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Cumberworth A, Lewith H, Sud A, Jefferson H, Athanassoglou V, Pandit JJ. Major complications of airway management: a prospective multicentre observational study. Anaesthesia 2022; 77:640-648. [PMID: 35254669 DOI: 10.1111/anae.15668] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with 'predicted easy' airways were rare (approximately 1 in 14,200), but 45 times more common in those with 'predicted difficult' airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.
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Affiliation(s)
- A Cumberworth
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Lewith
- Department of Anaesthetics, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - A Sud
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Jefferson
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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2
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Sud A, Tacchi S, Sagkovits D, Barton C, Sall M, Diez LH, Stylianidis E, Smith N, Wright L, Zhang S, Zhang X, Ravelosona D, Carlotti G, Kurebayashi H, Kazakova O, Cubukcu M. Tailoring interfacial effect in multilayers with Dzyaloshinskii-Moriya interaction by helium ion irradiation. Sci Rep 2021; 11:23626. [PMID: 34880294 PMCID: PMC8654828 DOI: 10.1038/s41598-021-02902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
We show a method to control magnetic interfacial effects in multilayers with Dzyaloshinskii-Moriya interaction (DMI) using helium (He[Formula: see text]) ion irradiation. We report results from SQUID magnetometry, ferromagnetic resonance as well as Brillouin light scattering results on multilayers with DMI as a function of irradiation fluence to study the effect of irradiation on the magnetic properties of the multilayers. Our results show clear evidence of the He[Formula: see text] irradiation effects on the magnetic properties which is consistent with interface modification due to the effects of the He[Formula: see text] irradiation. This external degree of freedom offers promising perspectives to further improve the control of magnetic skyrmions in multilayers, that could push them towards integration in future technologies.
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Affiliation(s)
- A. Sud
- grid.83440.3b0000000121901201London Centre for Nanotechnology, University College London, 17-19 Gordon Street, London, WC1H 0AH UK
| | - S. Tacchi
- grid.9027.c0000 0004 1757 3630Istituto Officina dei Materiali del CNR (CNR-IOM), Sede Secondaria di Perugia, c/o Dipartimento di Fisica e Geologia, Università di Perugia, 06123 Perugia, Italy
| | - D. Sagkovits
- grid.83440.3b0000000121901201London Centre for Nanotechnology, University College London, 17-19 Gordon Street, London, WC1H 0AH UK ,grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
| | - C. Barton
- grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
| | - M. Sall
- Spin-Ion Technologies, Palaiseau, France
| | - L. H. Diez
- grid.503099.6Centre de Nanosciences et de Nanotechnologies, Orsay, l̂le-de-France France
| | - E. Stylianidis
- grid.83440.3b0000000121901201London Centre for Nanotechnology, University College London, 17-19 Gordon Street, London, WC1H 0AH UK
| | - N. Smith
- grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
| | - L. Wright
- grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
| | - S. Zhang
- grid.45672.320000 0001 1926 5090King Abdullah University of Science and Technology Physical Sciences and Engineering Division, Thuwal, Mecca, Saudi Arabia
| | - X. Zhang
- grid.45672.320000 0001 1926 5090King Abdullah University of Science and Technology Physical Sciences and Engineering Division, Thuwal, Mecca, Saudi Arabia
| | - D. Ravelosona
- Spin-Ion Technologies, Palaiseau, France ,grid.503099.6Centre de Nanosciences et de Nanotechnologies, Orsay, l̂le-de-France France
| | - G. Carlotti
- grid.9027.c0000 0004 1757 3630Dipartimento di Fisica e Geologia, Università di Perugia, Via Pascoli, 06123 Perugia, Italy
| | - H. Kurebayashi
- grid.83440.3b0000000121901201London Centre for Nanotechnology, University College London, 17-19 Gordon Street, London, WC1H 0AH UK
| | - O. Kazakova
- grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
| | - M. Cubukcu
- grid.83440.3b0000000121901201London Centre for Nanotechnology, University College London, 17-19 Gordon Street, London, WC1H 0AH UK ,grid.410351.20000 0000 8991 6349National Physical Laboratory, Hampton Road, Teddington, TW11 0LW UK
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3
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Holt L, Sud A, Dixon G, Rutka O, Taylor J. 1665 Characterising the Escalation in Hospital Trauma Admission During the Easing of the COVID-19 Level 4 Lockdown Restrictions. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1065] [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: 11/13/2022]
Abstract
Abstract
Introduction
Major trauma reduced by over a third during the institution of UK level-4 national lockdown (Rajput K. et al; 2020). Easing of lockdown on a societal level posed unprecedented uncertainties. With the easing of restrictions, it is expected that the quantity of trauma would increase. In the absence of ‘normality’ it remains uncertain about the extent of the quantity, severity and aetiology of the trauma. The effect of lockdown easing on patterns of traumatic admissions has not been studied and it has important implications upon service provision.
Method
A retrospective cohort study using the data from 2017-2019 were used as a 3-year control to compare each month of 2020. Regional trauma data (TARN data) from Aintree level-1 Major Trauma Centre, the regional tertiary Specialist Units. Easing of restrictions to the regional tier system began in May-July. This index 3months was compared to the control data.
Results
Following easing of restrictions there was a significant increase in the Incident Severity Scores from trauma admissions. The %mortality during the level-4 lockdown decreases but as restrictions are eased there is an increase in the % mortality. The number of stabbings and road traffic collisions are also seen to increase following the ease of restrictions.
Conclusions
There is a decrease in the number of trauma calls seen following the easing of restrictions, yet the severity of the incident and the mortality rate has increased. Therefore, is the trauma more severe of does COVID-19 influence this?
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Affiliation(s)
- L Holt
- Aintree University Hospital, Liverpool, United Kingdom
| | - A Sud
- Aintree University Hospital, Liverpool, United Kingdom
| | - G Dixon
- Aintree University Hospital, Liverpool, United Kingdom
| | - O Rutka
- Aintree University Hospital, Liverpool, United Kingdom
| | - J Taylor
- Aintree University Hospital, Liverpool, United Kingdom
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Sud A, Athanassoglou V, Anderson EM, Scott S. A comparison of gastric gas volumes measured by computed tomography after high-flow nasal oxygen therapy or conventional facemask ventilation . Anaesthesia 2021; 76:1184-1189. [PMID: 33651914 DOI: 10.1111/anae.15433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
High-flow nasal oxygen therapy is increasingly used to improve peri-intubation oxygenation. However, it is unknown whether it may cause or exacerbate insufflation of gas into the stomach. High-flow nasal oxygen therapy is now standard practice in our hospital for adult patients undergoing percutaneous thermal ablation of liver cancer under general anaesthesia with tracheal intubation. We compared gastric gas volumes measured from computed tomography images that had been acquired immediately after intubation in two series of patients: 50 received peri-intubation high-flow nasal oxygen therapy and another 50 received conventional facemask pre-oxygenation and ventilation before intubation and before high-flow nasal oxygen therapy became standard practice in our unit. Median (IQR [range]) gastric gas volume was 24.0 (14.2-59.9 [3-167]) cm3 in the high-flow nasal oxygen therapy group and 23.8 (12.6-38.8 [0-185]) cm3 in the facemask group. There was no difference between the two groups in the volume of gastric gas measured by computed tomography imaging (Mann-Whitney U-test, U = 1136, p = 0.432, n1 = n2 = 50). Our results demonstrate that a small volume of gastric gas is commonly present after induction of anaesthesia, but that the use of peri-intubation high-flow nasal oxygen therapy for pre-oxygenation and during apnoea does not increase this volume compared with conventional facemask pre-oxygenation and ventilation. This is clinically relevant, as high-flow nasal oxygen therapy is increasingly being used in a peri-intubation context and in patients at higher risk of aspiration.
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Affiliation(s)
- A Sud
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E M Anderson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Scott
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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5
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Sud A, Jones ME, Broggio J, Loveday C, Torr B, Garrett A, Nicol DL, Jhanji S, Boyce SA, Gronthoud F, Ward P, Handy JM, Yousaf N, Larkin J, Suh YE, Scott S, Pharoah PDP, Swanton C, Abbosh C, Williams M, Lyratzopoulos G, Houlston R, Turnbull C. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol 2020; 31:1065-1074. [PMID: 32442581 PMCID: PMC7237184 DOI: 10.1016/j.annonc.2020.05.009] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival. PATIENTS AND METHODS We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations. RESULTS Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. CONCLUSIONS Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.
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Affiliation(s)
- A Sud
- Division of Genetics and Epidemiology, Institute of Cancer Research, London
| | - M E Jones
- Division of Genetics and Epidemiology, Institute of Cancer Research, London
| | - J Broggio
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London
| | - C Loveday
- Division of Genetics and Epidemiology, Institute of Cancer Research, London
| | - B Torr
- Division of Genetics and Epidemiology, Institute of Cancer Research, London
| | - A Garrett
- Division of Genetics and Epidemiology, Institute of Cancer Research, London
| | - D L Nicol
- Urology Unit, Royal Marsden NHS Foundation Trust, London
| | - S Jhanji
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London; Division of Cancer Biology, Institute of Cancer Research, London
| | - S A Boyce
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - F Gronthoud
- Department of Microbiology, Royal Marsden NHS Foundation Trust, London
| | - P Ward
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London
| | - J M Handy
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden NHS Foundation Trust, London
| | | | - J Larkin
- Skin and Renal Unit, Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, Institute of Cancer Research, London
| | - Y-E Suh
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London
| | - S Scott
- RM Partners, West London Cancer Alliance, Royal Marsden NHS Foundation Trust, London
| | - P D P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - C Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London
| | - C Abbosh
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London
| | - M Williams
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London; Computational Oncology Group, Imperial College London, London
| | - G Lyratzopoulos
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, University College London, London
| | - R Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK
| | - C Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London; National Cancer Registration and Analysis Service, Public Health England, Wellington House, London; Department of Clinical Genetics, Royal Marsden NHS Foundation Trust, London, UK.
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Sreenivasulu K, Chaudhari PS, Achanta S, Sud A, Dahanukar V, Cobley CJ, Llewellyn-Beard F, Bandichhor R. Synthesis of (R)-3-(tert-Butoxycarbonylamino)-4-(2,4,5-trifluorophenyl)butanoic Acid, a Key Intermediate, and the Formal Synthesis of Sitagliptin Phosphate. Chem Asian J 2020; 15:1605-1608. [PMID: 32128989 DOI: 10.1002/asia.202000092] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Indexed: 11/10/2022]
Abstract
An alternate formal synthesis of Sitagliptin phosphate is disclosed from 2,4,5-trifluorobenzadehyde in 8 linear steps with an overall yield of 31%. The chiral β-amino acid moiety present in sitaglitpin is installed via an asymmetric hydrogenation followed by a stereoselective Hofmann rearrangement as the key steps. The key chiral intermediate Boc-amino acid 1 prepared by this novel route was further converted to Sitagliptin phosphate following the known literature protocol.
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Affiliation(s)
- Kurella Sreenivasulu
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
| | - Pramod S Chaudhari
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
| | - Srinivas Achanta
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
| | - Abhishek Sud
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
| | - Vilas Dahanukar
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
| | - Christopher J Cobley
- Integrated Product Development Cambridge, Dr Reddy's Laboratories Ltd, 410 Cambridge Science Park, Milton Road, Cambridge, CB24 9JU, UK
| | - Fiona Llewellyn-Beard
- Integrated Product Development Cambridge, Dr Reddy's Laboratories Ltd, 410 Cambridge Science Park, Milton Road, Cambridge, CB24 9JU, UK
| | - Rakeshwar Bandichhor
- Integrated Product Development, Innovation Plaza, Dr. Reddy's Laboratories Ltd, Bachupally, Qutubullapur, R.R. Dist., 500072, Telangana, India
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7
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Loveday C, Sud A, Litchfield K, Levy M, Holroyd A, Broderick P, Kote-Jarai Z, Dunning AM, Muir K, Peto J, Eeles R, Easton DF, Dudakia D, Orr N, Pashayan N, Reid A, Huddart RA, Houlston RS, Turnbull C. Runs of homozygosity and testicular cancer risk. Andrology 2019; 7:555-564. [PMID: 31310061 DOI: 10.1111/andr.12667] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Testicular germ cell tumour (TGCT) is highly heritable but > 50% of the genetic risk remains unexplained. Epidemiological observation of greater relative risk to brothers of men with TGCT compared to sons has long alluded to recessively acting TGCT genetic susceptibility factors, but to date none have been reported. Runs of homozygosity (RoH) are a signature indicating underlying recessively acting alleles and have been associated with increased risk of other cancer types. OBJECTIVE To examine whether RoH are associated with TGCT risk. METHODS We performed a genome-wide RoH analysis using GWAS data from 3206 TGCT cases and 7422 controls uniformly genotyped using the OncoArray platform. RESULTS Global measures of homozygosity were not significantly different between cases and controls, and the frequency of individual consensus RoH was not significantly different between cases and controls, after correction for multiple testing. RoH at three regions, 11p13-11p14.3, 5q14.1-5q22.3 and 13q14.11-13q.14.13, were, however, nominally statistically significant at p < 0.01. Intriguingly, RoH200 at 11p13-11p14.3 encompasses Wilms tumour 1 (WT1), a recognized cancer susceptibility gene with roles in sex determination and developmental transcriptional regulation, processes repeatedly implicated in TGCT aetiology. DISCUSSION AND CONCLUSION Overall, our data do not support a major role in the risk of TGCT for recessively acting alleles acting through homozygosity, as measured by RoH in outbred populations of cases and controls.
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Affiliation(s)
- C Loveday
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A Sud
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - K Litchfield
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK
| | - M Levy
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A Holroyd
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - P Broderick
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - Z Kote-Jarai
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - A M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - K Muir
- Division of Health Sciences, Warwick Medical School, Warwick University, Warwick, UK
- Institute of Population Health, University of Manchester, Manchester, UK
| | - J Peto
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - R Eeles
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - D F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - D Dudakia
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - N Orr
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - N Pashayan
- Department of Applied Health Research, University College London, London, UK
| | - A Reid
- Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, UK
| | - R S Houlston
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
| | - C Turnbull
- Division of Genetics & Epidemiology, The Institute of Cancer Research, London, UK
- William Harvey Research Institute, Queen Mary University, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
- Public Health England, National Cancer Registration and Analysis Service, London, UK
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8
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Abstract
PURPOSE We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well. METHODS We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol. RESULTS Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%. CONCLUSION We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S. Chand
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - A. Mehtani
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - A. Sud
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - J. Prakash
- Central Institute of Orthopaedics, VMMC & Safdarjung Hospital, New Delhi, India
| | - A. Sinha
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - A. Agnihotri
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
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9
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Moore D, Sud A, Cheng J, Alves D, Huang W, Sutton R. Clinical measures to capture stratified outcomes of mild, moderate and severe acute pancreatitis. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.293] [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: 10/28/2022]
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10
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Levy M, Hall D, Sud A, Law P, Litchfield K, Dudakia D, Haugen TB, Karlsson R, Reid A, Huddart RA, Grotmol T, Wiklund F, Houlston RS, Turnbull C. Mendelian randomisation analysis provides no evidence for a relationship between adult height and testicular cancer risk. Andrology 2017; 5:914-922. [DOI: 10.1111/andr.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- M. Levy
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - D. Hall
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - A. Sud
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - P. Law
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - K. Litchfield
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - D. Dudakia
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - T. B. Haugen
- Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - R. Karlsson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - A. Reid
- Academic Radiotherapy Unit; Institute of Cancer Research; Sutton Surrey UK
| | - R. A. Huddart
- Academic Radiotherapy Unit; Institute of Cancer Research; Sutton Surrey UK
- Academic Uro-oncology Unit; The Royal Marsden NHS Foundation Trust; Sutton Surrey UK
| | - T. Grotmol
- Department of Research; Cancer Registry of Norway; Oslo Norway
| | - F. Wiklund
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - R. S. Houlston
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
| | - C. Turnbull
- Division of Genetics & Epidemiology; The Institute of Cancer Research; London UK
- William Harvey Research Institute; Queen Mary University; London UK
- Department of Clinical Genetics; Guy's and St Thomas’ NHS Trust; London UK
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Sud A, Shipman AR, Odeke M, Varma K, Read-Jones M, Carr RA. Follicular porokeratosis: four new cases. Clin Exp Dermatol 2017; 42:881-886. [PMID: 28748571 DOI: 10.1111/ced.13195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 01/01/2023]
Abstract
Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.
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Affiliation(s)
- A Sud
- Department of Dermatology, Warwick Hospital, Warwick, Warwickshire, UK.,Department of Cellular Pathology, Warwick Hospital, Warwick, Warwickshire, UK
| | - A R Shipman
- Department of Dermatology, Warwick Hospital, Warwick, Warwickshire, UK
| | - M Odeke
- Department of Plastic Surgery, University Hospital Coventry and Warwickshire, Coventry, Warwickshire, UK
| | - K Varma
- Department of Dermatology, Nuffield Health Wolverhampton Hospital, Wolverhampton, West Midlands, UK
| | - M Read-Jones
- Hastings House Medical Centre, Wellesbourne, Warwick, Warwickshire, UK
| | - R A Carr
- Department of Cellular Pathology, Warwick Hospital, Warwick, Warwickshire, UK
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12
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Went M, Sud A, Law PJ, Johnson DC, Weinhold N, Försti A, van Duin M, Mitchell JS, Chen B, Kuiper R, Stephens OW, Bertsch U, Campo C, Einsele H, Gregory WM, Henrion M, Hillengass J, Hoffmann P, Jackson GH, Lenive O, Nickel J, Nöthen MM, da Silva Filho MI, Thomsen H, Walker BA, Broyl A, Davies FE, Langer C, Hansson M, Kaiser M, Sonneveld P, Goldschmidt H, Hemminki K, Nilsson B, Morgan GJ, Houlston RS. Assessing the effect of obesity-related traits on multiple myeloma using a Mendelian randomisation approach. Blood Cancer J 2017; 7. [PMID: 28622301 PMCID: PMC5520395 DOI: 10.1038/bcj.2017.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- M Went
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - A Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - P J Law
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Försti
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - M van Duin
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - J S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - B Chen
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - O W Stephens
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - U Bertsch
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - C Campo
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - H Einsele
- Department of Internal Medicine II, Division of Hematology and Medical Oncology, University Hospital Würzburg, Würzburg, Germany
| | - W M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M Henrion
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - J Hillengass
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - G H Jackson
- Royal Victoria Infirmary, Newcastle upon Tyne, Newcastle, UK
| | - O Lenive
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - J Nickel
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - M M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - M I da Silva Filho
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - H Thomsen
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - B A Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Broyl
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - F E Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Langer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - M Hansson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Hematology Clinic, Skåne University Hospital, Lund, Sweden
| | - M Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - K Hemminki
- Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - B Nilsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Office of Medical Services, Lund, Sweden
- Broad Institute, 7 Cambridge Center, Cambridge, MA, USA
| | - G J Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - R S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- E-mail:
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Sud A, Chaudhari PS, Agarwal I, Mohammad AB, Dahanukar VH, Bandichhor R. Discovery of redox system enabling C–N–C bonds formation: Unprecedented Aza-Cannizzaro reaction. Tetrahedron Lett 2017. [DOI: 10.1016/j.tetlet.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The study included 57 patients with visceral leishmaniasis. The average duration of symptoms was 3.8 ± 3.55 months and pancytopenia was the commonest haematological abnormality. The parasite load directly correlated with the degree of anaemia at presentation (P=0.03). Splenic regression took 9.58 ±4.5 days and haematological parameters recovered in 14.5±9.07 days. There were five deaths over the five-year study duration. Leishmaniasis was not the first diagnosis in 14 patients, of whom eight were residents of non-endemic regions. Diagnosis was achieved in 13.5 days in these patients, compared to 4.5 days in patients where leishmaniasis was suspected at the outset.
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Affiliation(s)
- A Sud
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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15
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Abstract
Toxoplasma gondii is an important opportunistic infection among human immunodeficiency virus (HIV)-infected patients as it causes fatal encephalitis. In the present study, antibody response to T. gondii is assessed in saliva samples from 100 HIV-seropositive patients and 25 HIV-negative healthy controls by indirect enzyme-linked immunosorbent assay (ELISA). Sensitivity and specificity for detection of IgG and IgM in saliva is calculated using a positive antibody response in serum samples (from an earlier study) as the gold standard. IgG and IgM antibodies were found in 20% and 25% patients, respectively. One control subject showed the presence of IgM antibody. Sensitivity for IgG and IgM antibodies was 64% and 81.25%, respectively, while specificity was 94.67% and 85.71%, respectively. This study indicates that saliva samples can be used as an alternative to serum samples to detect anti-toxoplasma antibodies, particularly IgM, for the diagnosis of toxoplasma encephalitis in HIV/acquired immune deficiency syndrome patients.
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Affiliation(s)
- M P Singh
- Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India
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Malla N, Sengupta C, Dubey ML, Sud A, Dutta U. Antigenaemia and antibody response to Toxoplasma gondii in human immunodeficiency virus-infected patients. Br J Biomed Sci 2016; 62:19-23. [PMID: 15816207 DOI: 10.1080/09674845.2005.11732682] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Toxoplasma encephalitis in immunocompromised patients results from reactivation of previously acquired (latent) infection. The aim of the study is to assess the antigenaemia and antibody response to Toxoplasma gondii in human immunodeficiency virus (HIV)-infected patients to determine the best marker for early diagnosis of toxoplasmosis in such patients. Indirect enzyme-linked immunosorbent assay (ELISA) for detection of IgG, IgM and IgA anti-toxoplasma antibodies and double-sandwich ELISA for toxoplasma antigen is carried out in serum samples collected from 100 HIV seropositive patients and 75 controls. Toxoplasma-specific IgG, IgM and IgA antibody response and antigenaemia were detected in 12%, 6%, 7% and 14% of HIV-infected patients, respectively. On retrospective analysis of 14 patients with antigenaemia only one had central nervous system (CNS) symptoms attributable to toxoplasma infection. In this patient, the CD4+ cell count was below 50/microL and none of the specific immunoglobulin isotype responses could be detected. The patient showed clinical improvement following specific chemotherapy for toxoplasmosis. In 25 HIV-negative and anti-toxoplasma IgG antibody-positive controls, IgM was detected in two (8%), IgA in five (20%) and antigenaemia in 10 (40%), while 50 HIV seronegative healthy controls were negative for both antigen and antibody responses. The study indicates that detection of toxoplasma antigen in addition to IgG antibody response may prove to be a useful indicator in the early diagnosis of reactivated toxoplasmosis in HIV/AIDS patients.
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Affiliation(s)
- N Malla
- Department of Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
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17
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Tsirikos AI, Sud A, McGurk SM. Radiographic and functional outcome of posterolateral lumbosacral fusion for low grade isthmic spondylolisthesis in children and adolescents. Bone Joint J 2016; 98-B:88-96. [DOI: 10.1302/0301-620x.98b1.35672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/05/2022]
Abstract
Aims We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis. Methods No patient underwent spinal decompression or instrumentation placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative blood loss 200 ml (150 to 340). There was one wound infection treated with antibiotics but no other complication. Radiological assessment included standing posteroanterior and lateral, Ferguson and lateral flexion/extension views, as well as CT scans. Results A solid posterolateral fusion was confirmed in all patients at mean latest follow-up of 4.7 years (3.4 to 9.8) beyond skeletal maturity into early adult life. Fusion of the isthmic lesion was documented in nine patients bilaterally and eight patients unilaterally. The poor fusion rate across the spondylolysis has not affected the excellent functional results of the procedure, which in our series depended on achieving a stable lumbosacral junction. Conclusion Quality of life assessment demonstrated significant improvement in all functional scores and high patient satisfaction with 28 patients returning to previous sports activities at an elite competitive level. Take home message: Posterolateral arthrodesis in situ with autologous iliac crest bone without instrumentation has achieved a solid fusion between the L5 transverse processes and the sacral ala in patients with grade I to II isthmic lumbosacral spondylolisthesis and this has produced excellent clinical outcomes and high patient satisfaction. Cite this article: Bone Joint J 2016;98-B:88–96.
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Affiliation(s)
- A. I. Tsirikos
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
| | - A. Sud
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
| | - S. M. McGurk
- Royal Hospital For Sick Children, Sciennes
Road, Edinburgh, EH9 1LF, UK
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18
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Scott M, Sud A, Boess E, Klussmann M. Reaction progress kinetic analysis of a copper-catalyzed aerobic oxidative coupling reaction with N-phenyl tetrahydroisoquinoline. J Org Chem 2014; 79:12033-40. [PMID: 25203932 DOI: 10.1021/jo5018876] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The results from a kinetic investigation of a Cu-catalyzed oxidative coupling reaction between N-phenyl tetrahydroisoquinoline and a silyl enol ether using elemental oxygen as oxidant are presented. By using reaction progress kinetic analysis as an evaluation method for the obtained data, we discovered information regarding the reaction order of the substrates and catalysts. Based on this information and some additional experiments, a refined model for the initial oxidative activation of the amine substrate and the activation of the nucleophile by the catalyst was developed. The mechanistic information also helped to understand why silyl nucleophiles have previously failed in a related Cu-catalyzed reaction using tert-butyl hydroperoxide as oxidant and how to overcome this limitation.
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Affiliation(s)
- Martin Scott
- Max-Planck-Institut fuer Kohlenforschung , Kaiser-Wilhelm-Platz 1, 45470 Muelheim an der Ruhr, Germany
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19
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Schweitzer-Chaput B, Sud A, Pintér Á, Dehn S, Schulze P, Klussmann M. Synergistic Effect of Ketone and Hydroperoxide in Brønsted Acid Catalyzed Oxidative Coupling Reactions. Angew Chem Int Ed Engl 2013; 52:13228-32. [DOI: 10.1002/anie.201306752] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 11/09/2022]
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20
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Schweitzer-Chaput B, Sud A, Pintér Á, Dehn S, Schulze P, Klussmann M. Synergistischer Effekt von Keton und Hydroperoxid in Brønsted-Säure-katalysierten oxidativen Kupplungen. Angew Chem Int Ed Engl 2013. [DOI: 10.1002/ange.201306752] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Hanson D, Murray PG, Coulson T, Sud A, Omokanye A, Stratta E, Sakhinia F, Bonshek C, Wilson LC, Wakeling E, Temtamy SA, Aglan M, Rosser EM, Mansour S, Carcavilla A, Nampoothiri S, Khan WI, Banerjee I, Chandler KE, Black GCM, Clayton PE. Mutations in CUL7, OBSL1 and CCDC8 in 3-M syndrome lead to disordered growth factor signalling. J Mol Endocrinol 2012; 49:267-75. [PMID: 23018678 DOI: 10.1530/jme-12-0034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
3-M syndrome is a primordial growth disorder caused by mutations in CUL7, OBSL1 or CCDC8. 3-M patients typically have a modest response to GH treatment, but the mechanism is unknown. Our aim was to screen 13 clinically identified 3-M families for mutations, define the status of the GH-IGF axis in 3-M children and using fibroblast cell lines assess signalling responses to GH or IGF1. Eleven CUL7, three OBSL1 and one CCDC8 mutations in nine, three and one families respectively were identified, those with CUL7 mutations being significantly shorter than those with OBSL1 or CCDC8 mutations. The majority of 3-M patients tested had normal peak serum GH and normal/low IGF1. While the generation of IGF binding proteins by 3-M cells was dysregulated, activation of STAT5b and MAPK in response to GH was normal in CUL7(-/-) cells but reduced in OBSL1(-/-) and CCDC8(-/-) cells compared with controls. Activation of AKT to IGF1 was reduced in CUL7(-/-) and OBSL1(-/-) cells at 5 min post-stimulation but normal in CCDC8(-/-) cells. The prevalence of 3-M mutations was 69% CUL7, 23% OBSL1 and 8% CCDC8. The GH-IGF axis evaluation could reflect a degree of GH resistance and/or IGF1 resistance. This is consistent with the signalling data in which the CUL7(-/-) cells showed impaired IGF1 signalling, CCDC8(-/-) cells showed impaired GH signalling and the OBSL1(-/-) cells showed impairment in both pathways. Dysregulation of the GH-IGF-IGF binding protein axis is a feature of 3-M syndrome.
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Affiliation(s)
- D Hanson
- Paediatric Endocrinology, School of Biomedicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9WL, UK
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22
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Davis R, Murphy MF, Sud A, Noel S, Moss R, Asgheddi M, Abdur-Rahman I, Vincent C. Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective. Transfus Med 2012; 22:251-6. [PMID: 22519365 DOI: 10.1111/j.1365-3148.2012.01149.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre-transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. OBJECTIVES To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre-transfusion checking behaviours. MEASURES A cross-sectional design was employed assessing willingness to participate in pre-transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1-7. PARTICIPANTS One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. RESULTS Mean scores for patients' willingness to participate in safety-relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4.96-6.27 to 4.53-6.66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. CONCLUSION Overall, both patients and healthcare professionals view patient involvement in transfusion-related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.
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Affiliation(s)
- R Davis
- Department of Bio-Surgery and Surgical Technology, Clinical Safety Research Unit, Imperial College London, St. Mary's Hospital, London, United Kingdom.
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Qureshi J, Sud A, Vakil N. Funding source and conflict of interest disclosures by authors and editors in gastroenterology specialty journals revisited. Aliment Pharmacol Ther 2012; 35:690-5. [PMID: 22257079 DOI: 10.1111/j.1365-2036.2011.04989.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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] [Received: 09/11/2011] [Revised: 09/28/2011] [Accepted: 12/27/2011] [Indexed: 12/08/2022]
Abstract
BACKGROUND A survey of journals published in the field of Gastroenterology conducted 5 years ago showed marked variability in reporting of conflicts of interest or funding sources in these journals. AIM To re-examine reporting of conflicts of interest and funding sources for original articles and editorials in Gastroenterology and Hepatology journals. METHODS We evaluated all original articles and editorials in 15 leading journals (determined by impact factor-Thomson Reuter Science Citation Index) devoted to Gastroenterology and Hepatology for disclosures of conflicts and for editor's self disclosures. We examined each journal's editorial policy by contacting the journal directly if the information was not revealed on the Web site or print versions of the journal. RESULTS Of the 1574 articles evaluated, a total of 1207 (77%) reported the presence or absence of a potential conflict of interest and 1047 (67%) reported the presence or absence of funding sources. A total of 3 of the 15 (20%) journals (American Journal of Gastroenterology, Gastroenterology, and Alimentary Pharmacology and Therapeutics reported the presence or absence of funding sources in all their published original articles. Only 5 of 15 (33%) journals (Gut, Gastrointestinal Endoscopy, American Journal of Gastroenterology, Neurogastroenterology & Motility and Alimentary Pharmacology and Therapeutics) publicly disclosed the conflicts of interest of the editors. CONCLUSIONS (i) Funding sources and conflicts of interest are still reported variably in the GI literature. (ii) Editorials and review articles are influential, but have poor reporting of conflicts of interest. (iii) Editors of many journals still do not report their conflicts of interest.
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Affiliation(s)
- J Qureshi
- Aurora Sinai Medical Center, Milwaukee, WI, USA
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Boess E, Sureshkumar D, Sud A, Wirtz C, Farès C, Klussmann M. Mechanistic Studies on a Cu-Catalyzed Aerobic Oxidative Coupling Reaction with N-Phenyl Tetrahydroisoquinoline: Structure of Intermediates and the Role of Methanol As a Solvent. J Am Chem Soc 2011; 133:8106-9. [DOI: 10.1021/ja201610c] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Esther Boess
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Devarajulu Sureshkumar
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Abhishek Sud
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Cornelia Wirtz
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Christophe Farès
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Martin Klussmann
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
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Abstract
Skull-base osteomyelitis (SBO) occurs secondary to invasive bacterial and fungal infection. Distinguishing between fungal and bacterial aetiologies of SBO has significant therapeutic implications. An 18-year (1990-2007) retrospective review of patients with SBO presenting to Westmead Hospital was performed. Epidemiological, clinical, laboratory and radiology data were collated. Twenty-one patients (median age 58 years) with SBO were identified: ten (48%) had bacterial and 11 (52%) had fungal SBO. Diabetes mellitus (57%) and chronic otitis externa (33%) were the most frequent co-morbidities; immunosuppression was present in five cases (24%). Cranial nerve deficits occurred in ten (48%) patients. The commonest pathogens were Pseudomonas aeruginosa (50% bacterial SBO) and a zygomycete (55% fungal SBO). Compared to bacterial SBO, fungal SBO was more frequently associated with underlying chronic sinusitis, sinonasal pain, facial/periorbital swelling and nasal stuffiness or discharge and the absence of purulent ear discharge (all p <0.05). Bacterial SBO was more frequently associated with deafness, ear pain or ear discharge (all p <0.05). Median time to presentation was longer in patients with bacterial SBO (26.3 weeks vs. 8.1 weeks, p 0.08). Overall 6-month survival was 88% (14/18 patients). All four deaths occurred in patients with fungal SBO. Immunosuppression was a risk factor for death (p <0.05). Early diagnostic sampling is recommended in patients at increased risk of fungal SBO to enable optimal antimicrobial and surgical management.
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Affiliation(s)
- C C Blyth
- Centre for Infectious Diseases and Microbiology, ICPMR, Westmead Hospital, Westmead, NSW, Australia
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26
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Affiliation(s)
- Aron Pintér
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
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Pintér Á, Sud A, Sureshkumar D, Klussmann M. Autoxidative Bildung von Kohlenstoff-Kohlenstoff-Bindungen aus Kohlenstoff-Wasserstoff-Bindungen. Angew Chem Int Ed Engl 2010. [DOI: 10.1002/ange.201000711] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chatterjee I, Dulhunty JM, Iredell J, Gallagher JE, Sud A, Woods M, Lipman J. Predictors and outcome associated with an Enterococcus positive isolate during intensive care unit admission. Anaesth Intensive Care 2010; 37:976-82. [PMID: 20014605 DOI: 10.1177/0310057x0903700610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study reports the incidence, risk factors and mortality associated with a positive Enterococcus spp. isolate during admission to two tertiary intensive care units participating in an antibiotic cycling study. Incidence was low, with only 4.2% of admissions (36/852) at Royal Brisbane and Women's Hospital and 2.8% (31/1104) at Westmead Hospital developing a positive Enterococcus spp. isolate (P=0.087). A positive enterococcal isolate, while not an independent predictor of mortality (odds ratio [OR]=1.6, 95% confidence interval [CI] 0.80 to 3.2, P=0.18), may be a marker of the underlying severity of illness with higher unadjusted in-hospital mortality (26% or 17/66 vs 14% or 250/1855, P=0.007). Independent risk factors for a positive isolate were use of meropenem/imipenem (OR=5.7, 95% CI 2.4 to 14, P <0.001) and cefepime (OR=2.5, 95% CI 1.2 to 5.3, P=0.017) within 48 hours of intensive care unit admission, the presence of a nasogastric tube (OR=4.1, 95% CI 1.3 to 14, P=0.018), renal replacement therapy (OR=2.2, 95% CI 1.0 to 4.7, P=0.046), operative intervention (OR=1.8, 95% CI 1.0 to 3.2, P=0.035) and age (OR=1.2, 95% CI 1.1 to 1.5, P=0.009). None of these factors, except for the need for renal replacement therapy (OR=6.2, 95% CI 1.4 to 27, P=0.015), was associated with increased mortality. Enterococci-directed empiric therapy in the treatment of sepsis remains of unproven value, although this negative finding must be evaluated against other higher powered studies.
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Affiliation(s)
- I Chatterjee
- Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia.
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Klussmann M, Sureshkumar D, Sud A. Thieme Chemistry Journal Awardees - Where
Are They Now? Aerobic Oxidative Coupling of Tertiary Amines
with Silyl Enolates and Ketene Acetals. Synlett 2009. [DOI: 10.1055/s-0029-1217336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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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Sud A, Sureshkumar D, Klussmann M. Oxidative coupling of amines and ketones by combined vanadium- and organocatalysis. Chem Commun (Camb) 2009:3169-71. [DOI: 10.1039/b901282f] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sud A, Del Bono E, Haines J, Wiggs J. Fine mapping of the GLC1K juvenile primary open-angle glaucoma locus and exclusion of candidate genes. Mol Vis 2008; 14:1319-26. [PMID: 18648523 PMCID: PMC2480480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 07/14/2008] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Primary open-angle glaucoma is a leading cause of blindness worldwide. We previously identified a region on chromosome 20p12 associated with juvenile-onset primary open-angle glaucoma (JOAG) that was designated GLC1K. The aim of this study is to refine the boundaries of the GLC1K region and to screen selected candidate genes located within the refined region for biologically significant mutations. METHODS Four JOAG families (44 individuals) with linkage to GLC1K were used for this study. Informative single nucleotide polymorphism (SNP) markers located throughout the previously defined region were used for haplotype analysis. Four candidate genes within the refined region were screened for biologically significant mutations using direct genomic sequencing: bone morphogenetic protein 2 (BMP2); phospholipase C beta 1 (PLCB1); phospholipase C beta 4 (PLCB4); and BTB POZ domain containing 3 (BTBD3). RESULTS Haplotype analysis identified a new critical interval of 12.7 Mb using a combination of SNPs and microsatellite markers. This analysis extended the region of GLC1K from D20S846 to rs6081603 in affected individuals, and the region was further reduced to 9 Mb if unaffected recombinant individuals were included in the analysis. Biologically significant DNA sequence variants were not identified in the BMP2, PLCB1, PLCB4, or BTBD3 genes in these families. CONCLUSIONS Using recombinant breakpoint mapping and haplotypes based on a combination of SNP and microsatellite markers, the GLC1K region has been reduced to a maximum of 12.7 Mb and a minimum of 9 Mb. Four genes that are located within the refined region with attractive ocular expression and function have been excluded as causative genes for JOAG.
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Affiliation(s)
- A. Sud
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - E.A. Del Bono
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - J.L. Haines
- Center for Human Genetics Research, Vanderbilt School of Medicine, Nashville, TN
| | - J.L. Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA
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Wanchu A, Khullar M, Sud K, Sakhuja V, Thennarasu K, Sud A, Bambery P. Serum and urine nitrite and citrulline levels among patients with systemic lupus erythematosus: a possible addition to activity parameters? J Clin Rheumatol 2007; 7:10-5; discussion 15. [PMID: 17039080 DOI: 10.1097/00124743-200102000-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nitric oxide (NO) plays a significant role in the inflammatory process and has been implicated in several autoimmune disorders. This study was carried out prospectively to estimate the levels of nitrite and citrulline in the serum and urine, as surrogate markers of NO production, among patients with systemic lupus erythematosus (SLE). Forty-seven patients and 44 age- and sex-matched, healthy volunteers were studied. Nitrite and citrulline were measured in serum and urine by spectrophotometry.Median serum nitrite and citrulline levels and urine citrulline levels were higher among patients as compared with controls (p < 0.05). Patients with skin involvement stood out and had higher median serum and urine citrulline levels (p < 0.05). Disease activity correlated with steroid dosage, serum nitrite levels, and serum and urine citrulline levels (p < 0.05). Steroid dosage correlated with serum citrulline level (p < 0.05). Serum and urine citrulline levels correlated with each other (p < 0.01). In the subset of 13 individuals with renal involvement, serum and urine citrulline levels correlated with each other (p < 0.01) as did urine nitrite and citrulline levels (p < 0.05).NO production is increased among patients with SLE, and this increase correlates with disease activity and dosage of steroids used. The addition of a urine test to measure NO production as a marker of disease activity using simple spectrophotometry can be a valuable adjunct to other tests, can obviate the need for drawing a blood sample for this purpose, and can be repeated as often as necessary.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE To evaluate results of open reduction for late-presenting (more than 3 weeks) posterior dislocation of the elbow in 10 patients. METHOD Elbow stiffness was the main indication for surgery. The mean age of the patients was 34 (range, 13-65) years; the mean time since injury was 4 (range, 2-6) months. All patients had non-functional elbow movement for any activity of daily living. Three patients had associated fractures around the elbow joint. RESULTS At a mean follow-up of 19 (range, 11-28) months, 8 patients regained a functional range of movement for activities of daily living and maintained a median arc of flexion of 100 degrees and a supination-pronation arc of 140 degrees. According to the Mayo Elbow Performance Index, the results of 5 patients were excellent, 3 were good, and 2 were poor. Complications included pin site infection (n=2), ulnar neuritis (n=1), and delayed wound healing (n=1). CONCLUSION In patients with late-presenting, unreduced elbow dislocation occurring up to 6 months earlier, open reduction is effective in restoring the joint to a painless, stable and functional state.
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Affiliation(s)
- S Mehta
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
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Rao P, Sethi S, Sud A, Banga SS, Sharma M. Screening of patients with acute febrile illness for leptospirosis using clinical criteria and serology. Natl Med J India 2005; 18:244-6. [PMID: 16433137] [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: 05/06/2023]
Abstract
BACKGROUND Leptospirosis is one of the common zoonoses but, in most instances, the infection goes unnoticed. Rapid diagnostic modalities are needed to diagnose the disease in the early stages. We assessed the usefulness of clinical criteria and compared these with enzyme-linked immunosorbentassay (ELISA) for the early detection of leptospirosis. METHODS One hundred patients with a febrile illness for > 7 days were screened by Faine criteria and their sera were subjected to both IgM and IgG ELISA using a commercially available kit (Institut Virion Serion GmbH, Warburg, Germany). RESULTS Twenty-six patients satisfied the clinical criteria for leptospirosis and 8 of them tested positive for IgM antibodies while 1 patient who was clinically negative tested positive by serology. Thus, Faine criteria had a sensitivity of 88.9%, specificity of 80.2%, positive predictive value of 30.8% and a negative predictive value of 98.6%. Paired serum samples were obtained from 70 patients but the IgG levels of only 2 showed a 4-fold rise. CONCLUSION Faine criteria has moderate sensitivity and specificity but a high negative predictive value in comparison with IgM ELISA. The high negative predictive value may help to screen patients with acute febrile illness for leptospirosis during the early phase of the disease.
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Affiliation(s)
- P Rao
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Sachdeva N, Sehgal S, Sud A, Datta U, Arora SK. Incidence of lamivudine resistance associated mutations in pol-gene of HIV-1 in patients from north India: a preliminary report. INDIAN J PATHOL MICR 2005; 48:337-40. [PMID: 16761745] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Screening of drug-resistant variants is very important for the effective clinical management of HIV-infected patients and development of new strategies. The present study was aimed to detect codon-184 mutations in the pol-gene of HIV leading to resistance to lamivudine (3-TC) by nested cum ARMS-PCR approach in 10 treated and 9 treatment naive patients. For correlation the whole blood CD4/CD8 cell counts and the soluble TNFRII levels in plasma were also determined. Of the 19 patients tested, mutant variants were observed in 2 patients (Met Val in one and Met Val & lle in second) both being treated with 3-TC. No mutations were detected in the treatment-naive patients. The results confirmed that, drug resistant variants of codon-184 emerge rapidly in patients receiving 3-TC containing regimens including our population, which is mainly infected with subtypeC of the virus that could be detected along with wild viral population using sensitive approaches such as ARMS-PCR.
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Affiliation(s)
- N Sachdeva
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh
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Malla N, Sengupta C, Dubey ML, Sud A, Ansari NA, Salotra P. Antigenaemia and antibody response to Leishmania donovani stage-specific antigens and rk39 antigen in human immunodeficiency virus-infected patients. Br J Biomed Sci 2004; 60:210-6. [PMID: 14725337 DOI: 10.1080/09674845.2003.11783701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In order to define the possible markers for the early diagnosis of asymptomatic visceral leishmaniasis in human immunodeficiency virus (HIV)-infected individuals, the antigenaemia and antibody response to stage-specific Leishmania donovani and rk39 antigens is assessed by enzyme-linked immunosorbent assay (ELISA) and immunoreactivity to stage-specific antigens analysed by Western blot. Serum samples from two out of 100 HIV-infected individuals were found positive for antigenaemia, antibody response to stage-specific L. donovani antigens and rk39 antigen, and one sample was also positive for antigenaemia and antibody response to L. donovani antigens, while antibody detection to rk39 antigen was not carried on this sample. Additionally, one sample was found positive for amastigote antigenaemia and antibody response to amastigote antigen, while in this patient promastigote antigenaemia and antibody response to promastigote L. donovani and rk39 antigen could not be detected. One sample was found positive for antigenaemia, antibody response to amastigote antigen and negative for antibody response to promastigote antigen, while in this patient response to rk39 antigen was borderline. Although antibody response to rk39 antigen could be detected in 9/88 (10%) HIV-infected individuals, in six of these nine patients neither antigenaemia nor antibody response to stage-specific L. donovani antigens could be detected. All 10 confirmed visceral leishmaniasis and HIV-negative control patients had positive antigenaemia and antibody response to L. donovani amastigote and promastigote antigens, while all the normal healthy individuals were negative. The study indicated that detection of antibody response to rk39 antigen, amastigote antigenaemia and antibody response to amastigote antigen may prove to be better markers than detection of promastigote antigenaemia, antibody response to promastigote antigen and immunoblot reactivity.
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Affiliation(s)
- N Malla
- Department of Parasitology, PGIMER, Chandigarh-160012, India.
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Wanchu A, Arora S, Bhatnagar A, Sud A, Bambery P, Singh S. Beta2 microglobulin as a surrogate marker for HIV infection: good correlation with CD4 counts. INDIAN J PATHOL MICR 2004; 47:298-301. [PMID: 16295507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
To determine if beta-2 microglobulin (beta2M) levels were elevated in our HIV infected patient population and if it could be used as a surrogate marker for disease progression. Thirty-eight HIV infected individuals and 26 age and sex-matched controls were studied. Measurement of CD4 cell count was carried out on a flowcytometer using anti-human CD4 monoclonal antibody and beta2M was measured by an enzyme immunoassay. Mean levels of HIV infected individuals were 1.29 +/- 0.52 mg/L and were significantly higher than 0.74 +/- 0.07 mg/L, the value of controls (p value <0.01). There was a negative correlation between CD4 counts and beta2M levels (r-value-0.79, p value <0.001). Beta2M levels in HIV infected individuals who have no opportunistic infection are elevated and these levels correlate with the CD4 counts. Beta2M can be used for the clinical follow-up of patients with HIV infection.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Wanchu A, Sud A, Singh S, Bambery P. Human immunodeficiency virus infection in a patient with systemic lupus erythematosus. J Assoc Physicians India 2003; 51:1102-4. [PMID: 15260397] [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: 04/30/2023]
Abstract
We describe a 47 years lady with systemic lupus erythematosus (SLE) who was infected with human immunodeficiency virus (HIV), due to transfusion either by blood or platelet concentrate. There was a near remission in the disease and during the course of follow up she developed cryptococcal meningitis. The approach to the diagnosis of HIV infection in a patient with SLE, the effect of SLE on the virus and vice versa and some management issues in this setting are discussed.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post-graduate Institute of Medical Education and Research, Chandigarh, India
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Wanchu A, Chawla Y, Dhiman RK, Sud A, Bambery P. Paucity of anti-hepatitis C virus antibodies in the serum of Indian patients with Sjogren's syndrome and inflammatory myositis. INDIAN J PATHOL MICR 2003; 46:191-3. [PMID: 15022906] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Several extrahepatic manifestations have been associated with infection with Hepatitis C virus (HCV) infection. It has been associated with Sjogren's syndrome (SS) and inflammatory myositis (IM). The objective was to look at the prevalence of anti-HCV antibodies in the serum of SS and IM patients of Indian origin. Individuals satisfying the European Economic Community criteria for the diagnosis of SS and those satisfying the criteria of Bohan and Peter for the diagnosis of IM were recruited in the study. Routine evaluation for liver functions was made. Anti-HCV antibodies were tested by a third generation ELISA, using microplate HCV3.0 ELISA. Of the 23 patients with SS studied, 14 had extraglandular features. The commonest were anaemia and arthritis in six each, followed by in lymphopenia in two. One patient each had interstitial lung disease, hypothyroidism and chronic active hepatitis. Twenty-two patients with IM were studied alongside. None of the patients had abnormal liver functions. One patient with primary SS tested positive for anti-HCV antibodies. None of the patients with inflammatory myositis tested positive for anti-HCV antibodies. The presence of anti-HCV antibodies in our cohort of patients with SS and IM is low and more in keeping with the generally low prevalence of the infection in the Indian population.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh.
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Wanchu A, Bhatnagar A, Khullar M, Sud A, Bambery P, Singh S. Antitubercular therapy decreases nitric oxide production in HIV/TB coinfected patients. BMC Infect Dis 2002; 2:15. [PMID: 12147177 PMCID: PMC119853 DOI: 10.1186/1471-2334-2-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2002] [Accepted: 07/29/2002] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) production is increased among patients with human immunodeficiency virus (HIV) infection and also those with tuberculosis (TB). In this study we sought to determine if there was increased NO production among patients with HIV/TB coinfection and the effect of four weeks chemotherapy on this level. PATIENTS AND METHODS 19 patients with HIV/TB coinfection were studied. They were treated with standard four drug antitubercular therapy and sampled at baseline and four weeks. 20 patients with HIV infection but no opportunistic infections were disease controls and 20 individuals as healthy controls. Nitrite and citrulline, surrogate markers for NO, were measured it spectrophotometrically. RESULTS Mean age of HIV/TB patients was 28.4+6.8 years and CD4 count was 116+36.6/mm3. Mean nitrite level among HIV/TB coinfected was 207.6+48.8 nmol/ml. This was significantly higher than 99.7+26.5 nmol/ml, the value for HIV infected without opportunistic infections and 46.4+16.2 nmol/ml, the value for healthy controls (p value <0.01). Level of HIV/TB coinfected declined to 144.5+ 34.4 nmol/ml at four weeks of therapy (p value < 0.05). Mean citrulline among HIV/TB coinfected was 1446.8+468.8 nmol/ml. This was significantly higher than 880.8+ 434.8 nmol/ml, the value for HIV infected without opportunistic infections and 486.6+212.5 nmol/ml, the value for healthy controls (p value <0.01). Levels of HIV/TB infected declined to 1116.2+388.6 nmol/ml at four weeks of therapy (p value <0.05). CONCLUSION NO production is elevated among patients with HIV infection, especially so among HIV/TB coinfected, but declines significantly following 4 weeks of antitubercular therapy.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
| | - A Bhatnagar
- Department of Experimental Medicine and Biotechnology, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
| | - M Khullar
- Department of Experimental Medicine and Biotechnology, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
| | - A Sud
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
| | - P Bambery
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
| | - S Singh
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, INDIA
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Wanchu A, Sud A, Bambery P, Singh S. Paradoxical reaction in HIV and tuberculosis coinfection. J Assoc Physicians India 2002; 50:588-9. [PMID: 12164417] [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: 02/26/2023]
Abstract
Occurrence of paradoxical reaction following institution of antiretroviral therapy to patients with HIV and tuberculosis coinfection who are already on antitubercular therapy is distinctly uncommon. In this report we describe one such case and emphasize that such a reaction does not imply discontinuation of therapy.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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Sud A, Ray P, Bhasin DK, Wanchu A, Bambery P, Singh S. Helicobacter pylori in Indian HIV infected patients. Trop Gastroenterol 2002; 23:79-81. [PMID: 12632975] [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: 03/01/2023]
Abstract
Helicobacter pylori is a causative organism for chronic gastritis and associated with peptic ulcer disease. Infection may be asymptomatic as well. Human immuno-deficiency virus infection predisposes to a multitude of opportunistic infections, many of them resulting in gastrointestinal symptoms. We studied the prevalence of H pylori co-infection with HIV and its correlation with gastrointestinal symptoms in HIV infected patients. Seventy-three consecutive HIV infected patients presenting to the medical out patient department of Postgraduate Institute of Medical Education & Research, Chandigarh, India, were included in the study. Antibodies (IgG) to H pylori were tested by ELISA. There were 43 males, 30 females; mean age 26.1 +/- 4.7 years. Risk factors for acquiring HIV infection was predominantly heterosexual exposure. Eleven patients presented with gastrointestinal symptoms. Thirty-five of the 73 (47.9%) patients had serological evidence of H pylori infection. Six of them had gastrointestinal symptoms. These were odynophagia in 5, dyspepsia in 4 and recent diarrhoea in 2. Twenty-four patients with H pylori infection had AIDS. There was no difference in the prevalence of H pylori infection between patients with and without AIDS.
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Affiliation(s)
- A Sud
- Sexually Transmitted Diseases Research Center, Marian Villa, Westmead Hospital, Westmead, NSW 2145, Australia.
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Wanchu A, Sud A, Bambery P. Linear scleroderma and autoimmune hemolytic anaemia. J Assoc Physicians India 2002; 50:441-2. [PMID: 11922240] [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: 02/24/2023]
Abstract
Coexistence of localized scleroderma with other autoimmune disorders is not seen frequently. It has been reported to occur with myasthenia gravis, hemiatrophy and systemic lupus erythematosus. In this report we describe an association wherein linear scleroderma coexisted with autoimmune haemolytic anaemia.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wanchu A, Sud A, Bambery P, Prasad R, Kumar V. Plasma and peripheral blood mononuclear cells levels of Zn and Cu among Indian patients with RA. Ann Rheum Dis 2002; 61:88. [PMID: 11779773 PMCID: PMC1753872 DOI: 10.1136/ard.61.1.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gyetko MR, Sud S, Sonstein J, Polak T, Sud A, Curtis JL. Antigen-driven lymphocyte recruitment to the lung is diminished in the absence of urokinase-type plasminogen activator (uPA) receptor, but is independent of uPA. J Immunol 2001; 167:5539-42. [PMID: 11698423 DOI: 10.4049/jimmunol.167.10.5539] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The requirement for urokinase plasminogen activator (uPA) and uPA receptor (uPAR) in T lymphocyte migration is unknown. uPA(-/-) mice have fewer pulmonary lymphocytes in response to certain infections, but its unknown whether this is due to diminished recruitment. Primed, recipient mice were IT inoculated with Ag. Three days later, fluorescently labeled lymphoblasts from background-matched control wild-type (WT), uPA(-/-), or uPAR(-/-) donor mice were injected i.v., and their recruitment was determined. Approximately twice the number of uPA(-/-) compared with WT lymphoblasts were recruited to the lungs of WT recipients. This difference was eliminated when uPA(-/-) and WT lymphoblasts were injected into uPA(-/-) recipients. Thus, the reduced number of lung lymphocytes in infected uPA(-/-) mice is not due to reduced recruitment. However, uPAR is critically involved in recruitment. Markedly fewer uPAR(-/-) compared with WT lymphoblasts were recruited to the lung. These findings suggest that uPAR may be a novel target for immune modulation in T lymphocyte-mediated disorders.
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Affiliation(s)
- M R Gyetko
- Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, Ann Arbor Veterans Affairs Medical Center and University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
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Abstract
Pulmonary function abnormalities constitute the most important cause of morbidity and mortality in patients with systemic sclerosis (SSc). A restrictive ventilatory defect with a reduction in pulmonary carbon monoxide diffusion capacity (DLCO) is the commonest finding. Static lung compliance (Cst) is perhaps the most sensitive parameter for the detection of abnormal pulmonary mechanics. We compared the results of Cst and DLCO in patients with SSc and normal spirometry to identify early pulmonary disease. Sixteen of 50 patients had normal spirometry, eight of whom had abnormal Cst. Four of them also had a reduced DLCO. Two patients had abnormal DLCO but their Cst was normal. One of them had pulmonary hypertension on echocardiography. We conclude that Cst was helpful in diagnosing early pulmonary abnormality in 50% of patients with normal spirometry. Among these patients Cst was a better index of abnormality than DLCO.
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Affiliation(s)
- A Sud
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Wanchu A, Arora S, Bhatnagar A, Sud A, Bambery P, Singh S. Decline in beta-2 microglobulin levels after antitubercular therapy in tubercular patients with HIV infection. Indian J Chest Dis Allied Sci 2001; 43:211-215. [PMID: 18610664] [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: 05/26/2023]
Abstract
BACKGROUND Infection with Mycobacterium tuberculosis results in a state of immune activation, more so, when there is concomitant HIV infection. Beta-2 microglobulin (B2M) is a useful marker to study the state of immune activation among the HIV infected. Objective. To study the modulation of B2M levels among patients with HIV/TB coinfection, to correlate it with the CD4 count and also to study the change in these levels after four weeks of therapy. MATERIAL AND METHODS Twelve patients with HIV infection and having concomitant TB diagnosed on the basis of positive acid fast bacilli were studied both at baseline and then at four weeks. Fourteen HIV infected individuals who had no overt opportunistic infection at the time of the study were also studied along with fourteen age and sex matched healthy volunteers. CD4 counts were performed using a flowcytometer. B2M was measured using a commercially available ELISA kit. RESULTS B2M levels in HIV/TB coinfected patients were 1.62+/-0.45 mg/L (range 1-2.7 mg/L) and were significantly higher (p<0.0002) when compared with healthy controls, whose levels were 0.74+/-0.05 mg/L (range 0.48-81 mg/L). The levels in HIV infected individuals free of opportunistic infections were 1.2+/-0.16 mg/L (range 0.78-1.92 mg/L) and were significantly lower than the levels in HIV/TB coinfected (p<0.017), but significantly higher than the levels in healthy controls (p<0.01). Four weeks of antitubercular therapy resulted in a decline in B2M to 1.08+/-0.26 mg/L (range 0.8-1.74 mg/L) and was statistically significant (p<0.012). There was no correlation between the CD4 counts and the pre-treatment levels of B2M among these patients. CONCLUSION Patients with HIV/TB coinfection had significantly higher levels of B2M than individuals with HIV infection without associated opportunistic infection and healthy controls. Four weeks of anti-tuberculous therapy resulted in a significant decline in these levels.
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Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
Apoptosis may contribute to retinal ganglion cell loss in glaucoma and glaucoma models. Recent research has suggested that mitochondrially dependent apoptosis signaling may contribute to apoptosis in a rat model of glaucoma involving chronic increases in intraocular pressure. In some forms of apoptosis, mitochondrially dependent signaling involves increases in mitochondrial membrane permeability and the mitochondrial release of factors that signal for cell degradation. Opening of a multi-protein, mitochondrial megapore is one factor that contributes to the increased permeability and some anti-apoptotic proteins, particularly BCL-2 and BCL-X(L), bind at the megapore and facilitate megapore closure and reduce increases in mitochondrial membrane permeability. Phosphorylated protein kinase B (Akt) serves as an integrator for cellular survival signals and facilitates the megapore actions of BCL-2 and BCL-X(L), which could protect retinal ganglion cells against insults that induce apoptosis. Several anti-apoptotic agents are being evaluated for use in glaucoma, including brimonidine and propargylamines, which oppose mitochondrially dependent apoptosis through pathways involving phosphorylated Akt.
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Affiliation(s)
- W G Tatton
- Departments of Ophthalmology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Gupta D, Aggarwal AN, Sud A, Jindal SK. Static lung mechanics in patients of progressive systemic sclerosis without obvious pulmonary involvement. Indian J Chest Dis Allied Sci 2001; 43:97-101. [PMID: 11529415] [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: 02/21/2023]
Abstract
Pulmonary fibrosis is a common complication in progressive systemic sclerosis (PSS). Physical examination and/or routine pulmonary function tests can, however, detect only relatively advanced disease. We assessed the utility of static lung pressure-volume analysis in detecting lung involvement in patients of PSS without obvious clinical, radiological or spirographic evidence of pulmonary disease. Static lung volumes were determined and expiratory lung pressure-volume measurements were obtained in 10 patients with PSS, using a computerized whole body plethysmograph. Static pressure-volume data was also subjected to monoexponential analysis. All patients had normal total lung capacity. Three patients had reduced static compliance, of whom one also had reduced value for the shape constant K (calculated from exponential analysis of pressure-volume data). Examination of pressure volume curve showed a pattern consistent with interstitial fibrosis in these patients. We conclude that detailed study of lung mechanics can help identify early pulmonary involvement in patients with PSS.
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Affiliation(s)
- D Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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