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Harikrishnan S, Dinesh S, Sivakumar A, Awadh W, Alshehri A, Albar NH, Alamoudi A, Bahammam SA, Zidane B, Bahammam HA, Albar DH, Bahammam MA, Alzahrani KJ, Kalra S, Patil S. Comparative Evaluation of Various Lens and Ring Flash Combination for Intraoral Photography. Niger J Clin Pract 2023; 26:1800-1807. [PMID: 38158345 DOI: 10.4103/njcp.njcp_120_23] [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: 02/21/2023] [Accepted: 08/28/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Extraoral and intraoral dental photographs serve as preoperative records and document the entire treatment. Correctly composed orthodontic photographs are crucial for remote diagnosis and may serve as a bulwark against medicolegal challenges. MATERIALS AND METHODS In this prospective study, intraoral frontal photographs of patients with ideal occlusion were taken using two types of lenses (EF-S 18-55 mm f/3.5-5.6 IS STM lens (Canon, Tokyo, JP), SP 90 mm F/2.8 MACRO VC lens (Model F017 Tamron, NY, USA)) and two different ring flash systems (Meike FC-100 Macro Ring LED Light (Meike, China), Macro Ring flash Lite YN-14EX (Yongnuo digital, China)). The combination of lens and flash used was grouped into four groups. Twenty-eight intraoral photographs of patients were taken. An image quality assessment survey was distributed among two groups - 50 orthodontists and 50 other dental specialists. RESULTS The participants were asked to assess all the intraoral images and subjectively score them on a scale of one to ten, with one being very poor and ten being excellent, considering the sharpness, color, brightness, contrast, and overall quality of the image. The general dentists rated the images taken with a 90-mm macro lens and ring flash as the best quality photographs. Images obtained using an 18-55 mm lens and ring LED received significantly lesser scores and were graded good by dentists. CONCLUSION This combination of lens and flash may prove a valuable investment in the long-term aiding in excellent dental images for diagnosis and treatment monitoring.
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Affiliation(s)
- S Harikrishnan
- Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Sps Dinesh
- Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - A Sivakumar
- Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - W Awadh
- Department of Preventive Dental Sciences, Division of Orthodontics, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - A Alshehri
- Department of Preventive Dental Sciences, Division of Orthodontics, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - N H Albar
- Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - A Alamoudi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S A Bahammam
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina, Saudi Arabia
| | - B Zidane
- Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - H A Bahammam
- Department of Pediatric Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D H Albar
- Department of Preventive Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - M A Bahammam
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - K J Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - S Kalra
- Private Practice, New Delhi, India
| | - S Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UTAH-84095, USA
- Centre of Molecular Medicine and Diagnostics (COMManD), Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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Aldous R, Roy R, Cannata A, Abdrazak M, Mohanan S, Beckley-Hoelscher N, Stahl D, Kanyal R, Kordis P, Sunderland N, Parczewska A, Kirresh A, Nevett J, Fothergill R, Webb I, Dworakowski R, Melikian N, Kalra S, Johnson TW, Sinagra G, Rakar S, Noc M, Patel S, Auzinger G, Gruchala M, Shah AM, Byrne J, MacCarthy P, Pareek N. MIRACLE 2 Score Compared With Downtime and Current Selection Criterion for Invasive Cardiovascular Therapies After OHCA. JACC Cardiovasc Interv 2023; 16:2439-2450. [PMID: 37609699 DOI: 10.1016/j.jcin.2023.08.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The MIRACLE2 score is the only risk score that does not incorporate and can be used for selection of therapies after out-of-hospital cardiac arrest (OHCA). OBJECTIVES This study sought to compare the discrimination performance of the MIRACLE2 score, downtime, and current randomized controlled trial (RCT) recruitment criteria in predicting poor neurologic outcome after out-of-hospital cardiac arrest (OHCA). METHODS We used the EUCAR (European Cardiac Arrest Registry), a retrospective cohort from 6 centers (May 2012-September 2022). The primary outcome was poor neurologic outcome on hospital discharge (cerebral performance category 3-5). RESULTS A total of 1,259 patients (total downtime = 25 minutes; IQR: 15-36 minutes) were included in the study. Poor outcome occurred in 41.8% with downtime <30 minutes and in 79.3% for those with downtime >30 minutes. In a multivariable logistic regression analysis, MIRACLE2 had a stronger association with outcome (OR: 2.23; 95% CI: 1.98-2.51; P < 0.0001) than zero flow (OR: 1.07; 95% CI: 1.01-1.13; P = 0.013), low flow (OR: 1.04; 95% CI: 0.99-1.09; P = 0.054), and total downtime (OR: 0.99; 95% CI: 0.95-1.03; P = 0.52). MIRACLE2 had substantially superior discrimination for the primary endpoint (AUC: 0.877; 95% CI: 0.854-0.897) than zero flow (AUC: 0.610; 95% CI: 0.577-0.642), low flow (AUC: 0.725; 95% CI: 0.695-0.754), and total downtime (AUC: 0.732; 95% CI: 0.701-0.760). For those modeled for exclusion from study recruitment, the positive predictive value of MIRACLE2 ≥5 for poor outcome was significantly higher (0.92) than the CULPRIT-SHOCK (Culprit lesion only PCI Versus Multivessel PCI in Cardiogenic Shock) (0.80), EUROSHOCK (Testing the value of Novel Strategy and Its Cost Efficacy In Order to Improve the Poor Outcomes in Cardiogenic Shock) (0.74) and ECLS-SHOCK (Extra-corporeal life support in Cardiogenic shock) criteria (0.81) (P < 0.001). CONCLUSIONS The MIRACLE2 score has superior prediction of outcome after OHCA than downtime and higher discrimination of poor outcome than the current RCT recruitment criteria. The potential for the MIRACLE2 score to improve the selection of OHCA patients should be evaluated formally in future RCTs.
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Affiliation(s)
- Robert Aldous
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Roman Roy
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Antonio Cannata
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Muhamad Abdrazak
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Shamika Mohanan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Daniel Stahl
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ritesh Kanyal
- School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Peter Kordis
- Centre for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Nicholas Sunderland
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | - Ali Kirresh
- Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joanne Nevett
- London Ambulance Service NHS Trust, London, United Kingdom
| | | | - Ian Webb
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Rafal Dworakowski
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Narbeh Melikian
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Sundeep Kalra
- Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | - Serena Rakar
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marko Noc
- Centre for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Sameer Patel
- Faculty of Life Science and Medicine, King's College London, London, United Kingdom
| | - Georg Auzinger
- Faculty of Life Science and Medicine, King's College London, London, United Kingdom
| | - Marcin Gruchala
- Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Ajay M Shah
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Jonathan Byrne
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Philip MacCarthy
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine and Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom.
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Kalra S, Aggarwal G, Pawaria S, Yadav S, Ajmera P. Psychological health of postmenopausal women: a bibliometric analysis in the recent decade. Climacteric 2023; 26:428-436. [PMID: 37105217 DOI: 10.1080/13697137.2023.2194525] [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: 11/05/2022] [Revised: 03/08/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023]
Abstract
The aim of this study is to analyze the publication trends on the psychological health of postmenopausal women by performing a bibliometric and visualization analysis that can be used as a foundation for understanding current and future research plans. Publications were retrieved from Dimensions database from 2012 to June 2022. VOSviewer software was used for data mining and visualization. A total of 1718 papers were selected by keyword search and delimiting criteria. To evaluate the productive nations, authors, journals, articles and frequent joint citations, citation analysis, author keyword co-occurrence analysis, co-authorship analysis and co-citation analysis were performed. Results depict that the USA contributed the most papers (n = 457). Maximum articles (n = 192) were published in 2021. The highest number of articles are published in Menopause: The Journal of the North American Menopause Society and Climacteric: The Journal of the International Menopause Society. Out of the top 10 contributing organizations in the field, six organizations were from the USA. R. Nappi of Italy is the most productive author with 20 articles and 1138 citations. From the point of average citations per article, H. Joffe has the highest score (71.5). The data reported in this analysis contribute to discussions about the development, growth and current state of psychological health of postmenopausal women as well as its impact. These findings offer helpful guidance for researchers in choosing their potential fields of study and integrating different approaches to solve complicated issues, finding potential co-authors and choosing the right institutions for supporting academic studies or collaborative research.
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Affiliation(s)
- S Kalra
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - G Aggarwal
- Department of Pharmaceutics, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - S Pawaria
- Faculty of Physiotherapy, SGT University Gurugram, New Delhi, India
| | - S Yadav
- Department of Hospital Administration, School of Allied Health Sciences & Management, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - P Ajmera
- Department of Public Health, School of Allied Health Sciences & Management, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
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Verma Y, Sachdeva H, Kalra S, Kumar P, Singh G. UNVEILING THE COMPLEX ROLE OF NF-ΚB IN ALZHEIMER'S DISEASE: INSIGHTS INTO BRAIN INFLAMMATION AND POTENTIAL THERAPEUTIC TARGETS. Georgian Med News 2023:133-141. [PMID: 37991969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and dementia. One of the major pathologies underlying AD is chronic neuroinflammation mediated by microglia and astrocytes in the brain. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signalling pathway is a key regulator of inflammation and has been implicated in the neuroinflammatory processes associated with AD. This review comprehensively summarizes current findings on the complex role of NF-κB signalling in AD pathogenesis. The canonical and non-canonical NF-κB activation pathways are described, along with evidence from human studies and animal models demonstrating increased NF-κB activity in AD brains. The deleterious effects of NF-κB-mediated neuroinflammation are discussed, including the upregulation of inflammatory cytokines, chemokines, and enzymes that exacerbate neuronal damage over time. Targeting the NF-κB pathway is proposed as a promising therapeutic approach to dampen neuroinflammation in AD. Preclinical studies utilizing genetic or pharmacological inhibition of NF-κB are reviewed, and key challenges in translating these findings to clinical applications are analyzed. Overall, this review unveils the multifaceted contributions of NF-κB signalling to AD neuropathology and highlights anti-neuroinflammatory NF-κB modulation as a potential avenue for future AD treatments. Further research is warranted to fully elucidate the complex interactions between NF-κB and AD pathogenesis.
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Affiliation(s)
- Y Verma
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - H Sachdeva
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - S Kalra
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - P Kumar
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - G Singh
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
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Sørensen DM, Bostock H, Abrahao A, Alaamel A, Alaydin HC, Ballegaard M, Boran E, Cengiz B, de Carvalho M, Dunker Ø, Fuglsang-Frederiksen A, Graffe CC, Jones KE, Kallio M, Kalra S, Krarup C, Krøigård T, Liguori R, Lupescu T, Maitland S, Matamala JM, Moldovan M, Moreno-Roco J, Nilsen KB, Phung L, Santos MO, Themistocleous AC, Uysal H, Vacchiano V, Whittaker RG, Zinman L, Tankisi H. Estimating motor unit numbers from a CMAP scan: Repeatability study on three muscles at 15 centres. Clin Neurophysiol 2023; 151:92-99. [PMID: 37236129 DOI: 10.1016/j.clinph.2023.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the repeatability and suitability for multicentre studies of MScanFit motor unit number estimation (MUNE), which involves modelling compound muscle action potential (CMAP) scans. METHODS Fifteen groups in 9 countries recorded CMAP scans twice, 1-2 weeks apart in healthy subjects from abductor pollicis brevis (APB), abductor digiti minimi (ADM) and tibialis anterior (TA) muscles. The original MScanFit program (MScanFit-1) was compared with a revised version (MScanFit-2), designed to accommodate different muscles and recording conditions by setting the minimal motor unit size as a function of maximum CMAP. RESULTS Complete sets of 6 recordings were obtained from 148 subjects. CMAP amplitudes differed significantly between centres for all muscles, and the same was true for MScanFit-1 MUNE. With MScanFit-2, MUNE differed less between centres but remained significantly different for APB. Coefficients of variation between repeats were 18.0% for ADM, 16.8% for APB, and 12.1% for TA. CONCLUSIONS It is recommended for multicentre studies to use MScanFit-2 for analysis. TA provided the least variable MUNE values between subjects and the most repeatable within subjects. SIGNIFICANCE MScanFit was primarily devised to model the discontinuities in CMAP scans in patients and is less suitable for healthy subjects with smooth scans.
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Affiliation(s)
- D M Sørensen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - H Bostock
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - A Abrahao
- Department of Medicine, University of Toronto, Toronto, Canada
| | - A Alaamel
- Department of Neurology, Akdeniz University Hospital, Antalya, Turkey
| | - H C Alaydin
- Department of Neurology, Gazi University, Ankara, Turkey
| | - M Ballegaard
- Department of Clinical Neurology, Zealand University Hospital, Roskilde, Denmark
| | - E Boran
- Department of Neurology, Gazi University, Ankara, Turkey
| | - B Cengiz
- Department of Neurology, Gazi University, Ankara, Turkey
| | - M de Carvalho
- Faculty of Medicine, iMM, Centro de Estudos Egas Moniz, Universidade de Lisboa, Department of Neurosciences and Mental Health, CHULN, Lisbon, Portugal
| | - Ø Dunker
- Department of Neurology and Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway
| | - A Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | - C C Graffe
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - K E Jones
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - M Kallio
- Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland
| | - S Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - C Krarup
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Denmark
| | - R Liguori
- Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - T Lupescu
- Department of Neurology, Agrippa Ionescu Hospital, Bucharest, Romania
| | - S Maitland
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - J M Matamala
- Translational Neurology and Neurophysiology Lab, Department of Neurological Sciences and Biomedical Neuroscience Institute, University of Chile, Santiago, Chile
| | - M Moldovan
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - J Moreno-Roco
- Translational Neurology and Neurophysiology Lab, Department of Neurological Sciences and Biomedical Neuroscience Institute, University of Chile, Santiago, Chile
| | - K B Nilsen
- Department of Neurology and Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway
| | - L Phung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - M O Santos
- Faculty of Medicine, iMM, Centro de Estudos Egas Moniz, Universidade de Lisboa, Department of Neurosciences and Mental Health, CHULN, Lisbon, Portugal
| | - A C Themistocleous
- Nuffield Department of Clinical Neurosciences University of Oxford, Oxford, United Kingdom
| | - H Uysal
- Department of Medicine, University of Toronto, Toronto, Canada
| | - V Vacchiano
- Dipertimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - R G Whittaker
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - L Zinman
- UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Department of Clinical Institute, Aarhus University, Aarhus, Denmark.
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Kalra S, Peyser R, Ho J, Babbin C, Bohan N, Cortes A, Erley J, Fatima M, Flinn J, Horwitz E, Hsu R, Lee W, Lu V, Narch A, Navas D, Okoroafor K, Ouanemalay E, Ross S, Sowole F, Specht E, Woo J, Yu K, Coolon JD. Genome-wide gene expression responses to experimental manipulation of Saccharomyces cerevisiae repressor activator protein 1 (Rap1) expression level. Genomics 2023; 115:110625. [PMID: 37068644 DOI: 10.1016/j.ygeno.2023.110625] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023]
Abstract
Precise regulation of transcription in gene expression is critical for all aspects of normal organism form, fitness, and function and even minor alterations in the level, location, and timing of gene expression can result in phenotypic variation within and between species including evolutionary innovations and human disease states. Eukaryotic transcription is regulated by a complex interplay of multiple factors working both at a physical and molecular levels influencing this process. In Saccharomyces cerevisiae, the TF with the greatest number of putative regulatory targets is the essential gene Repressor Activator Protein 1 (RAP1). While much is known about the roles of Rap1 in gene regulation and numerous cellular processes, the response of Rap1 target genes to systematic titration of RAP1 expression level remains unknown. To fill this knowledge gap, we used a strain with a tetracycline-titratable promoter replacing wild-type regulatory sequences of RAP1 to systematically reduce the expression level of RAP1 and followed this with RNA sequencing (RNA-seq) to measure genome-wide gene expression responses. Previous research indicated that Rap1 plays a significant regulatory role in particular groups of genes including telomere-proximal genes, homothallic mating (HM) loci, glycolytic genes, DNA repair genes, and ribosomal protein genes; therefore, we focused our analyses on these groups and downstream targets to determine how they respond to reductions in RAP1 expression level. Overall, despite being known as both an activator and as a repressor of its target genes, we found that Rap1 acts as an activator for more target genes than as a repressor. Additionally, we found that Rap1 functions as an activator of ribosomal protein genes and a repressor of the silent mating locus genes consistent with predictions from the literature. Unexpectedly, we found that Rap1 functions as a repressor of glycolytic enzyme genes contrary to prior reports of it having the opposite effect. We also compared the expression of RAP1 to five different genes related to DNA repair pathway and found that decreasing RAP1 downregulated four of those five genes. Finally, we found no effect of RAP1 depletion on telomere-proximal genes despite its functioning to silence telomeric repeat-containing RNAs. Together our results enrich our understanding of this important transcriptional regulator. The graphical abstract is provided as a supplementary fig. (S-Fig 1).
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Affiliation(s)
- S Kalra
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - R Peyser
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - J Ho
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - C Babbin
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - N Bohan
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - A Cortes
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - J Erley
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - M Fatima
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - J Flinn
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - E Horwitz
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - R Hsu
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - W Lee
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - V Lu
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - A Narch
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - D Navas
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - K Okoroafor
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - E Ouanemalay
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - S Ross
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - F Sowole
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - E Specht
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - J Woo
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - K Yu
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America
| | - J D Coolon
- Department of Biology, Wesleyan University, Middletown, CT 06457, United States of America.
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Chawla M, Chawla P, Saboo B, Chawla R, Gangopadhyay KK, Kalra S, Aravind S, Sinha B, Shah T, Kesavadev J, Rajput R. Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts. Diabetes Metab Syndr 2022; 16:102587. [PMID: 36055167 DOI: 10.1016/j.dsx.2022.102587] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH. METHOD The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH. RESULT & Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.
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Affiliation(s)
- M Chawla
- Lina Diabetes Care Centre, Mumbai, India.
| | - P Chawla
- Consultant Diabetologist and Director of Clinical Research, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - B Saboo
- Dept of Endocrinology, Dia Care, Ahmedabad, Gujrat, India
| | - R Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - K K Gangopadhyay
- Consultant in Endocrinology, CK Birla Hospitals, Peerless Hospital, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | | | - B Sinha
- AMRI and Fortis Hospitals, Kolkata, India
| | - T Shah
- Director and Diabetologist Iva Diabetes Care Centre Mumbai, Sl Raheja Fortis Hospital, Mumbai, India
| | - J Kesavadev
- Jothydev's Diabetes and Research Center, Kerala, India
| | - R Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana, India
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8
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Saran M, Pawaria S, Kalra S. Kinesio taping with ballistic six plyometric training on speed, accuracy, target and joint proprioception in fast bowlers with glenohumeral instability. Comparative Exercise Physiology 2022. [DOI: 10.3920/cep220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cricket is one of the most popular international sports played worldwide. Ballistic six plyometric training improves throwing activity in throwing sports, improves rotator cuff muscular strength, and prevents and reduces the risk of shoulder injury associated with overhead pitching. Kinesiotaping is used in rehabilitation, as a treatment for sportsrelated injuries, and as a means of injury prevention. The objective of the study was to compare the combined effect of kinesiotaping with ‘ballistic six plyometric training’ and with ballistic six plyometric training alone on speed, accuracy, target and joint proprioception in fast bowlers with mild glenohumeral joint instability. Thirty male semiprofessional fast bowlers in the age group of 20-30 years were included in this study and randomly divided into two groups: group A and group B with 15 players in each group. Group A received kinesiotaping along with ballistic six plyometric training, whereas group B was only given ballistic six plyometric training. Both groups also performed conventional upper extremity workouts. All players were evaluated for bowling speed, accuracy, target and joint proprioception (internal rotation & external rotation) with a radar gun, cricket specific bowling accuracy test, no. of balls hit stump in an over and inclinometer, respectively. Both groups improved significantly at the end of week 8, however, group B showed significant difference for bowling speed, accuracy, target and joint proprioception (P<0.05). Rehabilitation protocol comprising of combined kinesiotaping, plyometrics along with conventional protocol can be beneficial in enhancing performance related variables, i.e. bowling speed, accuracy and target in fast bowlers with mild glenohumeral instability.
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Affiliation(s)
- M. Saran
- Chitiksha Hospital, Saket, New Delhi 110017, India
| | - S. Pawaria
- SGT University, Shree Guru Gobind Singh Tricentenary University, Department of Physiotherapy, Budhera, Gurugram, Haryana 122505, India
| | - S. Kalra
- Delhi Pharmaceutical Science and Research University, Push Vihar, New Delhi 110017, India
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9
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Pareek N, Beckley-Hoelscher N, Kanyal R, Cannata A, Kordis P, Sunderland N, Kirresh A, Nevett J, Fothergill R, Webb I, Dworakowski R, Melikian N, Kalra S, Johnson TW, Sinagra G, Rakar S, Noc M, Shah AM, Byrne J, MacCarthy P. MIRACLE 2 Score and SCAI Grade to Identify Patients With Out-of-Hospital Cardiac Arrest for Immediate Coronary Angiography. JACC Cardiovasc Interv 2022; 15:1074-1084. [PMID: 35589238 DOI: 10.1016/j.jcin.2022.03.035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of performing immediate coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) with stratification of predicted neurologic injury and cardiogenic shock on arrival to a center. BACKGROUND The role of immediate CAG for patients with OHCA is unclear, which may in part be explained by the majority of patients dying of hypoxic brain injury. METHODS Between May 2012 and July 2020, patients from 5 European centers were included in the EUCAR (European Cardiac Arrest Registry). Patients were retrospectively classified into low vs high neurologic risk (MIRACLE2 score 0-3 vs ≥4) and degree of cardiogenic shock on arrival (Society for Cardiovascular Angiography and Interventions [SCAI] grade A vs B-E). A multivariable logistic regression analysis including immediate CAG was performed for the primary outcome of survival with good neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge. RESULTS Nine hundred twenty-six patients were included in the registry, with 405 (43.7%) in the low-risk group and 521 (56.3%) in the high-risk group. Immediate CAG was independently associated with improved survival with good neurologic outcome in the low MIRACLE2 risk group with ST-segment elevation myocardial infarction (OR: 11.80; 95% CI: 2.24-76.74; P = 0.048) and with SCAI grade B to E shock (OR: 3.23; 95% CI: 1.10-9.50; P = 0.031). No subgroups, including those with ST-segment elevation myocardial infarction and with SCAI grade B to E shock, achieved any benefit from early CAG in the high MIRACLE2 group. CONCLUSIONS Combined classification of patients with OHCA with 12-lead electrocardiography, MIRACLE2 score 0 to 3, and SCAI grade B to E identifies a potential cohort of patients at low risk for neurologic injury who benefit most from immediate CAG.
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Affiliation(s)
- Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom.
| | | | - Ritesh Kanyal
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Antonio Cannata
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Peter Kordis
- Centre for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Nicholas Sunderland
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Ali Kirresh
- Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Joanne Nevett
- London Ambulance Service NHS Trust, London, United Kingdom
| | | | - Ian Webb
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Rafal Dworakowski
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Narbeh Melikian
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Sundeep Kalra
- Centre for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | - Serena Rakar
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marko Noc
- Centre for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Ajay M Shah
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Jonathan Byrne
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
| | - Philip MacCarthy
- King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine & Sciences, British Heart Foundation Centre of Excellence, King's College London, London, United Kingdom
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Jain R, Kalra S, Pawaria S. A cross sectional survey on physical fitness, mental health and associated factors in mothers of children with special needs. Comparative Exercise Physiology 2022. [DOI: 10.3920/cep210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mothers are the primary caregivers of a child. While caring for a special needs child, workload of caring increases by manifold and taking care of these children increases physical & mental overload. There is a dearth of studies that have objectively evaluated mental health and fitness of this group. To study status of physical fitness, mental health and associated factors in mothers of special needs children a cross-sectional survey done on 100 mothers of special needs children from special schools in the Gurugram District, Haryana, India. The Harvard Step test was used to evaluate cardiac fitness. Standard tests were used to evaluate different components of musculoskeletal fitness. Depression was assessed by Beck Depression Inventory. Descriptive statistics were used for data analysis. The Karl Pearson correlation test was used to identify correlations between mental health and fitness components and sociodemographic characteristics. Mean age and body mass index of mothers was 36.15±2.56 years and 27.4±3.25 kg/m2, respectively. 50% of the subjects were overweight, 89% scored poor in cardiopulmonary fitness, 63% had very poor muscle endurance, and 69% had average muscular flexibility. 81% of the mothers had symptoms of clinical depression. Inverse and significant correlation was present between depression and cardiorespiratory fitness (r=-0.197), strength (r=-0.242), and endurance (r=0.209). Income, total number of children and duration of care giving were inversely correlated with depression. Positive correlation was found between type of disability and depression. There was an overall decrement in cardiorespiratory and musculoskeletal fitness. Mental health was found to be poor with a large percentage of participants showing symptoms of depression.
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Affiliation(s)
- R. Jain
- SGT University, Faculty of Physiotherapy, Budhera Village 122505 Gurugram, Haryana, India
| | - S. Kalra
- Delhi Pharmaceutical Science & Research University, School of Physiotherapy, Pushp Vihar, 110017 New Delhi, India
| | - S. Pawaria
- SGT University, Faculty of Physiotherapy, Budhera Village 122505 Gurugram, Haryana, India
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11
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Koo CW, Larson NB, Parris-Skeete CT, Karwoski RA, Kalra S, Bartholmai BJ, Carmona EM. Prospective machine learning CT quantitative evaluation of idiopathic pulmonary fibrosis in patients undergoing anti-fibrotic treatment using low- and ultra-low-dose CT. Clin Radiol 2021; 77:e208-e214. [PMID: 34887070 DOI: 10.1016/j.crad.2021.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/09/2021] [Indexed: 01/01/2023]
Abstract
AIM To compare the machine learning computed tomography (CT) quantification tool, Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER) to pulmonary function testing (PFT) in assessing idiopathic pulmonary fibrosis (IPF) for patients undergoing treatment and determine the effects of limited (LD) and ultra-low dose (ULD) CT on CALIPER performance. MATERIALS AND METHODS Thirty-eight IPF patients underwent PFT and standard, LD, and ULD CT. CALIPER classified each CT voxel into either vessel-related structures (VRS), normal, reticular (R), honeycomb (HC) or ground-glass (GG) features. CALIPER-derived interstitial lung disease (ILD) extent represented the sum of GG, R and HC values. Repeated-measures correlation coefficient (ρrm) and 95% confidence interval (CI) evaluated CALIPER features correlation with PFT. Lin's concordance correlation coefficient (CCC) assessed concordance of CALIPER parameters across different CT dosages. RESULTS Twenty patients completed 12 months of follow-up. CALIPER ILD correlated significantly with percent predicted (%) forced vital capacity (FVC) and forced expiratory volume in 1 second (%FEV1; p=0.004, ρrm -0.343, 95% CI [-0.547, -0.108] and 0.008, -0.321, [-0.518, -0.07], respectively). VRS significantly correlated with %FVC and %FEV1 (p=0.000, ρrm -0.491, 95% CI [-0.685, -0.251] and -0.478, 0.000, [-0.653, -0.231], respectively). There was near perfect LD and moderate ULD concordance with standard dose CT for both ILD (CCC 0.995, 95% CI 0.988-0.999 and 0.9, 0.795-0.983, respectively) and VRS (CCC 0.989, 95% CI 0.963-0.997 and 0.915, 0.806-0.956, respectively). CONCLUSIONS CALIPER parameters correlate well with PFTs for evaluation of IPF in patients undergoing anti-fibrotic treatment without being influenced by dose variation. CALIPER may serve as a robust, objective adjunct to PFTs in assessing anti-fibrotic treatment related changes.
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Affiliation(s)
- C W Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - N B Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - R A Karwoski
- Biomedical Imaging Resources, Research Applications Solutions, Mayo Clinic, Rochester, MN, USA
| | - S Kalra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - B J Bartholmai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - E M Carmona
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Rathod KS, Jones DA, Jain AK, Lim P, MacCarthy PA, Rakhit R, Lockie T, Kalra S, Dalby MC, Malik IS, Whitbread M, Firoozi S, Bogle R, Redwood S, Cooper J, Gupta A, Lansky A, Wragg A, Mathur A, Ahluwalia A. The influence of biological age and sex on long-term outcome after percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiovasc Dis 2021; 11:659-678. [PMID: 34849299 PMCID: PMC8611266] [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] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Outcome following ST-segment elevation myocardial infarction (STEMI) is thought to be worse in women than in age-matched men. We assessed whether such differences occur in the UK Pan-London dataset and if age, and particularly menopause, influences upon outcome. METHODS We undertook an observational cohort study of 26,799 STEMI patients (20,633 men, 6,166 women) between 2005-2015 at 8 centres across London, UK. Patient details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (IQR: 2.2-5.8 years). RESULTS Kaplan-Meier analysis demonstrated a higher mortality rate in women versus men (15.6% men vs. 25.3% women, P<0.0001). Univariate Cox analysis revealed that female sex was a predictor of all-cause mortality (HR: 1.69 95% CI: 1.59-1.82). However, after multivariate adjustment, this effect of female sex diminished (HR: 1.05 95% CI: 0.90-1.25). In a sub-group analysis, we compared the sexes separated by age into the ≤55 and the >55 year olds. Age-stratified Cox analysis revealed that female sex was a univariate predictor of all-cause mortality (HR: 1.60 95% CI: 1.25-2.05) in the ≤55 group and in the >55 group (HR: 1.38 95% CI: 1.28-1.47). However, after regression adjustment incorporating the propensity score into a proportional hazard model as a covariate, whilst female sex was not a significant predictor of all-cause mortality in the ≤55 group it was a predictor in the >55 group. Moreover, whilst age did not influence outcome in <55 group, this effect in the >55 group was correlated with age. CONCLUSIONS Overall women have a worse all-cause mortality following primary PCI for STEMI compared to men. However, this effect was driven predominantly by women >55 years of age since after adjusting for co-morbidities the risk in younger women did not differ significantly from that in men. These observations support the view that as women advance past the menopausal years their risk of further events following revascularization increases substantially and we suggest that routine assessment of hormonal status may improve clinical decision-making and ultimately outcome for women post-PCI.
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Affiliation(s)
- Krishnaraj S Rathod
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Daniel A Jones
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Ajay K Jain
- Barts Health NHS TrustLondon, United Kingdom
| | - Pitt Lim
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Philip A MacCarthy
- Kings College Hospital, King’s College Hospital NHS Foundation TrustDenmark Hill, London, United Kingdom
| | - Roby Rakhit
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Tim Lockie
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Sundeep Kalra
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield HospitalHill End Road, Middlesex, United Kingdom
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith HospitalDu Cane Road, London, United Kingdom
| | - Mark Whitbread
- London Ambulance Service NHS TrustLondon, United Kingdom
| | - Sam Firoozi
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Richard Bogle
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Simon Redwood
- St. Thomas’ NHS Foundation Trust, Guys & St. Thomas HospitalWestminster Bridge Rd, London, United Kingdom
| | - Jackie Cooper
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Ajay Gupta
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Alexandra Lansky
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
- Section of Cardiology, Yale University School of MedicineNew Haven CT, USA
| | | | - Anthony Mathur
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Amrita Ahluwalia
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
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Hodgkinson-Brechenmacher V, Lounsberry J, Abrahao A, Benstead T, Breiner A, Briemberg H, Genge A, Grant I, Kalra S, Marrero A, Massie R, Matte G, O'Connell C, Pfeffer G, Schellenberg K, Shoesmith C, Taylor S, Izenberg A, Johnston W, Korngut L. MOTOR NEURON DISORDERS AND NEUROPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Pareek N, Kordis P, Beckley-Hoelscher N, Pimenta D, Kocjancic ST, Jazbec A, Nevett J, Fothergill R, Kalra S, Lockie T, Shah AM, Byrne J, Noc M, MacCarthy P. A practical risk score for early prediction of neurological outcome after out-of-hospital cardiac arrest: MIRACLE2. Eur Heart J 2021; 41:4508-4517. [PMID: 32731260 DOI: 10.1093/eurheartj/ehaa570] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/25/2020] [Accepted: 07/01/2020] [Indexed: 02/02/2023] Open
Abstract
AIMS The purpose of this study was to develop a practical risk score to predict poor neurological outcome after out-of-hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre. METHODS AND RESULTS From May 2012 to December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multivariable logistic regression to identify predictors of the primary outcome to derive a risk score. This was externally validated in two independent cohorts comprising 473 patients. The primary endpoint was poor neurological outcome at 6-month follow-up (Cerebral Performance Category 3-5). Seven independent predictors of outcome were identified: missed (unwitnessed) arrest, initial non-shockable rhythm, non-reactivity of pupils, age (60-80 years-1 point; >80 years-3 points), changing intra-arrest rhythms, low pH <7.20, and epinephrine administration (2 points). The MIRACLE2 score had an area under the curve (AUC) of 0.90 in the development and 0.84/0.91 in the validation cohorts. Three risk groups were defined-low risk (MIRACLE2 ≤2-5.6% risk of poor outcome); intermediate risk (MIRACLE2 of 3-4-55.4% of poor outcome); and high risk (MIRACLE2 ≥5-92.3% risk of poor outcome). The MIRACLE2 score had superior discrimination than the OHCA [median AUC 0.83 (0.818-0.840); P < 0.001] and Cardiac Arrest Hospital Prognosis models [median AUC 0.87 (0.860-0.870; P = 0.001] and equivalent performance with the Target Temperature Management score [median AUC 0.88 (0.876-0.887); P = 0.092]. CONCLUSIONS The MIRACLE2 is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission.
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Affiliation(s)
- Nilesh Pareek
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Peter Kordis
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | | | - Dominic Pimenta
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Spela Tadel Kocjancic
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Anja Jazbec
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Joanne Nevett
- London Ambulance Service NHS Trust, 220 Waterloo Rd, London SE1 8SD, UK
| | | | - Sundeep Kalra
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Tim Lockie
- Department of Cardiology, Royal Free Hospital NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Ajay M Shah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Marko Noc
- Centre for Intensive Internal Medicine, University Medical Center, Zaloska 7, Ljubljana 1000, Slovenia
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE59RS, UK.,School of Cardiovascular Medicine and Sciences, BHF Centre of Excellence, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
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Kalra S, Dhingra A, Sharma SK, Bhattacharya S. Sheehan's syndrome as a mimic of premature ovarian insufficiency: need for advocacy. Climacteric 2021; 24:526. [PMID: 33830850 DOI: 10.1080/13697137.2021.1905626] [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: 10/21/2022]
Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - A Dhingra
- Department of Endocrinology, Gangaram Bansal Hospital, Sri Ganganagar, India
| | - S K Sharma
- Department of Endocrinology, Dr. SK Sharma's Diabetes, Thyroid and Endocrine Centre, Jaipur, India
| | - S Bhattacharya
- Department of Endocrinology, Max Superspeciality Hospital, New Delhi, India
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Hodgkinson V, Lounsberry J, M'Dahoma S, Russell A, Jewett G, Benstead T, Brais B, Campbell C, Johnston W, Lochmüller H, McCormick A, Nguyen CT, O'Ferrall E, Oskoui M, Abrahao A, Briemberg H, Bourque PR, Botez S, Cashman N, Chapman K, Chrestian N, Crone M, Dobrowolski P, Dojeiji S, Dowling JJ, Dupré N, Genge A, Gonorazky H, Grant I, Hasal S, Izenberg A, Kalra S, Katzberg H, Krieger C, Leung E, Linassi G, Mackenzie A, Mah JK, Marrero A, Massie R, Matte G, McAdam L, McMillan H, Melanson M, Mezei MM, O'Connell C, Pfeffer G, Phan C, Plamondon S, Poulin C, Rodrigue X, Schellenberg K, Selby K, Sheriko J, Shoesmith C, Smith RG, Taillon M, Taylor S, Venance S, Warman-Chardon J, Worley S, Zinman L, Korngut L. The Canadian Neuromuscular Disease Registry 2010-2019: A Decade of Facilitating Clinical Research Througha Nationwide, Pan-NeuromuscularDisease Registry. J Neuromuscul Dis 2021; 8:53-61. [PMID: 32925088 PMCID: PMC7902956 DOI: 10.3233/jnd-200538] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the recruitment activities and outcomes of a multi-disease neuromuscular patient registry in Canada. The Canadian Neuromuscular Disease Registry (CNDR) registers individuals across Canada with a confirmed diagnosis of a neuromuscular disease. Diagnosis and contact information are collected across all diseases and detailed prospective data is collected for 5 specific diseases: Amyotrophic Lateral Sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), Myotonic Dystrophy (DM), Limb Girdle Muscular Dystrophy (LGMD), and Spinal Muscular Atrophy (SMA). Since 2010, the CNDR has registered 4306 patients (1154 pediatric and 3148 adult) with 91 different neuromuscular diagnoses and has facilitated 125 projects (73 academic, 3 not-for-profit, 3 government, and 46 commercial) using registry data. In conclusion, the CNDR is an effective and productive pan-neuromuscular registry that has successfully facilitated a substantial number of studies over the past 10 years.
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Affiliation(s)
- V Hodgkinson
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - J Lounsberry
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - S M'Dahoma
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A Russell
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - G Jewett
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - T Benstead
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - B Brais
- Montreal Neurological Institute and Hospital, Montreal, Canada
| | - C Campbell
- Department of Pediatrics, Children's Health Research Institute, London Health Sciences Centre, Western University, London, Canada
| | - W Johnston
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Lochmüller
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.,Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - A McCormick
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - C T Nguyen
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - E O'Ferrall
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - M Oskoui
- Department of Neurosciences, McGill University, Montréal, Canada.,Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - A Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - H Briemberg
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - P R Bourque
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - S Botez
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - N Cashman
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - K Chapman
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - N Chrestian
- Department of Medicine, Université Laval, Quebec City, Canada, Neuroscience axis, CHU de Québec-Université Laval
| | - M Crone
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - P Dobrowolski
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Dojeiji
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - J J Dowling
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - N Dupré
- Department of Medicine, Laval University, Québec City, Canada
| | - A Genge
- Department of Neurosciences, McGill University, Montréal, Canada
| | - H Gonorazky
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - I Grant
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Hasal
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - A Izenberg
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - S Kalra
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Katzberg
- University Health Network, University of Toronto, Toronto, Canada
| | - C Krieger
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - E Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - G Linassi
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - A Mackenzie
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - J K Mah
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - A Marrero
- CHU Dr. Georges-L-Dumont, Université de Sherbrooke, Moncton, Canada
| | - R Massie
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - G Matte
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - L McAdam
- Department of Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, Canada
| | - H McMillan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - M Melanson
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
| | - M M Mezei
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - G Pfeffer
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Medical Genetics, and Alberta Child Health Research Institute, University of Calgary, Calgary, Canada
| | - C Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Plamondon
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - C Poulin
- Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - X Rodrigue
- Department of Medicine, Laval University, Québec City, Canada
| | - K Schellenberg
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - K Selby
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, University of Vancouver, Vancouver, Canada
| | - J Sheriko
- Division of Neurology, Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - C Shoesmith
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - R G Smith
- Department of Pediatrics, KidsInclusive Centre for Child & Youth Development, Hotel Dieu Hospital, Queen's University, Kingston, Canada
| | - M Taillon
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S Taylor
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Venance
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - J Warman-Chardon
- Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - S Worley
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - L Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - L Korngut
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Rathod KS, Jain AK, Firoozi S, Lim P, Boyle R, Nevett J, Dalby MC, Kalra S, Malik IS, Sirker A, Mathur A, Redwood S, MacCarthy PA, Wragg A, Jones DA. Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group. European Heart Journal. Acute Cardiovascular Care 2020; 9:948-957. [DOI: 10.1177/2048872619882340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and aims:
In patients with ST-segment elevation myocardial infarction (STEMI), mortality is directly related to time to reperfusion with guidelines recommending patients be delivered directly to centres for primary percutaneous coronary intervention (PCI). The aim of this study was to describe the impact of inter-hospital transfer on reperfusion time and to assess whether or not treatment delays influenced clinical outcomes in comparison with direct admission to a primary PCI centre in a large regional network.
Method and results:
We undertook an observational cohort study of patients with STEMI treated with primary PCI between 2005 and 2015 in London, UK. Patient details were recorded at the time of the procedure in databases using the British Cardiovascular Intervention Society PCI dataset. The primary end-point was all-cause mortality at a median of 4.1 years (interquartile range: 2.2–5.8 years). Secondary outcomes were in-hospital major adverse cardiac events. Of 25,315 patients, 17,560 (69.4%) were admitted directly to a primary PCI centre and 7755 (31.6%) were transferred from a non-primary PCI centre. Patients in the direct admission group were older and more likely to have left ventricular impairment compared with the inter-hospital transfer group. Median time from call for help to reperfusion in transferred patients was 52 minutes longer compared with patients admitted directly (p <0.001). However, call to first hospital admission was similar. Kaplan–Meier analysis demonstrated significantly lower mortality rates in patients who were transferred directed to a primary PCI centre compared with patients who were transferred from a non-PCI centre (17.4% direct vs. 18.7% transfer, p=0.017). Furthermore, after propensity matching, direct admission for primary PCI was still a predictor of all-cause mortality (hazard ratio: 0.89, 95% confidence interval: 0.64–0.95).
Conclusions:
In this large registry of over 25,000 STEMI patients treated by primary PCI survival was better in patients admitted directly to a cardiac centre versus patients transferred for primary PCI, most likely due to longer call to balloon times in patient transferred from other hospitals.
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Affiliation(s)
| | | | - Sam Firoozi
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Pitt Lim
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Richard Boyle
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Jo Nevett
- London Ambulance Service NHS Trust, UK
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Sundeep Kalra
- Royal Free Hospital, Royal Free London Foundation Trust, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | | | | | - Simon Redwood
- St Thomas’ NHS Foundation Trust, Guys & St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK
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Panoulas V, Rathod K, Kain A, Firoozi S, Nevett J, Kalra S, Malik I, Mathur A, Redwood S, MacCarthy P, Wragg A, Jones D, Dalby M. Impact of early (<24h) versus delayed (>24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2523] [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
Background
In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management.
Purpose
We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention.
Methods
We examined the impact ofearly (≤24h) versus delayed (>24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching.
Results
Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p<0.001), most commonly male (76% vs. 72.9%, p<0.001) and were more frequently ventilated (2.3% vs. 1.4%, p<0.001) and in cardiogenic shock (3.6% vs. 1.4%, p<0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p<0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated >24h following their presentation (p<0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061).
Conclusions
Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - A Kain
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Firoozi
- St George's Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - J Nevett
- London Ambulance Service, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, Cardiology, London, United Kingdom
| | - I Malik
- Hammersmith Hospital, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, Cardiology, London, United Kingdom
| | - P.A MacCarthy
- King's College Hospital, Cardiology, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - D Jones
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - M.C Dalby
- Harefield Hospital, Interventional cardiology, London, United Kingdom
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19
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20
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Jethwani P, Saboo B, Jethwani L, Kesavadev J, Kalra S, Sahay R, Agarwal S, Hasnani D. Management of children and adolescents having type 1 diabetes during COVID-19 pandemic in India: challenges and solutions. Int J Diabetes Dev Ctries 2020; 40:335-339. [PMID: 32952333 PMCID: PMC7490475 DOI: 10.1007/s13410-020-00865-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/19/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Type 1 diabetes (T1D) requires a holistic approach and continuous care. The current COVID-19 pandemic has made the health care professionals realise its challenges even more ardently than in the normal times. In a country like India with its huge population burden and a significant number of people having T1D, the risk of COVID-19 in people having T1DM is considerably high. Methods In this article, we are sharing our practical experiences of problems faced by children and adolescents having T1DM during the past 2 months of lockdown. Results We have classified the challenges into 3 broad categories based on diabetes self-management, healthcare system and psychosocial aspects. We have tried to provide precise, comprehensive and region specific solutions to these challenges. Solutions briefly include maintaining the supply chain of essentials like insulin, syringes and glucose meter strips to psychological support, financial aid and support for hospitalization in case of COVID-19 itself or diabetes complications including diabetic ketoacidosis. Conclusions Children and adolescents having T1DM require special care and attention during this period of COVID-19 pandemic because of various challenges as discussed. Our proposed solutions may help them overcome these problems and help them in better diabetes management during such emergency situations.
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Affiliation(s)
| | - B. Saboo
- Diacare-Diabetes Care & Hormone Clinic, Ahmedabad, India
| | - L. Jethwani
- Jethwani Hospital, 5-Junction Plot, Rajkot-1, India
| | - J. Kesavadev
- Jothydev’s Diabetes Research Center, Thiruvananthapuram, India
| | - S. Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, India
| | - R. Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - S. Agarwal
- Department of Medicine, Ruby Hall Clinic, Pune, India
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21
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Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - A K Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - T Nair
- Dept. of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra
| | - M Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal
| | - S Chandrasekaran
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology & Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology & Diabetes, Royal Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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22
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Das AK, Mithal A, Kumar KMP, Unnikrishnan AG, Kalra S, Thacker H, Sethi B, Ghosh R, Mathew A, Chodankar D, Mohanasundaram S, Menon SK, Trivedi C, Naqvi M, Kanade V, Salvi V, Chatterjee G, Rais N, Wangnoo SK, Chowdhury S, Zargar AH, Joshi S. Rationale, study design and methodology of the LANDMARC trial: a 3-year, pan-India, prospective, longitudinal study to assess management and real-world outcomes of diabetes mellitus. Diabet Med 2020; 37:885-892. [PMID: 31691356 PMCID: PMC7216981 DOI: 10.1111/dme.14171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
AIM India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan-India longitudinal study was initiated to assess the real-world outcomes of diabetes across the country. METHODS The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months ± 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time-to-treatment adaptation or intensification. Overall, 6300 participants (aged 25-60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti-hyperglycaemic medications and any cardiovascular or other diabetes-related events occurring during the observational study period. CONCLUSIONS The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes. (Trial Registration No: CTRI/2017/05/008452).
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Affiliation(s)
- A. K. Das
- Pondicherry Institute of Medical Sciences (PIMS)PuducherryIndia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - N. Rais
- Chowpatti Medical CentreMumbaiIndia
| | - S. K. Wangnoo
- Apollo Hospital Education and Research FoundationNew DelhiIndia
| | | | - A. H. Zargar
- Center for Diabetes & Endocrine CareSrinagarIndia
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23
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital, BRIDE, Kunjpura Road, Karnal, Haryana, 132001, India.
| | - S Bhattacharya
- Department of Endocrinology, Max Super Speciality Hospital, Patparganj, Delhi, India
| | - A Joshi
- Department of Endocrinology, Bhaktivedanta Hospital, Mumbai, India
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Kalra S, Lowndes C, Durant L, Strange RC, Al-Araji A, Hawkins CP, Curnow SJ. Th17 cells increase in RRMS as well as in SPMS, whereas various other phenotypes of Th17 increase in RRMS only. Mult Scler J Exp Transl Clin 2020; 6:2055217319899695. [PMID: 32064115 PMCID: PMC6990617 DOI: 10.1177/2055217319899695] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background The nature and extent of inflammation seen in multiple sclerosis (MS) varies throughout the course of the disease. Changes seen in CD4+ T-helper cells in relapsing–remitting (RR) MS and secondary progressive (SP) MS might differ qualitatively and/or quantitatively. Objective The objective of this paper is to study the frequencies of all major CD4+ T-helper subtypes – Th17, Th22 and Th1 lineage cells – in relapse, remission and secondary progression alongside CCR6 status, a chemokine receptor involved in migration of these cells into the central nervous system. Methods We compared 100 patients (50 RRMS and 50 SPMS) and 50 healthy volunteers and performed flow cytometric analysis of lymphocytes in blood samples. Results We demonstrated raised frequencies of various cell types along the Th17 axis; Th17, Th17.1 (IL-17+ interferon gamma+) and dual IL-17+ IL-22+ cells in RRMS. Th22 and CCR6+ Th1 cells (nonclassical Th1) were also increased in RRMS. All these cells were CCR6+. Only Th17 frequencies were elevated in SPMS. Conclusions Increased frequencies of Th17 cells are implicated both in RRMS and SPMS. The CCR6 pathway includes Th17, Th22 and Th1 nonclassical cells, of which Th22 and Th1 cells represent the greatest subsets in MS.
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Affiliation(s)
- S Kalra
- Royal Stoke MS Centre of Excellence, Neurology Department, University Hospital North Midlands NHS Trust, UK
| | - C Lowndes
- Royal Stoke MS Centre of Excellence, Neurology Department, University Hospital North Midlands NHS Trust, UK
| | - L Durant
- Centre for Translational Inflammation Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
| | - R C Strange
- Institute for Science and Technology in Medicine, Keele University Medical School, UK
| | - A Al-Araji
- Royal Stoke MS Centre of Excellence, Neurology Department, University Hospital North Midlands NHS Trust, UK
| | - Clive P Hawkins
- Royal Stoke MS Centre of Excellence, Neurology Department, University Hospital North Midlands NHS Trust, UK
| | - S John Curnow
- Centre for Translational Inflammation Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK
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Das AK, Kalra S, Tiwaskar M, Bajaj S, Seshadri K, Chowdhury S, Sahay R, Indurkar S, Unnikrishnan AG, Phadke U, Pareek A, Purkait I. Expert Group Consensus Opinion: Role of Anti-inflammatory Agents in the Management of Type-2 Diabetes (T2D). J Assoc Physicians India 2019; 67:65-74. [PMID: 31801334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diabetes is a major public health emergency of the 21st century. Results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study have found prevalence of diabetes and prediabetes in India to be as high as 7.3% and 10.3%, respectively with nation-wide projection of 77.2 million people with prediabetes and 69.2 million with diabetes. It is well established that insulin resistance (IR) and islet β-cell failure are the two major features of T2D Multiple mechanisms including glucotoxicity, lipotoxicity, oxidative stress, endoplasmic reticulum stress, formation of amyloid deposits in the islets, etc. have been hypothesized to participate in the pathology of the disease. In the concluding decade of the last century, numerous studies - prospective and cross-sectional, have confirmed the role of chronic low-grade inflammation as a pathogenetic factor of T2D. It has been shown that increased levels of various inflammatory markers and mediators including fundamental markers like white blood cell count, C-reactive protein (CRP) to the more specific circulating cytokines like, interleukin-6 (IL-6), IL-1β, plasminogen activator inhibitor-1 (PAI-1), etc. correlate with incident T2D. Based on the robust evidence implying the role of inflammation in T2D pathogenesis, several studies have proven that the proinflammatory cytokines play a central role in the development of microvascular diabetic complications such as nephropathy, retinopathy, and neuropathy. Inflammation in T2D causes accelerated atherosclerosis which predisposes to CVD, the leading cause of mortality in these patients. Recently there is a considerable increase in the interest among the researchers about anti-inflammatory therapies in the setting of chronic disorders such as T2D and CV diseases. In a multi-country study conducted in Asia, approximately 50% of Indian respondents had poor diabetes control. Most patients initially respond to sulfonylurea and/or metformin, and later these agents lose their effectiveness with time. Therapeutic option in patients uncontrolled on two-drug combination therapy is either to add third oral drug or insulin. However, use of insulin is limited due to its high cost and poor compliance. Majority of new treatment options like GLP1 agonists, insulin analogs and SGLT2 inhibitors are costly considering they are still under patent. The thiazolidinedione class of drugs is associated with adverse effects like fluid retention and weight gain that may result in or exacerbate edema and congestive heart failure. Thus there is a need for a safe and inexpensive treatment option for the management of uncontrolled T2D. Considering the role of inflammation in T2D pathogenesis, the drug should not only have antihyperglycemic effects but also reduce inflammatory burden thus reducing the progression and complications of T2D. The current interest is apparently directed towards drugs targeting inflammation acting at different stages of the inflammatory cascade. In the recently published CANTOS study, canakinumab, a selective, high-affinity, fully human monoclonal antibody which inhibits IL-1β, has no consistent long-term benefits on HbA1c. Other selective inhibitors like anakinra (IL-1 receptor antagonist) and etanercept (TNF inhibitor) too have yielded modest effects on glycemic parameters and insulin sensitivity. However, hydroxychloroquine (HCQ), a broad anti-inflammatory agent has been shown to reduce HbA1c by 0.87%. Hydroxychloroquine (HCQ) is considered as one of the safest disease modifying anti-rheumatic drug, used widely for the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The effect of HCQ in preventing development of diabetes in patients with chronic inflammatory diseases was highlighted in a prospective observational study of 4905 adults with rheumatoid arthritis and no diabetes with 21.5 years of follow-up. Patients who took HCQ for more than 4 years had a significant 77% lower risk of diabetes compared with non users of HCQ (RR, 0.23; 95% CI, 0.11-0.50). Taking cue from this study highlighting the anti-diabetic effect of HCQ, pioneering research studies evaluating these effects of HCQ were conducted in India. In 2014, hydroxychloroquine 400 mg got DCGI approval as an adjunct to diet and exercise to improve glycemic control of patients on metformin, sulfonylurea combination in Type 2 diabetes.
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Affiliation(s)
- A K Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry , Corresponding Author
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
| | - M Tiwaskar
- Department of Medicine, Shilpa Medical Research Center, Mumbai, Maharashtra
| | - S Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - K Seshadri
- Visiting Professor, Sri Balaji Vidhyapeeth, Pondicherry
| | - S Chowdhury
- Department of Endocrinology, IPGMER and SSKM Hospital, Kolkata, West Bengal
| | - R Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana
| | - S Indurkar
- Consulting Diabetologist, Aurangabad, Maharashtra
| | | | - U Phadke
- Ruby Hall Clinic, Pune, Maharashtra
| | - A Pareek
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
| | - I Purkait
- Medical Affairs and Clinical Research, Ipca Laboratories Ltd., Mumbai, Maharashtra
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von Stempel C, Fayed H, Goode JA, Kalra S, Patel N. Viabahn stent graft in the management of a grade 3 coronary perforation. CVIR Endovasc 2019; 2:6. [PMID: 32026215 PMCID: PMC6966378 DOI: 10.1186/s42155-019-0050-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/07/2019] [Indexed: 05/30/2023] Open
Abstract
Background Coronary artery perforation during coronary intervention has high morbidity and mortality. This case describes the collaboration between interventional cardiologists and Interventional radiologists to successfully deploy a peripheral arterial stent graft in a coronary artery that demonstrated persistent extravasation after coronary specific stent graft placement. Case presentation An 84 year old female patient presented with acute coronary syndrome and coronary angiography identified a right coronary artery lesion. This was dilated and stented but resulted in a grade 3 coronary perforation. Conservative treatment with balloon tamponade failed, as did placement of a covered coronary-specific stent graft. A Viabahn peripheral arterial stent graft was placed within the indwelling stents and successfully sealed the endoleak. At 6 months the patient is clinically well and follow-up imaging has demonstrated stent patency. Conclusions In the emergency setting when coronary artery perforation fails to respond to standard initial and bail out techniques, peripheral arterial techniques and devices can be extremely useful. A good relationship between interventional cardiology and radiology is paramount.
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Chawla R, Makkar BM, Aggarwal S, Bajaj S, Das AK, Ghosh S, Gupta A, Gupta S, Jaggi S, Jana J, Keswadev J, Kalra S, Keswani P, Kumar V, Maheshwari A, Moses A, Nawal CL, Panda J, Panikar V, Ramchandani GD, Rao PV, Saboo B, Sahay R, Setty KR, Viswanathan V, Aravind SR, Banarjee S, Bhansali A, Chandalia HB, Das S, Gupta OP, Joshi S, Kumar A, Kumar KM, Madhu SV, Mittal A, Mohan V, Munichhoodappa C, Ramachandran A, Sahay BK, Sai J, Seshiah V, Zargar AH. RSSDI consensus recommendations on insulin therapy in the management of diabetes. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00783-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Beirne A, Rathod K, Jain A, Mathur A, Wragg A, Smith EJ, Jones DA, Kalra S, Malik I, Redwood S, MacCarthy P, Bogle R, Firoozi S, Dalby M. P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1106] [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
Background
Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG).
Methods
This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years).
Results
12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching.
Figure 1. Kaplan-Meier Curves
Conclusion
Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.
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Affiliation(s)
- A Beirne
- Barts Health NHS Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, London, United Kingdom
| | - A Jain
- Barts Health NHS Trust, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, London, United Kingdom
| | - E J Smith
- Barts Health NHS Trust, London, United Kingdom
| | - D A Jones
- Barts Health NHS Trust, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, London, United Kingdom
| | - I Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, London, United Kingdom
| | - P MacCarthy
- Kings College Hospital, London, United Kingdom
| | - R Bogle
- St Georges Hospital, London, United Kingdom
| | - S Firoozi
- St Georges Hospital, London, United Kingdom
| | - M Dalby
- Harefield Hospital, London, United Kingdom
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Abstract
Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for "diabesity."
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Affiliation(s)
- L Gupta
- Department of Dietetics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - P Gupta
- Department of Paediatrics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Dutta
- Department of Endocrinology, Venkateshwar Hospitals, New Delhi, India
| | - S Aggarwal
- Department of Medicine, Division of Endocrinology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Dutta D, Kalra S, Sharma M. Adenosine monophosphate-activated protein kinase-based classification of diabetes pharmacotherapy. J Postgrad Med 2019; 63:114-121. [PMID: 27652986 PMCID: PMC5414421 DOI: 10.4103/0022-3859.191007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The current classification of both diabetes and antidiabetes medication is complex, preventing a treating physician from choosing the most appropriate treatment for an individual patient, sometimes resulting in patient-drug mismatch. We propose a novel, simple systematic classification of drugs, based on their effect on adenosine monophosphate-activated protein kinase (AMPK). AMPK is the master regular of energy metabolism, an energy sensor, activated when cellular energy levels are low, resulting in activation of catabolic process, and inactivation of anabolic process, having a beneficial effect on glycemia in diabetes. This listing of drugs makes it easier for students and practitioners to analyze drug profiles and match them with patient requirements. It also facilitates choice of rational combinations, with complementary modes of action. Drugs are classified as stimulators, inhibitors, mixed action, possible action, and no action on AMPK activity. Metformin and glitazones are pure stimulators of AMPK. Incretin-based therapies have a mixed action on AMPK. Sulfonylureas either inhibit AMPK or have no effect on AMPK. Glycemic efficacy of alpha-glucosidase inhibitors, sodium glucose co-transporter-2 inhibitor, colesevelam, and bromocriptine may also involve AMPK activation, which warrants further evaluation. Berberine, salicylates, and resveratrol are newer promising agents in the management of diabetes, having well-documented evidence of AMPK stimulation medicated glycemic efficacy. Hence, AMPK-based classification of antidiabetes medications provides a holistic unifying understanding of pharmacotherapy in diabetes. This classification is flexible with a scope for inclusion of promising agents of future.
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Affiliation(s)
- D Dutta
- Department of Endocrinology, Post-graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - M Sharma
- Department of Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Dutta D, Kalra S, Sharma M. Reply to letter to editor regarding the article, "Adenosine monophosphate-activated protein kinase-based classification of diabetes pharmacotherapy". J Postgrad Med 2019; 63:276. [PMID: 29022567 PMCID: PMC5664879 DOI: 10.4103/jpgm.jpgm_443_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Dutta
- Department of Endocrinology, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - M Sharma
- Department of Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Rathod KS, Koganti S, Jain AK, Rakhit R, Dalby MC, Lockie T, Kalra S, Malik IS, Knight CJ, Whitbread M, Mathur A, Firoozi S, Bogle R, Redwood S, MacCarthy PA, Sirker A, O'Mahony C, Wragg A, Jones DA. Complete Versus Culprit only Revascularisation in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction: Incidence and Outcomes from the London Heart Attack Group. Cardiovasc Revasc Med 2019; 21:350-358. [PMID: 31327710 DOI: 10.1016/j.carrev.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/24/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite advances in technology, patients with Cardiogenic Shock (CS) presenting with ST-segment myocardial infarction (STEMI) still have a poor prognosis with high mortality rates. A large proportion of these patients have multi-vessel coronary artery disease, the treatment of which is still unclear. We aimed to assess the trends in management of CS patients with multi-vessel disease (MVD), particularly looking at the incidence and outcomes of complete revascularisation compared to culprit vessel only. METHODS AND RESULTS We undertook an observational cohort study of 21,210 STEMI patients treated between 2005 and 2015 at the 8 Heart Attack Centres in London, UK. Patients' details were recorded prospectively into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. 1058 patients presented with CS and MVD. Primary outcome was all-cause mortality. Patients were followed-up for a median of 4.1 years (IQR range: 2.2-5.8 years). 497 (47.0%) patients underwent complete revascularisation during primary PCI for CS with stable rates seen over time. These patients were more likely to be male, hypertensive and more likely to have poor LV function compared to the culprit vessel intervention group. Although crude, in hospital major adverse cardiac events (MACE) rates were similar (40.8% vs. 36.0%, p = 0.558) between the two groups. Kaplan-Meier analysis demonstrated no significant differences in mortality rates between the two groups (53.8% complete revascularisation vs. 46.8% culprit vessel intervention, p = 0.252) during the follow-up period. After multivariate cox analysis (HR 0.69 95% CI (0.44-0.98)) and the use of propensity matching (HR: 0.81 95% CI: 0.62-0.97) complete revascularisation was associated with reduced mortality. A number of co-variates were included in the model, including age, gender, diabetes, hypertension, hypercholesterolaemia, previous PCI, previous MI, chronic renal failure, Anterior infarct, number of treated vessels, pre-procedure TIMI flow, procedural success and GP IIb/IIIA use. CONCLUSION In a contemporary observational series of CS patients with MVD, complete revascularisation appears to be associated with better outcomes compared to culprit vessel only intervention. This supports on-going clinical trials in this area and provides further evidence of the association of complete revascularisation in STEMI with good outcomes.
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Affiliation(s)
- Krishnaraj S Rathod
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Sudheer Koganti
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Ajay K Jain
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Roby Rakhit
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Middlesex, London, United Kingdom of Great Britain and Northern Ireland
| | - Tim Lockie
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Sundeep Kalra
- Royal Free London NHS Foundation Trust, Pond Street, London, United Kingdom of Great Britain and Northern Ireland
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, Du Cane Road, London, United Kingdom of Great Britain and Northern Ireland
| | - Charles J Knight
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Mark Whitbread
- London Ambulance Service NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anthony Mathur
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Sam Firoozi
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Richard Bogle
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Simon Redwood
- St Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital, Westminster Bridge Rd, London, United Kingdom of Great Britain and Northern Ireland
| | - Philip A MacCarthy
- King's College Hospital, King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom of Great Britain and Northern Ireland
| | - Alexander Sirker
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Constantinos O'Mahony
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Wragg
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Daniel A Jones
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
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Tabesh M, Magliano DJ, Tanamas SK, Surmont F, Bahendeka S, Chiang C, Elgart JF, Gagliardino JJ, Kalra S, Krishnamoorthy S, Luk A, Maegawa H, Motala AA, Pirie F, Ramachandran A, Tayeb K, Vikulova O, Wong J, Shaw JE. Cardiovascular disease management in people with diabetes outside North America and Western Europe in 2006 and 2015. Diabet Med 2019; 36:878-887. [PMID: 30402961 PMCID: PMC6618273 DOI: 10.1111/dme.13858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/07/2023]
Abstract
AIM Optimal treatment of cardiovascular disease is essential to decrease mortality among people with diabetes, but information is limited on how actual treatment relates to guidelines. We analysed changes in therapeutic approaches to anti-hypertensive and lipid-lowering medications in people with Type 2 diabetes from 2006 and 2015. METHODS Summary data from clinical services in seven countries outside North America and Western Europe were collected for 39 684 people. Each site summarized individual-level data from outpatient medical records for 2006 and 2015. Data included: demographic information, blood pressure (BP), total cholesterol levels and percentage of people taking statins, anti-hypertensive medication (angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor blockers, thiazide diuretics) and antiplatelet drugs. RESULTS From 2006 to 2015, mean cholesterol levels decreased in six of eight sites (range: -0.5 to -0.2), whereas the proportion with BP levels > 140/90 mmHg increased in seven of eight sites. Decreases in cholesterol paralleled increases in statin use (range: 3.1 to 47.0 percentage points). Overall, utilization of anti-hypertensive medication did not change. However, there was an increase in the use of angiotensin II receptor blockers and a decrease in angiotensin-converting enzyme inhibitors. The percentage of individuals receiving calcium channel blockers and aspirin remained unchanged. CONCLUSIONS Our findings indicate that control of cholesterol levels improved and coincided with increased use of statins. The percentage of people with BP > 140/90 mmHg was higher in 2015 than in 2006. Hypertension treatment shifted from using angiotensin-converting enzyme inhibitors to angiotensin II receptor blockers. Despite the potentially greater tolerability of angiotensin II receptor blockers, there was no associated improvement in BP levels.
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Affiliation(s)
- M. Tabesh
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - D. J. Magliano
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - S. K. Tanamas
- Baker Heart and Diabetes InstituteMelbourneAustralia
| | | | - S. Bahendeka
- MKPGMS‐Uganda Martyrs University & St. Francis Hospital NsambyaKampalaUganda
| | - C.‐E. Chiang
- General Clinical Research CenterTaipei Veterans General HospitalTaipeiTaiwan
| | - J. F. Elgart
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP‐CONICET)La PlataArgentina
| | - J. J. Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP‐CONICET)La PlataArgentina
| | - S. Kalra
- Bharti Research Institute of Diabetes & EndocrinologyBharti HospitalKarnalHaryanaIndia
| | | | - A. Luk
- Department of Medicine and TherapeuticsPrince of Wales HospitalHong Kong SARChina
| | - H. Maegawa
- Shiga University of Medical ScienceShigaJapan
| | - A. A. Motala
- Department of Diabetes and EndocrinologyUniversity of KwaZulu NatalDurbanSouth Africa
| | - F. Pirie
- Department of Diabetes and EndocrinologyUniversity of KwaZulu NatalDurbanSouth Africa
| | | | - K. Tayeb
- Diabetes Center at AlNoor Specialist HospitalMakkahSaudi Arabia
| | - O. Vikulova
- FGBU ‘Endocrinology Research Center’Ministry of HealthMoscowRussia
| | - J. Wong
- Royal Prince Alfred Hospital Diabetes Centre and the University of SydneySydneyAustralia
| | - J. E. Shaw
- Baker Heart and Diabetes InstituteMelbourneAustralia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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McDonnell N, Funk R, Foote R, Kalra S, Neben-Wittich M. Treatment of tracheobronchial amyloidosis with external beam radiation therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kotecha T, Martinez-Naharro A, Boldrini M, Knight D, Hawkins P, Kalra S, Patel D, Coghlan G, Moon J, Plein S, Lockie T, Rakhit R, Patel N, Xue H, Kellman P, Fontana M. Automated Pixel-Wise Quantitative Myocardial Perfusion Mapping by CMR to Detect Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction: Validation Against Invasive Coronary Physiology. JACC Cardiovasc Imaging 2019; 12:1958-1969. [PMID: 30772231 DOI: 10.1016/j.jcmg.2018.12.022] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to assess the performance of cardiovascular magnetic resonance (CMR) myocardial perfusion mapping against invasive coronary physiology reference standards for detecting coronary artery disease (CAD, defined by fractional flow reserve [FFR] ≤0.80), microvascular dysfunction (MVD) (defined by index of microcirculatory resistance [IMR] ≥25) and the ability to differentiate between the two. BACKGROUND Differentiation of epicardial (CAD) and MVD in patients with stable angina remains challenging. Automated in-line CMR perfusion mapping enables quantification of myocardial blood flow (MBF) to be performed rapidly within a clinical workflow. METHODS Fifty patients with stable angina and 15 healthy volunteers underwent adenosine stress CMR at 1.5T with quantification of MBF and myocardial perfusion reserve (MPR). FFR and IMR were measured in 101 coronary arteries during subsequent angiography. RESULTS Twenty-seven patients had obstructive CAD and 23 had nonobstructed arteries (7 normal IMR, 16 abnormal IMR). FFR positive (epicardial stenosis) areas had significantly lower stress MBF (1.47 ± 0.48 ml/g/min) and MPR (1.75 ± 0.60) than FFR-negative IMR-positive (MVD) areas (stress MBF: 2.10 ± 0.35 ml/g/min; MPR: 2.41 ± 0.79) and normal areas (stress MBF: 2.47 ± 0.50 ml/g/min; MPR: 2.94 ± 0.81). Stress MBF ≤1.94 ml/g/min accurately detected obstructive CAD on a regional basis (area under the curve: 0.90; p < 0.001). In patients without regional perfusion defects, global stress MBF <1.82 ml/g/min accurately discriminated between obstructive 3-vessel disease and MVD (area under the curve: 0.94; p < 0.001). CONCLUSIONS This novel automated pixel-wise perfusion mapping technique can be used to detect physiologically significant CAD defined by FFR, MVD defined by IMR, and to differentiate MVD from multivessel coronary disease. A CMR-based diagnostic algorithm using perfusion mapping for detection of epicardial disease and MVD warrants further clinical validation.
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Affiliation(s)
- Tushar Kotecha
- Institute of Cardiovascular Science, University College London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Ana Martinez-Naharro
- Royal Free Hospital, London, United Kingdom; Division of Medicine, University College London, United Kingdom
| | | | - Daniel Knight
- Institute of Cardiovascular Science, University College London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Philip Hawkins
- Royal Free Hospital, London, United Kingdom; Division of Medicine, University College London, United Kingdom
| | | | | | | | - James Moon
- Institute of Cardiovascular Science, University College London, United Kingdom; Barts Heart Centre, London, United Kingdom
| | - Sven Plein
- Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Tim Lockie
- Royal Free Hospital, London, United Kingdom
| | - Roby Rakhit
- Institute of Cardiovascular Science, University College London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Niket Patel
- Institute of Cardiovascular Science, University College London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, Maryland
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, Maryland
| | - Marianna Fontana
- Royal Free Hospital, London, United Kingdom; Division of Medicine, University College London, United Kingdom.
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Bajaj H, Brown R, Bhullar L, Sohi N, Kalra S, Aronson R. SGLT2 inhibitors and incretin agents: Associations with alanine aminotransferase activity in type 2 diabetes. Diabetes & Metabolism 2018; 44:493-499. [DOI: 10.1016/j.diabet.2018.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023]
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Abstract
AbstractIn the present world people have become conscious of the fact that sugar is one of the commonest culprits for gain in weight and blood sugar in diabetes. One of the artificial sweetener, sucralose is widely used by diabetics is still under strict scrutiny because of the contradictory feedbacks obtained from various studies, often discouraging its use. Therefore, there arises a need to check whether the use of sucralose is safe or not. The present study was designed to determine to evaluate and compare the histological changes of sucralose on the islets of pancreas in albino rats. Methods: The adult Wistar albino rats were given sucralose orally by gavage in the dose of 3gms/kg body weight/day dissolved in distilled water and only distilled water for 30 days to experimental and control groups respectively. The animals were weighed prior to and after the experiment. The animals were sacrificed on day 31. The pancreas was dissected and observed grossly. Tissue was processed; paraffin blocks were prepared and 8 micron thick sections were cut. Sections were stained with Haemotoxylin and Eosin and Gomori's stains. Results: Pancreatic toxicity was observed in the form of vaculation of islets, lymphocytic infilterate, degeneration of islets and acini of Pancreas. The commonly used non-lethal dose of sucralose induced damage to Pancreas is startling. Conclusion: The results obtained have wide implications for nutrient sensing and nutrition in the treatment of obesity and diabetes.
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Affiliation(s)
- S. Gupta
- University College of Medical Sciences, Delhi- 110095, India
| | - S. Kalra
- Associate Professor, Department of Anatomy, University College of Medical Sciences, Delhi-110095, India
| | - V. Bharihoke
- Ex Head and Professor, Department of Anatomy, University College of Medical Sciences, Delhi-110095, India
| | - D. Dhurandhar
- Resident Doctor, Department of Anatomy, University College of Medical Sciences, Delhi-110095, India
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Kalra S, Lauritzen T, Sharmanov T, Akanov Z, Al Awadi F, Das AK, Espinosa López C, Medea G, Oh P, Samoilova Y, Shestakova M, Netto P, Cos X, Farghaly M, Du X. Alma-Ata to Berlin: diabetes prevention and treatment to achieve healthy living. Diabet Med 2017; 34:1169-1170. [PMID: 28477409 DOI: 10.1111/dme.13374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - T Lauritzen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - T Sharmanov
- Kazakh Academy of Nutrition, Almaty, Kazakhstan
- Academy of Preventive Medicine, Almaty, Kazakhstan
| | - Z Akanov
- Kazakh National Medical University, Almaty, Kazakhstan
| | - F Al Awadi
- Department of Endocrinology, Dubai Hospital, Dubai, UAE
| | - A K Das
- Department of Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - C Espinosa López
- Directorate of Epidemiology, Ministry of Health, Mexico City, Mexico
| | - G Medea
- Italian College of General Practitioners, Florence, Italy
| | - P Oh
- University Health Network, Toronto, Canada
| | - Y Samoilova
- Siberian State Medical University, Tomsk, Moscow, Russia
| | - M Shestakova
- Endocrinology Research Centre, Diabetes Institute, Moscow, Russia
| | - P Netto
- Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - X Cos
- Primary Care Diabetes Europe (PCDE), Spain
| | | | - X Du
- Peking Union Medical College, Beijing, China
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Y Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Panikar V, Sosale A, Agarwal S, Unnikrishnan A, Kalra S, Bhattacharya A, Chawla M, Anjana RM, Bhatt A, Jaggi S, Sosale B, Hasnani D, Vadgama J. RSSDI clinical practice recommendations for management of In-hospital hyperglycaemia—2016. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0528-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Holt RIG, Nicolucci A, Kovacs Burns K, Lucisano G, Skovlund SE, Forbes A, Kalra S, Menéndez Torre E, Munro N, Peyrot M. Correlates of psychological care strategies for people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. Diabet Med 2016; 33:1174-83. [PMID: 26939906 DOI: 10.1111/dme.13109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 09/22/2015] [Revised: 01/18/2016] [Accepted: 03/01/2016] [Indexed: 01/30/2023]
Abstract
AIMS To assess the ways in which healthcare professionals address psychological problems of adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. METHODS Approximately 120 primary care physicians, 80 diabetes specialists and 80 nurses and dietitians providing diabetes care participated in each of 17 countries (N=4785). Multiple regression analyses were used to evaluate independent statistically significant associations of respondent attributes concerning psychological care strategies, including assessment of diabetes impact on the patient's life, assessment of depression, provision of psychological assessment and support, and coordination with mental health professionals. RESULTS Psychological care strategies were positively associated with each other but differed by healthcare practice site and discipline; nurses and dietitians were less likely to assess depression than other healthcare professionals, while primary care physicians were less likely to coordinate with mental health specialists or ask patients how diabetes affects their lives. Psychological care was positively associated with healthcare professionals' beliefs that patients need help dealing with emotional issues and that clinical success depends on doing so, and also with level of psychological care training, multidisciplinary team membership and availability of resources for psychological care. There were significant between-country variations in psychological care strategies, before and after adjustment for individual-level factors, and significant country-by-covariate interactions for almost all individual-level factors investigated. CONCLUSIONS Improvements in training and resources, recognition and assessment of psychological problems, and increased belief in the efficacy of psychological support may enhance healthcare professionals' efforts to address psychological problems in adults with diabetes.
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Affiliation(s)
- R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - K Kovacs Burns
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - A Forbes
- Kings College London, London, UK
| | - S Kalra
- Bharti Hospital and BRIDE, Karnal, India
| | | | - N Munro
- University of Surrey, Guildford, UK
| | - M Peyrot
- Loyola University Maryland, Baltimore, MD, USA
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Grosskreutz J, Dahnke R, Gaser C, Prell T, Agosta F, Bede P, Benatar M, de Carvalho M, Kalra S, Kassubek J, Reischauer C, Turner M, van Damme P, van den Berg L, Weber M, Filipi M, Control Group NQ. EP 76. Quality control of high resolution T1 images in the global repository of the neuroimaging society in amyotrophic lateral sclerosis (NiSALS). Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.126] [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: 11/29/2022]
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German P, Bai S, Liu XD, Sun M, Zhou L, Kalra S, Zhang X, Minelli R, Scott KL, Mills GB, Jonasch E, Ding Z. Phosphorylation-dependent cleavage regulates von Hippel Lindau proteostasis and function. Oncogene 2016; 35:4973-80. [PMID: 26973240 DOI: 10.1038/onc.2016.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/03/2015] [Accepted: 01/12/2016] [Indexed: 01/04/2023]
Abstract
Loss of von Hippel Lindau (VHL) protein function is a key driver of VHL diseases, including sporadic and inherited clear cell renal cell carcinoma. Modulation of the proteostasis of VHL, especially missense point-mutated VHL, is a promising approach to augmenting VHL levels and function. VHL proteostasis is regulated by multiple mechanisms including folding, chaperone binding, complex formation and phosphorylation. Nevertheless, many details underlying the regulations of VHL proteostasis are unknown. VHL is expressed as two variants, VHL30 and VHL19. Furthermore, the long-form variant of VHL was often detected as multiple bands by western blotting. However, how these multiple species of VHL are generated and whether the process regulates VHL proteostasis and function are unknown. We hypothesized that the two major species are generated by VHL protein cleavage, and the cleavage regulates VHL proteostasis and subsequent function. We characterized VHL species using genetical and pharmacological approaches and showed that VHL was first cleaved at the N-terminus by chymotrypsin C before being directed for proteasomal degradation. Casein kinase 2-mediated phosphorylation at VHL N-terminus was required for the cleavage. Furthermore, inhibition of cleavage stabilized VHL protein and thereby promoted HIF downregulation. Our study reveals a novel mechanism regulating VHL proteostasis and function, which is significant for identifying new drug targets and developing new therapeutic approaches targeting VHL deficiency in VHL diseases.
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Affiliation(s)
- P German
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Bai
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X-D Liu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Sun
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Zhou
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Kalra
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Zhang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Minelli
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - K L Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - G B Mills
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - E Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Ding
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
With the increasing life expectancy, the geriatric population has been increasing over the past few decades. By the year 2050, it is projected to compose more than a fifth of the entire population, representing a 147% increase in this age group. There has been a steady increase in the number of medical and psychiatric disorders, and a large percentage of geriatric patients are now presenting to the emergency department with such disorders. The management of our progressively complex geriatric patient population will require an integrative team approach involving emergency medicine, psychiatry, and hospitalist medicine.
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Affiliation(s)
- Veronica Sikka
- Orlando VA Medical Center Emergency Medicine, Richmond, VA, USA; Emergency Medicine, UCF School of Medicine, Orlando, FL, USA.
| | - S Kalra
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, PA, USA
| | - Sagar Galwankar
- Orlando VA Medical Center Emergency Medicine, Richmond, VA, USA
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Singh Pradhan PM, Kalra S. Factors Associated with Tobacco Use among Female Adolescent Students in Dharan Municipality of Eastern Nepal. J Nepal Health Res Counc 2015; 13:220-225. [PMID: 27005716] [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: 06/05/2023]
Abstract
BACKGROUND Rising trend of female tobacco use is a serious concern in South East Asia Region. Gender differences in tobacco use is likely to be reduced in the future with continuous modernization in low and middle income countries like Nepal. METHODS Pre tested self administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 618 female adolescent students selected by stratified random sampling from different schools of Dharan Municipality from July 2011 to July 2012. Chi square test and binary logistic regression were applied. Probability of significance was set at 5%. RESULTS Prevalence of ever tobacco use was 4% (95% CI 2.4% to 5.5%).The mean age of initiation of tobacco smoking was 13.58 years (SD =1.71) and that of tobacco chewing was 13.80 years (SD = 1.47). More than a third of the tobacco users (36%) consumed tobacco at home whereas three fifth (60%) of the users purchased tobacco directly from the shops.The major reasons behind initiation of tobacco use were for recreational use (32%), pressure from friends (32%) and to relieve pain or stress in life (28%). Multivariate analysis showed that ever tobacco use was significantly associated with ever use of alcohol (AOR: 7.54, 95% CI: 2.61 to 21.78). CONCLUSIONS School and college based awareness raising campaigns are required for female adolescent students to counter the rising tobacco use (smoking and smokeless). Interventions like health education should focus on tobacco to prevent initiation during adolescence.
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Affiliation(s)
- P M Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Nepal
| | - S Kalra
- MD Anderson Cancer Center, Houston, Texas, United States
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Woods JA, Ferguson JS, Kalra S, Degabriele A, Gardner J, Logan P, Ferguson J. The phototoxicity of vemurafenib: An investigation of clinical monochromator phototesting and in vitro phototoxicity testing. J Photochem Photobiol B 2015; 151:233-8. [PMID: 26318280 DOI: 10.1016/j.jphotobiol.2015.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/26/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vemurafenib is a targeted therapy approved for the treatment of patients with metastatic melanoma harbouring the BRAF V600E mutation. Photosensitivity has been reported in over 50% of patients and has been demonstrated to involve at least the broadband UVA spectrum in most patients. Erythrocyte protoporphyrin levels have also been reported as elevated in some patients. OBJECTIVES We report the results of monochromator phototesting in one patient recorded before and while taking vemurafenib. Analysis of porphyrin levels was also conducted. RESULTS After one month of vemurafenib therapy the patient demonstrated markedly increased light sensitivity in the UVA spectrum between 335 ± 27 nm, 365 ± 27 nm and 400 ± 27 nm. However responses in the UVB (305 ± 5 nm) and blue light (430 ± 27 nm) regions were normal. There was no abnormal immediate erythemal response. Pre-vemurafenib baseline phototesting was normal, as was repeat testing two months later when the patient was taking high doses of systemic steroid. No abnormal porphyrins were detected and the antinuclear antibody test was normal. In parallel studies, HaCaT keratinocytes incubated with vemurafenib were killed by UVA but not by visible (blue) light and did not show evidence of detectable intracellular porphyrin in the presence of the drug. CONCLUSION These data confirm vemurafenib induced UVA photosensitivity with a probable phototoxic mechanism not mediated via enhanced porphyrin.
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Affiliation(s)
- J A Woods
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom.
| | - J S Ferguson
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; St George's Hospital, Department of Dermatology, Blackshaw Rd, Tooting, London, United Kingdom
| | - S Kalra
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - A Degabriele
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - J Gardner
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - P Logan
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - J Ferguson
- Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
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Kalra S, Deepak MC, Narang P, Singh V, Maheshwari A. Correlation between measures of hypoglycemia and glycemic improvement in sulfonylurea treated patients with type 2 diabetes in India: results from the OBSTACLE hypoglycemia study. J Postgrad Med 2015; 60:151-5. [PMID: 24823514 DOI: 10.4103/0022-3859.132322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
BACKGROUND This study aimed to assess correlation between measures of hypoglycemia and glycemic control in patients with type 2 diabetes mellitus (T2DM) treated with sulfonylureas. MATERIALS AND METHODS T2DM patients being initiated on a sulfonylurea (SU) on background of a failing oral antihyperglycemic regimen were followed up for 12 weeks. (HbA1c) was measured at baseline and end of follow-up. Hypoglycemia was assessed using Stanford Hypoglycemia Questionnaire at week 12. RESULTS Of the total 1069 patients enrolled, 950 were considered evaluable. A weak negative correlation was observed between end of follow-up HbA1c values and hypoglycemia score, using both linear regression analysis (correlation coefficient -0.12; P = 0.0002) and negative binomial regression (β slope -0.09; P = 0.0010). A similar correlation was also observed between change in HbA1c from baseline and hypoglycemia score (β slope -0.07; P = 0.0048). Mean HbA1c reduction was lowest (0.65 ± 2.27%) in patients not reporting any hypoglycemia and highest (1.28 ± 2.40%) in patients with hypoglycemia score greater than median of 2 (P = 0.0031). There was no correlation between hypoglycemia frequency and end of follow-up HbA1c values (P = 0.4111). CONCLUSION With addition of SU on a background of a failing oral anti-hyperglycemic regimen, the extent of glycemic control correlates directly with measures of patient reported hypoglycemia.
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Affiliation(s)
| | | | | | - V Singh
- Department of Medical Affairs, MSD Pharmaceuticals Pvt Ltd, Lucknow, Uttar Pradesh, India
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Iqbal MB, Khamis R, Ilsley C, Mikhail G, Crake T, Firoozi S, Kalra S, Knight C, Archbold A, Lim P, Mathur A, Meier P, Rakhit RD, Redwood S, Whitbread M, Bromage D, Rathod K, Jones DA, Wragg A, Dalby M, MacCarthy P, Malik IS. Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients. Circ Cardiovasc Interv 2015; 8:e002206. [PMID: 26038482 DOI: 10.1161/circinterventions.114.002206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction. Resources are limited during out of working hours (OWH). Whether PPCI outside working hours is associated with worse outcomes and whether outcomes have improved over time are unknown. METHODS AND RESULTS We analyzed 11 466 patients undergoing PPCI between 2004 and 2011 at all 8 tertiary cardiac centers in London, United Kingdom. We defined working hours as 9 am to 5 pm (Monday to Friday). We analyzed in-hospital bleeding and all-cause mortality ≤3 years, comparing OWH versus in-working hours. A total of 7494 patients (65.3%) were treated during OWH. Multivariable analyses demonstrated that PPCI during OWH was not a predictor for bleeding (odds ratio, 1.47; 95% confidence interval [CI], 0.97-2.24; P=0.071) or 3-year mortality (hazard ratio, 1.11; 95% CI, 0.94-1.32; P=0.20). This was confirmed in propensity-matched analyses. Time-stratified analyses demonstrated that PPCI during OWH was a predictor for bleeding (odds ratio, 2.00; 95% CI, 1.06-3.80; P=0.034) and 3-year mortality during 2005 to 2008 (hazard ratio, 1.23; 95% CI, 1.00-1.50; P=0.050), but this association was lost during 2009 to 2011. During 2005 to 2008, transradial access was predominantly used during in-working hours and PPCI during OWH was predictive of reduced transradial access use (odds ratio, 0.83; 95% CI, 0.71-0.98; P=0.033), but this association was lost during 2009 to 2011. CONCLUSIONS In this study of unselected patients with ST-segment-elevation myocardial infarction, PPCI during OWH versus in-working hours had comparable bleeding and mortality. Time-stratified analyses demonstrated a reduction in adjusted bleeding and mortality during OWH over time. This may reflect the improved service provision, but the increased adoption of transradial access during OWH may also be contributory.
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Affiliation(s)
- M Bilal Iqbal
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.).
| | - Ramzi Khamis
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Ilsley
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Ghada Mikhail
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Tom Crake
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sam Firoozi
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sundeep Kalra
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Knight
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Archbold
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pitt Lim
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Anthony Mathur
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pascal Meier
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Roby D Rakhit
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Simon Redwood
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Mark Whitbread
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Dan Bromage
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Krishna Rathod
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Daniel A Jones
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Wragg
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Miles Dalby
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Phil MacCarthy
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Iqbal S Malik
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
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Kalra S, Rini BI, Jonasch E. Alternate sunitinib schedules in patients with metastatic renal cell carcinoma. Ann Oncol 2015; 26:1300-4. [PMID: 25628443 DOI: 10.1093/annonc/mdv030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022] Open
Abstract
Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor exhibiting antiangiogenic activity. Sunitinib demonstrated improved outcomes in comparison to interferon-α in a large phase III study of treatment naïve patients with metastatic renal cell carcinoma. Maintaining patients on sunitinib treatment is essential for a sustained disease control as higher exposure to sunitinib has been associated with an improved overall response rate, progression-free survival and overall survival. Various studies have compared the outcomes of patients undergoing sunitinib therapy based on modifications from their standard dose and schedule. Several studies have shown that switching to an alternate schedule with more frequent dose interruptions without affecting dose density over a 6-week cycle is associated with improved outcomes and increased tolerability.
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Affiliation(s)
- S Kalra
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - B I Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - E Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
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