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Jaltotage B, Abraham A, Pang J, Krishnan A, Chow B, Ihdayhid A, Lu J, Watts G, Dwivedi G. Can we Predict High-Risk Plaques in Familial Hypercholesterolaemia Using Clinical Variables and Coronary Artery Calcium? Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dutton J, Zardab M, De Braal VJF, Hariharan D, MacDonald N, Hallworth S, Hutchins R, Bhattacharya S, Abraham A, Kocher HM, Yip VS. The accuracy of pre-operative (P)-POSSUM scoring and cardiopulmonary exercise testing in predicting morbidity and mortality after pancreatic and liver surgery: A systematic review. Ann Med Surg (Lond) 2020; 62:1-9. [PMID: 33489107 PMCID: PMC7804364 DOI: 10.1016/j.amsu.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiopulmonary exercise-testing (CPET) and the (Portsmouth) Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity ((P)-POSSUM) are used as pre-operative risk stratification and audit tools in general surgery, however, both have been demonstrated to have limitations in major hepatopancreatobiliary (HPB) surgery. Materials and methods The aim of this review is to determine if CPET and (P)-POSSUM scoring systems accurately predict morbidity and mortality. Eligible articles were identified with an electronic database search. Analysis according to surgery type and tool used was performed. Results Twenty-five studies were included in the final review. POSSUM predicted morbidity demonstrated weighted O/E ratios of 0.75(95%CI0.57–0.97) in hepatic surgery and 0.85(95%CI0.8–0.9) in pancreatic surgery. P-POSSUM predicted mortality in pancreatic surgery demonstrated an O/E ratio of 0.75(95%CI0.27–2.13) and 0.94(95%CI0.57–1.55) in hepatic surgery. In both pancreatic and hepatic surgery an anaerobic threshold(AT) of between 9 0.5–11.5 ml/kg/min was predictive of post-operative complications, and in pancreatic surgery ventilatory equivalence of carbon dioxide(˙VE/˙VCO2) was predictive of 30-day mortality. Conclusion POSSUM demonstrates an overall lack of predictive fit for morbidity, whilst CPET variables provide some predictive power for post-operative outcomes. Development of a new HPB specific risk prediction tool would be beneficial; the combination of parameters from POSSUM and CPET, alongside HPB specific markers could overcome current limitations. Current pre-operative scoring for pancreatic and liver surgery is inaccurate. In pancreatic and liver surgery anaerobic threshold scores were predictive of complications. In pancreatic surgery ventilatory equivalence of carbon dioxide was predictive of mortality. P-POSSUM is inaccurate for predicting mortality and morbidity in pancreatic surgery.
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Miller B, Green D, Barrett M, Farrer K, Ahmed S, Cloutier A, Teubner A, Abraham A, Lal S. The occurrence of chronic kidney disease in patients on long-term home parenteral nutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cloutier A, Deutsch L, Leahy G, Teubner A, Abraham A, Lal S. Outcomes associated with strong opioid use for non-cancer pain in patients with chronic intestinal failure. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cloutier A, Deutsch L, Leahy G, Miller B, Teubner A, Abraham A, Pironi L, Lal S. Factors affecting antidepressant use by patients requiring home parenteral nutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alhussain A, Abraham A, Grunes D, Subramony C. Intraductal Papillary Adenocarcinoma Of The Bile Duct With Associated Invasive Neuroendocrine Component: Case Report. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Casestudy
Intraductal papillary neoplasm of the bile duct (IPNB) is a variant of bile duct carcinoma that is characterized by intraductal growth and better outcomes compared with common cholangiocarcinoma. IPNBs are mainly found in patients from Far Eastern countries, where hepatolithiasis and clonorchiasis are endemic.
Approximately 40%-80% of IPNBs are associated with invasive carcinoma. The invasive carcinomas are most often tubular or mucinous type. Invasive neuroendocrine component has not been previously described.
We present a case of 69 year-old African American male who presented with worsening abdominal pain and jaundice over few months. Computed tomography showed 4 cm mass near the porta hepatis with massive ductal dilatation. A fine needle aspiration of the mass was performed and a diagnosis of adenocarcinoma was made. Subsequently, the patient underwent Right Trisegmentectomy.
Conclusion
Histologic sections revealed intraductal papillary neoplasm in the bile duct lumina. The papillae were lined by columnar epithelial cells with delicate fibrovascular cores. The tumor cell nuclei were slightly elongated, hyperchromatic and basally located without significant multilayering. The cytoplasm was eosinophilic with occasional intestinal differentiation. Frank invasion of the stalk and underlying periductular tissues was identified. Interestingly; the invasive component had different cytological features than the intraductal component, it was composed of small to medium sized cells with granular cytoplasm. The nuclei were uniform and round with “salt and pepper” chromatin. The invasive component stained positively for the neuroendocrine markers (Synaptophysin, Chromogranin and CD56), whereas the intraductal component stained positively for CK7, CK20 and CDX2 and negative for neuroendocrine markers.
Three years later, a recurrent tumor was found in the left lobe on imaging. Biopsy of the lesion showed metastatic neuroendocrine carcinoma. The intraductal papillary neoplasm with invasive neuroendocrine component is very unusual tumor, we think more studies are warranted to best evaluate the treatment options and the prognosis of such neoplasms.
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Bjornsdottir-Butler K, May S, Hayes M, Abraham A, Benner RA. Characterization of a novel enzyme from Photobacterium phosphoreum with histidine decarboxylase activity. Int J Food Microbiol 2020; 334:108815. [PMID: 32966918 DOI: 10.1016/j.ijfoodmicro.2020.108815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/01/2020] [Accepted: 08/02/2020] [Indexed: 11/16/2022]
Abstract
Histamine or scombrotoxin fish poisoning is caused by ingestion of bacterially produced histamine in fish. Histamine-producing bacteria generally contain the histidine decarboxylase gene (hdc). However, some strains of Photobacterium phosphoreum are known to produce significant levels of histamine, although the hdc gene in these strains has not been recognized. The objective of this study was to investigate a previously unidentified mechanism of histamine production by P. phosphoreum. We identified a protein with histidine decarboxylase (HDC) activity comparable to activity of the pyridoxal-5-phosphate (PLP) dependent HDC from P. kishitanii and M. morganii. The newly identified protein (HDC2) in P. phosphoreum and P. kishitanii strains, was approximately 2× longer than the HDC protein from other Gram-negative bacteria and had 12% similarity to previously identified HDCs. In addition, the hdc2 gene cluster in P. phosphoreum was identical to the hdc gene cluster in P. kishitanii. HDC2 had optimal activity at 20-35 °C, at pH 4, and was not affected by 0-8% NaCl concentrations. Compared to the hdc gene from P. kishitanii, expression of the hdc2 gene was constitutive and not affected by pH or excess histidine. This newly identified protein explains possible mechanisms of histamine production in P. phosphoreum. Characterization of this protein will help in designing control measures to prevent or reduce histamine production in fish.
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Bond A, Soop M, Taylor M, Purssell H, Abraham A, Teubner A, Carlson G, Lal S. Home parenteral nutrition and the older adult: Experience from a national intestinal failure unit. Clin Nutr 2020; 39:1418-1422. [DOI: 10.1016/j.clnu.2019.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/18/2022]
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Nguyen S, Arriaga Castellanos K, Abraham A, Rajfer J, Ferrini M. 169 COMP-4 Reduces Oxidative Stress Markers in the Rat Corpora Cavernosa and Media of the Penile Dorsal Artery. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Greenstein L, Abraham A, Tipping B. Treating complexity in the older adult - the role of the geriatric giants. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i6.5065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
As people age, they accumulate medical conditions. Geriatric giants comprise a group of conditions that lead to significant mortality and morbidity and contribute to the complexity in treating geriatric patients. They are common and rarely occur in isolation. The 5 Is of geriatric giants are: iatrogenesis, immobility, instability, incontinence and impaired cognition. Consequences for the patient and their caregivers include loss of functional independence, institutionalisation and caregiver burnout. Primary care practitioners are often the first port of call for geriatric patients in South Africa and by asking a few key questions and performing a thorough examination; these conditions can be recognised early. Whilst there are often limitations to cure, the main aim is to maintain the older adult’s functional independence as much as possible, and by following an organised management approach to each of these conditions, the quality of life of patients can be improved.
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Yadav SP, Abraham A, Nadig R, Vasudevan A. Burning Feet, Dilated Heart and Failed Kidneys. Indian J Nephrol 2019; 29:357-359. [PMID: 31571744 PMCID: PMC6755931 DOI: 10.4103/ijn.ijn_35_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fabry's disease, X-linked lysosomal storage disease, results from deficient activity of alpha galactosidaseA (α-GalA). Renal manifestation usually begins at third decade of life. We report a 16 year male with initial presentation with end stage renal disease (ESRD) and the diagnosis confirmed by presence of myeloid bodies on electron microscopy of kidney biopsy and low serum α-GalA level.
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Abraham A, Ostroff G, Levitz SM, Oyston PCF. A novel vaccine platform using glucan particles for induction of protective responses against Francisella tularensis and other pathogens. Clin Exp Immunol 2019; 198:143-152. [PMID: 31400225 PMCID: PMC6797901 DOI: 10.1111/cei.13356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Vaccines are considered the bedrock of preventive medicine. However, for many pathogens, it has been challenging to develop vaccines that stimulate protective, long-lasting immunity. We have developed a novel approach using β-1,3-D-glucans (BGs), natural polysaccharides abundantly present in fungal cell walls, as a biomaterial platform for vaccine delivery. BGs simultaneously provide for receptor-targeted antigen delivery to specialized antigen-presenting cells together with adjuvant properties to stimulate antigen-specific and trained non-specific immune responses. This review focuses on various approaches of using BG particles (GPs) to develop bacterial and fungal vaccine candidates. A special case history for the development of an effective GP tularaemia vaccine candidate is highlighted.
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Bogdan A, Barnett C, Ali A, AlQwaifly M, Abraham A, Mannan S, Ng E, Bril V. Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol 2019; 27:204-209. [PMID: 31408565 DOI: 10.1111/ene.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Stress is a known risk factor for the onset and modulation of disease activity in autoimmune disorders. The aim of this cross-sectional study was to determine any associations between myasthenia gravis (MG) severity and chronic stress, depression and personality type. METHODS In all, 179 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic between March 2017 and December 2017 were included. At baseline, patients were assessed clinically and they completed self-administered scales for disease severity, perceived stress, depression and personality type. RESULTS Higher disease severity [Myasthenia Gravis Impairment Index (MGII)] showed a moderate correlation with depression score (Beck's Depression Inventory, Second Edition, r = 0.52, P < 0.001) and a lower correlation with chronic stress (Trier Inventory for Assessment of Chronic Stress, r = 0.28, P = 0.001). Chronic stress scores were different according to personality types (anova, P = 0.02). The linear regression model with MGII score as the dependent variable showed R2 = 0.34, likelihood ratio chi-squared 74.55, with P < 0.0001. The only variables that predicted disease severity were depression scores (P < 0.0001) and female sex (P = 0.003). CONCLUSIONS A significant association of MG severity with depression and chronic stress was found, as well as with female gender. These findings should raise awareness that the long-term management of MG should address depression and potential stress and consider behavioural management to prevent stress-related immune imbalance.
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Chadwick P, Abraham A, Ryan K, Teubner A, Bond A, Lal S. SUN-PO262: Sensitivity of Differential Time to Positivity Compared to Pour Plates for Diagnosing Catheter-Related Blood Stream Infection: An Evaluation in Patients with Chronic Intestinal Failure. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abraham A, Sawbridge D, Cloutier A, Teubner A, Taylor M, Lal S. SUN-PO263: Are Femoral Tunnelled Central Venous Catheters Safe to use for HPN? Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thomas TVV, Gandhi S, Nittala M, Albert A, Abraham A, Packianathan S, Vijayakumar S. Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single Institution Patient Cohort. Is There a Will Rogers Phenomenon? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soop M, Khan H, Nixon E, Teubner A, Abraham A, Carlson G, Lal S. SUN-PO306: Causes and Outcomes of Intestinal Failure in Crohn’s Disease: An 18-Year Experience from a National Centre. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vengaloor Thomas T, Perekattu Kuruvilla T, Bhanat E, Albert A, Abraham A, Parr A, Vijayakumar S. Gender Disparities In Radiation Oncology Residency Programs In The United States- Current Status. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bond A, Teubner A, Taylor M, Cawley C, Varden J, Abraham A, Chadwick P, Soop M, Carlson G, Lal S. Catheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes. Clin Nutr 2019; 38:1828-1832. [DOI: 10.1016/j.clnu.2018.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
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Willenbrock F, Cox C, Wilhelm-benartzic C, Owens R, Sabbagh A, Abraham A, Maughan T, Hurt C, O’Neill E, Mukherjee S. CCL5 is associated with poor prognosis in locally advanced pancreatic cancer (LAPC): biomarker analysis from the randomised phase II SCALOP trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stewart K, Eska J, Chisholm G, Abraham A, Fleming N, Frumovitz M, Meyer L, Westin S, Aloia T, Soliman P. Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: Surgical outcomes and hospital charges. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, McMahon M, Leahy G, Abraham A, Soop M, Clamp AR, Hasan J, Mitchell C, Jayson GC, Lal S. A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019; 32:492-500. [PMID: 31006921 DOI: 10.1111/jhn.12650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. METHODS Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. RESULTS One hundred and twenty-five patients with active malignancy [mean (range) age 58 (25-80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter-related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. CONCLUSIONS This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.
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Ferrini M, Abraham A, Nguyen S, Flores M, Luna R, Artaza J, Rajfer J. 076 Exogenous Administration of L-arginine Does Not Stimulate the Endogenous NO-cGMP Pathway in Rat Penile Corpora Smooth Muscle Cells. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bond A, Purssell H, Taylor M, Teubner A, Abraham A, Soop M, Carlson G, Lal S. Home parenteral nutrition in the elderly: experience from a national intestinal failure centre. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, Leahy G, Abraham A, Clamp A, Jayson G, Lal S. A novel discharge pathway for patients requiring palliative home parenteral nutrition. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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