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Abbas LF, Joseph AK, Prasad S, Zhu JL, Fitch KS, Haley R, Torok KS, Jacobe HT. Revealing novel, latent subsets of patients with morphoea through principal component analysis. Br J Dermatol 2021; 186:193-195. [PMID: 34510409 DOI: 10.1111/bjd.20748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/14/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
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Kirby JS, Prens E, Jemec G, v. Malathong, Prasad S, Schall T, Staehr P, f. Investigators. LB791 Avacopan, a highly selective small molecule inhibitor of c5a receptor, in patients with Hidradenitis Suppurativa: Initial results from a randomized, double-blind, placebo-controlled, phase 2 study (aurora). J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prasad S. O-005 Mullerian anomalies overview. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.027] [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 text
Mullerian Duct Anomalies- An Overview
Prof. Sudha Prasad
President Indian Fertility Society, Director, Matritava Advanced IVF & Training Centre, New Delhi, India
Congenital anomalies of the mullerian duct system is one of the complex disorder encountered in gynecological practice. Mullerian ducts are paired embryological structures which undergo fusion and resorption in utero to form the uterus, fallopian tubes, cervix and upper two-thirds of the vagina. Disruption in the mullerian duct development throughout embryogenesis could result a large spectrum of inherent abnormalities identified as mullerian duct anomalies (MDAs).
There is a wide variation in the prevalence of MDAs across various studies, ranging from 1–10% in the general population to 2–8% among infertile women and 5–30% among women with a history of miscarriage. These discrepancies in the reported prevalence are mainly attributed to lack of a universal classification system.
Different varieties of malformations can occur when this system is not well developed. It ranges from absence of uterus, cervix or vagina, septum/duplication of vagina to of the uterus and vagina to minor uterine cavity abnormalities. Mullerian malformations are frequently associated with abnormalities of the renal and axial skeletal systems. Therefore, on initial examination of MDAs patients, these points should be kept in mind.
Most mullerian duct anomalies (MDAs) are associated with functioning ovaries and age-appropriate external genitalia. These abnormalities are often recognized after the onset of puberty. After the onset of puberty, young women often present to the gynecologist with menstrual disorders. Late presentations include infertility and obstetric complications.
A meta-analysis of nine studies comprising 3805 women with congenital uterine anomalies reviewed the obstetric outcome. The study reported that canalization defects such as septate and partial septate uteri had reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects (bicornuate, unicornuate and didelphic uteri) reduce fertility but some are related to miscarriage and prematurity. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine abnormalities increase the risk of fetal malformation during delivery1.
A retrospective longitudinal study concluded that reproductive performance of the unicornuate and didelphys uteri was poor (20–30% chance of carrying a pregnancy to term), while that of the septate and bicornuate uteri (live birth rate of 62%) was better than expected. The arcuate uterus had no impact on reproductive performance of women2.
Agenesis of uterus and vagina requires surgical techniques, such as the Vecchietti and McIndoe procedures, have enabled many women to have normal sexual relations. Uterine transplant has changed the perspective of all other surgical advances and assisted reproductive technologies to improve fertility and obstetric outcomes3, 4,5.
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Lancini D, Mylonas G, Sun J, Boots R, Atherton J, Prasad S, Martin P. Predictors of Critical Illness–Associated New Onset Atrial Fibrillation and its Burden. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.161] [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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Lancini D, Guppy-Coles K, Tan W, Boots R, Atherton J, Prasad S, Martin P. Long-term Atrial Fibrillation Diagnoses Following Critical Illness—associated New Onset Atrial Fibrillation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lancini D, Atherton J, Martin P, Prasad S. Echocardiographic Predictors of New Onset Atrial Fibrillation Post Acute Myocardial Infarction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.144] [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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Neeraja K, Holla V, Prasad S, Stezin A, Kamble N, Nethravathi M, Yadav R, Pal P. Utility of clinical exome sequencing in dystonia: A report from India. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shieh P, Kuntz N, Bönnemann C, Müller-Felber W, Lawlor M, Servais L, Smith B, Noursalehi M, Prasad S, Dowling J. MUSCLE FUNCTION & HOMEOSTASIS / MOLECULAR THERAPEUTIC APPROACHES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.070] [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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Surisetti B, Neeraja K, Prasad S, Holla V, Kamble N, Yadav R, Pal P. Neuroacanthocytosis: Beyond movement disorders. Parkinsonism Relat Disord 2020. [DOI: 10.1016/j.parkreldis.2020.06.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Prasad S, Zhu J, Schollaert-Fitch K, Haley R, Torok K, Jacobe H. 540 Characterizing morphea subsets using a multi-center, prospective, cross-sectional analysis of morphea in adults and children. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bhui K, Prasad S, George J, Shukla Y. Corrigendum to "Bromelain inhibits COX-2 expression by blocking the activation of MAPK regulated NF-kappa B against skin tumor-initiation triggering mitochondrial death pathway" [Canc. Lett. (2009) 282(2) 167-76 doi:10.1016/j.canlet.2009.03.003]. Cancer Lett 2020; 480:48. [PMID: 32035655 DOI: 10.1016/j.canlet.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karjigi U, Kodishala C, Chandrashekara S, Kumar S, Haridas V, R S, Jois R, Daware M, Rao VKR, Dharmanand BG, Jain VRK, Singh YP, Singhai S, Chebbi P, Dharmapalaiah C, Kamath A, Prasad S, C S, Aithala R, Pinto B, Nazir B, Alur Shivakumar H, K M M, Shobha V. AB0785 REAL LIFE EXPERIENCE OF METHOTREXATE BASED DUAL COMBINATION DMARDS IN PSORIATIC ARTHRITIS- RESULTS FROM KARNATAKA PSORIATIC ARTHRITIS COHORT (KPsAC). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Biologics have been the focus of recent treatment guidelines and ‘Treat to Target’ strategies for both psoriasis (PsO) & psoriatic Arthritis (PsA). However, in day-today practice, combination DMARDs anchored around methotrexate are mainstay in majority of patients.Objectives:To describe experience and effectiveness of Methotrexate in combination with conventional DMARDs in Karnataka Psoriatic Arthritis Cohort.Methods:Treatment information was extracted from KPsAC (n=549) which is a cross sectional, non-interventional study conducted across 17 rheumatology practicing centres in Karnataka, India using a structured proforma. This study was approved by respective Ethical committee. Information on efficacy was extracted for various csDMARDs in combination with methotrexate. Standard disease activity outcome measures were used for assessing the response to therapy (DAPSA, PASI, HAQ, MDA5). All participating rheumatologists underwent training to calculate PASI and other outcome scores.Results:Nearly half of the patients in our cohort were on methotrexate (44%) monotherapy. Proportion of patients who received combination csDMARD anchored on methotrexate were 29%. The choice of add on csDMARD was as per clinician discretion or subject preference. Patients were divided in to three groups based on treatments they were receiving at the time of study: Methotrexate (Mtx)+Leflunomide (Lef), Mtx+Sulfasalazine (SSz) and Mtx+Apremilast(Apr). Their characteristics along with outcome measures are depicted in table 1. In Mtx+Apr group: remission or low disease activity was present in 42%, HAQ score of <0.5 was seen in 82%, and only one patient had a PASI of > 10. PASI was significantly lower in the Mtx+Apr group compared to Mtx+Lef group (p<0.009) and Mtx +Ssz group (p < 0.020)Conclusion:Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4)**. In this observational study, 3 groups of methotrexate plus csDMARD- leflunomide, sulphasalazine and apremilast fared similarly for articular domain of PsA. However, in cutaneous domain, PASI was significantly lower in apremilast + methotrexate group. To our knowledge, this is the first real life report of the use of combination DMARDs in unselected PsA patients demonstrating effectiveness of apremilast in cutaneous domain. Methotrexate remains anchor DMARD for treatment of PsA in 2/3rdof PsA patients. Addition of apremilast to methotrexate inadequate responders appears to be beneficial in PsA with persistent cutaneous disease. However, being an observational study, this needs to be confirmed in controlled clinical trials.References:**Apremilast: A Review in Psoriasis and Psoriatic Arthritis, Drugs March 2017, Volume 77, Issue 4.Table.Characteristics and comparison of combination csDMARDsMTX+SSZ(N=39)MTX+LEF (n=77)MTX+APR(N=45)Median Age (years)373935Median disease duration (months)96101112Enthesitis (Ever)6(15%)21(27%)4(8%)Dactylitis (Ever)9((23%)28(36%)12 (26%)DAPSA < 46(15%)9(11%)10(22%) 4-1414(36%)25(32%)13(29%) 14-287(18%)24(31%)11(24%)PASI >107(18%) #14(18%) *1(2%) *#HAQ < 0.530(77%)60(78%)37(82%)MDA 5 achieved16(41%)25(32%)19(42%)*P value < 0.009 #P value <0.02Disclosure of Interests:None declared
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Kodishala C, Chandrashekara S, Kumar S, Haridas V, R S, Jois R, Daware M, Rao VKR, B G D, Jain VRK, Singh YP, Singhai S, Chebbi P, Dharmapalaiah C, Kamath A, Karjigi U, Prasad S, C S, Aithala R, Pinto B, Nazir B, Alur Shivakumar H, K M M, Shobha V. AB0790 CLINICAL PROFILING OF PSORIATIC ARTHRITIS (PsA): AN OBSERVATIONAL STUDY FROM A SOUTH INDIAN PSORIATIC ARTHRITIS COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Clinical patterns and disease burden of PsA varies in different parts of the world. Demographic studies from Indian subcontinent are sparseObjectives:To study the cutaneous, articular profile of PsA and describe their disease activity, disability and co-morbidities (CMs)Methods:This is a multicenter, cross-sectional, non-interventional study from Karnataka, India. All consecutive PsA patients defined by CASPAR or expert diagnosis were evaluated over 8 months from 17 Rheumatology centers across Karnataka using standard parameters such as PASI, DAPSA, Indian version of HAQ-DI1, psoriatic co-morbidity index2(Cidx) and MDA 5. Patient consent and EC obtainedResults:549 PsA patients were evaluated and their disease characteristics are shown in Table 1 & 2. PsA preceded psoriasis in in 81 (14.7%).Table 1.Patient characteristics (n=549)DEMOGRAPHICSPsACommonest age group of PsA (yrs)31-40PsA SubclassificationM:F6:5Symmetric polyarthritis216(40.7%)Type 1 PsoriasisType 2 Psoriasis279(55.8%)221(44.2%)Mean duration (yrs)Asymmetric oligoarthritis202(38.1%)Psoriasis8.8(±7.8)DIP predominant88(16.6%)PsA5.2(±6.3)Arthritis mutilans16(4.2%)PsA preceded psoriasis81(14.7%)Dactylitis182(33.9%)Family h/oPsoriasis107(19.7%)Enthesitis109(20.3%)PsA33(6%)Mean TJC686.3(±8.9)AS11(2%)Mean SJC683.5(±5.2)Uveitis5(0.9%)Type of PsoriasisPlaque253(59.9%)IBD3(0.5%)Erythrodermic 31(7.3%)Type I & II psoriasis did not differ in PASI, DAPSA, HAQ-DI or having a family h/o psoriasis. Type II psoriasis had higher Cidx than type I (p=0.0001). Pt pain VAS, DAPSA, PhyGA, PtGA & SJC significantly correlated with higher HAQ-DI (p<0.0001). TJC, ESR, CRP & PASI had minor correlation with HAQ-DI. Females had higher HAQ-DI compared to males (p=0.02). Knee joint involvement caused disability most frequently. Cidx was higher in males (p=0.008). Minor correlation was found between Cidx with age, HAQ-DI & DAPSA. Mean BMI of our cohort was 26.8(±14.8) kg/m2. 56.5% were overweight. Higher BMI was not associated with age, duration of arthritis, DAPSA, PASI, HAQ-DI & Cidx.Infections (any time) were recorded in 10.8%, of which skin was the commonest site in 38.9%; 30.5% of these needed hospitalizations.Conclusion:Despite mild skin disease in majority, more than half of the patients have moderate to severe joint activity. Mild to moderate functional disability in nearly half of our cohort indicate high burden of damage. High incidence of co-morbidities in PsA compared with general population is in line with published literature. In addition to aggressive control of articular activity, detection and control of co-morbidities must be an integral part of PsA management.References:[1]https://doi.org/10.1093/rheumatology/41.12.1457[2]http://dx.doi.org/10.1136/annrheumdis-2016-eular.4598Table 2.Disease characteristicsDISEASE ACTIVITYDISABILITYCO-MORBIDITIESMean PASI: 3.8(7.4)Mean HAQ-DI: 0.3(0.45)Mean Cidx: 0.98(1.6)Mild (PASI 0-5)480(80%)Mild-mod disability260(48.2%)N with 1 or more CMs232(42.3%)Severe (>10)57(10.6%)ADL with most frequent disabilityClimbing a flight of stairs 189(35%)HTNT2DMSmokingPsA severity19.8%16.6%5.4%3.2%Mean DAPSA: 18.8(16.6)ADL with highest disability scoreSitting cross-legged/squattingAnxietyIHDDyslipidemiaOthers3.1%2.3%2%<2% eachRemission100(19.9%)Low DA145(28.8%)Moderate DA137(27.2%)High DA123(24.5%)Family h/o CV dis/stroke72(15.2%)Disclosure of Interests:None declared
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G C Y, Singh YP, Prasad S, Srinivasulu N, Kumar S, R S, Chebbi P, Jain VRK, Jain N, Kumar C R S. C00006 PSYCHOLOGICAL IMPACT OF COVID 19 PANDEMIC ON PATIENTS WITH RHEUMATOLOGICAL DISORDERS - A WEB BASED CROSS-SECTIONAL MULTICENTRE SURVEY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The COVID-19 pandemic has resulted in uncertainty and negative psychological outcomes for patients with autoimmune rheumatic diseases for several reasons.1The anxiety is due to “underlying conditions” that are expected to increase the risk of infection and / or severe complications. Patients with rheumatological disorders fall into this group as they are believed to be immunosuppressed due to disease or the treatment. It is essential to understand the level of anxiety among the rheumatic disease patients at the current situation of COVID-19.Objectives:To study difference in Anxiety score (Mean/Avg Score) among following groups-underlying rheumatic disease, age, gender, marital status, educational status, employment status, medications, those who were on steroids/not, those who are Biologicals / Not.Methods:A web-based cross-sectional multi-centre survey was done across 5 rheumatology centres in India. The study duration was between 9th May and 16th May 2020.The questionnaire included consent, demographic details, medication history, opinion about tele rheumatology services and anxiety score measured by Beck Anxiety Inventory (BAI)2.Results:The survey was sent to 2987 patients, there were 933 responses and 581 were complete (Male =175). Complete responses were considered for data analysis. Most respondents were less than 50 years of age (70.6%). Rheumatoid arthritis (RA) was the most frequent (50.6%) diagnosis followed by other conditions. Most of the patients (43%) were on combination DMARD therapy, 12.7% of patients were on biological drugs and 23.9% of patients were on glucocorticoids. Statistically significant higher anxiety scores were observed in females, patients suffering from fibromyalgia, patients on glucocorticoids and biological agents. There was no difference in the anxiety scores with regard to age, educational status, and employment status.Difficulty in meeting rheumatologists and getting medications was expressed by 327 (56.2%) and 73 (29.7%) respondents respectively. Majority of respondents (86.6 %) agreed/strongly agreed regarding use of telemedicine to access health care during the crisis.Conclusion:The findings of the study revealed that anxiety is a major concern in patients with autoimmune rheumatic diseases. Fibromyalgia patients and those who were on glucocorticoids and biological drugs were found to have more anxiety levels compared to other groups of patients. In such periods of public health crises, telemedicine is a great tool for patients to access healthcare without fear of going to hospital. There is a need to intensify the awareness and address the mental health issues of rheumatology patients during this COVID-19 pandemic.References:[1]Pope, J.E. What Does the COVID-19 Pandemic Mean for Rheumatology Patients?. Curr Treat Options in Rheum (2020).https://doi.org/10.1007/s40674-020-00145-y.[2]Oh H, Park K, Yoon S, Kim Y, Lee SH, Choi YY, et al. Clinical utility of beck anxiety inventory in clinical and nonclinical Korean samples. Front Psychiatry.2018;9:666.https://doi.org/10.3389/fpsyt.2018.00666Disclosure of Interests:None declared
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Wood K, Ayers B, Bernstein W, Vidula H, Chen L, Barrus B, Prasad S, Gosev I. Sternal-Sparing LVAD Implantation Reduces the Incidence of Severe Right Heart Failure. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1008] [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] Open
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Ayers B, Wood K, Cheyne C, Alexis J, Chen L, Goldenberg I, Barrus B, Prasad S, Gosev I. Concurrent Left Atrial Appendage Occlusion and Sternal-Sparing LVAD Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ayers B, Marini T, Wood K, Kim S, Croake M, Bernstein W, Storozynsky E, Tallman M, Cheyne C, Barrus B, Prasad S, Gosev I. Sternal-Sparing Approach for LVAD Implantation Allows for a More Consistent Inflow Cannula Angle. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sharma A, Prasad S, Arun Kumar R, Jaiswal S, Agrawal P, Kant L, Bhatt J. Analytical assessment of maize kernels for Fe, Zn, and β-carotene dense cultivars with low phytate contents. ACTA ALIMENTARIA 2020. [DOI: 10.1556/066.2020.49.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The present paper reports that significant genetic variability was evident in Fe, Zn, β-carotene, and phytic acid (phytate, PA) contents in a set of 39 diverse maize genotypes collected from maize breeding programme of hill agriculture, India. The Fe, Zn, β-carotene, and PA concentrations were found to be in the range 19.31–50.64 mg kg−1, 12.60–37.18 mg kg−1, 0.17–8.27 µg g−1, and 6.59–7.13 g kg−1, respectively. The genotypes V335, V420, V393, V416, V414, V372, and V351 were identified to have higher concentration of β-carotene, Fe, and Zn but lower amount of PA. Possible availability of the minerals Fe and Zn was determined using molar ratio between PA as inhibitor and β-carotene as promoter for their absorption. The micronutrient molar ratio showed that Fe and Zn traits could be dependent of each other. Low R2 value revealed relation between β-carotene and kernel colour. The selected genotypes could be considered as potential sources of favourable genes for further breeding programs to develop micronutrient enriched maize cultivars.
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Guppy-Coles K, Johnstone M, Prasad S, Smith K, Lo A, Truloff T, Armstrong J, Atherton J. 342 Feasibility and Accuracy of Assessing Left Ventricular Systolic Function by Measuring Left Ventricular Ejection Fraction Using a Hand-held Echocardiography Device With an Automated Algorithm. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.349] [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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Sabatino J, Borrelli N, Aversani M, Filippini E, Paredes J, Josen M, Prasad S, Fraisse A, Indolfi C, Daubeney P, Di Salvo G. P1747 Left atrial strain identifies diastolic dysfunction in children with cardiomyopathies and correlates with invasive LV end-diastolic pressure. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
2-dimensional (2-D) left atrial (LA) strain accurately categorizes DD in adults but its diagnostic performance in children is unknown.
Aim of this study is to investigate whether LA strain and strain rate are able to diagnose and classify DD in children with dilated (CMD), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies (CM).
Methods
The study includes 136 children (aged 8.8 ± 6 years): 44 with DCM, 40 with HCM, 7 with RCM and 45 healthy controls (CTRL). They underwent standard echocardiography and 2-D speckle-tracking analyses (LV longitudinal peak systolic strain (LS), LA peak systolic strain and strain rate). Cardiac catheterization was performed within 24 hours after the echocardiographic study in 9 children (mean age 9 ± 7 years) with clinical indication and the LV end-diastolic pressure was measured.
Results
No significant differences in mitral E/A, E/E’, pulmonary S/D ratios and indexed left atrial volumes were observed among the 3 CM groups.
LA peak systolic strain and strain rate values showed a steady and significant decrease with worsening of DD. ROC curves showed area under the curve of 0.976 (p < 0.001) for LA strain and 0.946 (p < 0.001) for LA strain rate, to distinguish CTRL from CMs.
Moreover, univariate regression analysis demonstrated that peak LA strain had a strong significant inverse correlation with invasive LV end-diastolic pressure (r -0.892, p < 0.001). On the other hand, invasive LV end-diastolic pressure had non-significant correlations with E’ avg (r -0.139, p = 0.721), E/E’ avg (r 0.238, p = 0.537), MV DT (r 0.485, p = 0.186) and LAVi (r 0.514, p = 0.157).
Conclusions
LA strain is able to recognize and classify DD in children with cardiomyopathies and accurately correlates with invasive LV end-diastolic pressures.
Abstract P1747 Figure.
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Saxena S, Caprnda M, Ruia S, Prasad S, Fedotova J, Kruzliak P, Krasnik V. Spectral domain optical coherence tomography based imaging biomarkers for diabetic retinopathy. Endocrine 2019; 66:509-516. [PMID: 31571130 DOI: 10.1007/s12020-019-02093-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/13/2019] [Indexed: 01/17/2023]
Abstract
To evaluate the role of central subfield thickness (CST), cube average thickness (CAT), and cube volume (CV) as imaging biomarkers for severity of diabetic retinopathy within the ETDRS-based grades of retinopathy using spectral domain optical coherence tomography (SD-OCT). This study aims to evaluate the role of macular CST, CAT, and CV on SD-OCT as imaging biomarkers for severity of DR. One hundred ninety-four consecutive cases of type 2 diabetes mellitus were divided according to ETDRS classification: diabetes mellitus without retinopathy (No DR; n = 65), nonproliferative diabetic retinopathy (NPDR; n = 66), and proliferative diabetic retinopathy (PDR; n = 63). Sixty-three healthy controls were included. CST, CAT, and CV were analyzed using SD-OCT. Data were analyzed statistically. Analysis of variance revealed a significant increase in levels of CST, CAT, CV, and LogMAR visual acuity with the increase in severity of DR. Independent t-test revealed significant difference in CST, CAT, and CV between cases with DME and cases without DME. On multivariate linear regression analysis, increase in CST, CAT, and CV were found to indicate the increase in severity of DR. SD-OCT-based imaging biomarkers CST, CAT, and CV are effective tools for documenting the severity of diabetic retinopathy. These imaging biomarkers serve as significant indicators of severity of disease.
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Servais L, Shieh P, Dowling J, Kuntz N, Müller-Felber W, Smith B, Bönnemann C, Muntoni F, Bilder D, Duong T, Graham R, Jain M, Lawlor M, MacBean V, Noursalehi M, Pitts T, Rafferty G, Rico S, Prasad S. P.105INCEPTUS pre-phase 1, prospective, non-interventional, natural history run-in study to evaluate subjects aged 4 years and younger with X-linked myotubular myopathy (XLMTM). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bhatti YJ, O'hanlon R, Ismail TF, Pennell D, Vassiliou V, Prasad S. 1411The effect of eplerenone on fibrosis in hypertrophic cardiomyopathy. A randomised controlled trial assessed using cardiopulmonary exercise testing and cardiovascular magnetic resonance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Recent studies have implicated aldosterone, a hormone of the renin-angiotensin-aldosterone system to cardiac hypertrophy, and cardiac and vascular fibrosis in cardiomyopathy. High levels of circulating aldosterone have been shown to cause myocardial and aortic fibrosis in animal models. In humans, high aldosterone concentrations have been associated with endothelial dysfunction, myocardial infarction, left ventricular hypertrophy and death. Aldosterone antagonism with spironolactone or eplerenone reverses the process of fibrosis in animal models.
Purpose
Left ventricular dysfunction due to hypertrophic cardiomyopathy (HCM) is a disorder associated with an increased risk of morbidity and premature mortality. An important pathological feature seen in cardiomyopathy is the development of fibrosis and its association with functional impairment and arrhythmia, including predisposition to sudden cardiac death. This trial observes the effect of eplerenone on myocardial fibrosis and exercise tolerance in patients with HCM.
Methods
42 patients were recruited into a double-blinded, placebo-controlled randomised study. Each patient had an established diagnosis of HCM without exclusion criteria (figure 1). 2 patients withdrew before enrolment. Enrolled patients were established on maximally tolerated doses of standard drugs used in the treatment of HCM and the doses of these drugs remained unchanged in the 2 months preceding enrolment to the trial. Patients were randomised to receive a maximal dose of 50mg eplerenone (n=21) or placebo (n=19). The patients underwent cardiopulmonary exercise testing and cardiovascular magnetic resonance (CMR) scan at baseline and 52 week follow up.
Results
At 52 weeks follow up there was no difference between placebo and treatment groups in peak oxygen consumption (−1.05 vs 0.63, p=0.32), anaerobic threshold (0.4 vs 1.45, p=0.31) or ventilatory efficiency slope (−0.77 vs 1.76, p=0.065). In addition, there was no significant difference observed in LV mass or fibrosis as assessed by CMR.
Inclusion and Exclusion Criteria
Conclusion
In the first randomised controlled trial using eplerenone in humans with HCM, we report no effect of treatment after 52 weeks on exercise capacity compared with placebo. In addition, we report no effect of treatment on the presence of fibrosis detected by CMR. Interpretation of these results are limited by small sample size and further studies will require a multi-centre recruitment process. The data presented here support the feasibility of eplerenone treatment in patients with HCM and provide statistical power calculation for future trials.
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Dowling J, Shieh P, Kuntz N, Bonnemann C, Muller-Felber W, Lawlor M, Servais L, Smith B, Noursalehi M, Rico S, Prasad S. O.39ASPIRO phase 1/2 gene therapy trial in X-linked motubular myopathy (XLMTM): update on preliminary safety and efficacy findings. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Li RWH, Lipszyc JC, Prasad S, Tarlo SM. Work-related asthma from cleaning agents versus other agents. Occup Med (Lond) 2019; 68:587-592. [PMID: 30423151 DOI: 10.1093/occmed/kqy137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Cleaning agents have been commonly implicated as causative or triggering factors in work-related asthma (WRA), mainly from epidemiologic studies. Relatively few clinical series have been reported. Aims We aimed to compare socio-demographic and clinical features among tertiary clinic patients with WRA exposed to cleaning and non-cleaning products. Methods Analyses were conducted on a patient database containing 208 patients with probable WRA referred to the asthma and airway centre at a tertiary centre hospital in Canada from 2000 to 2014. Chi-squared and independent samples t-tests were used to analyse categorical and continuous data, respectively. Results Twenty-two (11%) WRA cases were attributed to a variety of cleaning product exposures, 12 were diagnosed as occupational asthma (OA) and 10 as work-exacerbated asthma (WEA) (10% of all OA and 11% of all WEA). There were multiple exposures and the responsible agent(s) could seldom be clearly identified. Most frequent categories of exposure were surfactants, alcohols, disinfectants and acids. Compared to WRA with other exposures, those with cleaning agent exposures had a significantly larger proportion of females (82 versus 35%, P < 0.001), included a higher percentage of workers in healthcare (41 versus 4%, P < 0.001), and submitted more workers' compensation claims (86 versus 64%, P = 0.05). Other characteristics were comparable. Conclusions In a tertiary referral clinic, patients with WRA from cleaning agent exposure had clinical characteristics that were similar to those with WRA from other causes. Most frequent exposures were surfactants, alcohols, disinfectants and acids.
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