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Connors C, Gupta K, Khusid JA, Khargi R, Yaghoubian A, Levy M, Gallante B, Atallah W, Gupta M. Evaluation of the Current Status of Artificial Intelligence for Endourology Patient Education: A Blind Comparison of ChatGPT and Google Bard against Traditional Information Resources. J Endourol 2024. [PMID: 38441078 DOI: 10.1089/end.2023.0696] [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: 03/06/2024] Open
Abstract
Introduction Artificial intelligence (AI) platforms such as ChatGPT and Bard are increasingly utilized to answer patient healthcare questions. We present the first study to blindly evaluate AI-generated responses to common endourology patient questions against official patient education materials. Methods 32 questions and answers spanning kidney stones, ureteral stents, BPH, and UTUC were extracted from official Urology Care Foundation (UCF) patient education documents. The same questions were input into ChatGPT 4.0 and Bard, limiting responses to within 10% of the word count of the corresponding UCF response to ensure fair comparison. Six endourologists blindly evaluated responses from each platform using Likert scales for accuracy, clarity, comprehensiveness, and patient utility. Reviewers identified which response they believed was not AI-generated. Lastly, Flesch-Kincaid Reading Grade Level formulas assessed the readability of each platform response. Ratings were compared using ANOVA and Chi-Square tests. Results ChatGPT responses were rated the highest across all categories including accuracy, comprehensiveness, clarity, and patient utility while UCF answers were consistently scored the lowest, all p<0.01. Sub-analysis revealed that this trend was consistent across question categories (i.e., kidney stones, BPH, etc.). However, AI-generated responses were more likely to be classified at an advanced reading level while UCF responses showed improved readability (college or higher reading level: ChatGPT = 100%, Bard = 66%, UCF = 19%), p<0.001. When asked to identify which answer was not AI-generated, 54.2% of responses indicated ChatGPT, 26.6% indicated Bard, and only 19.3% correctly identified it as the UCF response. Conclusions In a blind evaluation, AI-generated responses from ChatGPT and Bard surpassed the quality of official patient education materials in endourology, suggesting that current AI platforms are already a reliable resource for basic urologic care information. AI-generated responses do, however, tend to require a higher reading level, which may limit their applicability to a broader audience.
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Affiliation(s)
- Christopher Connors
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Kavita Gupta
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Johnathan Alexander Khusid
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574;
| | - Raymond Khargi
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Alan Yaghoubian
- University of California Los Angeles David Geffen School of Medicine, 12222, Urology, Los Angeles, California, United States;
| | - Micah Levy
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave L. Levy Place, New York, New York, United States, 10029;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 425 W. 59th Street, Suite 4F, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Mantu Gupta
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
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Gassmann K, Gupta K, Khargi R, Ricapito A, Yaghoubian AJ, Atallah WM, Gallante B, Gupta M. Review of efficacy and safety of same-day discharge after percutaneous nephrolithotomy. Am J Clin Exp Urol 2024; 12:8-17. [PMID: 38500868 PMCID: PMC10944367] [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] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Prior literature reviews have assessed the efficacy and safety of outpatient percutaneous nephrolithotomy (PCNL) with "outpatient" defined as discharge within twenty-four hours of surgery. To our knowledge, this is the first literature review analyzing ambulatory PCNLs (aPCNL) defined as hospital discharge on the same day as surgery. This review aims to assess the efficacy and safety of same-day discharge after PCNL. METHODS We conducted a search in the PubMed database for key search terms including "ambulatory PCNL", "ambulatory percutaneous nephrolithotomy", "outpatient PCNL", "outpatient percutaneous nephrolithotomy", and "day surgery percutaneous nephrolithotomy". We reviewed articles defining "ambulatory" as discharge the same day the PCNL was performed. 13 papers were identified in our search. RESULTS Overall, we found no difference in complication rates, emergency department visits, and postoperative admissions when comparing outpatient PCNL to inpatient PCNL, and to previously published statistics for inpatient PCNL. Some studies even showed lower rates of adverse outcomes in ambulatory cohorts when compared to inpatient cohorts. Additionally, ambulatory PCNL conferred significant healthcare savings over inpatient PCNL. CONCLUSION This literature review suggests that ambulatory PCNL can be safely performed in both optimal and suboptimal surgical candidates with no significant increase in complications. Additional high-quality studies are warranted to further the evidence surrounding outpatient PCNL and its outcomes.
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Affiliation(s)
- Kyra Gassmann
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Kavita Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Raymond Khargi
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Anna Ricapito
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Alan J Yaghoubian
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Blair Gallante
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai New York, NY, USA
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Ho K, Zhu D, Gupta K, Loloi J, Abramson M, Watts K, Agalliu I, Sankin A. Performance of cognitive vs. image-guided fusion biopsy for detection of overall and clinically significant prostate cancer in a multiethnic population. Urol Oncol 2024; 42:29.e1-29.e8. [PMID: 38114350 DOI: 10.1016/j.urolonc.2023.11.005] [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: 08/16/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Transrectal ultrasound-guided prostate biopsy remains the most used method for the detection of prostate cancer. We recently reported that detection of clinically significant prostate cancer (cs-CaP) using image-guided fusion biopsies (IGFB) varied by race/ethnicity, which calls for further comparison between cognitive fusion biopsy (CFB) and IGFB among non-Hispanic black and Hispanic populations. Therefore, the aim of our study is to compare the rates of detection of cs-CaP and overall CaP by CFB and IGFB in a multiethnic community. MATERIAL AND METHODS We performed a retrospective, cross-sectional review of men who underwent MRI-transrectal ultrasound-guided prostate biopsy at our diverse, urban academic medical center. Agreement and discordance between fusion biopsies and systematic biopsies for detection of cs-CaP and overall CaP were determined using Kappa statistics. Univariate and multivariate mixed-effects logistic regression models were used to find associations between fusion modalities and prostate cancer detection. RESULTS In total, 710 men underwent fusion prostate biopsies between December 2015 and June 2021. Upon univariate and multivariate logistic regression analysis, there was no significant association between IGFB vs. CFB and risk of overall CaP (OR = 0.66, 95% CI: 0.36-1.21, P = 0.18) or cs-CaP (OR = 0.57, 95% CI: 0.30-1.08, P = 0.09). We found moderate agreement between fusion and systematic biopsies for both CFB (κ = 0.56) and IGFB (κ = 0.52) in cs-CaP. CONCLUSIONS CFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. CFB represents an effective and accessible means of accurately diagnosing prostate cancer.
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Affiliation(s)
- Kevin Ho
- Albert Einstein College of Medicine, Bronx, NY
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Kavita Gupta
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Justin Loloi
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - Kara Watts
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Ilir Agalliu
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Alexander Sankin
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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Swetha PS, Gupta K, Saha S, Panda SK, Behera B. Predictors for multidrug-resistant organisms (MDROs) carriage in haemodialysis patients. J Family Med Prim Care 2024; 13:486-491. [PMID: 38605748 PMCID: PMC11006063 DOI: 10.4103/jfmpc.jfmpc_708_23] [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: 04/29/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction Infections in haemodialysis (HD) patients are an important cause of morbidity, hospitalization, and mortality. Patients undergoing HD are more prone to develop bacterial infections by multidrug-resistant organisms (MDROs). Objectives This study is aimed to detect MDROs colonization in HD patients and its associated risk factors and outcome. Methodology A total of 62 nasal swabs and 124 rectal swabs were collected from 62 patients coming to the haemodialysis unit from of March to May 2021 and were further screened for MRSA, VRE and CRE. Results Out of 62 patients, 22.59% showed the presence of methicillin-resistant staphylococcus aureus (MRSA) while VRE was present in four patients (4/62). CRE was found as 24.2% (15/62). Duration of dialysis was found as a significant risk factor-associated MRSA carriage, Whereas Charlson index and drug and medication were found as significant risk factor for VRE carriage. Discussion & Conclusion HD patients are particularly vulnerable to life threatening infections. Therefore, continuous epidemiological surveillance for these MDROs, including genotypic analysis and implementation of adequate decolonization strategies, is crucial and will reduce the possibility of autoinfection as well as disrupt transmission of multi-resistant isolates to others.
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Affiliation(s)
| | - Kavita Gupta
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India
| | | | | | - Bijayini Behera
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India
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Mohanty M, Mishra B, Satapathy AK, Gulla KM, Das RR, Dwibedi B, Gupta K, Mamidi P, Panda S. Human Bocavirus infection in childhood acute respiratory infection: Is it an innocent bystander? Indian J Med Microbiol 2023; 46:100436. [PMID: 37945128 DOI: 10.1016/j.ijmmb.2023.100436] [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: 04/19/2023] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Acute respiratory infection (ARI) is one of the major attributing factors of under-five mortality and morbidity all over the world. Viruses are the most common cause of ARI. Due to the availability of molecular techniques, new viruses are getting isolated from children with ARI. With the above background, the present study was conducted to enlighten on the pathogenic role of human bocavirus (HBoV) in children with ARI. METHODOLOGY This retrospective study was conducted over a period of >3 years duration. The clinical and laboratory data of the patients with signs and symptoms of ARI were retrieved and analyzed. Clinical profiles and outcome of the patients detected of having HBoV mono or co-infections were further analyzed in details. RESULTS A total of 237 respiratory samples were subjected to respiratory panel by fast track diagnosis (FTD) multiplex polymerase chain reaction (multiplex PCR), of which 10 samples (mono-infection = 4) were detected with the presence of HBoV. The clinical details of 8 cases were studied in details (details of rest 2 cases were missing). All the children were less than 3 years of age, with different co-morbid conditions such as low birth weight (n = 4), cholestatic jaundice (n = 1), operated case of congenital diaphragmatic hernia (n = 1), pancytopenia (n = 1), and primary immune deficiency (n = 1). Their clinical course did not improve following antibiotic administration, 2 succumbed to death while the rest 6 cases were discharged. CONCLUSION The present study highlights the fact that HBoV may not be an innocent bystander in the childhood ARI. Larger studies employing appropriate diagnostic modalities are needed to emboss it as a true pathogen and not merely a bystander.
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Affiliation(s)
- Monalisa Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Amit Kumar Satapathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Bhagirathi Dwibedi
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Kavita Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Prabhudutta Mamidi
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Sailendra Panda
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
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Rath S, Kar P, Gupta K, Som TK. Congenital syphilis: Toward elimination or resurgence?? J Family Med Prim Care 2023; 12:3000-3001. [PMID: 38186778 PMCID: PMC10771195 DOI: 10.4103/jfmpc.jfmpc_337_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Sutapa Rath
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Punyatoya Kar
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kavita Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tapas K. Som
- Department of Neonatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Khargi R, Bamberger JN, Ricapito A, Gupta K, Yaghoubian AJ, Khusid JA, Gallante B, Atallah WM, Gupta M. Comprehensive analysis of factors associated with significant blood loss during percutaneous nephrolithotomy. Am J Clin Exp Urol 2023; 11:420-428. [PMID: 37941646 PMCID: PMC10628626] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The objective of this study is to conduct a thorough investigation of the risk factors associated with blood loss during PCNL, within the setting of a US urban tertiary care center. MATERIALS AND METHODS We conducted a retrospective analysis of our endourology database to identify adult patients who underwent PCNL for stone extraction at our tertiary stone center between October 2014 and December 2022. Patients were categorized into two groups based on the extent of blood loss: significant blood loss (SBL) and no significant blood loss (NSBL). The cut-off value for SBL was determined as the median change in hematocrit levels from preoperative to postoperative among patients who required postoperative transfusions. Several factors were evaluated, including stone dimensions, operative details, the presence of preoperative drains, patient position, type of access, access site, number of accesses, tract size, tract length, stone location, number of stones, operative time, and the S.T.O.N.E. Nephrolithometry Scoring System. RESULTS Our analysis included a total of 695 procedures performed on 674 distinct patients who met our inclusion criteria. Of these, 102 patients (14.7%) were included in the SBL group. Patients in the SBL group had a higher mean number of accesses (1.57 vs. 1.29, P<0.001), were positioned prone more often (96.0% vs. 88.6%, P = 0.025), and underwent fluoroscopic-guided access more frequently (89.9% vs. 64.8%, P<0.001). Additionally, significant differences were observed in stone morphology, with the SBL group having higher rates of complete staghorn stones (42.2% vs. 27.0%, P = 0.019) and lower rates of partial staghorn stones (27.7% vs. 36.8%, P = 0.019). A larger proportion of patients in the SBL group required a 16 French nephrostomy tube for postoperative drainage (13.3% vs. 10.4%, P = 0.041). Lastly, the SBL group had a longer mean operative time compared to the NSBL group (P<0.001). Multiple logistic regression analysis identified stone volume (P = 0.039), number of accesses (P = 0.047), and operative time (P = 0.006) as independent risk factors associated with SBL status. CONCLUSION Surgical complexity factors such as stone volume, number of accesses, and operative time are linked to a higher risk of SBL during PCNL. Stone volume and the requirement for multiple accesses can usually be estimated with reasonable accuracy before surgery.
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Affiliation(s)
- Raymond Khargi
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Jacob N Bamberger
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
- Department of Urology, SUNY Downstate Health Sciences UniversityBrooklyn, NY, USA
| | - Anna Ricapito
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
- Department of Urology and Transplant, University of FoggiaFoggia, Italy
| | - Kavita Gupta
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Alan J Yaghoubian
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Blair Gallante
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
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Flammini D, Chaudhary A, Colangeli A, Fonnesu N, Guirao J, Gupta K, Kalwale S, Mariano G, Moro F, Previti A, Quatrevaux M, Shigin P, Udintsev V, Villari R. Neutronic analyses for the equatorial diagnostic port plug #12 in ITER. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Gupta R, Gupta P, Gupta K, Chandra D, Singh MK, Arora N, Rahman K. Nodular lymphocyte predominant Hodgkin lymphoma: An unusual case with peripheral blood atypical T-cell lymphocytosis. Int J Lab Hematol 2023; 45:586-588. [PMID: 36710455 DOI: 10.1111/ijlh.14027] [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] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Affiliation(s)
- R Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - P Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - K Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - D Chandra
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - M K Singh
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - N Arora
- Unipath Specialty Laboratory, Ahmedabad, India
| | - K Rahman
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Patel M G, Nidhi , Gupta K, Gupta M, Gupta S, Krupa S. THE IMPACT OF CLIMATE CHANGE ON INFECTIOUS DISEASES: A COMPREHENSIVE ANALYSIS OF VECTOR-BORNE DISEASES, WATER-BORNE DISEASES, AND PUBLIC HEALTH STRATEGIES. Georgian Med News 2023:136-142. [PMID: 37805887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Climate change is long-term modifications to weather patterns and a rise in extreme weather events. It might modify the hazard to human health and exacerbate current problems. The article explores the scientific data in a description of the effects of Infectious diseases in humans and climate change. It identifies scientific advancements and gaps in potential responses from human civilization and how it might prepare for the changes that come with it by adjusting to them. The impact reflects three aspects, such as climate variables, selected infectious diseases, and infectious disease components. This study demonstrates how vulnerable people are to any ill consequences that climate change may have on their health. Humans can actively influence controllable correlated health impacts by taking proactive measures, such as increasing our understanding of the detrimental effects associated with specific diseases and the patterns in climate change. We can also carefully distribute technology and resources, encouraging exercise and public awareness. It is advised to take the following adaption measures: Considering how infectious diseases and climate change are not the only things that science has discovered and create locally efficient early warning systems for those effects to produce more scientific justifications and go beyond scientific reports. Improve prediction of the spatiotemporal processes behind climate change and changes in infectious illnesses connected at different temporal and spatial scales.
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Affiliation(s)
- G Patel M
- 1Department of Community Medicine, Parul University, PO Limda, Tal.Waghodia, District Vadodara, Gujarat, India
| | - - Nidhi
- 2Department of Nursing, IIMT University, Meerut, Uttar Pradesh, India
| | - K Gupta
- 3Department of Ayurveda, Sanskriti University, Mathura, Uttar Pradesh, India
| | - M Gupta
- 4Department of Pharmacy, Vivekananda Global University, Jaipur, India
| | - S Gupta
- 5Department of Community Medicine, TeerthankerMahaveer University, Moradabad, Uttar Pradesh, India
| | - S Krupa
- 6Department of Chemistry & Biochemistry, School of Sciences, JAIN (Deemed-to-be University), Karnataka, India
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Gupta S, Maitra S, Farooqi AS, Gupta K, Wetpiriyakul P, Pereira M, Durbin-Johnson B, Gupta MC. Impact of implant metal type and vancomycin prophylaxis on postoperative spine infection: an in-vivo study. Spine Deform 2023; 11:815-823. [PMID: 36920741 DOI: 10.1007/s43390-023-00674-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE To evaluate the effectiveness of vancomycin prophylaxis on spinal implant metal types. METHODS 42 rabbits underwent posterior, single-level instrumentation at L5-L6 with stainless steel (n = 18), cobalt chrome (n = 12), or titanium (n = 12) wire. All implants were inoculated with 1 × 106 colony forming units (CFU) of methicillin-resistant S. Aureus (MRSA). In the intrawound vancomycin subgroup (n = 18, 6 from each metal type), 40 mg of vancomycin powder was placed in the wound. In the IV vancomycin subgroup (n = 6, all stainless steel), 15 mg/kg of IV vancomycin was given preoperatively. Local soft tissue and implants were harvested 1-week postoperatively and separately cultured. RESULTS Intrawound vancomycin significantly reduced the rate of soft tissue infection (44.4% vs 100%) and implant infection (27.8% vs 100%) (p < 0.001). Within the intrawound vancomycin subgroup, cobalt chrome implants were associated with higher median soft tissue MRSA growth (130 CFU) than stainless steel (0 CFU) or titanium (0 CFU) (p = 0.02). Cobalt chrome implants were also more likely to develop soft tissue MRSA infection (83.3%) as compared to stainless steel (16.7%) or titanium (33.3%) (p = 0.04). Median soft tissue MRSA growth among stainless steel implants without prophylaxis, with IV vancomycin, and with vancomycin powder was 1.18 × 107, 195, and 0 CFU, respectively. The rate of soft tissue MRSA infection without prophylaxis, with IV vancomycin, and with vancomycin powder was 100, 66.7, and 16.7%, respectively (p = 0.015). CONCLUSION Intrawound vancomycin is more effective than IV vancomycin and effectively reduces the risk of infection, but is less effective in cobalt chrome implants due to residual soft tissue infection.
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Affiliation(s)
- Sachin Gupta
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Sukanta Maitra
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Ali S Farooqi
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA
| | - Kavita Gupta
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Pumibal Wetpiriyakul
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Maria Pereira
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Blythe Durbin-Johnson
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Kaur V, Singh M, Wankhede DP, Gupta K, Langyan S, Aravind J, Thangavel B, Yadav SK, Kalia S, Singh K, Kumar A. Diversity of Linum genetic resources in global genebanks: from agro-morphological characterisation to novel genomic technologies - a review. Front Nutr 2023; 10:1165580. [PMID: 37324736 PMCID: PMC10267467 DOI: 10.3389/fnut.2023.1165580] [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: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Linseed or flaxseed is a well-recognized nutritional food with nutraceutical properties owing to high omega-3 fatty acid (α-Linolenic acid), dietary fiber, quality protein, and lignan content. Currently, linseed enjoys the status of a 'superfood' and its integration in the food chain as a functional food is evolving continuously as seed constituents are associated with lowering the risk of chronic ailments, such as heart diseases, cancer, diabetes, and rheumatoid arthritis. This crop also receives much attention in the handloom and textile sectors as the world's coolest fabric linen is made up of its stem fibers which are endowed with unique qualities such as luster, tensile strength, density, bio-degradability, and non-hazardous nature. Worldwide, major linseed growing areas are facing erratic rainfall and temperature patterns affecting flax yield, quality, and response to biotic stresses. Amid such changing climatic regimes and associated future threats, diverse linseed genetic resources would be crucial for developing cultivars with a broad genetic base for sustainable production. Furthermore, linseed is grown across the world in varied agro-climatic conditions; therefore it is vital to develop niche-specific cultivars to cater to diverse needs and keep pace with rising demands globally. Linseed genetic diversity conserved in global genebanks in the form of germplasm collection from natural diversity rich areas is expected to harbor genetic variants and thus form crucial resources for breeding tailored crops to specific culinary and industrial uses. Global genebank collections thus potentially play an important role in supporting sustainable agriculture and food security. Currently, approximately 61,000 germplasm accessions of linseed including 1,127 wild accessions are conserved in genebanks/institutes worldwide. This review analyzes the current status of Linum genetic resources in global genebanks, evaluation for agro-morphological traits, stress tolerance, and nutritional profiling to promote their effective use for sustainable production and nutrition enhancement in our modern diets.
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Affiliation(s)
- Vikender Kaur
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Mamta Singh
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Dhammaprakash Pandhari Wankhede
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Kavita Gupta
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Sapna Langyan
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Jayaraman Aravind
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Boopathi Thangavel
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Shashank Kumar Yadav
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Sanjay Kalia
- Department of Biotechnology, Ministry of Science and Technology, Government of India, New Delhi, India
| | - Kuldeep Singh
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Ashok Kumar
- Division of Germplasm Evaluation, Indian Council of Agricultural Research-National Bureau of Plant Genetic Resources, New Delhi, India
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Schulz AE, Green BW, Gupta K, Patel RD, Loloi J, Raskolnikov D, Watts KL, Small AC. Management of large kidney stones in the geriatric population. World J Urol 2023; 41:981-992. [PMID: 36856833 DOI: 10.1007/s00345-023-04333-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population. METHODS PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments. RESULTS Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates. CONCLUSIONS Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population.
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Affiliation(s)
| | | | - Kavita Gupta
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Rutul D Patel
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Justin Loloi
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Dima Raskolnikov
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Kara L Watts
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA
| | - Alexander C Small
- Montefiore Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Bronx, NY, 10461, USA.
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Liu Kot K, Labagnara K, Kim JI, Loloi J, Gupta K, Agalliu I, Small AC. Evaluating the American Urologic Association (AUA) dietary recommendations for kidney stone management using the National Health And Nutritional Examination Survey (NHANES). Urolithiasis 2023; 51:60. [PMID: 36976362 DOI: 10.1007/s00240-023-01423-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
Abstract
The objective of this study is to evaluate the conventional dietary recommendations for stone prevention among patients in the National Health and Nutritional Examination Survey (NHANES) and compare dietary components and special diets between stone formers and non-stone formers. We analyzed the NHANES 2011-2018 dietary and kidney condition questionnaires, among 16,939 respondents who were included in this analysis. Dietary variables were selected based on the American Urological Association (AUA) guideline for Medical Management of Kidney Stones and from other studies on kidney stone prevention. Weighted multivariate logistic regression models were used to assess the relationship of dietary food components (categorized into quartiles) and dietary recommendations with kidney stone formation (yes vs no), adjusted for total caloric intake, comorbidities, age, race/ethnicity, and sex. The prevalence of kidney stones was 9.9%. Our results showed association of kidney stones with lower levels of potassium (p for trend = 0.047), which was strongest for < 2000 mg (OR = 1.35; 95% CI 1.01-1.79). Higher vitamin C intake was inversely associated with stone formation (p for trend = 0.012), particularly at daily intake levels between 60 and 110 mg (OR = 0.76; 95% CI 0.60-0.95) and above 110mcg (OR = 0.80; 95% CI 0.66-0.97). There were no associations between other dietary components and kidney stone formation. Higher levels of dietary vitamin C and potassium intake may be indicated for stone prevention and warrants further investigation.
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Affiliation(s)
- Kevin Liu Kot
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
| | - Kevin Labagnara
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Joseph I Kim
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Justin Loloi
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kavita Gupta
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Ilir Agalliu
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alexander C Small
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Gupta K, Feiertag N, Jacobs D, Abramson M, Alaimo A, Harris A, Small AC, Watts K. Implementation and Usability of an Electronic Medical Record-based Ureteral Stent Tracker. Urology 2023; 173:81-86. [PMID: 36572224 DOI: 10.1016/j.urology.2022.12.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To design and implement a simple electronic medical record-based ureteral stent tracker. To assess its impact on stent dwell time and stent-related complications. METHODS Patients with stents placed 12 months before and 6 months after stent tracker implementation were identified at 3 urban hospitals. Those with stents-on-strings and intentional chronic indwelling stents (greater than 90 days) were excluded. Patient demographics, stent characteristics (eg, indication, string, dwell time), and clinical outcomes (eg, positive urine cultures, complications) were reviewed and compared between pre- and posttracker cohorts. A 12-question usability survey was administered to surgical nurses to assess usability. RESULTS A total of 323 stents (173 pre- and 150 posttracker) were placed in 217 patients. The prestent tracker cohort had a longer mean dwell time (pre: 40.9 ± 59.1 days vs post: 28.8 ± 22.0 days, P = .02) and a higher retention rate >90 days (pre: 8.1% [14/173] vs post: 1.3% [2/150], P = .005). The 2 cohorts had no significant differences in positive urine culture rates, patient phone calls to providers, stent-related emergency department visits, or hospitalizations. The usability survey showed that 86.4% of surgical nurses found the tracker to be user-friendly and 95.5% reported that it added less than 1 minute of work per procedure. CONCLUSION Implementation of an electronic medical record-based ureteral stent tracker decreased average stent dwell time and frequency of retained stents. Surgical nurses reported the tracker to be user-friendly and convenient. Stent trackers can improve the efficiency of postoperative removal of indwelling ureteral stents.
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Affiliation(s)
- Kavita Gupta
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Max Abramson
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angela Alaimo
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Andrew Harris
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Kara Watts
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
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Morsy MA, Gupta S, Dora CP, Jhawat V, Dhanawat M, Mehta D, Gupta K, Nair AB, El-Daly M. Venoms classification and therapeutic uses: a narrative review. Eur Rev Med Pharmacol Sci 2023; 27:1633-1653. [PMID: 36876699 DOI: 10.26355/eurrev_202302_31408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The mere glimpse of venomous animals has always terrified humans because of the devastating effects of their venoms. However, researchers across the globe have isolated therapeutically active ingredients from these venoms and continue to explore them for drug leads. These efforts lead to the discovery of therapeutic molecules that the US-FDA has approved to treat different diseases, such as hypertension (Captopril), chronic pain (Ziconotide), and diabetes (Exenatide). The main active constituents of most venoms are proteins and peptides, which gained more attention because of advancements in biotechnology and drug delivery. The utilization of newer screening approaches improved our understanding of the pharmacological complexity of venom constituents and facilitated the development of novel therapeutics. Currently, with many venom-derived peptides undergoing different phases of clinical trials, more are in pre-clinical drug development phases. This review highlights the various sources of venoms, their pharmacological actions, and the current developments in venom-based therapeutics.
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Affiliation(s)
- M A Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia.
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Agrawal P, Gupta K, Nikhra P, Jain M, Pandey M, Pandey A. Significance of Immunohistochemistry Testing in the Diagnosis and Subtyping of Lung Carcinomas- A Retrospective Study from a Tertiary Care Centre in Southern Rajasthan. NJLM 2023. [DOI: 10.7860/njlm/2023/55489.2698] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: In the present era, the classification of lung carcinoma is not confined to Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC). Precise subtyping of lung carcinoma has a direct impact on patient management and prognosis. Further molecular study helps in identifying adenocarcinoma receptors, such as Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK), which are useful in targeted therapy. Aim: To assess the role of Immunohistochemistry (IHC) in accurate diagnosis and subtyping of lung carcinoma and to analyse the prevalence of EGFR mutations and ALK rearrangement in lung adenocarcinoma. Materials and Methods: A retrospective hospital-based, observational study was conducted at the Department of Pathology of American International Institute of Medical Sciences, Udaipur, Rajasthan from January 2020 to August 2021. Total of 105 cases of guided core needle biopsies from lung and bronchoscopic biopsies were included. IHC markers were applied based on histopathological diagnosis from a panel of p63, Cytokeratin 7 (CK7), AE1/AE3, Thyroid Transcription Factor (TTF1), Napsin A, p40, synaptophysin, chromogranin, CD56 and Ki67. Adenocarcinoma cases were further analysed for EGFR mutations and ALK rearrangements. Data was tabulated and analysed statistically using Microsoft Excel to determine the percentage frequency distribution of cases. Results: Among 105, there were 88 males and 17 females and the mean age of the population was 60.57 years. The most prevalent subtype of lung malignancy was squamous cell carcinoma (44.7%) followed by adenocarcinoma (29.5%). The diagnostic accuracy of squamous cell carcinomas and adenocarcinomas on morphology was 93.1% and 84.6%, respectively and for small cell carcinoma it was 100%. Amongst 28 cases of adenocarcinoma, EGFR mutation was found in 46.42% cases whereas ALK mutation was found only in 21.42% cases. Conclusion: The study highlights the importance of IHC, and a substantial prevalence of EGFR mutations was found in patients with lung carcinoma.
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Gupta K, Feiertag N, Gottlieb J, Kase J, Zhu D, Green B, Small A, Watts K. Imaging After Ureteroscopy: Practice Patterns, Patient Adherence and Impact on Subsequent Management in an Urban Academic Hospital System. Urology 2023; 171:49-56. [PMID: 36265551 DOI: 10.1016/j.urology.2022.08.056] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate practice patterns of post-ureteroscopy (URS) imaging, to assess predictors of imaging order, type and completion, and to analyze impact on patient management. METHODS We conducted a retrospective review of patients who underwent URS for nephrolithiasis at a single institution between May, 2020 to May, 2021. Patient demographic, clinical and operative characteristics were reviewed, and surgeons' years in practice. Post-URS imaging studies less than 6 months post-operative were reviewed. Changes in patient management were defined as additional imaging tests ordered or subsequent unplanned surgery. Patient, provider and surgical variables were compared between those who had imaging ordered and those who did not. RESULTS A total of 289 patients underwent URS. About 234 (81.0%) had post-operative imaging ordered; 147 (62.8%) completed them. Baseline demographics, stone and surgical variables were similar among those who did and did not have imaging ordered and among patients who completed imaging and did not. Pre-operative hydronephrosis was associated with ordering of post-operative imaging (OR = 4.08, P = .01). Urologists in practice less than 5 years were more likely to order post-operative imaging compared to those in practice for more than 5 years (<5: 90.6%, 15+: 53.7%; P <.001). Management changed for 52 of 147 (35.4%) patients who completed imaging; additional imaging was ordered for 38 patients (25.9%) and a second, unplanned surgery was performed for 14 (9.5%). CONCLUSION The main predictive factor of ordering post-URS imaging was surgeons' time in practice and pre-operative hydronephrosis. Post-operative imaging changed management in 35.4% of patients. We recommend the development of guidelines encouraging routine imaging for patients following ureteroscopy.
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Affiliation(s)
- Kavita Gupta
- Department of Urology, Montefiore Medical Center
| | | | | | | | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY
| | | | - Alexander Small
- Department of Urology, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, NY
| | - Kara Watts
- Department of Urology, Montefiore Medical Center; Albert Einstein College of Medicine, Bronx, NY.
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Sharma M, Marodia Y, Singh AK, Kurdia K, Gupta K, Sandhu MS. Gastrointestinal: An unusual cause of biliary obstruction in a case of Peutz-Jeghers syndrome. J Gastroenterol Hepatol 2023; 38:8. [PMID: 35643980 DOI: 10.1111/jgh.15890] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Affiliation(s)
- M Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Y Marodia
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Kurdia
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M S Sandhu
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Talukder R, Makrakis D, Lin GI, Diamantopoulos LN, Dawsey S, Gupta S, Carril-Ajuria L, Castellano D, de Kouchkovsky I, Jindal T, Koshkin VS, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Tripathi N, Agarwal N, Vather-Wu N, Zakharia Y, Morales-Barrera R, Devitt ME, Cortellini A, Fulgenzi CAM, Pinato DJ, Nelson A, Hoimes CJ, Gupta K, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Murgic J, Fröbe A, Rodriguez-Vida A, Drakaki A, Liu S, Lu E, Kumar V, Lorenzo GD, Joshi M, Isaacsson-Velho P, Buznego LA, Duran I, Moses M, Barata P, Sonpavde G, Wright JL, Yu EY, Montgomery RB, Hsieh AC, Grivas P, Khaki AR. Association of the Time to Immune Checkpoint Inhibitor (ICI) Initiation and Outcomes With Second Line ICI in Patients With Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2022; 20:558-567. [PMID: 36155169 PMCID: PMC10233855 DOI: 10.1016/j.clgc.2022.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early progression on first-line (1L) platinum-based therapy or between therapy lines may be a surrogate of more aggressive disease and poor outcomes in advanced urothelial carcinoma (aUC), but its prognostic role regarding immune checkpoint inhibitor (ICI) response and survival is unclear. We hypothesized that shorter time until start of second-line (2L) ICI would be associated with worse outcomes in aUC. PATIENTS AND METHODS We performed a retrospective multi-institution cohort study in patients with aUC treated with 1L platinum-based chemotherapy, who received 2L ICI. Patients receiving switch maintenance ICI were excluded. We defined time to 2L ICI therapy as the time between the start of 1L platinum-based chemotherapy to the start of 2L ICI and categorized patients a priori into 1 of 3 groups: less than 3 months versus 3-6 months versus more than 6 months. We calculated overall response rate (ORR) with 2L ICI, progression-free survival (PFS) and overall survival (OS) from the start of 2L ICI. ORR was compared among the 3 groups using multivariable logistic regression, and PFS, OS using cox regression. Multivariable models were adjusted for known prognostic factors. RESULTS We included 215, 215, and 219 patients in the ORR, PFS, and OS analyses, respectively, after exclusions. ORR difference did not reach statistical significance between patients with less than 3 months versus 3-6 months versus more than 6 months to 2L ICI. However, PFS (HR 1.64; 95% CI 1.02-2.63) and OS (HR 1.77; 95% CI 1.10-2.84) was shorter among those with time to 2L ICI less than 3 months compared to those who initiated 2L ICI more than 6 months. CONCLUSION Among patients with aUC treated with 2L ICI, time to 2L ICI less than 3 months was associated with lower, but not significantly different ORR, but shorter PFS and OS compared to 2L ICI more than 6 months. This highlights potential cross resistance mechanisms between ICI and platinum-based chemotherapy.
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Affiliation(s)
- Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Scott Dawsey
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Shilpa Gupta
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario, Madrid, Spain
| | - Ivan de Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Tanya Jindal
- Division of Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Joseph J Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Tyler F Stewart
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Rana R McKay
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Nishita Tripathi
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | | | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael E Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London
| | - Ariel Nelson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH; Division of Medical Oncology, Duke University, Durham, NC
| | - Kavita Gupta
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb; School of Dental Medicine, Zagreb, Croatia
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar Research Institute, Barcelona, Spain
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric Lu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Pedro Isaacsson-Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Division of Oncology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla. IDIVAL. Santander, Spain
| | - Marcus Moses
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Pedro Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Center, Seattle, WA; Department of Urology, University of Washington, Seattle, WA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Robert Bruce Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Andrew C Hsieh
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Fred Hutchinson Cancer Center, Seattle, WA.
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
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Muacevic A, Adler JR, Singh AK, Mohapatra PR, Gupta K, Patro BK, Sahu DP, Kar P, Purushotham P, Saha S, Das S, Mamidi P, Panda S, Mandal MC, Bhuniya S. Comparison of Clinical Presentation and Vaccine Effectiveness Among Omicron and Non-omicron SARS Coronavirus-2 Patients. Cureus 2022; 14:e32354. [PMID: 36628021 PMCID: PMC9826697 DOI: 10.7759/cureus.32354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The rapidly mutating Omicron SARS-CoV-2 variant has replaced the previous dominant SARS-CoV-2 variants like alpha, and delta resulting in the amplification of coronavirus disease 2019 (COVID-19) cases. The present study was conducted to compare the clinical profile and vaccination status in patients infected with Omicron and non-Omicron SARS-CoV-2 variants. Methods All patients who tested positive for coronavirus disease 2019 (COVID-19) during the study period (January 2022 to February 2022) were further tested for detection of SARS-CoV-2 Omicron variant by using Omisure kit (TATA MD CHECK RT-PCR, TATA MEDICAL AND DIAGNOSTICS LIMITED, Tamil Nadu, INDIA). Clinico-demographic factors and vaccination status were compared between both Omicron and non-Omicron groups. Results A total of 1,722 patients who tested positive for COVID-19 were included in the study, of which 656 (38.1%) were Omicron and 1,066 (61.9%) were non-Omicron SARS-CoV-2 variants. Blood group and vaccination status were the major predictors for Omicron. The proportion of male patients was 58.4% in the Omicron group and 57.9% in the non-Omicron group. Maximum cases (86.2%) belonged to >18-60 years age group, 7.3% to >60 years age group, and least to 0-18 years (6.5%). The average age of the study participants was 35.4 ± 14.5 years. Vaccinated participants had less chance of having Omicron than the unvaccinated participants (p-value - 0.003). Fever and loss of smell were found to be significantly associated with the non-Omicron SARS-CoV-2 variant. (p-value < 0.05). Conclusion The present study reflects that the clinical course of the disease is milder in Omicron as compared to the non-Omicron variant. However rapid rise in cases can badly affect the healthcare system demanding good preparedness to tackle all the predicaments. Good Vaccination coverage should be of utmost priority irrespective of the variant type.
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22
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Gupta K, Zahedi S, Kakar TS, Zweig B. Independent prognostic value of ventricular premature complexes during exercise and recovery in asymptomatic patients: a meta-analysis of observational studies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2459] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Ventricular premature contractions (VPCs) are a common finding during a cardiac stress test. The independent prognostic value of these findings in asymptomatic participants is not clear.
Purpose
To investigate the cumulative independent prognostic value of VPC for adverse outcomes.
Methods
We conducted a systematic review and meta-analysis of observational studies in the following databases: MEDLINE, Embase®, and Cochrane Central from inception till January 28, 2022. The primary outcome was the cumulative hazard of all-cause mortality with VPCs during exercise or recovery in asymptomatic participants. The secondary outcome was cardiovascular mortality. We stratified results based on VPC during exercise or recovery.
We included studies with participants with no known CV disease and known CV disease. If there was known CV disease at baseline, the study should have adjusted for at least ≥1 known confounder. If a study reported low risk or higher risk VPCs, we included outcomes with higher risk VPCs to make the data comparable across literature. Random effect meta-analyses were used to predict cumulative hazard ratios. The review was registered with PROSPERO (registration number CRD42022297028)
Results
We found 10 studies with 47,497 participants that met our inclusion criteria (8 studies with all-cause and CV mortality, 2 studies with CV mortality only). Three studies included patients with baseline CV disease (proportion 12–33%). Follow-up duration ranged from 5.3 to 20.3 years. Definition of VPCs differed in the individual studies.
Both VPCs during exercise and recovery were associated with a higher hazard of all-cause mortality (HR 1.21, 95% confidence interval [CI] 1.07, 1.34 and 1.32, 95% CI 1.06, 1.58, p<0.001 and low heterogeneity for both, respectively, Figure 1A). There was no small study treatment effect bias.
Similarly, both VPCs during exercise and recovery were associated with a higher hazard of CV mortality (HR 1.63, 95% CI 1.30, 1.96 and 1.68, 95% CI 1.00, 2.35, p<0.001, and low heterogeneity for both, respectively, Figure 1B).
The presence of VPC had a numerically stronger association with CV mortality than all-cause mortality. VPCs during recovery seem to have more prognostic value than VPC during rest.
Conclusion
After adjusting for known confounders, VPCs during exercise and recovery predict a higher risk of all-cause and CV mortality. The risk is higher with VPCs during recovery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Gupta
- Henry Ford Hospital , Detroit , United States of America
| | - S Zahedi
- Henry Ford Hospital , Detroit , United States of America
| | - T S Kakar
- Henry Ford Hospital , Detroit , United States of America
| | - B Zweig
- Henry Ford Hospital , Detroit , United States of America
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Gupta S, Totade S, Gupta K, Bamrah P, Gupta S, Gupta S. Management of Obese Type 1 Diabetes Mellitus (Double Diabetes) Through Telemedicine During COVID-19 Pandemic Lockdown: A Case Report. Cureus 2022; 14:e30533. [PMID: 36415365 PMCID: PMC9675897 DOI: 10.7759/cureus.30533] [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: 07/25/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023] Open
Abstract
Metabolic syndrome in Type 1 diabetes mellitus (T1DM) has been shown to be an independent risk factor for macro-vascular and micro-vascular complications. Obesity also affects many people with T1DM across their lifetime with an increasing prevalence in recent decades. Individuals with T1DM who are overweight, have a family history of type 2 diabetes, and/or have clinical features of insulin resistance, are known as "double diabetes". It is challenging for a person with double diabetes to achieve reasonable glycemic control, avoid insulin-related weight gain, and prevent hypoglycaemia. This was especially true during the coronavirus disease 2019 (COVID-19) pandemic lockdown. The aim of this report is to show that lifestyle modification through telemedicine can immensely help in managing uncontrolled T1DM with associated morbid obesity in lockdown situations, with the help of the diabetes educator. In this case, the complicated history of double diabetes was taken through telephonic and online consultations with the help of a nutritionist and diabetes educator, and the treating clinician supervised the insulin doses and frequency. Patient Health Questionnaire (PHQ)-9 questionnaire was used to assess depression. Medical nutrition therapy (MNT) was given through online consultations, where the patient was reoriented to carbohydrate counting, insulin dose adjustment, along with modifications in the diet. Regular exercise was advised along with frequent self-monitoring of blood glucose (SMBG). Moreover, the diet order was changed to eat protein and fibre first, followed by carbohydrates, later. The three-tier system of the medical expert, clinical dietitian, and diabetes educator was applied. The subject was trained for carbohydrate counting and insulin dose adjustment by teaching her about the insulin-to-carb ratio and insulin sensitivity factor (ISF). She was asked to examine her insulin injection sites by visual and palpatory methods for lipohypertrophy. Once a week, the diabetes educator and nutritionist did telephonic follow-up and counselling, while online consultation was done by the treating clinician once a month. As a result, her weight, BMI, and waist circumference were reduced drastically, and there was an improvement in haemoglobin A1C (HbA1C), lipid parameters, and blood pressure after the intervention. Thus, implementing diabetes education via telemedicine in circumstances such as the COVID-19 pandemic can help achieve the best possible compliance for strict diet adherence, regular exercise and monitoring, reducing obesity, glycosylated HbA1c, insulin doses, and risk of depression in a person with double diabetes.
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Affiliation(s)
- Swar Gupta
- Pharmacology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sangita Totade
- Pharmacology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Kavita Gupta
- Nutrition, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Parvinder Bamrah
- Nutrition, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Shlok Gupta
- Internal Medicine, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
| | - Sunil Gupta
- Endocrinology, Sunil's Diabetes Care n' Research Centre, Nagpur, IND
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24
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Mahapatra A, Pati A, Gupta K. Role of Efflux Pumps in Reduced Susceptibility to Tigecycline among Clinical Isolates of Acinetobacter baumannii. Int J Appl Basic Med Res 2022; 12:243-248. [PMID: 36726662 PMCID: PMC9886155 DOI: 10.4103/ijabmr.ijabmr_219_22] [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: 03/24/2022] [Revised: 07/16/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acinetobacter baumannii (A. baumannii) is a very well-known emerging pathogen and has become a major burden on healthcare system especially in intensive care units (ICUs). Tigecycline is the last resort drug for treatment of multidrug-resistant A. baumannii infections. However, non-susceptibility to this drug is a rising problem. Resistance to tigecycline is mediated by Resistance-nodulation-cell division (RND) efflux pumps. Objective This study was done to detect efflux pump genes (adeABC) and regulator genes (adeS,adeR) responsible for tigecycline resistance among the clinical isolates of A. baumannii. Materials and Methods A total of 150 OXA-51 confirmed clinical isolates were subjected for tigecycline susceptibility test by broth microdilution (BMD) method. All isolates irrespective of their MIC were subjected to conventional PCR for detection of efflux genes (adeABC) and regulator genes (adeRS). Results Prevalence of tigecycline resistance was found to be 14 (9.33%) by the reference broth microdilution method (BMD). Overall prevalence of efflux genes was highest for adeB (69%) and lowest for adeR (29%). Combination of genes especially three, four or five were found more prevalent among resistant isolates with higher minimum inhibitory concentration (MIC). Conclusion Combination of efflux genes confer higher MIC and can be a major contributor for resistance to tigecycline.
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Affiliation(s)
- Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amresh Pati
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kavita Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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25
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Makrakis D, Talukder R, Lin GI, Diamantopoulos LN, Dawsey S, Gupta S, Carril-Ajuria L, Castellano D, de Kouchkovsky I, Koshkin VS, Park JJ, Alva A, Bilen MA, Stewart TF, McKay RR, Tripathi N, Agarwal N, Vather-Wu N, Zakharia Y, Morales-Barrera R, Devitt ME, Cortellini A, Fulgenzi CAM, Pinato DJ, Nelson A, Hoimes CJ, Gupta K, Gartrell BA, Sankin A, Tripathi A, Zakopoulou R, Bamias A, Murgic J, Fröbe A, Rodriguez-Vida A, Drakaki A, Liu S, Lu E, Kumar V, Lorenzo GD, Joshi M, Isaacsson-Velho P, Buznego LA, Duran I, Moses M, Jang A, Barata P, Sonpavde G, Yu EY, Montgomery RB, Grivas P, Khaki AR. Association Between Sites of Metastasis and Outcomes With Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2022; 20:e440-e452. [PMID: 35778337 PMCID: PMC10257151 DOI: 10.1016/j.clgc.2022.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sites of metastasis have prognostic significance in advanced urothelial carcinoma (aUC), but more information is needed regarding outcomes based on metastatic sites in patients treated with immune checkpoint inhibitors (ICI). We hypothesized that presence of liver/bone metastases would be associated with worse outcomes with ICI. METHODS We identified a retrospective cohort of patients with aUC across 26 institutions, collecting demographics, clinicopathological, treatment, and outcomes information. Outcomes were compared with logistic (observed response rate; ORR) and Cox (progression-free survival; PFS, overall survival; OS) regression between patients with/without metastasis beyond lymph nodes (LN) and those with/without bone/liver/lung metastasis. Analysis was stratified by 1st or 2nd+ line. RESULTS We identified 917 ICI-treated patients: in the 1st line, bone/liver metastases were associated with shorter PFS (Hazard ratio; HR: 1.65 and 2.54), OS (HR: 1.60 and 2.35, respectively) and lower ORR (OR: 0.48 and 0.31). In the 2nd+ line, bone/liver metastases were associated with shorter PFS (HR: 1.71 and 1.62), OS (HR: 1.76 and 1.56) and, for bone-only metastases, lower ORR (OR: 0.29). In the 1st line, LN-confined metastasis was associated with longer PFS (HR: 0.53), OS (HR:0.49) and higher ORR (OR: 2.97). In the 2nd+ line, LN-confined metastasis was associated with longer PFS (HR: 0.47), OS (HR: 0.54), and higher ORR (OR: 2.79); all associations were significant. CONCLUSION Bone and/or liver metastases were associated with worse, while LN-confined metastases were associated with better outcomes in patients with aUC receiving ICI. These findings in a large population treated outside clinical trials corroborate data from trial subset analyses.
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Affiliation(s)
- Dimitrios Makrakis
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | - Rafee Talukder
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Scott Dawsey
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Shilpa Gupta
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Lucia Carril-Ajuria
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ivan de Kouchkovsky
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Vadim S Koshkin
- Division of Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Joseph J Park
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Ajjai Alva
- Division of Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Tyler F Stewart
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Rana R McKay
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Nishita Tripathi
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Neeraj Agarwal
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT
| | | | - Yousef Zakharia
- Division of Oncology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michael E Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | | | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ariel Nelson
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher J Hoimes
- Division of Medical Oncology, Seidman Cancer Center at Case Comprehensive Cancer Center, Cleveland, OH; Division of Medical Oncology, Duke University, Durham, NC
| | - Kavita Gupta
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Alex Sankin
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Roubini Zakopoulou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb
| | - Ana Fröbe
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb; School of Dental Medicine, Zagreb, Croatia
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar Research Institute, Barcelona, Spain
| | - Alexandra Drakaki
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandy Liu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric Lu
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vivek Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Monika Joshi
- Division of Hematology/Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Pedro Isaacsson-Velho
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Division of Oncology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Ignacio Duran
- Hospital Universitario Marques de Valdecilla. IDIVAL. Santander, Spain
| | - Marcus Moses
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Albert Jang
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Pedro Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University, New Orleans, LA
| | - Guru Sonpavde
- Genitourinary Oncology Program, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Robert Bruce Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
| | - Ali Raza Khaki
- Division of Oncology, Department of Medicine, Stanford University, Palo Alto, CA.
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Green BW, Labagnara K, Feiertag N, Gupta K, Donnelly J, Watts KL, Crivelli JJ, Assimos DG, Small AC. Financial Toxicity of Nephrolithiasis: The First Assessment of the Economic Stresses of Kidney Stone Treatment. Urology 2022; 170:46-52. [PMID: 36183747 DOI: 10.1016/j.urology.2022.08.042] [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: 05/23/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the financial toxicity (FT) related to kidney stone treatment. METHODS We performed a cross-sectional cohort study with multi-institutional in-person and online cohorts of stone formers. Participants were surveyed using the validated COST tool (COmprehensive Score for financial Toxicity). The maximum score is 44 and lower scores indicate increased FT. "Moderate FT" was defined by COST scores between 25-14 points and "severe FT" for scores <14. Descriptive statistics, X2 tests, T tests, Spearman correlation, and logistic regression were performed using SPSS v28. RESULTS 241 participants were surveyed, including 126 in-person participants and 115 online. 60% of participants reported at least moderate FT (COST score <26) and 26% reported severe FT (COST score <14). Patients who reported moderate to severe FT were younger than those with low FT by a median difference of 8 years (95%CI = 4, 12). There was a significant correlation between out-of-pocket expense and COST scores, such that as out-of-pocket expenses increased, COST scores decreased, (Spearman's rho =-0.406, p = <0.001). Participants with moderate to severe FT tended to miss more workdays (p = 0.002), and their caretakers tended to miss more workdays (p = 0.007) due to their stone disease. CONCLUSIONS Most participants reported moderate to severe FT. As prior studies have shown that patients with "moderate FT" employ cost-coping strategies (i.e., medication rationing) and those with "severe FT" have worse health outcomes, urologists need to be sensitive to the financial burdens of treatment experienced by such patients undergoing kidney stone treatment.
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Affiliation(s)
| | | | | | - Kavita Gupta
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | | | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | - Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
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Padhi SR, John R, Bartwal A, Tripathi K, Gupta K, Wankhede DP, Mishra GP, Kumar S, Rana JC, Riar A, Bhardwaj R. Development and optimization of NIRS prediction models for simultaneous multi-trait assessment in diverse cowpea germplasm. Front Nutr 2022; 9:1001551. [PMID: 36211514 PMCID: PMC9539642 DOI: 10.3389/fnut.2022.1001551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cowpea (Vigna unguiculata (L.) Walp.) is one such legume that can facilitate achieving sustainable nutrition and climate change goals. Assessing nutritional traits conventionally can be laborious and time-consuming. NIRS is a technique used to rapidly determine biochemical parameters for large germplasm. NIRS prediction models were developed to assess protein, starch, TDF, phenols, and phytic acid based on MPLS regression. Higher RSQexternal values such as 0.903, 0.997, 0.901, 0.706, and 0.955 were obtained for protein, starch, TDF, phenols, and phytic acid respectively. Models for all the traits displayed RPD values of >2.5 except phenols and low SEP indicating the excellent prediction of models. For all the traits worked, p-value ≥ 0.05 implied the accuracy and reliability score >0.8 (except phenol) ensured the applicability of the models. These prediction models will facilitate high throughput screening of large cowpea germplasm in a non-destructive way and the selection of desirable chemotypes in any genetic background with huge application in cowpea crop improvement programs across the world.
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Affiliation(s)
- Siddhant Ranjan Padhi
- Division of Plant Genetic Resources, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Racheal John
- Division of Germplasm Evaluation, ICAR-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Arti Bartwal
- Division of Germplasm Evaluation, ICAR-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Kuldeep Tripathi
- Division of Germplasm Evaluation, ICAR-National Bureau of Plant Genetic Resources, New Delhi, India
| | - Kavita Gupta
- Division of Plant Quarantine, ICAR-National Bureau of Plant Genetic Resources, New Delhi, India
| | | | - Gyan Prakash Mishra
- Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Sanjeev Kumar
- Division of Bioinformatics, ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India
| | - Jai Chand Rana
- Alliance of Bioversity International and CIAT, Region-Asia, India Office, New Delhi, India
| | - Amritbir Riar
- Department of International Cooperation, Research Institute of Organic Agriculture FiBL, Frick, Switzerland
| | - Rakesh Bhardwaj
- Division of Germplasm Evaluation, ICAR-National Bureau of Plant Genetic Resources, New Delhi, India
- *Correspondence: Rakesh Bhardwaj
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28
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Green BW, Labagnara K, Macdonald E, Feiertag N, Zhu M, Gupta K, Mohan C, Watts KL, Rai A, Small AC. Evaluating the association between food insecurity and risk of nephrolithiasis: an analysis of the National Health and Nutrition Examination Survey. World J Urol 2022; 40:2641-2647. [PMID: 36125503 DOI: 10.1007/s00345-022-04150-9] [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: 05/18/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE This study aimed to investigate the relationship between self-reported food security and kidney stone formation. METHODS Data were collected from the National Health and Nutrition Examination Survey (NHANES), a database representative of the United States population. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Characteristics of patients were compared using the Chi-square test and the student t-test. Multivariate logistic regression was performed using a multi-model approach. RESULTS We analyzed 6,800 NHANES survey respondents. 37.2% of respondents were categorized as having "low food security" (scores 2-4) and 24.0% having "very low food security" (scores 5-6). 8.4% of respondents had a history of kidney stones. We found that people with very low food security had a 42% increased likelihood of developing kidney stones compared to those with high or marginal food security, after controlling for race, age, and comorbidities (OR 1.42; 95% CI 1.01-1.99). Between the different food security groups, no significant differences were observed in age, race/ethnicity, body mass index, gout history, osteoporosis history, or coronary artery disease history. Lower food security was associated with slightly younger age (< 1 year difference, p = 0.001), higher poverty-income ratio (p = 0.001), and many comorbidities, including kidney stones (p = 0.007). CONCLUSION Our study provides evidence for an association between food access and the risk of kidney stone disease. Given these findings, food insecurity should be investigated as a modifiable risk factor for the development of kidney stone disease.
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Affiliation(s)
- Benjamin W Green
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Kevin Labagnara
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Eric Macdonald
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Nathan Feiertag
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Michael Zhu
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Kavita Gupta
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Charan Mohan
- Smith Institute for Urology, Northwell Health System, New Hyde Park, NY, USA
| | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Arun Rai
- Smith Institute for Urology, Northwell Health System, New Hyde Park, NY, USA
| | - Alexander C Small
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA.
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Beine A, Albano Y, Deischter J, Gupta K, Palkovits R. Flexible conversion of sorbitol to the diols ethylene/propylene glycol and isosorbide – Catalysis over solid acids and bases. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255379] [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: 11/09/2022]
Affiliation(s)
- A. K. Beine
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - Y. Albano
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - J. Deischter
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - K. Gupta
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
| | - R. Palkovits
- RWTH Aachen University ITMC Worringerweg 2 52074 Aachen Germany
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Gupta K, Tang K, Loloi J, Fang R, Meeks W, North A. Professional Burnout of Advanced Practice Providers Based on 2019 American Urological Association Census Data. Urol Pract 2022; 9:491-497. [PMID: 37145720 DOI: 10.1097/upj.0000000000000334] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Burnout has been recognized as an occupational hazard among health care professionals. The objective of this study was to assess the extent and pattern of burnout in advanced practice providers (APPs) in urology by analyzing American Urological Association Census data. METHODS The American Urological Association conducts an annual census survey to all providers in the urological care community, including APPs. In the 2019 Census, the Maslach Burnout Inventory questionnaire was included to measure burnout among APPs. Demographic and practice variables were assessed to establish correlating factors to burnout. RESULTS A total of 199 APPs (83 physician assistants and 116 nurse practitioners) completed the 2019 Census. Slightly more than 1 in 4 APPs experienced professional burnout (25.3% in physician assistants and 26.7% in nurse practitioners). Observed higher burnout rates were seen in APPs who were aged 45 to 54 (34.3%), women (29.6% vs 10.8% in men, p value <0.05), non-White (33.3% vs 24.9% in White), those who had 4-9 years of practice (32.4%) and those who practiced in academic medical centers (31.7%). Except for gender, none of the above observed differences were statistically significant. Using a multivariate logistic regression model, gender remained the only significant factor associated with burnout (women vs men with an odds ratio of 3.2 [95% confidence interval: 1.1-9.6]). CONCLUSIONS Overall, APPs in urological care reported lower levels of burnout than urologists; however, there was a higher chance of female APPs experiencing higher professional burnout in comparison to their male counterparts. Future studies are needed to investigate possible reasons for this finding.
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Affiliation(s)
- Kavita Gupta
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kevin Tang
- Albert Einstein College of Medicine, Bronx, New York
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Raymond Fang
- Data and Statistics, American Urological Association, Linthicum, Maryland
| | - William Meeks
- Data and Statistics, American Urological Association, Linthicum, Maryland
| | - Amanda North
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Strickland G, Qu R, Gupta K, Jiang Y, Dong D, Saez C, Weng P, Taketo M, Klugar Y, Myung P. 704 Decomposing a deterministic path to hair follicle dermal niche formation: The intersection of two morphogen gradients. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.716] [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]
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Padhi SR, Bartwal A, John R, Tripathi K, Gupta K, Wankhede DP, Mishra GP, Kumar S, Archak S, Bhardwaj R. Corrigendum: Evaluation and multivariate analysis of cowpea [Vigna unguiculata (L.) walp] germplasm for selected nutrients—mining for nutri-dense accessions. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2022.986734] [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: 11/13/2022] Open
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Tayal A, Singh NP, Rai S, Gupta K, Gupta A, Agarwal AN, Saha R, Kaur IR. First study on detection of cryptic resistance to linezolid among clinical isolates of methicillin resistant Staphylococcus aureus from India. Indian J Med Microbiol 2022; 40:384-388. [PMID: 35667921 DOI: 10.1016/j.ijmmb.2022.05.004] [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: 10/20/2020] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Linezolid is an oral antibiotic which is widely used for serious infections caused by Methicillin Resistant Staphylococcus aureus (MRSA). With emergence of vancomycin MIC creep among clinical strains of MRSA, it is essential to know the possible emergence of subclinical resistance against linezolid as well. With this background, we aimed to detect evident (phenotypic) and cryptic (hidden or genotypic) linezolid resistance among MRSA isolates. METHODS 250 clinical isolates of MRSA were collected and their susceptibility patterns were determined. Every third MRSA isolate was subjected to PCR for domain V of the 23S rRNA for the mutation hotspot in the 746bp segment which harbors the classical mutation for linezolid resistance. Restriction Fragment Length Polymorphism was done to confirm presence of the G2576U mutation. RESULTS Six isolates (2.4%) were phenotypically resistant to linezolid. Among these six LRSA isolates, 5 demonstrated the G2576U mutation by PCR - RFLP. Cryptic resistance to Linezolid was identified in two isolates among linezolid susceptible isolates. CONCLUSIONS In the present study, hidden resistance to linezolid was observed in linezolid susceptible clinical isolates. Emergence of resistance against over-the-counter drugs like linezolid is major challenge. Identification of cryptic resistance among patients implies impending resistance to linezolid. Judicious use of antimicrobials, application of strict infection control practices and prescription audit needs to be made mandatory to preserve such drugs.
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Affiliation(s)
- Ayushi Tayal
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Narendra Pal Singh
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Sumit Rai
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Kavita Gupta
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Arun Gupta
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Aditya Nath Agarwal
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Rituparna Saha
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
| | - Iqbal Rajinder Kaur
- Department of Clinical Microbiology, University College of Medical Sciences, Delhi, India.
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Gupta K, Chopra R, Kulkarni P. Use of pulse oximetry during nitrous oxide- oxygen inhalation sedation: mandatory or recommended? Eur Arch Paediatr Dent 2022; 23:647-652. [PMID: 35655051 DOI: 10.1007/s40368-022-00717-7] [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: 01/31/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
AIM There is skepticism amongst many dentists about the interference of nitrous oxide with the physiological parameters. This commentary attempts to make clear recommendations on the use of pulse oximeter during nitrous oxide inhalation sedation. BACKGROUND Nitrous oxide is used commonly in dentistry as a tool to reduce fear/ anxiety and build a positive dental attitude. Dentists use pulse oximeter to monitor oxygen saturation during the period of administration of nitrous oxide. There is no consensus amongst various guidelines across the world on the necessity of using pulse oximeter during the period of administration of nitrous oxide CONCLUSION: Pulse oximetry may not be considered mandatory when nitrous oxide gas is being administered for minimal sedation to a healthy patient having no pre- existing diseases/illness.
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Affiliation(s)
- K Gupta
- Children's Dental Center, 8, FF, MGF Megacity Mall, MG Road, Gurugram, 122002, India.
- Sharad Pawar Dental College, Wardha, India.
- Peoples College of Dental Sciences, Bhopal, India.
| | - R Chopra
- Children's Neurology and Dentistry, Ghaziabad, India
| | - P Kulkarni
- Peoples College of Dental Sciences, Bhopal, India
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Hoang K, Win S, Gupta K. Abstract No. 147 Comparison of Celect inferior vena cava filter thrombus incidence based on filter position at time of filter retrieval. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.228] [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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Padhi SR, Bartwal A, John R, Tripathi K, Gupta K, Wankhede DP, Mishra GP, Kumar S, Archak S, Bhardwaj R. Evaluation and Multivariate Analysis of Cowpea [Vigna unguiculata (L.) Walp] Germplasm for Selected Nutrients—Mining for Nutri-Dense Accessions. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2022.888041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A total of 120 highly diverse cowpea [Vigna unguiculata (L.) Walp] genotypes, including indigenous and exotic lines, were evaluated for different biochemical traits using AOAC official methods of analysis and other standard methods. The results exhibited wide variability in the content of proteins (ranging from 19.4 to 27.9%), starch (from 27.5 to 42.7 g 100 g−1), amylose (from 9.65 to 21.7 g 100 g−1), TDF (from 13.7 to 21.1 g 100 g−1), and TSS (from 1.30 to 8.73 g 100 g−1). The concentration of anti-nutritional compounds like phenols and phytic acid ranged from 0.026 to 0.832 g 100 g−1 and 0.690 to 1.88 g 100 g−1, respectively. The correlation coefficient between the traits was calculated to understand the inter-trait relationship. Multivariate analysis (PCA and HCA) was performed to identify the major traits contributing to variability and group accessions with a similar profile. The first three principal components, i.e., PC1, PC2, and PC3, contributed to 62.7% of the variation, where maximum loadings were from starch, followed by protein, phytic acid, and dietary fiber. HCA formed six distinct clusters at a squared Euclidean distance of 5. Accessions in cluster I had high TDF and low TSS content, while cluster II was characterized by low amylose content. Accessions in cluster III had high starch, low protein, and phytic acid, whereas accessions in cluster IV contained high TSS, phenol, and low phytic acid. Cluster V was characterized by high protein, phytic acid, TSS, and phenol content and low starch content, and cluster VI had a high amount of amylose and low phenol content. Some nutri-dense accessions were identified from the above-mentioned clusters, such as EC170579 and EC201086 with high protein (>27%), TSS, amylose, and TDF content. These compositions are promising to provide practical support for developing high-value food and feed varieties using effective breeding strategies with a higher economic value.
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Singla A, Madan R, Kumar N, Goyal S, Tripathi M, Gupta K, Gupta D, Kapoor R. PO-1149 Clinico-pathological and prognostic factors of Medulloblastoma - Tertiary care centre in India. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03113-9] [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: 10/18/2022]
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Makrakis D, Talukder R, Dawsey S, Carril L, Stewart TF, Morales-Barrera R, Park JJ, Fulgenzi CAM, Murgic J, Vather-Wu N, de Kouchkovsky I, Devitt ME, Di Lorenzo G, Gupta K, Tripathi N, Zakopoulou R, Tripathi A, Lu E, Grivas P, Khaki AR. Association of time to second-line (2L) immune-checkpoint inhibitors (ICI) and outcomes with ICIs in patients (pts) with advanced urothelial carcinoma (aUC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.505] [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: 11/20/2022] Open
Abstract
505 Background: Current standard therapy for most pts with aUC is first-line (1L) platinum-based chemotherapy followed by ICI maintenance (or 2L if progression). Shorter time on 1L or between therapy lines may be a surrogate of more aggressive disease and poor outcome, but its prognostic role in ICI response is unclear. We hypothesized that shorter time until start of 2L ICI would be associated with worse outcomes in aUC. Methods: We performed a retrospective multi-institution cohort study in pts with aUC treated with 1L platinum-based chemotherapy, who later received 2L ICI. Pts receiving maintenance ICI were excluded. We calculated the time from start of 1L platinum chemotherapy to start of 2L ICI, dichotomizing the exposure into ≤6 months and >6 months. We compared overall response rate (ORR) to 2L ICI, progression-free survival (PFS) and overall survival (OS) from the start of 2L ICI between the two populations. ORR was compared among groups using multivariable logistic regression and PFS, OS using cox regression. Analysis was adjusted for calculated Bellmunt score. Results: From a total of 1283 pts, 462 received 1L platinum chemotherapy; among those, 350 received 2L ICI. After exclusions, 270, 269 and 260 pts were included in the ORR, PFS and OS analyses, respectively. Median age was 70 years, 78% men, 75% White, 74% with pure urothelial histology, 21% upper tract, 60% received cisplatin in 1L. Pts with time to 2L ICI ≤6 months had significantly higher Bellmunt scores (32% vs 22% score=2, 9% vs 3% score=3). ORR and PFS were comparable between pts with ≤ and >6 months to 2L ICI. However, OS was significantly longer for pts with >6 months to 2L ICI (median [m]OS 13 vs 7 months, p=0.002), (Table). Conclusions: Among pts with aUC treated with 2L ICI, time to 2L ICI ≤6 months from 1L platinum based chemotherapy was associated with similar ORR and PFS but shorter OS. Limitations include retrospective nature, patient selection, confounding factors. More studies are needed on the impact of platinum resistance in pts with aUC treated with ICIs.[Table: see text]
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Affiliation(s)
| | | | - Scott Dawsey
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Lucia Carril
- Medical Oncology, Institute Gustave Roussy, Villejuif, France
| | | | - Rafael Morales-Barrera
- Vall d’Hebron Institute of Oncology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph J. Park
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jure Murgic
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Ivan de Kouchkovsky
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Michael Edward Devitt
- Division of Hematology/Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Kavita Gupta
- Montefiore Einstein Center for Cancer Care, New York, NY
| | | | | | - Abhishek Tripathi
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Eric Lu
- Division of Hematology-Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Petros Grivas
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
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Behera B, Tripathy S, Venkateshan M, Mahapatra A, Mohanty S, Gupta K, Mishra B, Rao PB, Mitra JK, Mohapatra PR, Panigrahi MK, Bhuniya S, Bal SK. Spectrum of Bacterial Pathogens in Critical COVID-19 Patients Admitted in Intensive Care Units of a Tertiary Care Hospital During the First and Second Wave of the Pandemic. J Assoc Physicians India 2022; 70:11-12. [PMID: 35436819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study intends to compare the clinical characteristics and the prevalence and spectrum of bacterial pathogens in COVID-19 patients admitted to ICU during the first and second waves at a tertiary care, teaching and referral hospital of eastern India. METHOD This is a hospital-based retrospective study which analysed demographic details, clinical profile and bacterial culture results of severe and critically ill COVID-19 patients admitted in intensive care units (ICU) during April -Oct 2020 (1st wave) and April -July 2021 (2nd wave). RESULT The patients admitted during the 2nd wave were comparatively older and had multiple comorbidities compared to the 1st wave. (23.8%) (45/189) and 50% (173/346) of the COVID-19 patients admitted to ICU developed bacterial infection during the 1st and 2nd wave respectively. Overall, there was predominance of multidrug resistant Gram negative bacilli in both the waves. There was increased isolation of intrinsic colistin resistant microorganisms. CONCLUSION Multidrug resistant Gram negative bacterial infections, remain a dreaded complication in severe and critically ill hospitalised COVID-19 patients requiring ICU care and high usage of colistin spirals the emergence and spread of pathogens intrinsically resistant to colistin.
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Affiliation(s)
- Bijayini Behera
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha; Corresponding Author
| | - Swagata Tripathy
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Mahalingam Venkateshan
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Ashoka Mahapatra
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Srujana Mohanty
- Additional Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Kavita Gupta
- Assistant Professor, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Baijayantimala Mishra
- Professor, Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - P Bhaskar Rao
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Jayanta Kumar Mitra
- Additional Professor, Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | | | - Manoj Kumar Panigrahi
- Additional Professor, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Sourin Bhuniya
- Additional Professor,All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
| | - Shakti Kumar Bal
- Assistant Professor, Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha
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Gupta K, Thapa B, Gupta S, Sharma S. Lung Function Tests in Hairdressers of Gangtok: A Cross-Sectional Study. Indian J Occup Environ Med 2022; 26:91-94. [PMID: 35991197 PMCID: PMC9384880 DOI: 10.4103/ijoem.ijoem_264_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
Background Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways. Aim The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok. Method This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720. Results All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342). Conclusion Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function.
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Affiliation(s)
- K. Gupta
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - B. Thapa
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India,Address for correspondence: Dr. B. Thapa, Department of Physiology, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, Sikkim, India. E-mail:
| | - S. Gupta
- Sikkim Manipal College of Physiotherapy, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - S. Sharma
- Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
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Gupta K, Kudva R, Monappa V, Nikhra P. Clinicopathological Study of Primary Gastrointestinal Lymphoma from a Tertiary Care Hospital in Southern India. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/53661.16504] [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: 11/24/2022]
Abstract
Introduction: Primary Gastrointestinal Lymphoma (PGIL) is a heterogeneous disease in terms of patient characteristics, site, histologic types and treatment modalities. Although rare disease, it is the most common site for extranodal lymphomas accounting for 10-15% of all non-Hodgkin lymphoma and 30-40% of all extranodal lymphoma. Aim: To study the different types of PGIL and its anatomic distribution along with its association with the clinical outcomes. Materials and Methods: This was a retrospective study conducted in Department of Pathology of a tertiary care hospital, South India over a period of five years (2009 to 2013). A total of 61 cases of PGIL were identified, which included both resected surgical and endoscopic biopsy specimens. Histopathological classification of all cases was done based on morphologic and immunophenotypic criteria according to latest World Health Organisation (WHO) 2008 classification. Anatomic distribution of various types of lymphoma and associated clinical features were studied. The cases were then followed-up and survival analysis was also done. Descriptive statistical analysis methods were used to analyse the data. Overall Survival (OS) rates were calculated using Kaplan Meier method for 33 cases. Results: There was predominance of men with peak incidence in 7th decade. Abdominal pain was the commonest presenting symptom seen in 77% of the cases. The most common site of involvement was stomach (41%) followed by large intestine (37.7%). All cases of primary GI lymphomas were of non-Hodgkin type. B cell lymphomas (n=54; 88.5%) were more frequent than T cell lymphomas (n=7; 11.5%). Diffuse Large B Cell Lymphoma (DLBCL) was the most common subtype accounting for 67.2% of cases (n=41) followed by MALT lymphoma (n=9; 14.8%). Followup was possible in 33 cases out of which 20 patients (32.8%) died with a median overall survival period of 13 months (95% CI, 7.8-18.2). The five-year overall survival (OS) for 33 patients who were followed-up was 67.2%. Conclusion: Diagnosing PGILs correctly according to the recent WHO classification is important so that correct treatment protocols can be followed.
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Joshi R, Medhi B, Prakash A, Chandy S, Ranjalkar J, Bright HR, Basker J, Govindraj L, Chugh PK, Tripathi CD, Badyal DK, Balakrishnan S, Jhaj R, Shukla AK, Atal S, Najmi A, Banerjee A, Kamat S, Tripathi RK, Shetty YC, Parmar U, Rege N, Dikshit H, Mishra H, Roy SS, Chatterjee S, Hazra A, Bhattacharya M, Das D, Trivedi N, Shah P, Chauhan J, Desai C, Gandhi AM, Patel PP, Shah S, Sheth S, Raveendran R, Mathaiyan J, Manikandan S, Jeevitha G, Gupta P, Sarangi SC, Yadav HN, Singh S, Kaushal S, Arora S, Gupta K, Jain S, Cherian JJ, Chatterjee NS, Kaul R, Kshirsagar NA. Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity. Indian J Pharmacol 2022; 54:321-328. [PMID: 36537400 PMCID: PMC9846909 DOI: 10.4103/ijp.ijp_976_21] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
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Affiliation(s)
- R Joshi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - B Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Medhi B, Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail:
| | - A Prakash
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Chandy
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Ranjalkar
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - HR Bright
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Basker
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - L Govindraj
- Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - PK Chugh
- Vardhman Mahavir Medical College, New Delhi, India
| | - CD Tripathi
- Vardhman Mahavir Medical College, New Delhi, India
| | - DK Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - R Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - AK Shukla
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Najmi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - A Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - S Kamat
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - RK Tripathi
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - YC Shetty
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - U Parmar
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Rege
- Department of Pharmacology and Therapeutics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - H Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - SS Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - A Hazra
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - M Bhattacharya
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - D Das
- Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - N Trivedi
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - P Shah
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - J Chauhan
- Department of Pharmacology, Government Medical College, Baroda, Gujarat, India
| | - C Desai
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - AM Gandhi
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - PP Patel
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - S Sheth
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - R Raveendran
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - J Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - G Jeevitha
- Department of Pharmacology, Jawaharlal Institute of Post Medical Education and Research, Puducherry, India
| | - P Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - HN Yadav
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Arora
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Gupta
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - JJ Cherian
- Indian Council of Medical Research, New Delhi, India
| | - NS Chatterjee
- Indian Council of Medical Research, New Delhi, India
| | - R Kaul
- Indian Council of Medical Research, New Delhi, India
| | - NA Kshirsagar
- Indian Council of Medical Research, New Delhi, India
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Kumar S, Akif S, Parmar K, Singh P, Thummala Y, Panda I, Gupta K. Metachronous isolated inferior vena cava tumour thrombus in renal cell cancer: a rare aftermath. Ann R Coll Surg Engl 2021; 104:e139-e142. [PMID: 34941460 DOI: 10.1308/rcsann.2021.0230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal cell cancer (RCC) accounts for 3% of all solid malignancies. Synchronous tumour thrombus in the renal vein or inferior vena cava is reported in 4-10% cases and is a surgical challenge. Contemporary imaging modalities that are used to define the presence and extent of venous thrombus include colour Doppler, contrast-enhanced computed tomography and magnetic resonance venography. Surgical management depends upon the degree of tumour thrombus. We report isolated recurrence of RCC in the inferior vena cava 2 years after radical nephrectomy, and discuss its pathophysiology and management.
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Affiliation(s)
- S Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Akif
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Parmar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P Singh
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Y Thummala
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - I Panda
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Gupta
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mahapatra A, Nikitha K, Rath S, Behera B, Gupta K. Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital. J Lab Physicians 2021; 13:358-361. [PMID: 34975256 PMCID: PMC8714405 DOI: 10.1055/s-0041-1732494] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
Spread of carbapenem-resistant
Enterobacterales
(CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome
Klebsiella pneumoniae
carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference.
Methods
Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria).
Results
Using CDC method, total 41 CRE isolates were recovered comprising of 29
Escherichia coli
, 11 Klebsiella, and 1
Enterobacter
spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were
E. coli
, 15 Klebsiella, and 1
Enterobacter
sp.
Statistical Analysis
Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference.
Conclusion
HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.
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Affiliation(s)
- Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - K Nikitha
- All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Sutapa Rath
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Kavita Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Gupta K, Khusid JA, Lundon D, Gallante B, Sadiq AS, Atallah W, Gupta M. Criteria Used by Endourology Society Fellowship Program Directors for the Selection and Evaluation of Fellows. J Endourol 2021; 36:562-571. [PMID: 34779662 DOI: 10.1089/end.2021.0670] [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
Introduction An understanding of which trainee factors Endourology Society (ES) fellowship program directors (PDs) value may help urology residents optimize their fellowship candidacy and help current fellows optimize their fellowship performance. In the present study, we evaluated which factors are most important to ES PDs in selecting fellowship candidates and evaluating current fellows. Methods A survey was constructed using REDCap software and emailed to PDs of fellowships registered with the ES. Fellowships in the ES include Endourology-Stone Disease (ESD) programs, robotic-laparoscopic surgery programs (MIS), and combination programs. A Likert scale ranging from 1 (not important) to 5 (extremely important) was used to rank the criteria for selecting and evaluating fellows. The survey captured program demographics such as geographic region, program type, and program duration. Results Of the 52 ES PDs, 35 (67%) responded. Respondents represented 8 (23%) ESD programs, 7 (20%) MIS programs, and 20 (57%) combination programs. Furthermore, sixteen (46%) represented one-year programs and 19 (54%) represented two-year programs. The top-five factors for candidate selection were perceived fit of the applicant, perceived level of applicant interest, initial interview, personal emails from applicants' advocates, and personal phone calls from applicants' advocates. Advocacy on behalf of the applicant appeared to be especially important for two-year fellowships. The top-five factors for the evaluation of fellows in training were patient interactions, professionalism, attitude/demeanor, operative skills, and interactions with ancillary staff. Research productivity was of greater importance for the evaluation and selection of two-year fellows and ESD fellows. Conclusions Applicants for ES fellowships should focus on the initial interview and recruiting supportive mentors to advocate for their applications, particularly for two-year programs. Though PDs value both clinical skills and research productivity, research productivity was more important for two-year programs and ESD programs. Further research into applicant perspectives on the fellowship application process is warranted.
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Affiliation(s)
- Kavita Gupta
- Montefiore Medical Center, 2013, 1250 Water's Place, Bronx, New York, United States, 10467-2490;
| | - Johnathan Alexander Khusid
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Dara Lundon
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Areeba Setara Sadiq
- Mount Sinai Health System, 5944, Urology, 425 W59th Street, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Mantu Gupta
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
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46
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Survival Outcomes of Patients With Unresectable Hepatocellular Carcinoma Secondary to Viral vs. Non-Viral Etiologies Treated with Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.398] [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: 12/01/2022]
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47
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Mamidanna S, Neibart S, Chundury A, Sayan M, Alexander H, August D, Berim L, Boland P, Grandhi M, Gulhati P, Gupta K, Hochster H, Kennedy T, Langan R, Minacapelli C, Spencer K, Nosher J, Jabbour S. Comparing Acute Toxicities of Patients With Unresectable Hepatocellular Carcinoma Treated With Definitive Proton vs. Photon-Based Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.399] [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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48
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Mishra B, Behera B, Singh AK, Mohapatra PR, Patro BK, Panigrahi MK, Pillai JSK, Barik S, Mahapatra A, Mohanty S, Hallur V, Gupta K, Batmanabane G. Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in a teaching hospital in Eastern India. J Family Med Prim Care 2021; 10:2974-2979. [PMID: 34660434 PMCID: PMC8483124 DOI: 10.4103/jfmpc.jfmpc_2486_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022] Open
Abstract
Statement of the Problem: Healthcare workers (HCW) are the most vulnerable group for contracting SARS-CoV-2. Assessment of seroprevalence of SARS-CoV-2 antibodies among HCW, thus can provide important data on pathogen exposure, infectivity, and adherence to personal protective equipment (PPE). The present study aimed at assessing SARS-CoV-2 seroprevalence among HCW and exploring associations with demographics, category of exposure to COVID-19 patients, preventive measures taken and relation with COVID-19 symptoms. Method of Study: HCWs with a minimum gap 2 weeks from last duty were eligible to participate in the study. The enrolled HCW were categorized into high-risk and low-risk category based on work in COVID-19 areas. HCWs SARS-CoV-2 specific IgG and IgM antibodies were detected using rapid immunochromatography test. Results: Out of 821 randomly selected HCWs, either IgM or IgG antibody was detected in 32 HCWs (32/821, 3.9%). Only IgM antibodies were detected in 14 (1.7%), only IgG was detected in 9 (1.0%), and both IgM and IgG antibodies were present in 9 HCWs. Seropositivity was significantly higher in high-risk category (5.7% vs. 2.2.%), HCWs who ever had COVID-19 related symptoms in last 3 months (5.6% vs. 2.8%), and those who had earlier tested positive for SARS-CoV-2 with real-time reverse transcriptase PCR (36.6% vs. 3.5%). Seroprevalence was highest (6.9%) among housekeeping and sanitation staff. Conclusions: Overall, low seroprevalence of SARS-CoV-2 antibodies in our HCWs is an indicator of effective infection control practice. HCW posted in dedicated COVID ward need more stringent implementation of infection prevention measures.
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Affiliation(s)
| | - Bijayini Behera
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India
| | - Arvind K Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Binod K Patro
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | - Manoj K Panigrahi
- Department of Pulmonary Medicine and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Jawahar S K Pillai
- Department of Hospital Administration, AIIMS, Bhubaneswar, Odisha, India
| | - Sadanand Barik
- Department of Trauma and Emergency Medicine, AIIMS, Bhubaneswar, Odisha, India
| | | | - Srujana Mohanty
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India
| | | | - Kavita Gupta
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India
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Avolio E, Carrabba M, Kavanagh Williamson M, Milligan R, Gupta K, Gamez M, Foster R, Berger I, Caputo M, Davidson A, Hill D, Madeddu P. The SARS-CoV-2 Spike protein alters human cardiac pericyte function and interaction with endothelial cells through a non-infective mechanism involving activation of CD147 receptor signalling. Eur Heart J 2021. [PMCID: PMC8524576 DOI: 10.1093/eurheartj/ehab724.3383] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Human cardiac pericytes (PC) were proposed as the main cellular target for SARS-CoV-2 in the heart due to high transcriptional levels of the angiotensin-converting enzyme 2 (ACE2) receptor. Emerging reports indicate CD147/Basigin (BSG), highly expressed in endothelial cells (EC), is an alternative SARS-CoV-2 receptor. To date, the mechanism by which the virus infects and disrupts the heart vascular cells was not identified yet. Moreover, cleaved Spike (S) protein molecules could be released into the bloodstream from the leaking pulmonary epithelial-endothelial barrier in patients with severe COVID-19, opening to the possibility of non-infective diseases in organs distant from the primary site of infection.
Purposes
(1) to confirm that human primary cardiac PC express ACE2 and CD147; (2) to verify if PC are permissible to SARS-CoV-2 infection; (3) to investigate if the recombinant SARS-CoV-2 S protein alone, without the other viral elements, can trigger molecular signalling and induce functional alterations in PC; (4) to explore which viral receptor is responsible for the observed events.
Methods and results
Cardiac PC express both the ACE2 and CD147 receptors at mRNA and protein level. Incubation of PC for up to 5 days with SARS-CoV-2 expressing the green fluorescent protein (GFP) did not show any evidence of cell infection or viral replication. Next, we exposed the PC to the recombinant S protein (5.8 nM) and confirmed that the protein engaged with cellular receptors (western blot analysis of S protein in treated and control PC). Incubation with the S protein increased PC migration (wound closure assay, P<0.01 vs ctrl) and reduced the formation of tubular structures between PC and EC in a Matrigel assay (P<0.01 vs ctrl). Moreover, the S protein promoted the production of pro-inflammatory factors typical of the cytokine storm in PC (ELISA measurement of MCP1, IL-6, IL-1β, TNFα, P<0.05 vs ctrl), and induced the secretion of pro-apoptotic factors responsible for EC death (Caspase 3/7 assay, P<0.05 vs ctrl). Signalling studies revealed that the S protein triggers the phosphorylation/activation of the extracellular signal-regulated kinase 1/2 (ERK1/2) through the CD147 receptor, but not ACE2, in cardiac PC. The neutralization of CD147, using a blocking antibody, prevented ERK1/2 activation in PC, and was reflected into a partial rescue of the cell functional behaviour (migration and pro-angiogenic capacity). In contrast, blockage of CD147 failed to prevent the pro-inflammatory response in PC.
Conclusions
We propose the novel hypothesis that COVID-19 associated heart's microvascular dysfunction is prompted by circulating S protein molecules rather than by the direct coronavirus infection of PC. Besides, we propose CD147, and not ACE2, as the leading receptor mediating S protein signalling in cardiac PC.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): BHF project grant “Targeting the SARS-CoV-2 S-protein binding to the ACE2 receptor to preserve human cardiac pericytes function in COVID-19” BHF Centre for Vascular Regeneration II
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Affiliation(s)
- E Avolio
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - M Carrabba
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - M Kavanagh Williamson
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - R Milligan
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - K Gupta
- University of Bristol, School of Biochemistry, Bristol, United Kingdom
| | - M Gamez
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - R Foster
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - I Berger
- University of Bristol, School of Biochemistry, Bristol, United Kingdom
| | - M Caputo
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - A Davidson
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - D Hill
- University of Bristol, School of Cellular and Molecular Medicine, Bristol, United Kingdom
| | - P Madeddu
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
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50
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Singh N, Gupta K, Khan T, Rahman E, Singh-Ranger D. 516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.588] [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]
Abstract
Abstract
Aim
Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.
Method
All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.
Results
There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).
Conclusions
Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.
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Affiliation(s)
- N Singh
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - K Gupta
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - T Khan
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - E Rahman
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - D Singh-Ranger
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
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