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Tomelleri A, Padoan R, Kavadichanda CG, Jose A, Singh K, Iorio L, Rathore U, Rinaldi E, Baldissera E, Agarwal V, Dagna L, Campochiaro C, Misra DP. Validation of the 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Rheumatology (Oxford) 2023; 62:3427-3432. [PMID: 37018125 DOI: 10.1093/rheumatology/kead161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES The present study validates the 2022 ACR/European Alliance of Associations for Rheumatology (EULAR) classification criteria for Takayasu's arteritis (TAK), compared with the 1990 ACR TAK classification criteria. METHODS The fulfilment of 2022 ACR/EULAR and 1990 ACR TAK criteria from four referral centres was assessed for TAK compared with extracranial giant cell arteritis (EC-GCA) and other controls. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio of a positive test (LR+) or negative test (LR-), and area under receiver operating characteristics curve (AUC) were calculated. RESULTS Among 504 patients with TAK (404 females) and 222 controls (151 females, 144 patients with EC-GCA), the 2022 ACR/EULAR criteria had better sensitivity (95.83% vs 82.94%) and NPV, but poorer specificity (63.51% vs 90.54%), PPV, LR+, LR- and AUC at the pre-determined cut-offs than the 1990 ACR criteria. The 2022 ACR/EULAR criteria had greater specificity (76.06% vs 57.62%) and AUC (0.845 vs 0.771), with similar sensitivity (93% vs 96.53%) in males as in females. The 2022 ACR/EULAR criteria performed similarly with only EC-GCA as controls (sensitivity 95.83%, specificity 60.42%, AUC 0.781). Sensitivity remained similar, whereas specificity was higher for 40-60 years vs <40 years. Cut-offs of ≥6 (sensitivity 91.87%, specificity 82.88%) and ≥7 (sensitivity 86.71%, specificity 86.49%), or removing the point for female sex (sensitivity 92.64%, specificity 81.08%) greatly improved the balance between sensitivity and specificity. CONCLUSION The poor specificity of the 2022 ACR/EULAR TAK criteria in real-life settings was improved by increasing the cut-off to 6 or 7, or removing the point for female sex.
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Affiliation(s)
- Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Chengappa G Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Augustine Jose
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Luca Iorio
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Emma Rinaldi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Elena Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Hanly A, Johnston RD, Lemass C, Jose A, Tornifoglio B, Lally C. Phosphotungstic acid (PTA) preferentially binds to collagen- rich regions of porcine carotid arteries and human atherosclerotic plaques observed using contrast enhanced micro-computed tomography (CE-µCT). Front Physiol 2023; 14:1057394. [PMID: 36818446 PMCID: PMC9932683 DOI: 10.3389/fphys.2023.1057394] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims: Atherosclerotic plaque rupture in the carotid artery can cause small emboli to travel to cerebral arteries, causing blockages and preventing blood flow leading to stroke. Contrast enhanced micro computed tomography (CEμCT) using a novel stain, phosphotungstic acid (PTA) can provide insights into the microstructure of the vessel wall and atherosclerotic plaque, and hence their likelihood to rupture. Furthermore, it has been suggested that collagen content and orientation can be related to mechanical integrity. This study aims to build on existing literature and establish a robust and reproducible staining and imaging technique to non-destructively quantify the collagen content within arteries and plaques as an alternative to routine histology. Methods: Porcine carotid arteries and human atherosclerotic plaques were stained with a concentration of 1% PTA staining solution and imaged using MicroCT to establish the in situ architecture of the tissue and measure collagen content. A histological assessment of the collagen content was also performed from picrosirius red (PSR) staining. Results: PTA stained arterial samples highlight the reproducibility of the PTA staining and MicroCT imaging technique used with a quantitative analysis showing a positive correlation between the collagen content measured from CEμCT and histology. Furthermore, collagen-rich areas can be clearly visualised in both the vessel wall and atherosclerotic plaque. 3D reconstruction was also performed showing that different layers of the vessel wall and various atherosclerotic plaque components can be differentiated using Hounsfield Unit (HU) values. Conclusion: The work presented here is unique as it offers a quantitative method of segmenting the vessel wall into its individual components and non-destructively quantifying the collagen content within these tissues, whilst also delivering a visual representation of the fibrous structure using a single contrast agent.
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Affiliation(s)
- A. Hanly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - R. D. Johnston
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - C. Lemass
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - A. Jose
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - B. Tornifoglio
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland
| | - C. Lally
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin, Ireland,Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland,*Correspondence: C. Lally,
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Jose A, Dhar M, Ajmal M, Mohan L, Saxena Y, Bhat NK. Stroke Characteristics as Predictors of New-onset Seizure in Patients with Acute Ischemic Stroke. J Assoc Physicians India 2022; 70:11-12. [PMID: 37355969 DOI: 10.5005/japi-11001-0160] [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] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The current guidelines on diagnosis and management of new-onset seizures in stroke are not well defined, especially in the Indian setting. Our study aims at providing insight into the hospital prevalence risk of new-onset seizures following ischemic stroke and to correlate seizure risk with the characteristics of stroke and other clinical parameters. METHODS A total of 127 patients were analyzed for the study where we assessed the clinical severity and the imaging severity of stroke using the National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT (ASPECT) score, respectively. Seizure-related variables including semiology, timing, and details of antiepileptic drugs (AEDs) were assessed under the domain of early and late poststroke seizures (PSSs). All patients were followed for 6 months for the seizure recurrence and change in Barthel index. In statistical analysis, quantitative variables were compared using the independent t-test/Mann-Whitney U test, and qualitative variables were correlated using Chi-square test/Fisher's exact test. Univariate and multivariate logistic regression was used to find out the significant risk factors of acute symptomatic seizure. RESULTS The mean age of the study population was 59.72 years (±14.77), with a male predominance (60.63%). About 78.74% of the cases had an NIHSS score more than or equal to 6.24% had posterior circulation strokes and the rest had anterior circulation strokes. A cortical location of infarct was observed in 62.2% of cases and a subcortical location in 61.4% of cases. The prevalence of early PSSs observed in our study was 10.6%. Of those, 80% had generalized seizures, 13.3% had focal seizures, and 6.67% had focal seizures with secondary generalizations. No patient in the study group had late-onset seizures. Total leukocyte count, serum protein levels, serum uric acid levels, and erythrocyte sedimentation rate (ESR) values were associated with early seizures (p<0.05). Patients with early seizures were found to have a longer hospital stay (8 vs 6 days with p<0.05). In the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) etiological classification, an acute stroke of undetermined etiology was found to have a significant association with the occurrence of early seizure in both univariate and multivariate analysis [p = 0.030; odds ratio (OR) 4.735 (1.160-22.576)]. There was no difference in change in the Barthel index among the two groups. CONCLUSION There was no recurrence of seizures in those who defaulted for AED and one patient had a seizure even on AED. Prophylactic AEDs in stroke patients based on stroke characteristics could not be ascertained, but the sample size was small. Knowing the fact that antiepileptics cause sedation and increase the chance of aspiration, continuing AEDs in patients who develop acute symptomatic seizures should be judged judiciously.
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Affiliation(s)
| | - Minakshi Dhar
- Additional Professor Department of Internal Medicine; Corresponding Author
| | | | - Latika Mohan
- Professor, Department of Physiology, All India Institute of Medical Sciences, Rishikesh
| | - Yogesh Saxena
- Professor, Department of Physiology, Swami Rama Himalayan University, Dehradun
| | - Nowneet K Bhat
- Professor, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Panda S, Sehrawat A, Kayal S, Sundriyal D, Khanna M, Philips A, Jain D, Moharana L, Tiwari K, Kaaviya D, Cyriac S, Jose A, Saju S, Rathnam K, Ganesan P. 56P Clinico-pathological profile of adolescent and young adult colorectal cancer patients: Multicentre collaborative registry data from India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.088] [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: 12/05/2022] Open
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Behera G, Gera P, Stephen M, Jose A, Thabah MM, Wadwekar V. Bilateral Optic Neuritis and Facial Palsy Following COVID-19 Infection. Cureus 2022; 14:e28735. [PMID: 36072783 PMCID: PMC9440666 DOI: 10.7759/cureus.28735] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
Cases of optic neuritis have been reported following the novel coronavirus disease 2019 (COVID-19), with most being unilateral and associated with demyelinating illness. We report a case of a 22-year-old woman who presented with sudden onset painless diminution of vision in both eyes six weeks following COVID-19 infection. She also had a history of left lower motor neuron (LMN) facial palsy immediately following COVID-19 disease that recovered fully on steroids. Ocular examination and ancillary and laboratory investigations pointed to bilateral atypical optic neuritis. The patient responded well to the standard optic neuritis treatment protocol. We diagnosed her as a case of left LMN facial palsy and parainfectious bilateral optic neuritis following COVID-19. Parainfectious bilateral optic neuritis and facial nerve palsy associated with COVID-19 can occur following COVID-19 disease. Ours is the first case to report the occurrence of both in a patient.
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Nolde J, Lugo-Gavidia LM, Kannenkeril D, Chan J, Robinson S, Jose A, Joyson A, Schlaich L, Carnagarin R, Azzam O, Kiuchi M, Schlaich M. Simultaneously measured interarm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events, previous studies have demonstrated associations with other risk parameters.
Purpose
We aimed to reproduce these associations in a cohort of 199 treated, at-risk, hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage.
Methods
Simultaneously measured Inter-arm blood pressure differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients of a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multivariate regression models.
Results
Out of 199 participants, 90 showed an Inter-arm blood pressure difference of more than 5 mmHg. The Inter-arm difference was not associated with PWV. Furthermore, neither observed single blood pressure measurements nor 24 hour ambulatory blood pressure was associated with Inter-arm blood pressure differences.
Conclusion
In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design or the sample characteristics of this treated, hypertensive cohort may explain the negative results. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Nolde
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L M Lugo-Gavidia
- The University of Western Australia, School of Medicine, Perth, Australia
| | - D Kannenkeril
- University of Erlangen-Nuremberg, Department for Nephrology, Erlangen, Germany
| | - J Chan
- The University of Western Australia, School of Medicine, Perth, Australia
| | - S Robinson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Jose
- The University of Western Australia, School of Medicine, Perth, Australia
| | - A Joyson
- The University of Western Australia, School of Medicine, Perth, Australia
| | - L Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
| | - R Carnagarin
- The University of Western Australia, School of Medicine, Perth, Australia
| | - O Azzam
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Kiuchi
- The University of Western Australia, School of Medicine, Perth, Australia
| | - M Schlaich
- The University of Western Australia, School of Medicine, Perth, Australia
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Magendiran B, Jose A, Kolar Vishwanath V, Bammigatti C. Immune-mediated Coombs negative intravascular haemolysis in systemic lupus erythematosus (SLE). BMJ Case Rep 2021; 14:e244459. [PMID: 34417246 PMCID: PMC8381295 DOI: 10.1136/bcr-2021-244459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.
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Affiliation(s)
- Bhoobalan Magendiran
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Augustine Jose
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vinod Kolar Vishwanath
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Jose A, Dhar M, Panda PK, Kishore S. Expanded dengue syndrome with small-medium-vessel vasculitis: A case report. Int J Crit Illn Inj Sci 2021; 11:39-42. [PMID: 34159136 PMCID: PMC8183367 DOI: 10.4103/ijciis.ijciis_109_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 01/01/2023] Open
Abstract
Expanded dengue syndrome (EDS) is a well-described entity in the literature (after 2009), with various new atypical presentations being identified each year. We report a case of 38-year-old man who presented to the emergency department with high-grade, intermittent fever for 7 days along with myalgia and headache. He had multiple painless palpable purpura over both lower limbs and breathlessness from the 4th day of fever. On admission, purpura progressed in the severity and dry impending gangrene of the toes of both feet developed. Blood cultures turned out to be sterile, and other infectious markers (malaria, scrub typhus, and chikungunya) were negative except for dengue serology (enzyme-linked immunosorbent assay-immunoglobulin M [ELISA-IgM]). Skin biopsy confirmed to be cutaneous small-vessel vasculitis. The respiratory distress was due to myocarditis (supported by raised NT-pro-BNP levels) and pulmonary edema. He also had possibly hemolytic anemia due to microangiopathy. Although there are many EDS cases of dengue myocarditis reported till date, dengue resulting in widespread endothelial activation and extensive vasculitis (small vessel due to purpura and medium vessel due to gangrene) is a rare phenomenon.
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Affiliation(s)
- Augustine Jose
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan Kumar Panda
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjeev Kishore
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Darbari A, Kumar B, Jose A, Kumar A. Unexplained recurrent pericardial effusion in a young adult male: Think beyond tuberculosis. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_39_21] [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: 11/04/2022] Open
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Panda P, Jose A. Expanding scrub typhus beyond territories with a varied presentation in the holy Himalayas (DPST–AIIMS Rishikesh study). Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.090] [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: 10/22/2022] Open
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Jose A, Binu AJ, Cherian KE, Kapoor N, Asha HS, Paul TV. Vitamin D assessment and precision of clinical referrals: Insights gained from a teaching hospital in southern India. J Postgrad Med 2020; 66:194-199. [PMID: 33037169 PMCID: PMC7819383 DOI: 10.4103/jpgm.jpgm_599_19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: Vitamin D deficiency is widely prevalent worldwide. This has led to a significant surge in referrals for vitamin D assessment in recent years. The cost-effectiveness and rationalization of this practice is uncertain. This study aimed to evaluate the referral pattern for vitamin D testing from a tertiary center in southern India. Materials and Methods: This was a cross-sectional study done over a period of one year (2017). A total of 95,750 individuals, referred for vitamin D screening were included in this study. Details regarding referring departments and indications for referral were obtained from the computerized hospital information processing system (CHIPS). Results: The study population exhibited a female preponderance (54.1%) with mean (SD) age of 40.3 (18.5) years. Overall, 44% were found to have vitamin D deficiency. Most of the referrals were from nephrology (15.4%), neurology (10.1%), and orthopedics (9.1%). Nevertheless, dermatology, the staff-clinic, and hematology which contributed to 3.3%, 1.7%, and 1.7% of referrals, had a higher proportion of vitamin D deficiency of 59.1%, 57.7%, and 64.6%, respectively. Although the most common indications for referral were generalized body aches (20.5%) and degenerative bone disorders (20.1%), the proportion of subjects with vitamin D deficiency referred for these indications were 46.1% and 41.6%, respectively. In contrast, chronic steroid use that accounted for 3.3% of the referrals had 59.1% of subjects who were deficient in vitamin D. Conclusion: To ensure a rational approach to vitamin D testing, clinicians ought to use their discretion to screen those truly at risk for vitamin D deficiency on a case to case basis and avoid indiscriminate testing of the same.
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Affiliation(s)
- A Jose
- Department of Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - A J Binu
- Internal Medicine, Christian Medical College and Hospital, Vellore, India
| | - K E Cherian
- Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - N Kapoor
- Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - H S Asha
- Endocrinology, Christian Medical College and Hospital, Vellore, India
| | - T V Paul
- Endocrinology, Christian Medical College and Hospital, Vellore, India
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Kholakiya Y, Jose A, Rawat A, Nagori SA, Jacob S, Roychoudhury A. Surgical management of oral submucous fibrosis with "Seagull-nasolabial flap" combined with short-term oral pentoxifylline for preventing relapse. J Stomatol Oral Maxillofac Surg 2020; 121:512-516. [PMID: 31904528 DOI: 10.1016/j.jormas.2019.12.015] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
The aim of the study was to evaluate the effectiveness of seagull-shaped nasolabial flap (NLF) along with adjunctive short-term oral pentoxifylline in the surgical reconstruction of oral sub mucous fibrosis (OSMF) following fibrotomy. We retrospectively evaluated 18 patients with grade IV oral sub mucous fibrosis treated by NLF. There were 3 females and 15 males. All patients were classified as stage IV OSMF with a mean preoperative mouth opening of 8.11±3.38mm. Postoperatively, patients were administered 400mg of pentoxifylline (PTX) thrice daily for 3 months. Patients were followed up at one month, six months and one year. Mouth opening, presence or absence of malignant transformation, relapse and complications were recorded at each follow-up. We found statistically significant increase in mouth opening from 8.11±3.3 to 37.67±3.74 in the postoperative period. The complications associated with NLF were very minimal. The PTX was well tolerated by all the patients. There was no incidence of relapse or rebound fibrosis seen in our series. To the best of our knowledge, this is the first time that oral pentoxifylline has been administered along with surgical treatment of oral submucous fibrosis to prevent relapse. The use of oral PTX as an adjunct along with surgical reconstruction in OSMF improves mouth opening, reduces burning sensation and relapse.
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Affiliation(s)
- Y Kholakiya
- Department of oral and maxillofacial surgery, All India institute of medical sciences, New Delhi, India
| | - A Jose
- Division of oral and maxillofacial surgery, Army dental centre research and referral, New Delhi, India.
| | - A Rawat
- Division of oral and maxillofacial surgery, Army dental centre research and referral, New Delhi, India
| | | | | | - A Roychoudhury
- Department of oral and maxillofacial surgery, All India institute of medical sciences, New Delhi, India
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Nagori S, Jose A, Roy I, Chattopadhyay P, Roychoudhury A. Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis. Int J Oral Maxillofac Surg 2019; 48:787-800. [DOI: 10.1016/j.ijom.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/10/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022]
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Radhakrishnan DM, Jose A, Kumar N, Warrier AR, Shree R. Retinal astrocytic hamartoma-ophthalmologic marker of tuberous sclerosis. QJM 2019; 112:451-452. [PMID: 30541150 DOI: 10.1093/qjmed/hcy288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D M Radhakrishnan
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - A Jose
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - N Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - A R Warrier
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - R Shree
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Panda P, Pattupara A, Jose A, Goel V. Cocktail treatment of antibiotic, steroid, and analgesic in a tubercular case; the urgency to set up antimicrobial stewardship practices in the community. J Family Med Prim Care 2019; 8:1789-1791. [PMID: 31198760 PMCID: PMC6559109 DOI: 10.4103/jfmpc.jfmpc_4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kumar N, Radhakrishnan D, Gogisetti Y, Jose A, Shree R. Acute onset vision loss as a presenting manifestation of carcinoma lung. Ann Indian Acad Neurol 2019; 23:407-409. [PMID: 32606558 PMCID: PMC7313616 DOI: 10.4103/aian.aian_82_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/26/2019] [Accepted: 03/12/2019] [Indexed: 11/05/2022] Open
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Kumar P, Jose A, Sharma A, Bagre V, Bhalla S. PO261 Need of Capacity Building In Hypertension Management of Primary Care Physicians In India. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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18
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Seguin L, Chaffanet M, Sabatier R, Jose A, Garnier S, Carbuccia N, Guille A, Birnbaum D, Bertucci F, Goncalves A. A major response to carboplatin in a metastatic triple-negative breast cancer patient with somatic mutation of BRCA1 and RAD51B: When chemotherapy meets precision medicine. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagori SA, Roy Chowdhury SK, Thukral H, Jose A, Roychoudhury A. Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review. J Oral Rehabil 2018; 45:810-818. [DOI: 10.1111/joor.12665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 01/18/2023]
Affiliation(s)
| | - S. K. Roy Chowdhury
- Division of Oral and Maxillofacial Surgery; Armed Forces Medical College; Pune India
| | - H. Thukral
- Department of Oral and Maxillofacial Surgery; Army Dental Centre (Research & Referral); Delhi Cantt-10; New Delhi India
| | - A. Jose
- Department of Oral and Maxillofacial Surgery; Army Dental Centre (Research & Referral); Delhi Cantt-10; New Delhi India
| | - A. Roychoudhury
- Department of Oral and Maxillofacial Surgery; All India Institute of Medical Sciences; New Delhi India
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Jose A, King C, Welt E, Shlobin O, Brown A, Aryal S, Weir N, Nathan S. Abnormal Invasive Pulmonary Hemodynamics Predict Outcomes in Exercising Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.117] [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: 10/17/2022] Open
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21
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Jose A, Nagori SA, Agarwal B, Roychoudhury A. Closed technique for naso-orbito-ethmoid fracture management: Technical note. J Stomatol Oral Maxillofac Surg 2017; 119:242-244. [PMID: 29246757 DOI: 10.1016/j.jormas.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/24/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
Trauma to the naso-orbito-ethmoid region invariably results in detachment of medial canthal tendon. The shape of medial canthus is of important esthetic and functional concern. Accurate reposition of the medial canthus is important to achieve normal form and function. The various available techniques advocate open approach leaving an obvious scar in the esthetically prominent region. This technique intends to address these fractures through a closed approach with the possibility to make finer adjustments as and when required. We report the experience of treating 4 naso-orbito-ethmoid fractures with a new innovative technique with predictable results.
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Affiliation(s)
- A Jose
- 15 Corps Dental Unit, c/o 56 APO, India.
| | | | - B Agarwal
- Department of Oral & Maxillofacial surgery, CDER, All India Institute of Medical Sciences, 110029 New Delhi, India.
| | - A Roychoudhury
- Department of Oral & Maxillofacial surgery, CDER, All India Institute of Medical Sciences, 110029 New Delhi, India
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22
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Jose A, Yiannoullou P, Bhutani S, Denley H, Morton M, Picton M, Summers A, van Dellen D, Augustine T. Renal Allograft Failure After Ipilimumab Therapy for Metastatic Melanoma: A Case Report and Review of the Literature. Transplant Proc 2017; 48:3137-3141. [PMID: 27932166 DOI: 10.1016/j.transproceed.2016.07.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
Transplant recipients are at an increased risk of malignant melanoma, a result of chronic immunosuppression. Ipilimumab is a newer biological agent targeting T lymphocytes to potentiate an immune response against melanoma, and the use of this agent results in a new adverse effect profile that the clinician must be aware of while a patient is on therapy. We report the case of a male renal transplant recipient who developed graft failure while treated with ipilimumab and minimal immunosuppressive therapy for metastatic ocular melanoma, with biopsy evidence of glomerulonephritis and acute rejection. We highlight the immunological side effects that can manifest from ipilimumab therapy and conclude that it did influence graft function in this patient. Our case illustrates the importance of weighing the risks and benefits to graft function and long-term survival as well as the importance of considering other treatment modalities in this specific group of melanoma patients.
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Affiliation(s)
- A Jose
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom.
| | - P Yiannoullou
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - S Bhutani
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - H Denley
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M Morton
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M Picton
- Department of Nephrology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - A Summers
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - D van Dellen
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - T Augustine
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
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Jose A, Cramer AK, Davar K, Gutierrez G. A case of drug-induced lupus erythematosus secondary to trimethoprim/sulfamethoxazole presenting with pleural effusions and pericardial tamponade. Lupus 2016; 26:316-319. [PMID: 27357280 DOI: 10.1177/0961203316657435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of drug-induced lupus erythematosus (DILE) secondary to trimethoprim/sulfamethoxazole (TMP/SMX) in a patient with underlying inflammatory bowel disease (IBD). The initial presentation was with febrile pleural and pericardial effusions followed by cardiac tamponade. The patient was treated with a short course of corticosteroids with complete resolution of symptoms. To our knowledge this is the first reported case of TMP/SMX-induced DILE presenting with life-threatening serositis. When confronted with sterile exudative effusions, clinicians should strongly consider non-infectious etiologies.
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Affiliation(s)
- A Jose
- Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University, Washington, DC, USA
| | - A K Cramer
- Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University, Washington, DC, USA
| | - K Davar
- Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University, Washington, DC, USA
| | - G Gutierrez
- Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University, Washington, DC, USA
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Ramage G, Lappin DF, Millhouse E, Malcolm J, Jose A, Yang J, Bradshaw DJ, Pratten JR, Culshaw S. The epithelial cell response to health and disease associated oral biofilm models. J Periodontal Res 2016; 52:325-333. [PMID: 27330034 PMCID: PMC5412879 DOI: 10.1111/jre.12395] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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] [Accepted: 04/30/2016] [Indexed: 02/03/2023]
Abstract
Background and Objective Different bacteria differentially stimulate epithelial cells. Biofilm composition and viability are likely to influence the epithelial response. In vitro model systems are commonly used to investigate periodontitis‐associated bacteria and their interactions with the host; therefore, understanding factors that influence biofilm–cell interactions is essential. The present study aimed to develop in vitro monospecies and multispecies biofilms and investigate the epithelial response to these biofilms. Material and Methods Bacterial biofilms were cultured in vitro and then either live or methanol‐fixed biofilms were co‐cultured with epithelial cells. Changes in epithelial cell viability, gene expression and cytokine content of culture supernatants were evaluated. Results Bacterial viability was better preserved within mixed‐species biofilm culture than within single‐species biofilm culture. Both mixed‐ and single‐species biofilms stimulated increased expression of mRNA for interleukin 8 (IL8), C‐X‐C motif chemokine ligand 3 (CXCL3), C‐X‐C motif chemokine ligand 1 (CXCL1), interleukin 1 (IL1), interleukin 6 (IL6), colony‐stimulating factor 2 (CSF2) and tumour necrosis factor (TNF), and the response was greatest in response to mixed‐species biofilms. Following co‐culture, cytokines detected in the supernatants included IL‐8, IL‐6, granulocyte colony‐stimulating factor and granulocyte–macrophage colony‐stimulating factor, with the greatest release of cytokines found following co‐culture with methanol‐fixed, mixed‐species biofilms. Conclusions These data show that epithelial cells generate a distinct cytokine gene‐ and protein‐expression signature in response to live or fixed, single‐ or multispecies biofilms.
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Affiliation(s)
- G Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK
| | - D F Lappin
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK
| | - E Millhouse
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK
| | - J Malcolm
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A Jose
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK.,GlaxoSmithKline Consumer Healthcare, St George's Avenue, Weybridge, Surrey, UK
| | - J Yang
- GlaxoSmithKline Consumer Healthcare, St George's Avenue, Weybridge, Surrey, UK
| | - D J Bradshaw
- GlaxoSmithKline Consumer Healthcare, St George's Avenue, Weybridge, Surrey, UK
| | - J R Pratten
- GlaxoSmithKline Consumer Healthcare, St George's Avenue, Weybridge, Surrey, UK
| | - S Culshaw
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, University of Glasgow, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Coco BJ, Bagg J, Cross LJ, Jose A, Cross J, Ramage G. MixedCandida albicansandCandida glabratapopulations associated with the pathogenesis of denture stomatitis. ACTA ACUST UNITED AC 2008; 23:377-83. [DOI: 10.1111/j.1399-302x.2008.00439.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jose A, Joseph MR. Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 2003; 21:147-51. [PMID: 14765615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
The purpose of this study was to know the prevalence and pattern of dental health problems in rural school children of Kerala and to identify the priority area for dental health education programmes. The children were examined and findings recorded. the findings show that more than 50% of the children in the 12 to 15 years of age group in rural Kerala suffers from some form of dental diseases. Males and females are equally affected and dental caries is the most common problem encountered.
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Affiliation(s)
- A Jose
- Department of Dental Surgery, M.O.S.C. Medical College, Kolenchery
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LóPez-Garcí P, Jose A, Abad P, Amils R. Genome Analysis of Different Haloferax mediterranei Strains Using Pulsed-Field Gel Electrophoresis. Syst Appl Microbiol 1993. [DOI: 10.1016/s0723-2020(11)80485-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Jose A, Crout JR, Kaplan NM. Suppressed plasma renin activity in essential hypertension. Roles of plasma volume, blood pressure, and sympathetic nervous system. Ann Intern Med 1970; 72:9-16. [PMID: 4312105 DOI: 10.7326/0003-4819-72-1-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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30
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Jose A. Plasma renin activity in the diagnosis of primary aldosteronism: failure to distinguish primary aldosteronism from essential hypertension. ACTA ACUST UNITED AC 1969. [DOI: 10.1001/archinte.123.2.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Jose A, Kaplan NM. Plasma renin activity in the diagnosis of primary aldosteronism: failure to distinguish primary aldosteronism from essential hypertension. Arch Intern Med 1969; 123:141-6. [PMID: 5812600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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