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Md Yusof MY, Smith EMD, Ainsworth S, Armon K, Beresford MW, Brown M, Cherry L, Edwards CJ, Flora K, Gilman R, Griffiths B, Gordon C, Howard P, Isenberg D, Jordan N, Kaul A, Lanyon P, Laws PM, Lightsone L, Lythgoe H, Mallen CD, Marks SD, Maxwell N, Moraitis E, Nash C, Pepper RJ, Pilkington C, Psarras A, Rostron H, Skeates J, Skeoch S, Tremarias D, Wincup C, Zoma A, Vital EM. Management and treatment of children, young people and adults with systemic lupus erythematosus: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2023; 7:rkad093. [PMID: 38058676 PMCID: PMC10695902 DOI: 10.1093/rap/rkad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023] Open
Abstract
The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of SLE that builds upon the existing treatment guideline for adults living with SLE published in 2017. This will incorporate advances in the assessment, diagnosis, monitoring, non-pharmacological and pharmacological management of SLE. General approaches to management as well as organ-specific treatment, including lupus nephritis and cutaneous lupus, will be covered. This will be the first guideline in SLE using a whole life course approach from childhood through adolescence and adulthood. The guideline will be developed with people with SLE as an important target audience in addition to healthcare professionals. It will include guidance related to emerging approved therapies and account for National Institute for Health and Care Excellence Technology Appraisals, National Health Service England clinical commissioning policies and national guidance relevant to SLE. The guideline will be developed using the methods and rigorous processes outlined in 'Creating Clinical Guidelines: Our Protocol' by the British Society for Rheumatology.
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Affiliation(s)
- Md Yuzaiful Md Yusof
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eve M D Smith
- Department of Women’s and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Kate Armon
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael W Beresford
- Department of Women’s and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Lindsey Cherry
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Kalveer Flora
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rebecca Gilman
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Natasha Jordan
- Department of Adolescent Rheumatology, St James’s Hospital and Children’s Health Ireland, Dublin, Ireland
| | - Arvind Kaul
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Peter Lanyon
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip M Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Liz Lightsone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hanna Lythgoe
- Department of Paediatric Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christian D Mallen
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Elena Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Department, University College of London Great Ormond Street Institute of Child Health, London, UK
| | - Clare Nash
- Pharmacy Department, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Ruth J Pepper
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Antonios Psarras
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jade Skeates
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah Skeoch
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Chris Wincup
- Department of Clinical and Academic Rheumatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Asad Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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VEERANKI V, Prasad N, Meyyappan J, Bhadauria D, Kaul A, Patel M, Kushwaha R, Behera M, Yachha M. WCN23-1143 DOES THE CHANGING EPIDEMIOLOGY AND THE THERAPEUTICS HAVE INFLUENCE ON THE SPECTRUM OF RENAL DISEASES IN PATIENTS WITH DIABETES MELLITUS? Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.457] [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: 03/22/2023] Open
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Kumari N, Singh P, Singh D, Mishra A, Kaul A, Ojha H, Tiwari AK. Comparison of 18 kDa protein (TSPO) during pulmonary inflammation with comparative analysis of PIC and EDTA coupled Acetamidobenzoxazolone vehicle. NEW J CHEM 2023. [DOI: 10.1039/d2nj06175a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
2-(bis(pyridin-2-ylmethyl)amino) acetic acid (PIC) and Ethylenediaminetetraacetic acid (EDTA) vehicle based acetamidobenzoxazolone probes have been evaluated for assessment of 18 kDa translocator protein (TSPO). Here PIC and EDTA are working as...
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Biddle K, Kaul A. Lingual Raynaud’s phenomenon: a rare presentation. BMJ Case Rep 2022; 15:15/11/e251988. [DOI: 10.1136/bcr-2022-251988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A woman in her mid-60s presented to transient ischaemic attack (TIA) clinic with a 3-year history of intermittent sensory changes and white discolouration affecting the left side of her tongue. Following extensive investigation, a provisional diagnosis of posterior circulation TIA was made, and the patient was commenced on clopidogrel therapy. Despite anti-platelet treatment, she continued to have identical episodic symptoms. She was referred to the rheumatology team for assessment of possible underlying autoimmune pathology. On rheumatology assessment, the patient reported colour changes on the tongue, associated with numbness, followed by paraesthesia of the affected area. A comprehensive assessment excluded secondary causes and a diagnosis of primary Raynaud’s phenomenon of the tongue was made. The diagnosis of TIA was revoked. This case illustrates a rare presentation of a common condition and highlights the sensory symptoms which are associated with Raynaud’s phenomenon.
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Saha P, Srikantharajah D, Kaul A, Sofat N. Tocilizumab for relapsing and remitting giant cell arteritis: a case series. J Med Case Rep 2022; 16:389. [PMID: 36289554 PMCID: PMC9607773 DOI: 10.1186/s13256-022-03625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant cell arteritis is a large vessel vasculitis of the arteries in the head and neck. The mainstay of management is with high-dose corticosteroids, and patients often face difficulties stopping or reducing steroids without recurrence of symptoms. Corticosteroids are well established to have numerous associated side effects, including osteoporosis, weight gain, and diabetes. Therefore, when tocilizumab was approved for up to 1 year for cases of relapsing or refractory giant cell arteritis by the National Institute of Health and Care Excellence (NICE) in April 2018, this offered an opportunity to benefit from new funding and to reduce steroid burden. CASE PRESENTATION This case series describes the impact of the establishment of a new hub and spoke referral pathway for the use of tocilizumab in refractory or relapsing giant cell arteritis, with case examples from consecutive patients who accessed the funding between August 2018 and April 2021. A total of 16 patients were identified: 11 female and 5 male, with an average age of 72.4 (range 61-82) years, with a majority of 11 ethnically white. The central assessing hub is St George's University Hospitals NHS Foundation Trust Hospital, serving a population of 1.3 million in the south of England. This is the first large case series looking into the impact of the establishment of a regional clinical pathway for the new tocilizumab funding. CONCLUSIONS The case series demonstrates that the use of tocilizumab has reduced both the duration and the dose of corticosteroids in these 16 cases (mean prednisolone reduction 20.4 mg: 95% CI 13.0-27.8 mg), with 50% of patients continuing on tocilizumab after the initial 12 month funding period. The disease course, patterns of response, and maintenance of remission are discussed, and we describe the benefits of replicating this hub and spoke tocilizumab pathway in other centers.
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Affiliation(s)
- Pratyasha Saha
- grid.264200.20000 0000 8546 682XInstitute for Infection & Immunity, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK ,grid.451349.eSt George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Denesh Srikantharajah
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Arvind Kaul
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Nidhi Sofat
- grid.264200.20000 0000 8546 682XInstitute for Infection & Immunity, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK ,grid.451349.eSt George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
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Iqbal A, Kaul A, Sheen AJ. P-083 AMYANDS HERNIA WITH RENAL CELL CARCINOMA - A RARE CASE PRESENTATION. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.181] [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
47 year old gentleman presented to the emergency department with 2 days history of lower abdominal pain and right inguinal swelling which has increased in size during the same duration, he also had one episode of vomiting, bloating and constipation since 2 days. Investigations revealed an inflamed appendix within the right inguinal hernia along with a left renal lesion. The patient underwent emergency open primary repair of inguinal hernia with appendicectomy. Followed up with urology as an outpatient regarding renal lesion and with MDT discussion the patient was subjected for a partial nephrectomy.
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Affiliation(s)
- A Iqbal
- Hepato pancreato biliary surgery , Manchester royal Infirmary , Manchester, United Kingdom
| | - A Kaul
- Hepato pancreato biliary surgery , Manchester royal Infirmary , Manchester, United Kingdom
| | - A J Sheen
- Hepato pancreato biliary surgery , Manchester royal Infirmary , Manchester, United Kingdom
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Shenoy R, Prasad N, Kaul A, Bhadauria D. POS-106 PROFILE OF CRYPTOCOCCAL INFECTIONS IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shinde R, Kaul A, Bhadauria D, Behera M, Yachha M, Kushwah R, Patel M, Gala R, Prasad N. POS-108 POST-TRANSPLANT INFECTIONS AND LONG TERM OUTCOMES IN RENAL TRANSPLANT RECIPIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Sharma H, George R, Prasad N, Kaul A, Bahaduria D, Patel M, Behera M, Kushwaha R, Yaccha M. POS-107 LONG TERM OUTCOMES OF RENAL TRANSPLANTATION WITH PRE- AND POST-TRANSPLANT TUBERCULOSIS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.125] [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: 10/14/2022] Open
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Patil A, Kaul A, Bhadauria D, Umair M, Jha G, Prasad N. POS-105 EXPERIENCE OF TUNNELED CUFFED CATHETERS AS VASCULAR ACCESS IN A TERTIARY CARE HOSPITAL. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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van der Feltz-Cornelis CM, Sweetman J, Edwards M, Gall N, Gilligan J, Hayle S, Kaul A, Moriarty AS, Perros P, Sampford J, Smith N, Elfeddali I, Varley D, Gower J. Identifying the top research priorities in medically not yet explained symptoms (MNYES): a James Lind Alliance priority setting partnership. BMJ Open 2022; 12:e061263. [PMID: 35777869 PMCID: PMC9252198 DOI: 10.1136/bmjopen-2022-061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study establishes research priorities for medically not yet explained symptoms (MNYES), also known as persistent physical symptoms or medically unexplained symptoms, from the perspective of patients, caregivers and clinicians, in a priority setting partnership (PSP) following the James Lind Alliance (JLA) approach. Research into such symptoms in general has been poorly funded over the years and so far has been primarily researcher-led with minimal input from patients, caregivers and clinicians; and sometimes has been controversial. DESIGN JLA PSP method. The PSP termed these symptoms MNYES. METHODS The study was conducted according to the JLA's detailed methodology for conducting priority setting exercises. It involved five key stages: defining the appropriate term for the conditions under study by the PSP Steering Group; gathering questions on MNYES from patients, caregivers and clinicians in a publicly accessible survey; checking these research questions against existing evidence; interim prioritisation in a second survey; and a final multi-stakeholder consensus meeting to determine the top 10 unanswered research questions using the modified nominal group methodology. RESULTS Over 700 responses from UK patients, caregivers and clinicians were identified in the two surveys and charities contributed from a broad range of medical specialties and primary care. The final top 10 unanswered research questions cover, among others: treatment strategies, personalisation of treatment, collaborative care pathways, training for clinicians and outcomes that matter to patients. INTERPRETATION The top 10 unanswered research questions are expected to generate much needed, relevant and impactful research into MNYES.
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Affiliation(s)
- Christina Maria van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- York Biomedical Research Institute, University of York, York, UK
- R&D Department, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
- Institute of Health Informatics, University College London, London, UK
| | | | - Mark Edwards
- St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Gall
- Department of Cardiology, University of London Kings College Hospital, London, UK
| | | | | | - Arvind Kaul
- St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Stephen Moriarty
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James Sampford
- Liaison team, Tees Esk and Wear Valleys Foundation Trust, York, UK
| | - Natalie Smith
- Department of Health Sciences, University of York, York, UK
| | - Iman Elfeddali
- Tranzo Department, Tilburg University, Tilburg, Netherlands
- Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, The Netherlands
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Mathews T, Pushkar D, Bhaduaria D, Kaul A, Prasad N, Patel M, Behera M, Yachha M, Kushwaha R, Srivastava A. Early versus late acute graft pyelonephritis: A retrospective analysis of graft and patient outcomes. Transpl Immunol 2022; 75:101657. [PMID: 35787934 DOI: 10.1016/j.trim.2022.101657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Acute graft pyelonephritis (AGPN) is thought to affect graft and patient survival among renal transplant recipients. The objective was to compare outcomes among early AGPN (<6 months from transplant) versus late AGPN (>6 months from transplant). METHODS This retrospective study analysed 150 patients with AGPN dividing them into early and late AGPN from 2008 to 2016. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analysed using Kaplan-Meyer survival plots. RESULTS 55.3% (n = 83) had early AGPN and 44.7% (n = 67) had late AGPN. In an early AGPN group, 13.3% had CMV disease on the follow-up, compared to only 3% in the late AGPN group (p > 0.05). Furthermore, 38.6% had prolonged DJ stent in-situ (> 2 weeks) following transplant surgery in the early AGPN compared to only 19.4% in the late AGPN group (p < 0.05). Recurrent GPN was more common in the late AGPN group - (35.8% versus 18.1%). The presence of renal abscess was predictive of graft loss in Univariate analysis (HR-6.12, p < 0.004). There was decreased death-censored graft survival in the early AGPN group (p = 0.035), without a significant difference in the patient survival among the two groups. CONCLUSION The occurrence of early AGPN had a significant impact on long-term graft survival in renal transplant recipients, with no significant effect on patient survival. This study underlines the paramount importance of the prevention of urinary tract infection (UTI) in renal transplant recipients.
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Affiliation(s)
- T Mathews
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Pushkar
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Bhaduaria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - N Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Behera
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Yachha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Srivastava
- Department of Urology Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Kaul A, Bhaduaria D, Behera MR, Kushwaha R, Prasad N, Yachha M, Patel M, Kalitha J. Psycho-social health and quality of life among kidney donors following transplantation. Transpl Immunol 2022; 74:101649. [PMID: 35777614 DOI: 10.1016/j.trim.2022.101649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Living kidney donation is a complex psychological experience for donors. The present study examined the psychosocial impact of kidney donation on donors. METHODS The retrospective study included 506 donors who donated a kidney between 2010 and 2018 at a transplant centre in India. These donors responded via a donor insight questionnaire about their hospital anxiety, and their possible level of depression. The information included socio-demographic form with multiple information. The health survey was used periodically evaluate the psychosocial impact among donors following donation, including the transplant outcomes. RESULTS The majority of donors were females (79.4%). There was a significant improvement in the quality of life among donors (SF-36) following the donation of a kidney, especially among those donors who maintained good graft functions themselves as well as those who were informed about good kidney function in transplanted recipients. These donors showed a lesser degree of depressive and anxiety scores (HAD score 3.5 and BDI II 4.8) than donors who had problems themselves and/or whose donated kidneys did not function well. Most living donors (89.1%) felt that the act of donation had a positive impact on their lives and those donors would encourage others to donate a kidney. Overall, the graft outcomes impacted the donor's state of mind. CONCLUSION The study showed a very positive impact of the acknowledgment of the donor by the recipient, especially those donors whose kidney transplants were well functioning. The state of depression, anxiety, and psycho-social outcomes correlated with the graft outcomes. Donors showed positive insight towards donation, with inner conscience still conclusively willing to donate and encourage others.
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Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India.
| | - D Bhaduaria
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Ranjan Behera
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Yachha
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - M Patel
- Department of Nephrology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
| | - J Kalitha
- Department of Neurology, Sanjay Gandhi Post Graduate institute of Medical Science, Lucknow, India
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Kaul A, Savage L, Gorecki P. P255 Collaboration in the treatment of psoriasis and psoriatic arthritis: a survey of UK clinical practice. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.254] [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: 11/14/2022] Open
Abstract
Abstract
Background/Aims
Treatment guidelines for psoriatic arthritis consider both skin and joint involvement and recommend collaborative multidisciplinary team (MDT) working when selecting therapy. However, multidisciplinary practice for psoriatic disease (PD) has not been well studied, with little data on service models and current practice. This survey explored collaborative working in PD treatment by rheumatology and dermatology healthcare professionals (HCPs) to provide a better understanding of current working patterns, collaborating specialties, as well as benefits and challenges of combined clinics for PD management.
Methods
An online survey was emailed to rheumatology and dermatology HCPs using professional networks. We requested information on role, collaborating specialties, benefits and barriers to collaborative working in PD, and the impact of COVID-19. The ideal service model and additional comments completed the survey.
Results
We received 80 responses between October 2020 and April 2021, covering England, Wales, Scotland and Northern Ireland. Of these, 56 respondents (70.0%) were consultants, 22 (27.5%) clinical nurse specialists and one each a lead pharmacist (1.3%) and specialist registrar (1.3%). Rheumatology HCPs accounted for 40.0% of respondents (n = 32) and dermatology HCPs for 60.0% (n = 48). As part of their PD MDT, most respondents (n = 60, 75.0%) worked collaboratively with other specialties. Combined clinics, whether virtual, face to face or an MDT, accounted for 51.5% of collaborative working for rheumatology HCPs and 58.9% for dermatology HCPs. Collaboration with other specialists mainly occurred by email or written referrals (Table 1). The most important perceived benefits of combined clinics were shared knowledge, better patient outcomes and patient satisfaction. The biggest challenges to setting up combined clinics were job plan time (rated as ‘difficult’ or ‘very difficult’ by 78.8% of respondents), logistics (67.5%) and unsupportive senior management (66.3%), while 77.5% felt COVID-19 had partial or significant impact on combined clinics.
Conclusion
This is the first survey to explore UK collaborative working in PD. Approaches varied, with different models of working and little consistency. While HCPs appreciated the benefits of collaborative working, numerous challenges in establishing formal arrangements were identified. More evidence is needed to demonstrate the perceived benefits of collaborative working in improving patient outcomes by standardising best practice.
Disclosure
A. Kaul: Consultancies; AK has received payment for advisory boards from AbbVie, Janssen, Leo, MSD, Novartis and Pfizer. Honoraria; AK has received speaker fees from AbbVie, Eli Lilly, Janssen, Leo, MSD, Novartis and Pfizer. L. Savage: Consultancies; LS has received payment for advisory boards from AbbVie, Almirall, Biogen, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer and UCB. Honoraria; LS has received speaker fees from AbbVie, Amgen, Almirall, Celgene, Celltrion, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer, MSD and UCB. Grants/research support; LS has received grants/research funding from Pfizer. P. Gorecki: Other; PG is an employee of Janssen-Cilag Ltd.
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Affiliation(s)
- Arvind Kaul
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, UNITED KINGDOM
| | - Laura Savage
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UNITED KINGDOM
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Srikantharajah D, Joseph V, Kaul A. P239 Are patients with acute pericardial syndromes adequately screened for connective tissue diseases? Results from a single-centre study and comparison to European Society of Cardiology Guidelines. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.238] [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] Open
Abstract
Abstract
Background/Aims
Pericardial syndromes (PS) comprising pericarditis, pericardial effusions, cardiac tamponade, and constrictive pericarditis, can be presenting features of connective tissue disease (CTD) including lupus (SLE) and rheumatoid arthritis (RA). PS comprise 0.1% of all hospital admissions and 5% of acute non-cardiac chest pain. PS occur as single episodes but recur in 30% of patients within 18 months after the first episode. The 2015 European Society of Cardiology (ESC) pericardial disease guidelines recommend assessment of NSAID response with follow-up and tests in those who are NSAID non-responders or who have recurrent PS. We audited the management of patients presenting with PS in a tertiary referral centre, using the 2015 ESC guideline standards to determine if investigations to uncover autoimmune diseases as a cause of PS were performed.
Methods
We obtained data on all patients coded with PS presenting to St George’s Hospital Emergency Department between Jan 1st, 2019, and October 31st, 2020. We also searched data including patients’ length of stay, test results including blood tests, imaging (X-ray, ultrasound, CT and MRI), initial management, outpatient follow-up, recurrence numbers and identifiable cause. Data were compared to the 2015 ESC guidelines.
Results
We identified 132 PS cases, of which 37 (28%) had recurrent pericardial disease. Of these, 15 (41%) were screened for connective tissue disease with antinuclear antibody (ANA) testing. Of those tested, nine (60%) had a positive ANA (titre 1/80 or greater), with three (33%) positive for extractable nuclear antigens (anti-Ro, anti-Sm and anti-RNP). Only 14 patients (38%) with recurrent disease had rheumatoid factor (RhF) tested, with four of these (29%) positive, while one of eight (12.5%) patients tested was anti-CCP antibody positive. Only 13 of 37 recurrent cases (35%) had both ANA and RhF tested. Furthermore, 37 of all PS cases (28%) were not followed up after initial presentation, while only five (14%) of recurrent cases received any follow up. By contrast, presumed infection tested serologically was found in only 7.8% of all cases tested, most commonly Mycoplasma or raised ASOT.
Conclusion
A high proportion of recurrent PS patients screened in our study had a positive ANA, ENA or RhF suggesting screening can identify new potential CTD, including SLE or RA. These patients require different treatment strategies to infectious PS. We demonstrated screening was inconsistent despite the absence of obvious infective causes in most cases and limited to 41% of patients with recurrent disease, which present the highest risk of association with CTD. ESC guidelines recommend all patients be followed up after 1 week, yet few high-risk patients received any outpatient review, from any speciality. There is a pressing need to ensure potential cases of CTD presenting as PS are not missed as doing so may prolong symptoms and worsen outcome.
Disclosure
D. Srikantharajah: None. V. Joseph: None. A. Kaul: None.
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Affiliation(s)
- Denesh Srikantharajah
- St. George's University Hospitals NHS Foundation Trust, Rheumatology, London, UNITED KINGDOM
| | - Vikram Joseph
- St. George's University Hospitals NHS Foundation Trust, Rheumatology, London, UNITED KINGDOM
| | - Arvind Kaul
- St. George's University of London, Rheumatology, London, UNITED KINGDOM
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Kaul A, Mason A, Edwards C, Vital E. P244 The use of anti-malarial therapy in UK Rheumatology practice. A UK-based pilot survey for the BILAG group. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac133.243] [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] Open
Abstract
Abstract
Background/Aims
Antimalarials have an important role in the management of autoimmune rheumatic disease, especially lupus (SLE) and other connective tissue diseases (CTD). A large North American study demonstrated a risk of retinopathy with hydroxychloroquine, increasing at doses above 5mg/kg and after 10 years or more of continuous therapy. This has influenced the development of specific monitoring ocular guidance for hydroxychloroquine although there has been less attention to potential side effects in routine use. Our aim was to examine hydroxychloroquine use including the effect of changes in ophthalmology guidance
Methods
We designed a 21-question internet-based survey. This requested information on antimalarials including hydroxychloroquine brand, dosing, monitoring and concerns about use. We requested information about alternatives to hydroxychloroquine including mepacrine and chloroquine, barriers to and indications for prescribing these alternative antimalarials.
Results
We received 69 responses, 59 (86%) Consultants, 10 (14%) ST’s from across the United Kingdom of which 51% worked in a district general hospital (DGH) setting. Of the Consultants, 28 (47%) ran dedicated CTD clinics. Regarding hydroxychloroquine, 39 respondents (57%) used a defined local pathway for Hydroxychloroquine retinopathy screening. While 59/69 (86%) did not know which hydroxychloroquine brand their pharmacy dispensed, of the remainder, 14/19 (74%) used Quinoric. Regarding hydroxychloroquine dosing, 83% targeted weight-based maintenance dosing with most of these (77%) maintaining at the currently recommended 5mg/kg body weight or less, while 23% used 6.5mg/Kg. No participants measured hydroxychloroquine drug levels. Potential ocular toxicity, cardiac arrythmias and skin hyperpigmentation were reported as the most significant concerns with hydroxychloroquine usage. Of the alternatives, mepacrine was never used by 39%, (77% for chloroquine) while only 4% used either often or very often. Barriers to prescription of these alternative antimalarials were most commonly GP or local Pharmacy unavailability (39% and 17 retrospectively). However, mepacrine/ hydroxychloroquine combination was used by 32% of respondents, most often for refractory skin disease (21 respondents), refractory joint disease (five respondents) and as a steroid sparing drug (six respondents).
Conclusion
Our results suggest several aspects in which hydroxychloroquine use could be improved. Although recent evidence demonstrates the potential for significant ocular toxicity with Hydroxychloroquine in those taking > 5mg/kg body weight and for >10 years we found practice still varied with 43% Rheumatologists not using a dedicated ocular screening pathway making monitoring long term potentially hazardous. Alternatives to hydroxychloroquine are not considered by 39% perhaps reflecting paucity of data for mepacrine and chloroquine, especially in circumstances including pregnancy but also cost and lack of availability. Our results suggest a need for standardised hydroxychloroquine monitoring processes including improved ophthalmic screening with Optical Coherence Tomography, a need for more evidence about the potential benefits and hazards of hydroxychloroquine and alternative antimalarials and availability of prescribing guidelines.
Disclosure
A. Kaul: Consultancies; Dr Kaul has received fees for Advisory Boards for AbbVie, Janssen, Novartis, Lilly. Member of speakers’ bureau; r Kaul has received speaker fees from AbbVie, Novartis, Janssen, Leo, Pfizer. A. Mason: None. C. Edwards: None. E. Vital: None.
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Affiliation(s)
- Arvind Kaul
- St. George's University of London, Rheumatology, London, UNITED KINGDOM
| | - Alice Mason
- Rheumatology, University Hospitals Southampton NHS Foundation Trust, Southampton, UNITED KINGDOM
| | - Christopher Edwards
- Rheumatology, NIHR Southampton Clinical Research Facility, University Hospital Southampton., Southampton, UNITED KINGDOM
| | - Ed Vital
- Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre, Leeds, UNITED KINGDOM
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SHARMA H, Prasad N, Kaul A, Bahaduria Singh D, Patel Ranjan M, Behera Ranjan M, Yaccha M, Kushwaha Singh R. POS-812 FACTORS PREDICTING POST RENAL TRANSPLANT TUBERCULOSIS: A TERTIARY CARE CENTRE EXPERIENCE. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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S S, Bhadauria D, Prasad N, Kaul A, Patel M, Behera M, Yachha M, Kushwaha R. POS-807 THE DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN COEXISTING BKV NEPHROPATHY WITH ACUTE REJECTION - A SINGLE CENTRE EXPERIENCE FROM NORTH INDIA. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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S S, Prasad N, Kaul A, Bhadauria D, Patel M, Kushwaha R, Behera M, Yachha M. POS-808 "Renal allograft cortical necrosis" - Disappearing entity in live renal transplant over two decades - A Single centre experience. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.844] [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] Open
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20
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Kaul A, Mistry J, Iagnocco A, Baraliakos X, Bosworth A, McNicol I. Inequality of access to advanced therapies for patients with inflammatory arthritis: a postcode lottery? Rheumatol Adv Pract 2021; 5:rkab081. [PMID: 34859176 PMCID: PMC8634385 DOI: 10.1093/rap/rkab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Advanced therapies (AT), including biologics, biosimilars and Janus kinase inhibitors, have dramatically improved the quality of life of patients with RA, PsA and axial spondyloarthritis (axSpA). Evidence-based criteria for prescribing these drugs in England and Wales is formulated by the National Institute for Health and Care Excellence (NICE) through health technology appraisals and guidelines, with the aim of providing equitable access to AT for patients with severe or resistant disease. Similar bodies exist in some, but not all European countries, with disparities in AT access between countries for RA. We examined whether this disparity was mirrored in England for RA, PsA and axSpA despite the National Health Service in England and Wales being legally obliged to provide funding for AT recommended by NICE's Health Technology Appraisal board, through the commissioning bodies, the clinical commissioning groups (CCGs). METHODS We requested AT pathways from CCGs in England. Where these were not available, individual hospital Trusts were contacted using freedom of information requests. RESULTS We found marked variability in the way that CCGs in England interpret NICE guidance. We found 41, 29 and 25 different pathways for RA, PsA and axSpA, respectively. Similar disparities existed with sequential prescribing where one AT did not work, with limits on the numbers of sequential AT in 54%, 59% and 59% of CCGs for RA, PsA and axSpA, respectively, and with these limits being different for the same condition between CCGs. CONCLUSION Although patients at identical stages of their disease course should have access to the same NICE-approved AT, we found this is not the case for large parts of England. Inequality of access was found between regions, mirroring the variability that occurs between countries throughout Europe. Harmonization of access needs to be addressed by policymakers to ensure fairness in the way that clinicians and patients can access AT.
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Affiliation(s)
- Arvind Kaul
- Institute of Medical and Biomedical Education, St. George’s University of London
- Department of Rheumatology, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jatin Mistry
- Institute of Medical and Biomedical Education, St. George’s University of London
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università Degli Studi Di Torino, Torino, Italy
| | | | - Ailsa Bosworth
- National Rheumatoid Arthritis Society, Maidenhead, Berkshire, UK
| | - Iain McNicol
- National Rheumatoid Arthritis Society, Maidenhead, Berkshire, UK
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21
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Lisberg A, Liu B, Salehi-Rad R, Lee J, Tran L, Kostyantyn K, Lim R, Dumitras C, Jing Z, Abtin F, Suh R, Genshaft S, Fishbein G, Kaul A, Kahlon K, Ashouri S, Goldman J, Elashoff D, Garon E, Dubinett S. P11.01 Phase I Trial of in Situ Vaccination With Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined With Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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van der Feltz-Cornelis CM, Bakker M, Kaul A, Kuijpers TW, von Känel R, van Eck van der Sluijs JF. IL-6 and hsCRP in Somatic Symptom Disorders and related disorders. Brain Behav Immun Health 2021; 9:100176. [PMID: 34589907 PMCID: PMC8474154 DOI: 10.1016/j.bbih.2020.100176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022] Open
Abstract
Interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are biomarkers of systemic low-grade inflammation (SLI) in depression and anxiety. The question if SLI in those conditions is related to comorbid chronic medical conditions has not been resolved. DSM-5 Somatic symptom disorders and related disorders (SSRD) are conditions with serious distress related to physical symptoms as main criterion. They can occur in patients with medically unexplained symptoms (MUS) and in patients with known comorbid chronic medical conditions. Often, comorbid depression and anxiety are present. SSRDs offer the opportunity to explore the role of SLI in relation to mental distress, including trauma, MUS, chronic medical conditions and comorbid mental disorder. AIM We hypothesized that increased IL-6 and hsCRP may be directly linked to SLI in SSRD, and that comorbid chronic medical conditions, childhood trauma, current stress and comorbid depression and anxiety may be risk factors that account for some of the variance of SLI in SSRD. METHODS We explored these relationships in a large sample of 241 consecutive outpatients with SSRD. RESULTS Mean hsCRP level was 3.66 mg/l, and mean IL-6 level was 3.58 pg/ml. IL-6 and hsCRP levels were associated with each other: τ = 0.249, p < .001; a medium size correlation. Comorbid chronic medical conditions, adverse childhood events other than sexual trauma, and current stress levels were not associated with IL-6 or hsCRP levels. CONCLUSION IL-6 and hsCRP are elevated in SSRD, indicating SLI in SSRD independently of comorbid chronic medical conditions. In clinical research, elevated IL-6 and hsCRP can be used as biomarkers of SLI and can indicate risk for childhood sexual abuse in SSRD. Elevated hsCRP may be a biomarker indicating risk for comorbid depression or high pain levels in SSRD as well.
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Affiliation(s)
- Christina M. van der Feltz-Cornelis
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
- Corresponding author. Department of Health Sciences, MHARG, HYMS, YBRI, University of York, ARRC Building, T204, Heslington, York, YO10 5DN, UK.
| | - Marjan Bakker
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Arvind Kaul
- St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Taco W. Kuijpers
- Emma Children’s Hospital, Dept. of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonna F. van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands
- Altrecht Psychosomatic Medicine, Zeist, the Netherlands
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Short W, Li H, Yu L, Kaul A, Balaji S, Keswani S, Wang X. 619 IL-10 producing CD4+ T-cells mitigate dermal fibrosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.648] [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: 10/21/2022]
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24
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Parikh U, Short W, Kaul A, Li H, Balaji S. 645 Role of energy metabolism in patient heterogeneity in the degree of fibrosis in dermal wounds. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.674] [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: 10/21/2022]
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25
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Kaul A, Kraus W, Schmitt-Hannig A. Exposure of the public from man-made and natural sources of radiation / Strahlenexposition der Bevölkerung durch zivilisatorische und natürliche Strahlenquellen. KERNTECHNIK 2021. [DOI: 10.1515/kern-1994-590307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Kaul A. Present and future tasks of the International Commission on Radiological Protection / Die gegenwärtigen und zukünftigen Aufgaben der Internationalen Kommission für Strahlenschutz. KERNTECHNIK 2021. [DOI: 10.1515/kern-1994-594-522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Mistry J, Hill D, Bosworth A, Kaul A. P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.090] [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] Open
Abstract
Abstract
Background/Aims
NICE publishes guidance underpinned by act of Parliament and legally enforceable, on the use of biological therapies in the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) which should allow harmonisation of access independent of region. However, sufficient guidance is not provided on the use of sequential biologics nor is a numerical cap placed on the number of biologics a patient can attempt if they have had an inadequate response. We have previously reported that in a limited sample, Clinical Commissioning Groups (CCGs) interpret NICE guidance variably and restrict access to NICE approved treatments depending on geography, the so-called “postcode lottery”. We determined the variability of biologics pathways in all CCG’s in England to examine whether a potentially unfair postcode lottery exists for sequential biologics use.
Methods
All 135 England CCGs covering over 55 million people, were sent Freedom of Information requests, for their biologic pathways for RA, PsA and AS. Where CCGs did not have this information, the relevant acute trusts were contacted, with responses recorded under that CCG. For every CCG the local biologics pathways were examined for detail on the number and type of biologics commissioned before an Individual Funding Request was needed. “No Cap” was recorded if CCG’s responded with no restriction on the number of biologics.
Results
Responses were obtained from 124/135 CCG’s for RA, 122/135 for PsA and AS, all covering an estimated population in excess of 45 million people. For RA, 55% CCG’s had no cap on the number of commissioned RA biologics. 45% had a variable cap from 3 to 6 commissioned biologics. For PsA, the figures were 54% with no cap and 46% with variable capping between 2-5 biologics allowed, for AS the figures were 51% and 49% respectively. In total this represented 41 different local pathways for RA, 29 different pathways for PsA and in AS where fewer biologics choices exist, 25 different pathways depending on CCG and location.
Conclusion
There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patient care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriate biologic. The results of this national study demonstrate the variability of biologics pathways in many areas of England ensuring a postcode lottery still exists in many regions.
Disclosure
J. Mistry: None. D. Hill: None. A. Bosworth: None. A. Kaul: None.
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Affiliation(s)
- Jatin Mistry
- St. George's University of London, Rheumatology, London, UNITED KINGDOM
| | - Diane Hill
- St. George's University Hospitals NHS Foundation Trust, Rheumatology, London, UNITED KINGDOM
| | - Ailsa Bosworth
- National Patient Champion, National Rheumatoid Arthritis Society (NRAS), Maidenhead, UNITED KINGDOM
| | - Arvind Kaul
- St. George's University of London, Rheumatology, London, UNITED KINGDOM
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28
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Baker EH, Patel K, Ball J, Edwards S, Harrison TS, Kaul A, Koh M, Krishna S, Leaver S, Kumar V, Forton DM. Insights from compassionate use of tocilizumab for COVID-19 to inform appropriate design of randomised controlled trials. Br J Clin Pharmacol 2020; 87:1584-1586. [PMID: 32656822 PMCID: PMC7405226 DOI: 10.1111/bcp.14466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Emma H Baker
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Pharmacy and Medicines Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kamal Patel
- Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ball
- Adult Critical Care Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Edwards
- Department of Science and Technology Studies, University College London, London, UK
| | - Thomas S Harrison
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Arvind Kaul
- Department of Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mickey Koh
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sanjeev Krishna
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Clinical Infection Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Susannah Leaver
- Adult Critical Care Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vinodh Kumar
- Pharmacy and Medicines Directorate, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel M Forton
- Institute of Infection and Immunity, St George's, University of London, London, UK.,Department of Gastroenterology and Hepatology, St George's University Hospitals NHS Foundation Trust, London, UK
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Kaul A, Katelaris A, Haider A, Alnajjar H, Muneer A. Microdissection oncoTESE (micro-oncoTESE) in azoospermic men - is there a difference in surgical sperm retrieval (SSR) rates for benign and malignant testicular lesions? An eUROGEN centre study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32829-9] [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: 10/23/2022] Open
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30
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Nevins EJ, Rao R, Nicholson J, Murphy KD, Moore A, Smart HL, Stephens N, Grocock C, Kaul A, Gunasekera RT, Hartley MN, Howes NR. Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy. Ann R Coll Surg Engl 2020; 102:693-696. [PMID: 32538118 DOI: 10.1308/rcsann.2020.0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The incidence of delayed gastric emptying (DGE) following oesophagogastrectomy with gastric conduit reconstruction is reported to be between 1.7% and 50%. This variation is due to differing practices of intraoperative pylorus drainage procedures, which increase the risk of postoperative biliary reflux and dumping syndrome, resulting in significant morbidity. The aim of our study was to establish rates of DGE in people undergoing oesophagogastrectomy without routine intraoperative drainage procedures, and to evaluate outcomes of postoperative endoscopically administered Botulinum toxin into the pylorus (EBP) for people with DGE resistant to systemic pharmacological treatment. METHODS All patients undergoing oesophagogastrectomy between 1 January 2016 and 31 March 2018 at our unit were included. No intraoperative pyloric drainage procedures were performed, and DGE resistant to systemic pharmacotherapy was managed with EBP. RESULTS Ninety-seven patients were included. Postoperatively, 29 patients (30%) were diagnosed with DGE resistant to pharmacotherapy. Of these, 16 (16.5%) were diagnosed within 30 days of surgery. The median pre-procedure nasogastric tube aspirate was 780ml; following EBP, this fell to 125ml (p<0.001). Median delay from surgery to EBP in this cohort was 13 days (IQR 7-16 days). Six patients required a second course of EBP, with 100% successful resolution of DGE before discharge. There were no procedural complications. CONCLUSIONS This is the largest series of patients without routine intraoperative drainage procedures. Only 30% of patients developed DGE resistant to pharmacotherapy, which was managed safely with EBP in the postoperative period, thus minimising the risk of biliary reflux in people who would otherwise be at risk following prophylactic pylorus drainage procedures.
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Affiliation(s)
- E J Nevins
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - R Rao
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - J Nicholson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - K D Murphy
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - A Moore
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - H L Smart
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - N Stephens
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - C Grocock
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - A Kaul
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - R T Gunasekera
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - M N Hartley
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - N R Howes
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
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31
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Schnyder J, Monahan J, Smith W, Hope H, Kelly D, Burt D, Huff E, Kaul A, Hildebrand A, Burnette B, Klug N, Bangs M, Gordon D. SAT0143 A PHASE 1 STUDY IN HEALTHY VOLUNTEERS EXPLORING THE SAFETY, PHARMACOKINETICS AND PHARMACODYNAMICS OF ATI-450: A NOVEL ORAL MK2 INHIBITOR. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:ATI-450, is an investigational small molecule inhibitor of the MAPK-activated protein kinase 2 (MK2) signaling pathway. This pathway drives the expression of multiple cytokines including TNFα, IL-1α and β, and IL-6.Objectives:We evaluated the safety and tolerability of ATI-450 in healthy volunteers as well as pharmacokinetics (PK) and pharmacodynamics (PD). Here we present data from single and multiple ascending dose cohorts. The aim was to select a dose for evaluation in phase 2 in patients with rheumatoid arthritis.Methods:Safety, PK and PD were assessed in a randomized, observer-blind, placebo-controlled, phase 1 study in male and female healthy subjects aged 18-55 (n=77).Part A: Single Ascending Dose (SAD) (n=32, 8 subjects per dose cohort - 2 placebo, 6 active). A single dose of 10mg, 30mg, 50mg and 100mg was tested.Part B: Multiple Ascending Dose (MAD) (n=30, 10 subjects per dose cohort - 2 placebo, 8 active). 10mg BID, 30mg BID and 50mg BID doses were tested over 7 days of administration.Safety and tolerability of ATI-450 was evaluated based on adverse events, clinical laboratory, vital signs, 12-lead ECG, Holter monitoring, and physical examination. Blood was drawn for PK analysis at 0.5, 1, 2, 4, 6, 8, 12 hours, 24, 36, and 48 hours post dose in the SAD cohort and on day 7 of the MAD cohort. PD of ATI-450 were explored by investigating the inhibition of a target biomarker, phospho-HSP27 (pHSP27) and proinflammatory cytokines, TNFα, IL1β, IL6 and IL8 inex-vivoLPS-stimulated blood samples collected 4 and 12 hours post dose on day 7 from subjects in the MAD cohorts.Results:ATI-450 was generally well tolerated. No serious adverse events or severe adverse events were reported, and no adverse events led to discontinuation of the study medication. The most common adverse events (reported by 2 or more subjects who received ATI-450) observed during the trial were dizziness, headache, upper respiratory tract infection, constipation, nausea, and abdominal pain. All adverse events were mild. A trend of a decrease in absolute neutrophil count (ANC) was observed without correlated clinical sequelae.ATI-450 had dose proportional PK with a terminal half-life (t½) of 9-12 hours in the MAD cohort on day 7. A dose and concentration dependent inhibition ofex vivostimulated cytokines and target biomarker was observed. On day 7, patients in the 50mg BID dose (the dose with the highest degree of inhibition) recorded mean trough drug levels (12 hours post dose) that were 1.4, 2.5, 2.5 and 2.4 times greater than the IC80for TNFα, IL1β, IL8 and pHSP27 respectively. Mean Cmax drug levels (4 hours post dose) were 3.6, 6.4, 6.2 and 6.0 times greater than the IC80for TNFα, IL1β, IL8 and pHSP27 respectively. IL6 levels were inhibited by more than 50% for part of the dosing interval.Conclusion:Oral ATI-450 was generally well tolerated at all doses with dose proportional PK. The t½ suggests that once or twice daily oral dosing may be possible. At the 50mg BID dose, marked inhibition of TNFα, IL1β and IL8, IL6 and pHSP27 was observed. ATI-450 has the potential to be an oral, small molecule drug which can target multiple cytokines. Exploration of its benefit to risk profile in patients with rheumatoid arthritis is warranted.Disclosure of Interests:Judy Schnyder Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, Joe Monahan Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, Walter Smith Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, Heidi Hope Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, Deborah Kelly Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, David Burt Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, E Huff Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, A Kaul Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, A Hildebrand Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, B Burnette Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, N Klug Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics, M Bangs Shareholder of: Aclaris Therapeutics, Employee of: Aclaris Therapeutics, David Gordon Shareholder of: aclaris therapeutics, Employee of: aclaris therapeutics
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Abstract
Abstract
Background
NICE guidance approves pathways for inflammatory arthritis biologic therapies. Locally, CCG's commission pathways based on their interpretation of NICE guidance. For patients to have equal access to biologics, CCG pathways in different areas must be uniform. We examined whether CCG biologics pathways complied with this standard.
Methods
Using Freedom of Information requests, direct requests and internet searches, we found 21 approved biologics pathways in England for rheumatoid arthritis, 12 for psoriatic arthritis and 11 for ankylosing spondylitis. This covered 22.8 million people in England for RA (2017 population estimates). CCG Pathways were compared to NICE guidance with respect to restrictions and number of therapies allowed before an Individual Funding Request (IFR) was needed.
Results
We studied NICE guidance and determined an 'ideal' pathway for patients requiring > 1 biologic. All CCG pathways followed NICE guidance for 1st line biologics but there was significant variation for biologic failures. 18/21 CCG RA pathways indicated the maximum number of drugs that the CCG would commission without the clinician needing IFR. 7/18 allowed 1-3 biologics serially, 10/18 allowed 4-6 and 1/18 was unrestricted. Rituximab is NICE approved in RA in inadequate responders/intolerance to DMARDs/anti-TNF-α. 17/21 RA pathways allowed rituximab 1stline for haematological or treated solid malignancies, 4/21 did not. 6/21 CCG’s allowed rituximab 5 years after solid organ malignancy, 5/21 after 10 years, 10/21 did not specify or allow this usage. NICE guidelines for RA approve 11 biologics. 14/21 RA pathways allowed all 11 biologics, 7/21 pathways excluded sarilumab, tofacitinib or baricitinib or all three. NICE guidelines for PsA recommend the least expensive drug used first of the injected biologics or JAK inhibitors. IFR was required after 3 drugs in 9/12 pathways with 1/12 allowing 4 lines of therapy. For AS, 5/11 allowed 2 lines of therapy, the remainder 3 or 4 lines. Again, many pathways pre-specified which biologics could be used and excluded other NICE approved drugs at specific stages.
Conclusion
NICE specify the least expensive drug should be used for injected biologics with variation for administration mode/dosage. CCG’ s commission variably restrictive pathways potentially against NICE guidance, both with number and type of therapies before IFR submission is required. Some pathways allowed little scope to use therapies from earlier pathway points without breaching CCG limits. The IFR process for NICE approved therapies can exhibit wide variation in our experience with different outcomes for similar cases, and is time consuming with CCG decision making being opaque, despite NICE approval being legally enforceable. CCG biologic pathways introduce wide regional variation and potential unfairness in their interpretation of NICE guidance. This may disadvantage the worst affected patients who fail several therapies and prevent access to life changing therapy depending on geographical location.
Disclosures
J. Mistry None. D. Hill None. A. Kaul None.
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Affiliation(s)
- Jatin Mistry
- St George's University of London, Rheumatology, London, UNITED KINGDOM
| | - Diane Hill
- St George's Hospital, Rheumatology, London, UNITED KINGDOM
| | - Arvind Kaul
- St George's University of London, Rheumatology, London, UNITED KINGDOM
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Saha P, Sandhu V, Robinson H, Ezeonyeji A, Al-Shakarchi I, Chander S, Suresh R, Kaul A, Sofat N. P184 Developing a pathway for tocilizumab treatment in giant cell arteritis: a South London regional experience. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.179] [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: 11/14/2022] Open
Abstract
Abstract
Background
Tocilizumab is now approved by the National Institute of Health and Care Excellence (NICE) for up to a year in relapsing or refractory giant cell arteritis (GCA). The practicalities of developing a pathway for referral using a hub and spoke model were previously unknown. Here we discuss our novel experiences utilising tocilizumab for GCA in its first year of licensing, after the introduction of a new regional multi-disciplinary team referral pathway.
Methods
We assessed all patients started on tocilizumab for GCA between August 2018-May 2019. The central assessing hub is St George’s University Hospitals NHS Foundation Trust, a large tertiary rheumatology department in the South of England, serving a population of 1.3 million.
Results
As per Table 1 below. A total of 9 patients were identified: 6 female and 3 male, with an average age of 74.2 (range 63-80). 5 patients were referred internally from clinicians at St George’s Hospital, with the remainder from local district general hospitals. Steroid protocols between patients were varied, and two-thirds required a 3-day IV methylprednisolone course, including all 4 patients with visual symptoms. A third of patients were on concurrent methotrexate, a disease-modifying antirheumatic drug. 8 of 9 patients were on alendronate, vitamin D/calcium, and a gastroprotective agent, and 7 were on aspirin. Reported side effects from steroids were common, with weight gain, increased appetite and osteoporosis noted. All our 9 patients continue their tocilizumab injections, with one individual having a 3-month break for a routine hip operation, and another a 1-month hiatus due to temporary derangement in liver function tests. Tocilizumab proffered improved disease control and few side effects were noted. 3 patients have now been on tocilizumab for 12 months and raise interesting discussions about ongoing funding and treatment efficacy.
Conclusion
Our case series shows the development and delivery of an effective hub and spoke referral pathway for tocilizumab treatment in GCA. We show that steroid dosing could be reduced with tocilizumab, and that all subjects received full funding for treatment. Our referral pathway has encouraged the uptake of the IL-6 monoclonal antibody treatment for GCA and compliance with NICE guidelines.
Disclosures
P. Saha None. V. Sandhu None. H. Robinson None. A. Ezeonyeji None. I. Al-Shakarchi None. S. Chander None. R. Suresh None. A. Kaul None. N. Sofat None.
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Affiliation(s)
- Pratyasha Saha
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Virinderjit Sandhu
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Helena Robinson
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Amara Ezeonyeji
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Israa Al-Shakarchi
- Rheumatology, Kingston Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Sumeet Chander
- Rheumatology, Royal Surrey County NHS Foundation Trust, Guildford, UNITED KINGDOM
| | - Resmy Suresh
- Rheumatology, Croydon Health Services NHS Trust, London, UNITED KINGDOM
| | - Arvind Kaul
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
| | - Nidhi Sofat
- Rheumatology, St George's Hospital NHS Foundation Trust, London, UNITED KINGDOM
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Pieńkowska-Schelling A, Kaul A, Schelling C. X chromosome aneuploidy and micronuclei in fertile mares. Theriogenology 2020; 147:34-38. [PMID: 32086049 DOI: 10.1016/j.theriogenology.2020.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/16/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
Abstract
Abnormalities of chromosomes are an important and well documented cause of disorders of sexual development, fertility problems and congenital anomalies in mammals. Detection of low-level 63,X/64,XX mosaicism during routine cytogenetic evaluation is a challenge because its clinical significance is not yet fully clear. This study describes the prevalence and levels of 63,X mosaicism for a cohort of fertile mares and compares the results with eight problem mares for which no clinical cause of sub-fertility was found. The study design allowed for the analysis of micronuclei which are biomarkers of genomic instability and can disturb cell divisions, drive cancer development or cause congenital diseases. Although 27% of the fertile mares were identified to be 63,X mosaics, the results showed that the rates of abnormal cells were very low (1-3%). Levels of abnormal cells in problem mares with 63,X mosaicism were similar or higher. The average rate of micronuclei in the blood of the fertile mares was ∼1%, well below the baseline (5%) which was proposed for peripheral blood of normal healthy humans. We found weak to modest, but not significant, correlations between the age of fertile mares and 63,X cells (Kendall's tau b = 0.2905; p > 0.05) as well as the rate of micronuclei (Kendall's tau b = 0.1896; p > 0.05). Likewise, the correlation between presence of a 63,X cell line and micronuclei rate was not significant (Kendall's tau b = 0.3201; p > 0.05). The presence of 63,X cells in rates greater than 3% may indeed indicate a higher risk for sub-fertility and eventually for associated health problems in such mares. Detection and elimination of mares with high level of X aneuploidies from breeding may have a positive effect on the fertility within the general horse population. This data may support the evaluation of problem mares with mosaic karyotypes involving the X chromosome.
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Affiliation(s)
- A Pieńkowska-Schelling
- Institute of Genetics, Vetsuisse-Faculty Bern, University of Bern, Bremgartenstrasse 109a, 3000, Bern, Switzerland; Clinic of Reproductive Medicine and Center for Clinical Studies, Vetsuisse-Faculty Zurich, University of Zurich, Eschikon 27, 8315, Lindau, Switzerland.
| | - A Kaul
- Veterinary Practice Letschin, Küstriner Strasse 2a, 15324, Letschin, Germany.
| | - C Schelling
- Clinic of Reproductive Medicine and Center for Clinical Studies, Vetsuisse-Faculty Zurich, University of Zurich, Eschikon 27, 8315, Lindau, Switzerland.
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Makarevich A, Makarevich O, Ivanov A, Sharovarov D, Eliseev A, Amelichev V, Boytsova O, Gorodetsky A, Navarro-Cía M, Kaul A. Hydrothermal epitaxy growth of self-organized vanadium dioxide 3D structures with metal–insulator transition and THz transmission switch properties. CrystEngComm 2020. [DOI: 10.1039/c9ce01894h] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The hydrothermal method is an effective approach for the synthesis of VO2 films with unique crystallites morphology and sharp electrical and optical switch properties.
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Affiliation(s)
- A. Makarevich
- Department of Chemistry
- Lomonosov Moscow State University
- Moscow
- Russia
- SuperOx
| | - O. Makarevich
- Department of Chemistry
- Lomonosov Moscow State University
- Moscow
- Russia
| | - A. Ivanov
- Department of Material Science
- Lomonosov Moscow State University
- Moscow
- Russia
| | - D. Sharovarov
- Department of Material Science
- Lomonosov Moscow State University
- Moscow
- Russia
| | - A. Eliseev
- Department of Material Science
- Lomonosov Moscow State University
- Moscow
- Russia
| | | | - O. Boytsova
- Department of Chemistry
- Lomonosov Moscow State University
- Moscow
- Russia
- Department of Material Science
| | - A. Gorodetsky
- ITMO University
- St. Petersburg 197101
- Russia
- School of Physics and Astronomy
- University of Birmingham
| | - M. Navarro-Cía
- School of Physics and Astronomy
- University of Birmingham
- Birmingham
- UK
| | - A. Kaul
- Department of Chemistry
- Lomonosov Moscow State University
- Moscow
- Russia
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Affiliation(s)
- A Kaul
- St George’s University of London, UK
| | | | - J Kotecha
- St George’s University of London, UK
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Kaul A, Agrawal V, Bhaduaria D, Agrawal V, Prasad N, Gupta A, Sharma RK. Vasculitis and vasculopathy in Lupus Nephritis: Clinical variability, outcome, and new insight into treatment. Saudi J Kidney Dis Transpl 2019; 28:415-424. [PMID: 28352031 DOI: 10.4103/1319-2442.202777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
More than 50% of patients with systemic lupus erythematosus (SLE) have renal involvement at presentation or during their illness. Lupus nephritis (LN) encompasses several patterns of renal disease, including glomerular, tubulointerstitial, and vascular pathologies. The presence and significance of renal vascular lesions (VLs) are often overlooked. VLs in LN are not rare with an incidence of 10%-40% on renal biopsies from various studies and their presence is often labeled as poor prognostic markers. The current treatment protocol for LN is mainly based on the glomerular pathology, and no guidelines/consensus exists for treatment of LN with VLs. We describe the clinical presentation, course, response to therapy, and outcomes in five patients with SLE with histological evidence of renal VLs.
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Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V Agrawal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhaduaria
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agrawal
- Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Matson AG, Bunting JP, Kaul A, Smith DJ, Stonestreet J, Herd K, Hodgson RS, Bell SC. A non-randomised single centre cohort study, comparing standard and modified bowel preparations, in adults with cystic fibrosis requiring colonoscopy. BMC Gastroenterol 2019; 19:89. [PMID: 31195989 PMCID: PMC6567575 DOI: 10.1186/s12876-019-0979-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adults with cystic fibrosis (CF) have been reported to be at five to ten-fold risk (25 to 30 fold risk after solid organ transplant) of colorectal cancer (CRC) than the general population. Limited publications to date have reported on practical aspects of achieving adequate colonic cleanse producing good visualisation. In this study, we compared two bowel preparation regimens, standard bowel preparation and a modified CF bowel preparation. METHODS A non-randomised study of adults with CF attending a single centre, requiring colonoscopy investigation were selected. Between 2001 and 2015, 485 adults with CF attended the clinic; 70 adults with CF had an initial colonoscopy procedure. After five exclusions, standard bowel preparation was prescribed for 27 patients, and modified CF bowel preparation for 38 patients. Demographic and clinical data were collected for all consenting patients. RESULTS There was a significant difference between modified CF bowel preparation group and standard bowel preparation group in bowel visualisation outcomes, with the modified CF bowel preparation group having a higher proportion of "excellent/good" GI visualisation cleanse (50.0% versus 25.9%) and lower rates of "poor" visualisation cleanse (10.5% versus 44.5%) than standard bowel preparation (p = 0.006). Rates of "fair" GI cleanse visualisation were similar between the two groups (39.4% versus 29.6%) (Additional file 1: Table S1). Detection rates of adenomatous polyps at initial colonoscopy was higher in modified CF bowel preparation cohort than with standard preparation group (50.0% versus 18.5%, p < 0.01). Positive adenomatous polyp detection rate in patient's age > 40 years of age was higher (62.5%) than those < 40 years of age (24.3%) (p = 0.003). Colonic adenocarcinoma diagnosis was similar in both groups. CONCLUSION This study primarily highlights that standard colonoscopy bowel preparation is often inadequate in patients with CF, and that colonic lavage using modified CF bowel preparation is required to obtain good colonic visualisation. A higher rate of polyps in patients over 40 years of age (versus less than 40 years) was evident. These results support adults with CF considered for colonoscopy screening at 40 years of age, or prior to this if symptomatic; which is earlier than CRC screening in the non-CF Australian population.
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Affiliation(s)
- A G Matson
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia.
| | - J P Bunting
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia
| | - A Kaul
- Department of Gastroenterology. TPCH, Queensland, Brisbane, Australia
| | - D J Smith
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia
| | - J Stonestreet
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia
| | - K Herd
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia
| | - R S Hodgson
- Department of Gastroenterology. TPCH, Queensland, Brisbane, Australia
| | - S C Bell
- The Adult Cystic Fibrosis Centre. The Prince Charles Hospital. (TPCH), Queensland, Brisbane, Australia
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Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking. METHODS Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time. RESULTS SLE admissions increased from 8.97 to 9.04 per 100,000 (p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 (p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 (p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively. CONCLUSIONS Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.
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Affiliation(s)
- J Hannah
- 1 Department of Rheumatology, King's College Hospital, London, UK
| | - J Galloway
- 2 Department of Academic Rheumatology, King's College Hospital, London, UK
| | - A Kaul
- 3 Department of Rheumatology, St George's University Hospital, London, UK
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Abstract
BACKGROUND With increasing graft survival, post-transplant immunoglobulin A nephropathy (IgAN) has emerged as an important cause of chronic graft dysfunction in renal allograft recipients. We studied the clinico-pathological features of post-transplant IgAN regardless of the primary disease. The aim was to study the usefulness of the Oxford classification in predicting survival. METHODS Indication graft biopsy specimens (n = 915) were received during a 10-year period; 27 biopsy specimens from 22 patients were diagnosed as IgAN. RESULTS Post-transplant IgAN was seen in 2.6% of biopsy specimens. Mean time to occurrence was 71.6 ± 47.6 months (range, 6.8 months to 16 years), occurring most commonly 4 to 8 years after transplant. Associated rejection was present in 4 biopsies; 72.7% (16/22), 91% (20/22), and 31.8% (7/22) presented with rise in serum creatinine, proteinuria, and hematuria, respectively. Four (21%) patients had nephrotic range proteinuria. Mesangial hypercelullarity (M1), endocapillary hypercelullarity (E1), segmental glomerulosclerosis (S1), and tubulo-interstitial fibrosis (T1-2) was present in 36.6%, 22.7%, 54.5%, and 31.8% biopsies, respectively. The most frequent Haas class was III (n = 7; 29.1%), followed by classes IV and I (n = 5; 20.8% each). The 2- and 5-year graft survival rates were 75% and 56%, respectively. High serum creatinine, low estimated glomerular filtration rate, E1 and T lesions, and degree of interstitial inflammation predicted graft survival. Interestingly, percentage (>25%) of segmentally sclerosed glomeruli and not S1 correlated with graft outcome. CONCLUSIONS The Oxford MEST scheme is useful in predicting graft survival in post-transplant IgAN. The degree of interstitial inflammation is also an important feature for determining graft outcomes in post-transplant IgAN.
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Affiliation(s)
- V Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - A Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Verma
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Pandey
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kaul A, Strand V, McInnes I, Mease P, Choy E, Nash P, Thom H, Kalyvas C, Gandhi K, Pricop L, Jugl S. 175 Comparative effectiveness of secukinumab and infliximab in psoriatic arthritis assessed by matching-adjusted indirect comparison using pivotal Phase III clinical trial data. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arvind Kaul
- Rheumatology, St George's Hospital and Medical School, London, UNITED KINGDOM
| | - Vibeke Strand
- Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UNITED KINGDOM
| | - Philip Mease
- Rheumatology, Swedish Medical Center and University of Washington, Seattle, WA, USA
| | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UNITED KINGDOM
| | - Peter Nash
- Medicine, University of Queensland, Brisbane, AUSTRALIA
| | - Howard Thom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UNITED KINGDOM
| | | | - Kunal Gandhi
- Worldwide Medical Affairs, Immunology and Dermatology, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Luminita Pricop
- Clinical Development, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Steffen Jugl
- Immunology and Dermatology, Novartis Pharma AG, Basel, SWITZERLAND
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Hannah JR, Galloway J, Kaul A. K3 Hospitalisation trends for systemic lupus erythematosus and rheumatoid arthritis in England from 1998 to 2014. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jennifer R Hannah
- Department of Rheumatology, Guys and St Thomas' NHS Trust, London, UNITED KINGDOM
| | - James Galloway
- Department of Rheumatology, Kings' College London, London, UNITED KINGDOM
| | - Arvind Kaul
- Department of Rheumatology, St George's Hospital, London, UNITED KINGDOM
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Behera MR, Kaul A, Kishore R, Karthikeyan B, Bhadauria DS, Mishra P, Prasad N, Gupta A, Sharma RK. Optimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant. Indian J Nephrol 2018; 28:433-440. [PMID: 30647497 PMCID: PMC6309383 DOI: 10.4103/ijn.ijn_305_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82–0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37–0.80, p = 0.002) were significant predictors of survival. In the 1st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.
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Prasad N, Manjunath R, Rangaswamy D, Jaiswal A, Agarwal V, Bhadauria D, Kaul A, Sharma R, Gupta A. Efficacy and Safety of Cyclosporine versus Tacrolimus in Steroid and Cyclophosphamide Resistant Nephrotic Syndrome: A Prospective Study. Indian J Nephrol 2018. [PMID: 29515301 PMCID: PMC5830809 DOI: 10.4103/ijn.ijn_240_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Calcineurin inhibitors (CNIs) are the preferred drugs for treatment of childhood steroid-resistant nephrotic syndrome (SRNS) who are also resistant to cyclophosphamide (CYC). Although few studies have shown a benefit of one over the other, efficacy and safety of either CNIs (tacrolimus [TAC] or cyclosporine [CSA]) in this special population remained to be assessed in long-term studies. Forty-five children with SRNS who were also resistant to CYC (CYC-SRNS) from January 2006 to June 2011, were included in the study. Patients were treated with CNI either TAC or CSA based on 1:1 allocations and were prospectively observed. Patients who were nonresponsive to CNIs had been treated with mycophenolate mofetil. Outcomes were measured in terms of remission of NS, adverse effects of drugs, and progression of disease. After 6 months of treatment, 16/23 (69.5%) patients on CSA achieved remission and 18/22 (81.8%) on TAC achieved remission (P = 0.3). The side effects hypertrichosis, and gum hyperplasia were significantly less in TAC group as compared to CSA group (P < 0.001). The 1-, 2-, 3-, 4-, and 5-year estimated renal survival (doubling of serum creatinine as event) in CSA group was 96%, 91%, 85%, 54%, and 33% and in TAC group was 96%, 95%, 90%, 89%, and 79%, respectively (P = 0.02). Although TAC and CSA are equally efficacious, TAC has significantly less side effects. The long-term outcome of renal function was significantly better in patients who were treated with TAC as compared to CSA.
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Affiliation(s)
- N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Manjunath
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Rangaswamy
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Jaiswal
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kaul A, Behera MR, Rai MK, Mishra P, Bhaduaria DS, Yadav S, Agarwal V, Karoli R, Prasad N, Gupta A, Sharma RK. Neutrophil Gelatinase-associated Lipocalin: As a Predictor of Early Diabetic Nephropathy in Type 2 Diabetes Mellitus. Indian J Nephrol 2018. [PMID: 29515302 PMCID: PMC5830810 DOI: 10.4103/ijn.ijn_96_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m2 and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.
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Affiliation(s)
- A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M K Rai
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - P Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D S Bhaduaria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Yadav
- Department of Medicine, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - V Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R Karoli
- Department of Endocrinology, ERA Medical College, Lucknow, Uttar Pradesh, India
| | - N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Prasad N, Patel MR, Pandey A, Jaiswal A, Bhadauria D, Kaul A, Sharma RK, Mohindra S, Pandey G, Goel A, Gupta A. Direct-acting Antiviral Agents in Hepatitis C Virus-infected Renal Allograft Recipients: Treatment and Outcome Experience from Single Center. Indian J Nephrol 2018; 28:220-225. [PMID: 29962673 PMCID: PMC5998719 DOI: 10.4103/ijn.ijn_190_17] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Hepatitis C virus (HCV) infection in renal allograft recipient is associated with increased morbidity and mortality. At present, only few studies related to treatment and outcomes of HCV-infected renal allograft recipients with DAAs have been published. We aimed the study to assess the efficacy and safety of sofosbuvir-based regimens in HCV-infected renal allograft recipients. We analyzed data of 22 eligible HCV-infected renal allograft recipients (14 genotype-3, 6 genotype-1, one each genotype-2 and 4) who were treated with DAAs at our institute. DAA regimen included sofosbuvir and ribavirin with or without ledipasvir or daclatasvir for 12–24 weeks. Patients were followed up for 24 weeks after completion of treatment. A rapid viral response of 91%, end of therapy response of 100%, and sustained viral response at 12 and 24 weeks of 100% with rapid normalization of liver enzymes were observed. Therapy was well tolerated except for ribavirin-related anemia. A significant decrease in tacrolimus trough levels was observed and most patients required increase in tacrolimus dose during the study. Treatment with newer DAAs is effective and safe for the treatment of HCV-infected renal allograft recipients.
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Affiliation(s)
- N Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Pandey
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Jaiswal
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Mohindra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - G Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kaul A, Bhaduaria D, Pradhan M, Sharma RK, Prasad N, Gupta A. Pregnancy Check Point for Diagnosis of CKD in Developing Countries. J Obstet Gynaecol India 2017; 68:440-446. [PMID: 30416269 DOI: 10.1007/s13224-017-1055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Evidences suggest that females with CKD are associated with high risk of maternal and fetal complications. Early referral in CKD with pregnancy for specialist care may prove useful for maternal and fetal outcome. Methods Study looked for assessment of impact of CKD detection at the time of pregnancy and its impact on fetal and maternal outcome. Results A total of 465 females were retrospectively evaluated for renal status during their pregnancies, 172 females were unaware about their renal illness at the time of pregnancy, while 208 females were under regular obstetrical and nephrological follow-up during their pregnancy. 44.1% of these females in both groups had GFR < 60 ml/min. Preeclampsia was observed in 17.6% of planned pregnancies, while it was observed in 47.5% of unplanned pregnancies. Worsening of renal failure during and following pregnancy was observed among all stages of CKD, and there was greater decline in GRF with progression to ESRD earlier during or after pregnancy among unplanned pregnancies. Planned pregnancy group had better fetal outcome. Low birth babies weighing < 2500 g in unplanned group were much higher than in planned pregnancies. Conclusions Chronic kidney disease is often clinically silent until renal impairment is advanced. Pregnancy can be a check point for detection of renal disease and managed appropriately for better maternal and fetal outcome.
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Affiliation(s)
- A Kaul
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - D Bhaduaria
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M Pradhan
- 2Department of Maternal and Foetal Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - R K Sharma
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - N Prasad
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - A Gupta
- 1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Gilbert T, Nicholson J, Javed M, Rigby K, Chadwick M, Macadam R, Kanwar S, Kaul A. Whiston's Hot Gallbladder Service. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chaturvedi S, Kaul A, Hazari PP, Mishra AK. Mapping neuroreceptors with metal-labeled radiopharmaceuticals. Medchemcomm 2017; 8:855-870. [PMID: 30108802 PMCID: PMC6072260 DOI: 10.1039/c6md00610h] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/07/2017] [Indexed: 01/27/2023]
Abstract
The growing epidemiological and economic burden of neurological diseases on society is tremendous. A correct and timely diagnosis can help in lowering the burden and improving the life quality of both the diseased person and the caretaker. Imaging of the brain (neuroimaging) using CT, MRI, and nuclear imaging methods can provide anatomical and functional information. Neuroreceptors are central to neurotransmission and neuromodulation in the CNS. In vivo imaging of receptors in the brain provides powerful tools for the functional study of the central nervous system (CNS) in normal or diseased states. Presently, PET imaging using non-metallic radiotracers dominates the imaging of neuroreceptors. Metal-based probes for SPECT and PET can be economical and logistically easier to use without compromising the information. This review focuses on the development of metallic radiotracers for (99mTc) SPECT and (68Ga) PET along with future directions based on the metallic probes developed for other imaging modalities namely MRI.
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Affiliation(s)
- S Chaturvedi
- Division of Cyclotron and Radiopharmaceutical Sciences , Institute of Nuclear Medicine and Allied Sciences , Brig. S.K. Mazumder Road , Delhi 110054 , India . ; ; ; Tel: +91 11 23095117
| | - A Kaul
- Division of Cyclotron and Radiopharmaceutical Sciences , Institute of Nuclear Medicine and Allied Sciences , Brig. S.K. Mazumder Road , Delhi 110054 , India . ; ; ; Tel: +91 11 23095117
| | - Puja P Hazari
- Division of Cyclotron and Radiopharmaceutical Sciences , Institute of Nuclear Medicine and Allied Sciences , Brig. S.K. Mazumder Road , Delhi 110054 , India . ; ; ; Tel: +91 11 23095117
| | - Anil K Mishra
- Division of Cyclotron and Radiopharmaceutical Sciences , Institute of Nuclear Medicine and Allied Sciences , Brig. S.K. Mazumder Road , Delhi 110054 , India . ; ; ; Tel: +91 11 23095117
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Altaf K, Xiong JJ, la Iglesia DD, Hickey L, Kaul A. Meta-analysis of biomarkers predicting risk of malignant progression in Barrett's oesophagus. Br J Surg 2017; 104:493-502. [PMID: 28295252 DOI: 10.1002/bjs.10484] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/18/2016] [Accepted: 12/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Barrett's oesophagus is a precursor to the development of oesophageal adenocarcinoma. This study sought to clarify the role of genetic, chromosomal and proliferation biomarkers that have been the subjects of multiple studies through meta-analysis. METHODS MEDLINE, Embase, PubMed and the Cochrane Library were searched for clinical studies assessing the value of p53, p16, Ki-67 and DNA content abnormalities in Barrett's oesophagus. The main outcome measure was the risk of development of high-grade dysplasia (HGD) or oesophageal adenocarcinoma. RESULTS Some 102 studies, with 12 353 samples, were identified. Mutation (diagnostic odds ratio (DOR) 10·91, sensitivity 47 per cent, specificity 92 per cent, positive likelihood ratio (PLR) 4·71, negative likelihood ratio (NLR) 0·65, area under the curve (AUC) 0·792) and loss (DOR 16·16, sensitivity 31 per cent, specificity 98 per cent, PLR 6·66, NLR 0·41, AUC 0·923) of p53 were found to be superior to the other p53 abnormalities (loss of heterozygosity (LOH) and overexpression). Ki-67 had high sensitivity in identifying high-risk patients (DOR 5·54, sensitivity 82 per cent, specificity 48 per cent, PLR 1·59, NLR 0·42, AUC 0·761). Aneuploidy (DOR 12·08, sensitivity 53 per cent, specificity 87 per cent, PLR 4·26, NLR 0·42, AUC 0·846), tetraploidy (DOR 5·87, sensitivity 46 per cent, specificity 85 per cent, PLR 3·47, NLR 0·65, AUC 0·793) and loss of Y chromosome (DOR 9·23, sensitivity 68 per cent, specificity 80 per cent, PLR 2·67, NLR 0·49, AUC 0·807) also predicted malignant development, but p16 aberrations (hypermethylation, LOH, mutation and loss) failed to demonstrate any advantage over the other biomarkers studied. CONCLUSION Loss and mutation of p53, and raised level of Ki-67 predicted malignant progression in Barrett's oesophagus.
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Affiliation(s)
- K Altaf
- Department of Surgery, Whiston Hospital, St Helen's and Knowsley Hospitals NHS Foundation Trust, Liverpool, UK
| | - J-J Xiong
- Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - D De la Iglesia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - L Hickey
- Department of Surgery, Whiston Hospital, St Helen's and Knowsley Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Kaul
- Department of Surgery, Whiston Hospital, St Helen's and Knowsley Hospitals NHS Foundation Trust, Liverpool, UK
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