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Ogbebor O, Seth H, Min Z, Bhanot N. Guillain-Barré syndrome following the first dose of SARS-CoV-2 vaccine: A temporal occurrence, not a causal association. IDCases 2021; 24:e01143. [PMID: 33968610 PMCID: PMC8086372 DOI: 10.1016/j.idcr.2021.e01143] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 04/22/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 01/12/2023] Open
Abstract
Safety monitoring is of paramount importance for vaccines authorized for emergent use (EUA) by the US Food and Drug Administration (FDA) against SARS-CoV-2. Mass immunization is an essential tool to end the current pandemic, but vaccine surveillance is necessary to identify any potentially associated harms. At the same time, probability of temporal bias should be borne in mind before making conclusions about causality between the vaccine and an attributable undesired effect. We report a case of Guillain-Barré syndrome after the first dose of SARS-CoV-2 vaccine and believe this is a temporal, rather than causal association.
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Affiliation(s)
- Osakpolor Ogbebor
- Division of Infectious Disease, Medicine Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Harshit Seth
- Division of Hospitalist Medicine, Medicine Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Zaw Min
- Division of Infectious Disease, Medicine Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
| | - Nitin Bhanot
- Division of Infectious Disease, Medicine Institute, Allegheny Health Network, Pittsburgh, PA 15212, United States
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Kashyap R, Vashistha K, Saini C, Dutt T, Raman D, Bansal V, Singh H, Bhandari G, Ramakrishnan N, Seth H, Sharma D, Seshadri P, Daga MK, Gurjar M, Javeri Y, Surani S, Varon J. Critical care practice in India: Results of the intensive care unit need assessment survey (ININ2018). World J Crit Care Med 2020; 9:31-42. [PMID: 32577414 PMCID: PMC7298589 DOI: 10.5492/wjccm.v9.i2.31] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A diverse country like India may have variable intensive care units (ICUs) practices at state and city levels.
AIM To gain insight into clinical services and processes of care in ICUs in India, this would help plan for potential educational and quality improvement interventions.
METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed. A pan- India survey "Indian National ICU Needs" assessment (ININ 2018-I) was designed on google forms and deployed from July 23rd-August 25th, 2018. The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories (UTs). In addition to emails and phone calls, social medial applications-WhatsApp™, Facebook™ and LinkedIn™ were used to remind and motivate providers. By completing and submitting the survey, providers gave their consent for research purposes. This study was deemed eligible for category-2 Institutional Review Board exempt status.
RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24 (83% out of 29) states, and two (28% out of 7) UTs in 61 cities. They had median (IQR) 16 (10-25) beds and most, were mixed medical-surgical, 111(83%), with 108(81%) being adult-only ICUs. Representative responders were young, median (IQR), 38 (32-44) years age and majority, n = 108 (81%) were males. The consultants were, n = 101 (75%). A total of 77 (57%) reported to have 24 h in-house intensivist. A total of 68 (51%) ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio. More than 80% of the ICUs were open, and mixed type. Protocols followed regularly by the ICUs included sepsis care, ventilator- associated pneumonia (83% each); nutrition (82%), deep vein thrombosis prophylaxis (87%), stress ulcer prophylaxis (88%) and glycemic control (92%). Digital infrastructure was found to be poor, with only 46 % of the ICUs reporting high-speed internet availability.
CONCLUSION In this large, national, semi-structured, need-assessment survey, the need for improved manpower including; in-house intensivists, and decreasing patient-to-nurse ratios was evident. Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized. Additionally, subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Kirtivardhan Vashistha
- Department of Infectious Disease, Mayo Clinic, Rochester, MN 55905, United States
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, United States
| | - Chetan Saini
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 14061, United States
| | - Taru Dutt
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States and Department of Psychiatry, Hennepin County Medical Center, Minneapolis, MN 55415, United States
| | - Dileep Raman
- Department of Medicine, Cloud Physician Healthcare, Bangalore 560038, India
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Harpreet Singh
- Department of Internal Medicine, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi 110002, India
| | - Geeta Bhandari
- Department of Anesthesiology, Government Medical College, Haldwani, Nainital 263129, India
| | | | - Harshit Seth
- Department of Hospitalist Medicine, Allegany Clinic, Allegany Health Network, Pittsburgh, PA 15222, United States
| | - Divya Sharma
- Department of Medicine, MAAGF Healthcare, Chennai 600024, India
| | | | - Mradul Kumar Daga
- Department of Internal Medicine and Center for Occupational and Environment Health, Maulana Azad Medical College, New Delhi, Delhi 110002, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Yash Javeri
- Department of Critical Care Medicine, Regency Super Speciality Hospital, Lucknow 208005, India
- Nayati Healthcare, New Delhi, Delhi 110065, India
| | - Salim Surani
- Department of Pulmonary and Critical Care Medicine, Texas A&M University, College Station, TX 77843, United States
| | - Joseph Varon
- Department of Critical Care, United Memorial Medical Center, Houston, TX 77091, United States
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Vizlin-Hodzic D, Zhai Q, Illes S, Södersten K, Truvé K, Parris TZ, Sobhan PK, Salmela S, Kosalai ST, Kanduri C, Strandberg J, Seth H, Bontell TO, Hanse E, Ågren H, Funa K. Early onset of inflammation during ontogeny of bipolar disorder: the NLRP2 inflammasome gene distinctly differentiates between patients and healthy controls in the transition between iPS cell and neural stem cell stages. Transl Psychiatry 2017; 7:e1010. [PMID: 28117838 PMCID: PMC5545741 DOI: 10.1038/tp.2016.284] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
Neuro-inflammation and neuronal communication are considered as mis-regulated processes in the aetiology and pathology of bipolar disorder (BD). Which and when specific signal pathways become abnormal during the ontogeny of bipolar disorder patients is unknown. To address this question, we applied induced pluripotent stem cell (iPSC) technology followed by cortical neural differentiation on adipocyte-derived cells from BD type I patients (with psychotic episodes in psychiatric history) and healthy volunteers (controls). RNA sequencing in iPSC and cortical neural stem cell (NSC) lines were used to examine alterations between the transcriptomes from BD I and control samples during transition from the pluripotent stage towards the neural developmental stage. At the iPSC stage, the most highly significant differentially expressed gene (DEG) was the NLRP2 inflammasome (P=2.66 × 10-10). Also among 42 DEGs at the NSC stage, NLRP2 showed the strongest statistical significance (P=3.07 × 10-19). In addition, we have also identified several cytoskeleton-associated genes as DEGs from the NSC stage, such as TMP2, TAGLN and ACTA2; the former two genes are recognised for the first time to be associated with BD. Our results also suggest that iPSC-derived BD-cortical NSCs carry several abnormalities in dopamine and GABA receptor canonical pathways, underlining that our in vitro BD model reflects pathology in the central nervous system. This would indicate that mis-regulated gene expression of inflammatory, neurotransmitter and cytoskeletal signalling occurs during early fetal brain development of BD I patients.
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Affiliation(s)
- D Vizlin-Hodzic
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Q Zhai
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Illes
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Oncology Laboratory, Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Södersten
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Truvé
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Z Parris
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P K Sobhan
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Salmela
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S T Kosalai
- Institute of Biomedicine, Department of Medical Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Kanduri
- Institute of Biomedicine, Department of Medical Genetics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Strandberg
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Seth
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T O Bontell
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Hanse
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Ågren
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, SE 405 30 Gothenburg, Sweden E-mail:
| | - K Funa
- Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Oncology Laboratory, Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden,Oncology Laboratory, Department of Pathology, Sahlgrenska University Hospital, SE 413 45 Gothenburg, Sweden. E-mail:
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Deb S, Prasad KB, Seth H, Eagles JM. A comparison of obstetric and neonatal complications between children with autistic disorder and their siblings. J Intellect Disabil Res 1997; 41 ( Pt 1):81-86. [PMID: 9089463 DOI: 10.1111/j.1365-2788.1997.tb00680.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Sixty-one children had a diagnosis of autistic disorder according to the DSM3-R criteria in a population based study of mentally retarded children between the ages of 5 and 19 years in the Aberdeen city area of Scotland. Obstetric case records were traced for 36 out of these 61 autistic children. The obstetric case records of siblings of 30 of these autistic children were also traced. Modified versions of Prechtl's obstetric optimality scale along with that of Parnas were used to score pre-, peri- and neonatal obstetric complications in the autistic group and their normal sibling controls. A Spearman's correlation coefficient test between the scores of the Childhood Autism Rating Scale (CARS) and the Obstetric and Neonatal Complication (ONC) scores of all autistic children did not reveal any significant correlation. However, among the 20 severe autistic children, Spearman's test showed significant correlation between the scores of CARS and some ONC scores. Overall, no statistically significant difference between the autistic children and their siblings in the scores of obstetric optimality was detected by using the Wilcoxon test.
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Affiliation(s)
- S Deb
- Welsh Centre for Learning Disabilities, University of Wales College of Medicine, Cardiff, Wales
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