried out as an important cause of preventable recurrent AKI in tropical countries.
Collapse
Affiliation(s)
- Anupma Kaul
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pallavi Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Niraj Kumari
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhaduaria
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - N Prasad
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Narendra Krishnani
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
40
|
Mundkür BB, Prasad N. On a New Ravenelia from India. Mycologia 2018. [DOI: 10.1080/00275514.1938.12017313] [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: 10/28/2022]
Affiliation(s)
- B. B. Mundkür
- Mycological Section, Imperial Agricultural Research Institute, New Delhi, India
| | - N. Prasad
- Mycological Section, Imperial Agricultural Research Institute, New Delhi, India
| |
Collapse
|
41
|
Prasad N, Manjunath R, Bhadauria D, Marak RSK, Sharma RK, Agarwal V, Jain M, Gupta A. Mucormycosis of the Thyroid Gland: A Cataclysmic Event in Renal Allograft Recipient. Indian J Nephrol 2018; 28:232-235. [PMID: 29962676 PMCID: PMC5998715 DOI: 10.4103/ijn.ijn_192_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Invasive fungal infection is a complication seen in immunocompromised patients. A disseminated fungal infection has a high rate of mortality. Although disseminated infection is known to be seen in most organs, thyroid involvement is rarely reported. Hence, we report a fatal case of thyroid mucormycosis which resulted into laryngeal nerve paralysis and death of a renal allograft recipient.
Collapse
Affiliation(s)
- N Prasad
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R Manjunath
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R S K Marak
- Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - M Jain
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, SGPGIMS, Lucknow, Uttar Pradesh, India
| |
Collapse
|
42
|
Lal H, Yadav P, Kumar N, Prasad N. Late posttransplant lymphoproliferative disease: Report of a rare case and role of positron emission tomography-computed tomography. Indian J Nephrol 2018; 28:393-396. [PMID: 30271004 PMCID: PMC6146733 DOI: 10.4103/ijn.ijn_262_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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Posttransplant lymphoproliferative disease (PTLD) is an uncommon complication of immunosuppression after solid organ transplantation. Early PTLD (<1 year after transplantation) is frequently found around the allograft, whereas late PTLD (>1 year after transplantation) does not have such a preference. 18-Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) has clinical significance in the evaluation of PTLD. 18FDG PET-CT scan allows precise anatomic localization of FDG-avid lesions, hence helpful in staging of disease and evaluation of response to therapy. It can better characterize persistent lesions and differentiate residual tumor from fibrosis or necrosis. We present a rare case report of a perigraft PTLD developing 12 years after renal transplantation sparing the graft, in an Epstein–Barr virus-negative patient.
Collapse
|
43
|
Behera MR, Kaul A, Kishore R, Karthikeyan B, Bhadauria DS, Mishra P, Prasad N, Gupta A, Sharma RK. Optimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant. Indian J Nephrol 2018; 28:433-440. [PMID: 30647497 PMCID: PMC6309383 DOI: 10.4103/ijn.ijn_305_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82–0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37–0.80, p = 0.002) were significant predictors of survival. In the 1st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.
Collapse
|
44
|
Prasad N, Manjunath R, Rangaswamy D, Jaiswal A, Agarwal V, Bhadauria D, Kaul A, Sharma R, Gupta A. Efficacy and Safety of Cyclosporine versus Tacrolimus in Steroid and Cyclophosphamide Resistant Nephrotic Syndrome: A Prospective Study. Indian J Nephrol 2018. [PMID: 29515301 PMCID: PMC5830809 DOI: 10.4103/ijn.ijn_240_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/22/2022] Open
Abstract
Calcineurin inhibitors (CNIs) are the preferred drugs for treatment of childhood steroid-resistant nephrotic syndrome (SRNS) who are also resistant to cyclophosphamide (CYC). Although few studies have shown a benefit of one over the other, efficacy and safety of either CNIs (tacrolimus [TAC] or cyclosporine [CSA]) in this special population remained to be assessed in long-term studies. Forty-five children with SRNS who were also resistant to CYC (CYC-SRNS) from January 2006 to June 2011, were included in the study. Patients were treated with CNI either TAC or CSA based on 1:1 allocations and were prospectively observed. Patients who were nonresponsive to CNIs had been treated with mycophenolate mofetil. Outcomes were measured in terms of remission of NS, adverse effects of drugs, and progression of disease. After 6 months of treatment, 16/23 (69.5%) patients on CSA achieved remission and 18/22 (81.8%) on TAC achieved remission (P = 0.3). The side effects hypertrichosis, and gum hyperplasia were significantly less in TAC group as compared to CSA group (P < 0.001). The 1-, 2-, 3-, 4-, and 5-year estimated renal survival (doubling of serum creatinine as event) in CSA group was 96%, 91%, 85%, 54%, and 33% and in TAC group was 96%, 95%, 90%, 89%, and 79%, respectively (P = 0.02). Although TAC and CSA are equally efficacious, TAC has significantly less side effects. The long-term outcome of renal function was significantly better in patients who were treated with TAC as compared to CSA.
Collapse
Affiliation(s)
- N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Manjunath
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Rangaswamy
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Jaiswal
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
45
|
Kaul A, Behera MR, Rai MK, Mishra P, Bhaduaria DS, Yadav S, Agarwal V, Karoli R, Prasad N, Gupta A, Sharma RK. Neutrophil Gelatinase-associated Lipocalin: As a Predictor of Early Diabetic Nephropathy in Type 2 Diabetes Mellitus. Indian J Nephrol 2018. [PMID: 29515302 PMCID: PMC5830810 DOI: 10.4103/ijn.ijn_96_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/16/2022] Open
Abstract
This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m2 and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.
Collapse
Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M K Rai
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - P Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D S Bhaduaria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Yadav
- Department of Medicine, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Karoli
- Department of Endocrinology, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
46
|
Prasad N, Patel MR, Pandey A, Jaiswal A, Bhadauria D, Kaul A, Sharma RK, Mohindra S, Pandey G, Goel A, Gupta A. Direct-acting Antiviral Agents in Hepatitis C Virus-infected Renal Allograft Recipients: Treatment and Outcome Experience from Single Center. Indian J Nephrol 2018; 28:220-225. [PMID: 29962673 PMCID: PMC5998719 DOI: 10.4103/ijn.ijn_190_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/23/2023] Open
Abstract
Hepatitis C virus (HCV) infection in renal allograft recipient is associated with increased morbidity and mortality. At present, only few studies related to treatment and outcomes of HCV-infected renal allograft recipients with DAAs have been published. We aimed the study to assess the efficacy and safety of sofosbuvir-based regimens in HCV-infected renal allograft recipients. We analyzed data of 22 eligible HCV-infected renal allograft recipients (14 genotype-3, 6 genotype-1, one each genotype-2 and 4) who were treated with DAAs at our institute. DAA regimen included sofosbuvir and ribavirin with or without ledipasvir or daclatasvir for 12–24 weeks. Patients were followed up for 24 weeks after completion of treatment. A rapid viral response of 91%, end of therapy response of 100%, and sustained viral response at 12 and 24 weeks of 100% with rapid normalization of liver enzymes were observed. Therapy was well tolerated except for ribavirin-related anemia. A significant decrease in tacrolimus trough levels was observed and most patients required increase in tacrolimus dose during the study. Treatment with newer DAAs is effective and safe for the treatment of HCV-infected renal allograft recipients.
Collapse
Affiliation(s)
- N Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Pandey
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Jaiswal
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Mohindra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - G Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
47
|
Mackay AJ, Patel ARC, Singh R, Sapsford RJ, Donaldson GC, Prasad N, Goehring UM, Nip TK, Wedzicha JA. Randomized Double-Blind Controlled Trial of Roflumilast at Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 196:656-659. [PMID: 28146642 DOI: 10.1164/rccm.201612-2518le] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alex J Mackay
- 1 Barts Health NHS Trust London, United Kingdom.,8 * University College London London, United Kingdom
| | | | - Richa Singh
- 1 Barts Health NHS Trust London, United Kingdom.,9 * Imperial College London London, United Kingdom
| | | | | | - Niyati Prasad
- 4 Vertex Pharmaceuticals (Europe) Ltd. London, United Kingdom and.,5 * Takeda Development Centre Europe Ltd. London, United Kingdom
| | - Udo-Michael Goehring
- 5 * Takeda Development Centre Europe Ltd. London, United Kingdom.,7 Vifor Pharma Ltd. Glattbrugg, Switzerland and
| | - Tsz Keung Nip
- 6 Takeda Development Centre Europe Ltd. London, United Kingdom
| | | |
Collapse
|
48
|
Kaul A, Bhaduaria D, Pradhan M, Sharma RK, Prasad N, Gupta A. Pregnancy Check Point for Diagnosis of CKD in Developing Countries. J Obstet Gynaecol India 2017; 68:440-446. [PMID: 30416269 DOI: 10.1007/s13224-017-1055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/06/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Evidences suggest that females with CKD are associated with high risk of maternal and fetal complications. Early referral in CKD with pregnancy for specialist care may prove useful for maternal and fetal outcome. Methods Study looked for assessment of impact of CKD detection at the time of pregnancy and its impact on fetal and maternal outcome. Results A total of 465 females were retrospectively evaluated for renal status during their pregnancies, 172 females were unaware about their renal illness at the time of pregnancy, while 208 females were under regular obstetrical and nephrological follow-up during their pregnancy. 44.1% of these females in both groups had GFR < 60 ml/min. Preeclampsia was observed in 17.6% of planned pregnancies, while it was observed in 47.5% of unplanned pregnancies. Worsening of renal failure during and following pregnancy was observed among all stages of CKD, and there was greater decline in GRF with progression to ESRD earlier during or after pregnancy among unplanned pregnancies. Planned pregnancy group had better fetal outcome. Low birth babies weighing < 2500 g in unplanned group were much higher than in planned pregnancies. Conclusions Chronic kidney disease is often clinically silent until renal impairment is advanced. Pregnancy can be a check point for detection of renal disease and managed appropriately for better maternal and fetal outcome.
Collapse
Affiliation(s)
- A Kaul
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Bhaduaria
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Pradhan
- 2Department of Maternal and Foetal Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R K Sharma
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - N Prasad
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Gupta
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
49
|
Affiliation(s)
- V Kute
- Faculty of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - R M Jindal
- USU-Walter Reed Department of Surgery, Uniformed Services University, Bethesda, MD
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
50
|
Pedersen SE, Prasad N, Goehring UM, Andersson H, Postma DS. Control of moderate-to-severe asthma with randomized ciclesonide doses of 160, 320 and 640 μg/day. J Asthma Allergy 2017; 10:35-46. [PMID: 28331346 PMCID: PMC5349703 DOI: 10.2147/jaa.s111712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The inhaled corticoteroid (ICS) ciclesonide (Cic), controls asthma symptoms in the majority of patients at the recommended dose of 160 µg/day. However, the relationship between the level of asthma control and increasing doses of Cic is unknown. This study investigated whether long-term treatment with higher doses of Cic would further improve asthma symptoms in patients with uncontrolled asthma despite ICS use. Patients and methods In a double-blind, randomized, parallel-group study, 367 patients were allocated to one of three treatment arms (Cic 160, 320 and 640 µg/day). After a single-blind, 3-week baseline period with Cic 160 µg/day, eligible patients were randomized to receive 52 weeks of treatment with Cic 160, 320 or 640 µg/day (double-blind period) during which forced expiratory volume in 1 second (FEV1), exacerbations and Asthma Control Questionnaire (ACQ) scores were measured. Results Treatment with all the three doses was associated with significant improvements in ACQ scores, FEV1 and asthma symptoms (P<0.01). There were no statistically significant differences between the three doses. The results of the primary end point analysis showed a numerical improvement in the ACQ score with Cic 640 µg/day compared with Cic 160 µg/day (least square [LS] mean: −0.122; two-sided P-value: 0.30). Post hoc subgroup analyses showed that the improvement in the ACQ score with Cic 640 µg/day compared with Cic 160 µg/day was statistically significant in subjects who experience at least one exacerbation per year (LS mean: −0.586; 95% confidence interval: −1.110, −0.062, P=0.0285). Adverse events were low and consistent with the known safety profile of Cic. Conclusion In patients with persistent, uncontrolled asthma, increasing the Cic dose from 160 to 640 µg/day provided no clear additional effect. Patients who experience more than one exacerbation per year may benefit from higher doses; however, further studies are necessary to confirm this. All Cic doses were well tolerated.
Collapse
Affiliation(s)
- Søren E Pedersen
- Pediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | | | | | - Henrik Andersson
- Swedish Social Insurance Agency, Government Offices of Sweden, Stockholm, Sweden
| | - Dirkje S Postma
- Department of Pulmonology, Griac Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|