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Tickley I, Van Blydenstein SA, Meel R. Time to thrombolysis and factors contributing to delays in patients presenting with ST-elevation myocardial infarction at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J 2023; 113:53-58. [PMID: 37882136 DOI: 10.7196/samj.2023.v113i9.500] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Acute coronary syndrome is a public health burden both worldwide and in South Africa (SA). Guidelines recommend thrombolysis within 1 hour of symptom onset and 30 minutes of hospital arrival for patients with ST-elevation myocardial infarction (STEMI) in order to prevent morbidity and mortality. There is a paucity of data pertaining to the time between onset of chest pain and thrombolysis in STEMI patients in SA. OBJECTIVES To elucidate the time to thrombolytic therapy, establish the reasons for treatment delays, and calculate the loss of benefit of thrombolysis associated with delays in treatment of patients presenting with STEMI at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA. METHOD A prospective observational study of 100 consecutive patients with STEMI was conducted at CHBAH (2021 - 2022). RESULTS The mean (standard deviation) age was 55.6 (11.6) years, with a male predominance (78%). Thrombolytic therapy was administered to 51 patients, with a median (interquartile range (IQR)) time to thrombolysis of 360 (258 - 768) minutes; 10 of the patients who received a thrombolytic (19.6%) did so within 30 minutes of arrival at the hospital. The median (IQR) time from symptom onset to calling for help was 60 (30 - 240) minutes, the median time from arrival of help to hospital arrival was 114 (48 - 468) minutes, and the median in-hospital delay to thrombolysis after arrival was 105 (45 - 240) minutes. Numerous reasons that led to delay in treatment were identified, but the most frequent was prehospital delays related to patient factors. Late presentation resulted in 26/49 patients (53.1%) not receiving thrombolytic therapy. Five patients died and 43 suffered from heart failure. Thirty per 1 000 participants could have been saved had they received thrombolytic therapy within 1 hour from the onset of chest pain. CONCLUSION Prehospital and hospital-related factors played a significant role in delays to thrombolysis that led to increased morbidity and mortality of patients with STEMI.
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Affiliation(s)
- I Tickley
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S A Van Blydenstein
- Department of Internal Medicine and Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - R Meel
- 1 Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Hitzeroth J, van der Bijl P, Michel F, Meel R, Cupido BJ, Klug E. SA Heart consensus statement on closure of patent foramen ovale 2021. Cardiovasc J Afr 2023; 34:35-39. [PMID: 35687070 PMCID: PMC10392800 DOI: 10.5830/cvja-2022-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/07/2022] [Indexed: 06/07/2023] Open
Abstract
A patent foramen ovale (PFO) is associated with numerous clinical conditions. The most severe of these is cryptogenic stroke. This consensus statement aims to provide a clinical guideline on which patients should be offered PFO closure.
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Affiliation(s)
- J Hitzeroth
- Medical School, University of Cape Town, Cape Town, South Africa
| | | | - F Michel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Meel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B J Cupido
- Medical School, University of Cape Town, Cape Town, South Africa
| | - E Klug
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Jha J, Singh MK, Singh L, Pushker N, Lomi N, Meel R, Chosdol K, Sen S, Bakhshi S, Kashyap S. Association of TYRP1 with hypoxia and its correlation with patient outcome in uveal melanoma. Clin Transl Oncol 2021; 23:1874-1884. [PMID: 33811629 DOI: 10.1007/s12094-021-02597-7] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Molecular mechanisms of uveal melanoma development in association with high pigmentation are unclear. Tyrosinase Related Protein (TYRP1) is not only one of the important melanogenesis marker that contributes to melanin synthesis, but can also prevents the melanocyte death. The induction of melanogenesis leads to induction of HIF-1α which can affect the behavior of melanoma cells and its surrounding environment. The aim of our study was to determine the expression of TYRP1 and HIF-1α at the protein and RNA level and determine its prognostic significance. METHODS In the present study, the expression of TYRP1 and HIF-1α was investigated on 61 formalin-fixed paraffin-embedded choroidal melanoma samples by immunohistochemistry. Fresh 50 samples were validated by real-time PCR. Results were correlated with clinicopathological parameters and Kaplan-Meier was performed to determine the prognostic significance. RESULTS High immunoexpression of TYRP1 and HIF-1α was present in 61 and 54% of patients, respectively. Both TYRP1 and HIF-1α correlated well with high pigmentation and BAP1 (BRCA1 Associated Protein-1) loss (p < 0.05) at IHC level as well as transcriptional level. There was reduced metastatic free survival in patients with necrosis and this was statistically significant (p = 0.010). CONCLUSION Our findings indicate that TYRP1 can be used as a potential biomarker in the development of targeted therapy in UM. Further studies on melanogenesis markers associated with TYRP1 could provide us a better understanding in this field.
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Affiliation(s)
- J Jha
- Department of Ocular Pathology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M K Singh
- Department of Dermatology, University of Wisconsin, Madison, USA
| | - L Singh
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - N Pushker
- Department of Ophthalmology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - N Lomi
- Department of Ophthalmology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - R Meel
- Department of Ophthalmology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - K Chosdol
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - S Sen
- Department of Ocular Pathology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kashyap
- Department of Ocular Pathology, Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Singh MK, Singh L, Pushker N, Chosdol K, Bakhshi S, Meel R, Sen S, Kashyap S. Constitutive expression of c-REL in uveal melanoma patients: correlation with clinicopathological parameters and patient outcome. Clin Transl Oncol 2020; 22:1193-1204. [PMID: 31768922 DOI: 10.1007/s12094-019-02247-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Uveal melanoma (UM) is the most common intraocular cancer with a high mortality rate that requires new research in the field of prevention and treatment. c-REL is a member of the nuclear factor κB (NF-κB) transcription factor family and an emerging regulator of tumorigenesis. Therefore, the objective of the study is to evaluate the constitutive expression of c-REL in uveal melanoma patients and its prognostic significance. METHODS Detection of c-REL expression was carried out by immunohistochemistry in all 75 patients, and qRT-PCR performed on 58 fresh cases of uveal melanoma along with IL-6 status. Immunoblot was performed to validate immunohistochemistry results. Expression of c-REL protein correlated with clinicopathological parameters and overall survival of patients. RESULTS Immunohistochemistry results revealed nuclear expression of the c-REL protein (56%) in our cases. Out of 75 cases, 31 cases showed nuclear expression, and 11 cases had cytoplasmic expression. qRT-PCR showed upregulation of the REL gene in 56.89% cases at the transcriptional level. There was a statistically significant difference in the overall survival of patients with c-REL nuclear immunopositivity (p = 0.0048). On multivariate analysis, scleral invasion and c-REL nuclear expression found to be an independent prognostic factor (p < 0.05) CONCLUSIONS: To the best of our knowledge, this was the first study reporting the expression of the c-REL protein in uveal melanoma. Strong nuclear immunoexpression of c-Rel suggests NFκB pathway activation which might be involved in the progression of the disease. Differential expression of c-REL protein may be used as an attractive target for the development of anticancer strategies.
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Affiliation(s)
- M K Singh
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - L Singh
- Departrment of Biosciences, JMI, New Delhi, India
| | - N Pushker
- Department of Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - K Chosdol
- Department of Biochemistry, AIIMS, New Delhi, India
| | - S Bakhshi
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India
| | - R Meel
- Department of Ophthalmology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Sen
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S Kashyap
- Department of Ocular Pathology, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Brown LAE, Thomas K, Reskovic Luksic V, Bernard AB, Montilla Padilla I, Savelev A, Tufaro V, Nossikoff A, Ingimarsdottir IJ, Almeida Morais L, Meel R, Surkova E, Moharem-Elgamal S, Macabeo RAM, Cueva Recalde JF, Teixeira R, Petrovic M, Mahmoud HM, Lavanco V, De Kleijn MC, Vertes V, Kozan H, Padron-Encalada R, Zheng AW, Main SE, Jancis RSC, Steadman CD, Carpenter JP, Senaratne DNS, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ljubas Macek J, Pasalic M, Ostojic Z, Matasic R, Veceric S, Separovic Hanzevacki J, Martinez C, Dulgheru RE, Reskovic V, Lancellotti P, Jimenez Lopez-Guarch C, Velazquez Martin M, Nuche Berenguer J, Jimenez J, Solis J, Alonso S, Lopez Gude MJ, Perez Vela JL, Escribano Subias P, Tregubov AV, Shubik YV, Bandera F, Generati G, Alfonzetti E, Guazzi M, Evrev D, Razboynikov R, Atanasova A, Angelov K, Lazarova G, Radkova M, Stamboliyski G, Simova I, Kalionsky R, Hadjidekov G, Plachkov I, Petkov R, Gatzov P, Donova T, Hellgren Johansson L, Flachskampf FA, Galrinho A, Moura Branco L, Abreu J, Timoteo AT, Pinto-Teixeira P, Aguiar-Rosa S, Rio P, Portugal G, Cruz-Ferreira R, Nethononda R, Peters F, Libhaber E, Essop MR, Bidviene J, Brunello G, Veronesi F, Cavalli G, Cherata D, Romeo G, Badano LP, Muraru D, Tawfik M, Samir R, Amin M, Abol Maaty M, Pestano NSP, Estanislao IHE, Gayan Ordas J, Lacambra I, Pelegrin Diaz J, Dinis P, Monteiro R, Santos M, Botelho A, Quintal N, Goncalves L, Giga V, Boskovic N, Rakocevic I, Trifunovic D, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Stepanovic J, Hassan M, Nagy M, Samaan A, Kharabish A, Philip P, Wagdy K, Elmaghawry M, Elguindy A, Yacoub M, Leo AL, Pasotti E, Faletra FF, Moccetti T, Houthuizen P, Bracke FALE, Lopata RGP, Nogradi A, Porpaczy A, Minier T, Czirjak L, Komocsi A, Faludi R, Sade LE, Turgay O, Pirat B, Muderrisoglu H, Barreiro-Perez M, Diaz-Pelaez E, Martin-Garcia A, Cruz-Gonzalez I, Jimenez-Candil J, Sanchez PL. HIT Poster session 3P915Direct access to transthoracic echocardiography in a district general hospital: are referrals appropriate?P916Surveillance echocardiography for valve disease; have the AHA valve guidelines translated in clinical practice? A retrospective study from a large general hospital in the United KingdomP917Effects of immediate echo guided AV and VV CRT optimization on left ventricular function and hemodynamicsP9183D echocardiography estimation of ventricular performance : correlation between 3D strain and elastancesP919 Right ventricular reverse remodeling after balloon pulmonary angioplasty in patients with non operable chronic thromboembolic pulmonary hypertensionP920Pseudonormal and restrictive left ventricular filling patterns are associated with lower effectiveness of pulmonary vein isolation in patients with paroxysmal atrial fibrillationP921Impact of new guidelines on diastolic dysfunction classification of HFrEF patients and correlation with cardiopulmonary exercise test functional parametersP922Prevalence of proximal DVT on compression ultrasound in patients with acute pulmonary embolism and it's diagnostic utility as a rule-in point-of-care testP923Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prosthesesP924New insights into the mechanics of left ventricular systolic and diastolic function in severe aortic stenosisP925Comparison of cardiac magnetic resonance and echocardiography for evaluation of mitral regurgitation severity in patients with rheumatic heart diseaseP926Tricuspid annulus remodeling in patients with permanent atrial fibrillation and functional tricuspid regurgitationP927Assessment of ventricular electromechanical dyssynchrony in CRT candidatesP928Native aortic valve infective endocarditis due to streptococcus sanguinis in a patient with possible behcets disease, patent foramen ovale and thymomaP929GLS is associated with conduction abnormalities in patients with type 1-myotonic dystrophyP930Descending aortic mechanics and stroke: a two-dimensional echocardiographic speckle tracking studyP931Correlation between prognostic markers of stress echocardiography and angiographic severity of coronary artery disease in patients after primary PCIP932A novel method for calculating the mitral valve area in patients with rheumatic mitral stenosisP933Three dimensional printing of cardiac anatomical structures from three dimensional echocardiograpfic images: preliminary experienceP934Reliability of fully automated calculation of global longitudinal strain by commercially available software: implications for daily practiceP935Global longitudinal strain is a suitable tool to unmask the subclinical left ventricular dysfunction in patients with systemic sclerosisP936Concomitant use of echocardiographic strain analysis and treadmill stress testing to predict coronary artery diseaseP937Cardiac-CT and transoesophageal echocardiography comparison for left atrial appendage clots detection in patients referred for left atrial interventional procedures. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sen S, Lyngdoh AD, Pushker N, Meel R, Bajaj MS, Chawla B. Impression cytology diagnosis of ulcerative eyelid malignancy. Cytopathology 2014; 26:26-30. [PMID: 24750348 DOI: 10.1111/cyt.12133] [Citation(s) in RCA: 5] [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] [Accepted: 12/05/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The utility of impression cytology in ocular diseases has predominantly been restricted to the diagnosis of dry eye, limbal stem cell deficiency and conjunctival neoplasias. Its role in malignant eyelid lesions remains largely unexplored. Although scrape cytology is more popular for cutaneous lesions, impression cytology, being non-traumatic, has an advantage in small and delicate areas such as the eyelid. The present study has been designed to evaluate its role in the diagnosis and management of malignant eyelid lesions. METHODS Thirty-two histopathologically proven malignant eyelid lesions diagnosed over a 2-year period, including 13 basal cell carcinomas, 11 sebaceous carcinomas, four squamous cell carcinomas, two malignant melanomas and two poorly differentiated carcinomas, formed the study group. RESULTS The results of impression cytology were compared with those of histopathology in the study group and with an age- and sex-matched group of benign cases as controls. The sensitivity of impression cytology was 84% (27/32) for the diagnosis of malignancy and 28% (9/32) for categorization of the type of malignancy. CONCLUSIONS Impression cytology is a simple, useful, non-invasive technique for the detection of malignant ulcerative eyelid lesions. It is especially useful as a follow-up technique for the detection of recurrences.
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Affiliation(s)
- S Sen
- Ocular Pathology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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