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Ahuja K, Batra V, Kumar R, Datta TK. Transient suppression of Wnt signaling in poor-quality buffalo oocytes improves their developmental competence. Front Vet Sci 2024; 10:1324647. [PMID: 38274663 PMCID: PMC10808588 DOI: 10.3389/fvets.2023.1324647] [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: 10/19/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction One of the most evolutionary conserved communication systems, the Wnt signaling pathway is a major gene regulatory pathway that affects the developmental competence of oocytes and regulates most embryonic developmental processes. The present study was undertaken to modulate the canonical Wnt (Wingless/integration) signaling pathway in the poor-quality (colorless cytoplasm after Brilliant Cresyl Blue staining, BCB-) buffalo cumulus-oocyte complexes (COCs) to improve their in vitro maturation (IVM) and embryo production (IVEP) rates. Methods The expression of key Wnt pathway genes was initially assessed in the good (blue cytoplasm after Brilliant Cresyl Blue staining, BCB+) and poor quality (BCB-) buffalo COCs to establish a differential activity of the Wnt pathway. The BCB- COCs were supplemented with the Wnt pathway inhibitor, Dickkopf-related protein 1 (DKK1) and later subjected to IVM and IVEP along with the BCB+ and BCB- controls. The cumulus expansion index (CEI), rate of nuclear maturation (mean percentage of oocytes in the MII stage) and embryo production, and the expression of developmentally important genes were evaluated to assess the effect of Wnt pathway inhibition on the development competence of these poor-quality oocytes. Results The Wnt pathway genes exhibited a significantly higher expression (p < 0.05) in the poor-quality BCB- oocytes compared to the good-quality BCB+ oocytes during the early maturation stages. The supplementation of BCB- COCs with 100 ng/mL DKK1 effectively inhibited the expression of the key mediators of the Wnt pathway (β-catenin and dishevelled homolog 1, DVL1). DKK1 supplemented BCB- COCs exhibited significantly improved cytoplasmic and nuclear maturation indices, development rates and significantly elevated expression (p < 0.05) of genes implicated in germinal vesicle breakdown (GVBD) and embryonic genome activation (EGA) vis-à-vis BCB- control COCs. Conclusion These data indicate that inhibition of the Wnt pathway during the initial course of oocyte maturation can improve the development competence of poor-quality buffalo oocytes.
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Affiliation(s)
- Kriti Ahuja
- Animal Genomics Lab, Animal Biotechnology Centre, ICAR-National Dairy Research Institute, Karnal, India
| | - Vipul Batra
- Animal Genomics Lab, Animal Biotechnology Centre, ICAR-National Dairy Research Institute, Karnal, India
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Rakesh Kumar
- Animal Genomics Lab, Animal Biotechnology Centre, ICAR-National Dairy Research Institute, Karnal, India
| | - Tirtha Kumar Datta
- Animal Genomics Lab, Animal Biotechnology Centre, ICAR-National Dairy Research Institute, Karnal, India
- ICAR-Central Institute for Research on Buffaloes, Hisar, India
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2
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Prajapat SK, Mishra L, Khera S, Owusu SD, Ahuja K, Sharma P, Choudhary E, Chhabra S, Kumar N, Singh R, Kaushal PS, Mahajan D, Banerjee A, Motiani RK, Vrati S, Kalia M. Methotrimeprazine is a neuroprotective antiviral in JEV infection via adaptive ER stress and autophagy. EMBO Mol Med 2024; 16:185-217. [PMID: 38177535 PMCID: PMC10897192 DOI: 10.1038/s44321-023-00014-w] [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] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024] Open
Abstract
Japanese encephalitis virus (JEV) pathogenesis is driven by a combination of neuronal death and neuroinflammation. We tested 42 FDA-approved drugs that were shown to induce autophagy for antiviral effects. Four drugs were tested in the JE mouse model based on in vitro protective effects on neuronal cell death, inhibition of viral replication, and anti-inflammatory effects. The antipsychotic phenothiazines Methotrimeprazine (MTP) & Trifluoperazine showed a significant survival benefit with reduced virus titers in the brain, prevention of BBB breach, and inhibition of neuroinflammation. Both drugs were potent mTOR-independent autophagy flux inducers. MTP inhibited SERCA channel functioning, and induced an adaptive ER stress response in diverse cell types. Pharmacological rescue of ER stress blocked autophagy and antiviral effect. MTP did not alter translation of viral RNA, but exerted autophagy-dependent antiviral effect by inhibiting JEV replication complexes. Drug-induced autophagy resulted in reduced NLRP3 protein levels, and attenuation of inflammatory cytokine/chemokine release from infected microglial cells. Our study suggests that MTP exerts a combined antiviral and anti-inflammatory effect in JEV infection, and has therapeutic potential for JE treatment.
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Affiliation(s)
- Surendra K Prajapat
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Laxmi Mishra
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Sakshi Khera
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Shadrack D Owusu
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
- Institut de Biologie Moléculaire et Cellulaire (IBMC), Université de Strasbourg, 67000, Strasbourg, France
| | - Kriti Ahuja
- Laboratory of Calciomics and Systemic Pathophysiology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Puja Sharma
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Eira Choudhary
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Simran Chhabra
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Niraj Kumar
- Structural Biology & Translation Regulation Laboratory, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Rajan Singh
- Advanced Technology Platform Centre, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
- Department of Life Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Prem S Kaushal
- Structural Biology & Translation Regulation Laboratory, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Dinesh Mahajan
- Chemistry and Pharmacology Lab, Centre for Drug Design and Discovery, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Arup Banerjee
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Rajender K Motiani
- Laboratory of Calciomics and Systemic Pathophysiology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Sudhanshu Vrati
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India
| | - Manjula Kalia
- Virology Research Group, Regional Centre for Biotechnology, NCR Biotech Science Cluster, Faridabad, 121001, India.
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3
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Neupane N, Thapa S, Bhattarai A, Ahuja K, Schlam I, Mittal A, Tolaney SM, Tarantino P. Opportunities and Challenges for a Histology-Agnostic Utilization of Trastuzumab Deruxtecan. Curr Oncol Rep 2023; 25:1467-1482. [PMID: 37938529 DOI: 10.1007/s11912-023-01469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW This review delves into the prospects and challenges offered by a potential pan-histological utilization of trastuzumab deruxtecan (T-DXd) in patients with advanced solid tumors. RECENT FINDINGS The HER2-targeted antibody-drug conjugate (ADC) T-DXd has shown broad activity across cancer types, with current indications for patients with biomarker-selected breast, gastric, and non-small-cell lung cancer and relevant activity observed in multiple histology-specific trials. Moreover, two recently reported phase 2 trials (DESTINY-Pantumor02 and HERALD) have supported the potential for a pan-cancer utilization of this ADC in patients with advanced cancers expressing HER2 or with HER2 amplifications. By improving the delivery of cytotoxic chemotherapy, ADCs have allowed for meaningful clinical advantages in broad populations of cancer patients, often leading to survival advantages over conventional chemotherapy. Notably, the broad spectrum of activity of certain ADCs has led to the hypothesis of a histology-agnostic utilization based on detecting specific biomarkers, similar to what is already established for certain targeted treatments and immunotherapy. To date, T-DXd has shown the broadest activity across cancer types, with current approvals in breast, gastric, and lung cancer, and relevant antitumor activity observed in a multiplicity of additional cancer types. The optimization of the drug dose, identification of predictive biomarkers, and clarification of mechanisms of resistance will be critical steps in view of a pan-histological expansion in the use of T-DXd.
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Affiliation(s)
| | - Sangharsha Thapa
- Westchester Medical Center, New York Medical College, New York, NY, USA
| | - Abhinav Bhattarai
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Medical Database, Irvine, CA, USA
| | - Kriti Ahuja
- Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Ilana Schlam
- Division of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA
- Tufts University, Boston, MA, USA
| | - Abhenil Mittal
- Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Sara M Tolaney
- Breast Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Paolo Tarantino
- Breast Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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Tanwar J, Ahuja K, Sharma A, Sehgal P, Ranjan G, Sultan F, Priya A, Venkatesan M, Yenamandra VK, Singh A, Madesh M, Sivasubbu S, Motiani RK. Mitochondrial calcium signaling mediated transcriptional regulation of keratin filaments is a critical determinant of melanogenesis. bioRxiv 2023:2023.05.26.542250. [PMID: 37292659 PMCID: PMC10245956 DOI: 10.1101/2023.05.26.542250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mitochondria are versatile organelles that regulate several physiological functions. Many mitochondria-controlled processes are driven by mitochondrial Ca2+ signaling. However, role of mitochondrial Ca2+ signaling in melanosome biology remains unknown. Here, we show that pigmentation requires mitochondrial Ca2+ uptake. In vitro gain and loss of function studies demonstrated that Mitochondrial Ca2+ Uniporter (MCU) is crucial for melanogenesis while the MCU rheostats, MCUb and MICU1 negatively control melanogenesis. Zebrafish and mouse models showed that MCU plays a vital role in pigmentation in vivo. Mechanistically, MCU controls activation of transcription factor NFAT2 to induce expression of three keratins (keratin 5, 7 and 8), which we report as positive regulators of melanogenesis. Interestingly, keratin 5 in turn modulates mitochondrial Ca2+ uptake thereby this signaling module acts as a negative feedback loop that fine-tunes both mitochondrial Ca2+ signaling and melanogenesis. Mitoxantrone, an FDA approved drug that inhibits MCU, decreases physiological melanogenesis. Collectively, our data demonstrates a critical role for mitochondrial Ca2+ signaling in vertebrate pigmentation and reveal the therapeutic potential of targeting MCU for clinical management of pigmentary disorders. Given the centrality of mitochondrial Ca2+ signaling and keratin filaments in cellular physiology, this feedback loop may be functional in a variety of other pathophysiological conditions.
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Affiliation(s)
- Jyoti Tanwar
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Kriti Ahuja
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Akshay Sharma
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Paras Sehgal
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Gyan Ranjan
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Farina Sultan
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Anshu Priya
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Manigandan Venkatesan
- Department of Medicine, Center for Mitochondrial Medicine, Cardiology Division, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Vamsi K Yenamandra
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Archana Singh
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Muniswamy Madesh
- Department of Medicine, Center for Mitochondrial Medicine, Cardiology Division, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Sridhar Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002 India
| | - Rajender K Motiani
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
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5
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Sultan F, Ahuja K, Motiani RK. Potential of targeting host cell calcium dynamics to curtail SARS-CoV-2 infection and COVID-19 pathogenesis. Cell Calcium 2022; 106:102637. [PMID: 35986958 PMCID: PMC9367204 DOI: 10.1016/j.ceca.2022.102637] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/11/2022]
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and associated coronavirus disease 2019 (COVID-19) has severely impacted human well-being. Although vaccination programs have helped in reducing the severity of the disease, drug regimens for clinical management of COVID-19 are not well recognized yet. It is therefore important to identify and characterize the molecular pathways that could be therapeutically targeted to halt SARS-CoV-2 infection and COVID-19 pathogenesis. SARS-CoV-2 hijacks host cell molecular machinery for its entry, replication and egress. Interestingly, SARS-CoV-2 interacts with host cell Calcium (Ca2+) handling proteins and perturbs Ca2+ homeostasis. We here systematically review the literature that demonstrates a critical role of host cell Ca2+ dynamics in regulating SARS-CoV-2 infection and COVID-19 pathogenesis. Further, we discuss recent studies, which have reported that SARS-CoV-2 acts on several organelle-specific Ca2+ transport mechanisms. Moreover, we deliberate upon the possibility of curtailing SARS-CoV-2 infection by targeting host cell Ca2+ handling machinery. Importantly, we delve into the clinical trials that are examining the efficacy of FDA-approved small molecules acting on Ca2+ handling machinery for the management of COVID-19. Although an important role of host cell Ca2+ signaling in driving SARS-CoV-2 infection has emerged, the underlying molecular mechanisms remain poorly understood. In future, it would be important to investigate in detail the signaling cascades that connect perturbed Ca2+ dynamics to SARS-CoV-2 infection.
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Affiliation(s)
- Farina Sultan
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad, Delhi-NCR, India
| | - Kriti Ahuja
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad, Delhi-NCR, India
| | - Rajender K Motiani
- Laboratory of Calciomics and Systemic Pathophysiology (LCSP), Regional Centre for Biotechnology (RCB), Faridabad, Delhi-NCR, India.
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Rahmati M, Ripanelli A, Nair S, Gill A, Linara-Demakakou E, Ahuja K, Macklon N. P-335 How to define recurrent implantation failure and when to start investigating the endometrium? Lessons from three years’ experience in a dedicated unit. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Should we always define recurrent implantation failure (RIF) after three unsuccessful transfers and only then start investigating the endometrium?
Summary answer
Endometrial investigations can be beneficial for patients with RIF. However, waiting for three previous failures before instituting assessment might not be appropriate in every situation.
What is known already
The definition of unexplained recurrent implantation failure (RIF) continues to be debated. This usually implies a lack of embryo implantation after the transfer of three good quality blastocysts on an apparently responsive and anatomically normal endometrium. To deal with this frustrating and distressing situation for both the patient and the clinician, additional empirical interventions are often blindly used. This approach may exacerbate rather than ameliorate any underlying aetiology. There is a need therefore to base interventions on diagnostic rationale wherever possible.
Study design, size, duration
In order to base advice and any interventions for RIF on diagnostic rationale, we created a referral unit dedicated to the investigation and treatment of patients meeting the traditional criteria for RIF. Over three years, 395 patients were referred to this unit and 237 completed their investigations. Here we present the clinical outcomes and insights obtained over these three years.
Participants/materials, setting, methods
Blood sampling for serum progesterone level and endometrial pipelle biopsy were performed after five days of luteal support in a standardised substituted cycle. The samples underwent dating by gene expression (ERA test) and immune assessment describing the recruitment and activation of the uterine Natural Killer cells (MLI test, Matrice Lab Innove). A personalised treatment plan was thus derived and suggested to the referring clinician. The outcomes after the subsequent personalised single embryo transfer were monitored.
Main results and the role of chance
The patients referred had an average of 4.3 previous good quality blastocysts transferred in the past. 58% of the referred patients had used their own eggs, including 49% after conventional IVF or ICSI, and 9% after using PGT-A. 42% of the referred patients had used donor eggs. To date, 237 patients completed their endometrial assessment. 92% of the tested patients revealed at least one disrupted endometrial marker. With the subsequent personalised single embryo transfer, an implantation rate of 58% was observed. The ongoing pregnancy rate at 12 weeks was reported at 39%.
Limitations, reasons for caution
While confirmatory prospective controlled studies are required, these data indicate that more targeted rather than blind usage of simple known therapeutics could be beneficial for patients experiencing RIF. The clinical context these referred was highly variable, including patients undergoing PGT-A and egg donation.
Wider implications of the findings
Given the higher implantation rates to be expected in some groups, waiting for at least three embryos to fail before investigating the endometrium may be inappropriate and underlie the relatively high miscarriage rate observed. The investigation of implantation failure should be driven by context rather than arbitrary definition.
Trial registration number
Not Applicable
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Affiliation(s)
- M Rahmati
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - A Ripanelli
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - S Nair
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - A Gill
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | | | - K Ahuja
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
| | - N Macklon
- London Women's Clinic, Reproductive Medicine , London, United Kingdom
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Abreu L, Linara-Demakakou E, Carroll M, Ahuja K. P-191 Differences in morphokinetic patterns and clinical outcomes between fresh and frozen oocytes; a retrospective analysis. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there a difference in morphokinetics and clinical outcomes between embryos from fresh and vitrified oocytes?
Summary answer
Embryos from vitrified versus fresh oocytes showed a delay at the cellular stage, but no impact on time to blastulation or clinical outcomes was evident.
What is known already
Oocyte vitrification has greatly impacted assisted reproduction, with the number of treatments cycles using frozen oocytes more than doubling in the UK since 2013. Studies of thawed vitrified oocytes have shown similar success rates and outcomes compared to fresh, allowing the technique to be considered safe and effective. However, vitrification and thawing subjects the oocyte to stress and osmotic changes that may be evident in alterations in the timing of their morphological events. Analysis of morphokinetic markers using time-lapse incubators was performed to investigate this.
Study design, size, duration
Matched cohort study. A total of 823 embryos were analysed, 414 embryos from fresh oocytes and 409 from vitrified. The embryos were from the 288 ICSI treatment cycles performed at LWC in 2019. Fresh oocytes were from women less than 35 years old undergoing fertility treatment and vitrified oocytes were from egg donors under 35.
Participants/materials, setting, methods
Embryos graded AA, BB, BA, AB, were selected and annotated retrospectively on the Embryoscope for the following events: pronuclei appearance (tPNa) and disappearance (tPNf), time until two (t2), four (t4) and eight cells (t8), compaction initiation (tSC), the start of blastulation (tSB) and time to expanded blastocyst (tEB). PN duration, second and third embryo cell cycle (ECC), compaction and blastulation duration were also calculated as well as differences in clinical outcomes.
Main results and the role of chance
Embryos derived from vitrified oocytes (EVO) were observed to have a statistically significant delay in 4/8 morphokinetic events studied: t4 (p = 0.03), t8 (p < 0.01), tSC (p < 0.01) and tSB (p = 0.01). A mean delay of 1h50min was observed when compared to embryos from fresh oocytes (EFO). ECC duration showed a statistically significant difference with a delay of 48 minutes in the vitrified group. However, compaction occurred on average just 84min faster in this group, meaning no differences were observed in the time needed to achieve a full expanded blastocyst.
Regression analysis revealed a correlation between the age of the oocyte and morphokinetic timings. Oocytes from older women demonstrated slower development, with age having a statistically significant impact in the following categories: tPNa, tPNf, t2 and t4.
No differences found between fresh and vitrified groups in fertilization rate (80% EFO vs 79% EVO) (p = 0.841), embryo utilization rate (60% EFO and 61% EVO) (p = 0.432), implantation rate (54% EFO vs 52% EVO) (p = 0.837) and clinical pregnancy rates (49% EFO vs 42% EVO) (p = 0.502).
Limitations, reasons for caution
Limitations of the present study include the retrospective analysis, small sample size and the lack of adjustment for potential contributory/confounding factors such as semen quality, body mass index (BMI), antimüllerian hormone (AMH) levels, type of ovarian stimulation or type of infertility which are known possible influencers of embryo morphokinetics.
Wider implications of the findings
The delay observed at the cellular stage by EVO had no impact on the time the embryos needed to achieve full expansion. While vitrification affects embryo morphokinetics, it does not seem to impact the ability of the oocyte to be fertilized, activated, or to produce a viable blastocyst and pregnancy.
Trial registration number
Not applicable
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Affiliation(s)
- L Abreu
- London Womens Clinic, Embryology , London, United Kingdom
| | | | - M Carroll
- Manchester Metropolitan University, Course director- MSc Clinical Science / Cellular Science , Manchester, United Kingdom
| | - K Ahuja
- London Womens Clinic, Embryology , London, United Kingdom
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8
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Bodri D, Pataia V, Linara-Demakakou E, Kováts T, Vendola M, Wolska M, Nair S, Macklon N, Ahuja K. P-592 The effect of ethnicity on ovarian stimulation outcomes of altruistic oocyte donors from the largest UK vitrified egg bank: a retrospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Are there differences in ovarian stimulation outcomes among different ethnicities in the largest UK vitrified oocyte donation programme?
Summary answer
No significant differences were observed in ovarian response between non-White and White ethnic donor groups. Only AMH and baseline AFC correlated well with ovarian response.
What is known already
Ethnic disparities in ART outcomes have received much attention recently. Studies based on national registries have reported inferior outcomes for South Asian and Black ethnicities undergoing non-donor IVF treatment. Ovarian response has also been reported to differ across ethnicities, which was attributed to genetic or environmental factors, but also ethnic differences in ovarian reserve markers and body weight. A few US studies have evaluated recipient outcomes in oocyte donation treatment and found lower success rates for Black recipients. So far, no large study has evaluated the effect of ethnicity on ovarian response in a large cohort of oocyte donors.
Study design, size, duration
All consecutive oocyte donation cycles (n = 1.421) from the UK’s largest, private vitrified egg bank between 2017 and 2021 were included in this retrospective cohort analysis. Donors underwent general health evaluation, ovarian reserve (AMH, AFC) and infectious disease screening. Ovarian stimulation with recFSH was commenced on cycle day 2-3, with starting doses ranging from 112.5-450 IU. GnRH antagonist was given from day 6, and final oocyte maturation was triggered with a GnRH agonist (0.5 ml buserelin).
Participants/materials, setting, methods
Altruistic oocyte donors (n = 1.027) were stratified according to ethnicity; White (77%), mixed (7.4%), Black (5.4%), South-Asian (4.1 %), other Asian (3.5%) and South American (2.2%). In a univariate analysis, Kruskal-Wallis test was applied to compare age, BMI, AMH between ethnic groups and total and mature oocyte number during treatment cycles. In a multi-variate analysis, the effect of ethnicity, age, BMI, AMH and baseline AFC was evaluated on the number of total and mature oocytes obtained.
Main results and the role of chance
Univariate analysis showed no difference between ethnic groups in BMI (total average:23.5±3.1) AMH (total average:29.5±16.0 pmol/L) whereas other Asians were older (30.5±4.6 years, p < 0.001) and South Americans younger (24.4±4.7 years, p = 0.005) compared to Whites (27.1±4.6 years). The total number of eggs retrieved did not differ significantly between ethnic groups; White:19.6±9.1, mixed:19.6±9.0, Black:20.1±10.3, South-Asian:18±8.3, other Asian: 17.6±8.8 and South American:17.7±8.4, p = 0.24). The same applied to mature eggs obtained: White:14.2±7.1, mixed:13.9±7.2, Black:12.7±7.1, South-Asian:13.4±7.1, other Asian: 13±7.2, South American:12.8±7.1, p = 0.19). However, oocyte maturity rate was significantly lower in Black compared to White donors (64±19% vs 73±18%, p = 0.003). In a multivariate analysis, only baseline AFC (p < 0.0001) and AMH (p < 0.0001) correlated well with either the number of retrieved total or mature eggs.
Limitations, reasons for caution
Retrospective cohort studies might have inherent biases that make comparisons difficult. Slightly different inclusion criteria (age, AMH) for different ethnicities might have affected ovarian stimulation outcomes. The size of some subgroups was too low to yield statistically meaningful results. Some baseline donor variables were not included in our analysis.
Wider implications of the findings
Ovarian response outcomes were not substantially different across various ethnic groups of altruistic, UK oocyte donors. This study indicates that reported ethnic differences in IVF outcomes is unlikely to be due to response to ovarian stimulation. Donor egg programs can anticipate similar numbers of eggs irrespective of donor ethnicity.
Trial registration number
n/a
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Affiliation(s)
- D Bodri
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - V Pataia
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | | | - T Kováts
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - M Vendola
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - M Wolska
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - S Nair
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - N Macklon
- London Womens Clinic, London Egg Bank , London, United Kingdom
| | - K Ahuja
- London Womens Clinic, London Egg Bank , London, United Kingdom
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9
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Delikari O, Hashimi BA, Gibson G, Porta C, Macklon N, Ahuja K, Linara- Demakakou E. P-206 Could day 7 embryo culture become standard practice to improve patients’ treatment and outcome? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What are the clinical outcomes following transfer of day 7 embryos; could day 7 embryo culture become part of standard embryology practice?
Summary answer
Although clinical outcomes remain low, success has been seen following transfer of day 7 embryos. Extended culture plays an important role in standard embryology practice.
What is known already
In vitro culture conditions and cryopreservation techniques have improved greatly in recent years, allowing for extended culture, and freezing of embryos at the blastocyst stage. Optimally, embryos should develop to the blastocyst stage on day 5, however deviation from normal development can sometimes occur due to problems in either the embryonic intrinsic factors or imprinting timings. Live births have been reported from slower developing day 7 embryos. Extended culture to day 6 is standard practice in most IVF laboratories, however the aim of this study is to investigate the outcomes following prolonged embryo culture to day 7.
Study design, size, duration
This is a retrospective analysis study of 47 patients who underwent frozen embryo transfers (FETs) with a cryopreserved day 7 embryo at a UK licensed centre between 2017-2021. Patients were split into two groups: those transferring untested (non-PGT-A) day 7 embryos, and those transferring euploid PGT-A tested day 7 embryos. Clinical pregnancy (CPR) was analysed to study the clinical outcome of day 7 embryo culture followed by a frozen transfer.
Participants/materials, setting, methods
All patients who had FET with a day 7 embryo between 2017-2021 were included in this study. A total of 49 FETs (48 eSET,1 DET) involving 47 patients took place: 38 with untested embryos and 11 with euploid embryos. Clinical pregnancy rate (CPR) and live birth (LBR) was analysed to study the efficacy in transfer of day 7 embryos and the two groups of patients (untested and PGT-A tested) were compared.
Main results and the role of chance
The overall CPR per embryo transfer was 8% (47 patients, 49 ETs, 50 embryos transferred) and the LBR per embryo transfer was 4%. In the PGT-A group, a total of 201 day 7 embryos were biopsied over the 5-year study period; 28 were euploid following testing (14% euploidy rate). Of these, 11 have been transferred; 4 resulted in a pregnancy and 2 in a live birth. (LBR 18%) There is a significant difference in CPR between the PGT-A group (11 patients, 11 FETs; 11 embryos transferred, 4 foetal hearts seen, CPR=36%) and the untested group (36 patients, 38 ETs; 39 embryos transferred, CPR=0%) Chi square test performed and confirmed (p < 0.001). The mean age of the patient at the time of embryo transfer was 38.6 ± 0.5 and the mean age of the embryo transferred was 35.6± 0.5 (this was the patient’s age at the time of embryo freezing).
Limitations, reasons for caution
Limiting factors include the retrospective study design and the small sample size. It is also worth noting the high number of day 7 embryos required to undergo PGT-A testing to result in a low number of euploid embryos suitable for embryo transfer.
Wider implications of the findings
This study indicates the value of day 7 embryo culture as it has resulted in some patients achieving an ongoing pregnancy and a live birth. However, care must be taken to counsel patients appropriately around the chance of success when transferring day 7 embryos, particularly patients using untested embryos.
Trial registration number
Not Applicable
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Affiliation(s)
- O Delikari
- London Women's Clinic, IVF lab , London, United Kingdom
| | - B. Al Hashimi
- London Women's Clinic, IVF lab , London, United Kingdom
| | - G Gibson
- London Women's Clinic, IVF lab , London, United Kingdom
| | - C Porta
- London Women's Clinic, IVF lab , London, United Kingdom
| | - N Macklon
- London Women's Clinic, IVF lab , London, United Kingdom
| | - K Ahuja
- London Women's Clinic, IVF lab , London, United Kingdom
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10
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Band G, Garratt J, Linara-Demakakou E, Macklon N, Ahuja K. P-116 Clinical predictors of live birth rate (LBR) in donor-intrauterine insemination (D-IUI) cycles. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Which clinical parameters can predict LBR in D-IUI cycles?
Summary answer
Only age returned as a clinical predictor of D-IUI LBR. Total motile sperm count for insemination (TMSC) and stimulation protocol may help clinicians optimise LBR.
What is known already
D-IUI cycles are a popular treatment option for patients requiring male gamete donation. For both patient and clinician, identification of parameters that can guide clinical decision-making during fertility treatment is important to optimise clinical outcomes. To date, few studies have investigated D-IUI cycle parameters with live birth as the primary outcome. Moreover, previous studies can be limited from lack of control of covariates, as well not accounting for data skewing from inclusion of multiple cycles per patient.
Study design, size, duration
A retrospective analysis of 1925 D-IUI cycles in 638 patients between 2018-2020 at a single UK-based centre was performed. All donors were recruited by the London Sperm Bank as per the HFEA regulations. Inclusion criteria for donor sperm quality were all samples that met the WHO criteria. Exclusion criteria were cycles where live birth outcome was unknown.
Participants/materials, setting, methods
Patients underwent natural or stimulation cycle. Stimulation included clomiphene or letrozole, gonadotrophins +/- GnRH agonist, an hCG trigger or LH-monitoring to time insemination and micronised vaginal progesterone for luteal support. Insemination was scheduled 24 hours following surge detection/trigger administration. TMSC is presented per 0.5ml vial, which is post-preparation sample for insemination. T-test for continuous variables and Fisher’s Exact test for categorical variables were performed. For multivariate analysis, a generalised mixed effects logistic regression was performed.
Main results and the role of chance
Median cohort age was 36 ± SE 0.1, median TMSC was 14x106 ± SE 0.2x106. Of recipients, 53% were same sex couples, 41% were single women, 6.3% were heterosexual couples. There was no significant difference in TMSCs between cycles that produced a live birth and those that did not (14x106 and 13.9x106 respectively, P = 0.1). Dividing TMSC into 5x106 increments demonstrated that small increases in LBR per cycle occurred between 2.5-25x106. On average, LBR increased by 1.3% with each increment up to 25x106, reaching 15%. Beyond this, no further increase in LBR was observed. However, these incremental increases were not statistically significant (P = 0.6). Gonadotrophin stimulation (without agonist) achieved significantly higher LBRs than all other protocols (17.1%, P < 0.001). This persisted when stratifying by age (<35; 30%, 35-37; 29%, 38+; 12.6%). A mixed effects logistic regression model demonstrated that only age returned as a significant negative predictor of LBR (aOR 0.9, 95% CI 0.86-0.94, P < 0.001). There was no effect of TMSC on LBR (aOR 1.0, 95% CI 0.99-1.02, P = 0.7). Gonadotropin stimulation was associated with over double increased odds of achieving a live birth, which came close to significance (aOR 2.29, 95% CI 0.98-5.4, P = 0.06).
Limitations, reasons for caution
The choice of management regimen could have been influenced by uncontrolled factors, introducing bias in this retrospective study. Other semen parameters were not included in the multivariate analyses which could, in turn, have affected live birth outcome, which should be considered.
Wider implications of the findings
These findings demonstrate that increasing TMSC may be associated with small rises in LBR up to 25x106 in D-IUI cycles. While gonadotrophin stimulation appeared most effective, only age was shown to be an independent predictor of LBR. Collectively, these parameters may assist clinicians in optimising LBR in D-IUI cycles.
Trial registration number
None
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Affiliation(s)
- G Band
- London Sperm Bank , 1 ST Thomas street, London, United Kingdom
| | - J Garratt
- London Women's Clinic , 113-115 Harley street, London, United Kingdom
| | | | - N Macklon
- London Women's Clinic , 113-115 Harley street, London, United Kingdom
| | - K Ahuja
- London Women's Clinic , 113-115 Harley street, London, United Kingdom
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11
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Ahuja K, Shrivastava T, Shah M, Dasgupta M, Abate E, Ferreira de Araujo Litvin R, Batra K, Gupta S. Development of breast cancer after thyroid cancer and trends over time. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12066] [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
12066 Background: Thyroid cancer occurs early in adulthood and is thrice as common in women. Further, 1 of 8 women in the U.S develop breast cancer, usually later in life. We are studying the development of breast cancer after thyroid cancer in women within the US. Methods: The Incidence – SEER Research Data, 18 registries, Nov 2020 Sub (2000-2018) database was queried with SEER*Stat 8.3.9.2 for thyroid cancer in females and subsequent breast cancer. Further, the MP-SIR function of SEER*Stat 8.3.9.2 was applied to evaluate the Incidence – SEER Research Data, 18 Registries (excl AK), Nov 2020 Sub (2000-2018) for risk of developing breast cancer after thyroid cancer in females in terms of SIR (Standardized Incidence Ratio) and Excess Risk, stratified by age categories. Results: From 2000 to 2018, 151654 cases of thyroid cancer were diagnosed in 150787 women, most of which were papillary adenocarcinoma, NOS (50.2%) and papillary carcinoma, follicular variant (26.8%). About 64% cases occurred in Non-Hispanic Whites (NHW) and 60% of all cases developed from ages 30 to 60 (̃ 20% per decade). There was a considerable rise in incidence over the years, from > 4000 cases in year 2000 to > 9500 cases in 2018, with percentage change (PC) of 122.3%, and Annual Percentage change (APC) of 4.6% (CI 3.6-5.7, p < 0.05) across all age groups, highest in 60-69 age group (APC 7.5; CI 6-9.1, p < 0.05). At follow-up, 3300 cases of primary breast cancer were diagnosed in 3062 women of the above population. Infiltrating duct carcinoma, NOS constituted 70.5% cases, followed by lobular carcinoma, NOS at 10%. About 4 out of 5 breast tumors were ER positive (82.6%). NHW constituted > 70% cases and >50% cases occurred in age group 50-69 (approximately 25% per decade). We found an overall increasing trend in frequency of breast cancer after thyroid cancer with APC 14.1 (CI 11.9-16.3, p < 0.05). MP-SIR function in Incidence – SEER Research Data, 18 Registries (excl AK), Nov 2020 Sub (2000-2018) indicated that 3005 women developed breast cancer after thyroid cancer (consistent with the above data as it has latency criteria of 2 months and excludes AK). Overall, an increased risk of developing breast cancer after thyroid cancer was found, with SIR 1.21 (CI 1.16-1.25, p < 0.05) and Excess risk 4.88 across all age categories, highest at 1 year following diagnosis of thyroid cancer with SIR 1.29 (CI 1.15-1.44, p < 0.05) and excess risk 5.91. Among different age categories, SIR was highest for ages ≥70 at 1.32 (CI 1.2-1.45, p < 0.05) with excess risk 13.45. Conclusions: Women with thyroid cancer are at increased risk for subsequent primary breast cancers (usually ER+), with an overall increasing trend from 2000 to 2018. As we continue to make progress in the diagnosis and treatment of thyroid cancer in women, it is important to be cognizant of their increased risk for developing a subsequent primary and possible significance in terms of breast cancer screening.
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Affiliation(s)
- Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Mihir Shah
- John H. Stroger Hospital of Cook County, Chicago, IL
| | - Mona Dasgupta
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Elias Abate
- John H. Stroger Hospital of Cook County, Chicago, IL
| | | | - Kunnal Batra
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Shweta Gupta
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL
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12
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Shrivastava T, Ghimire P, Lingamaneni P, Ahuja K, Batra K. Long-term time trends in incidence, survival, and mortality of malignant melanoma in the United States. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21599] [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
e21599 Background: While there have been newer treatments that were developed in the last decade for metastatic melanoma, there is lack of data that directly looks at survival in melanoma before and after introduction of these new agents. We tried to explore the epidemiology of malignant melanoma including incidence to look at the trends of its incidence, survival and mortality in different groups over the last two decades. Methods: Data was obtained from the Surveillance, Epidemiology, and End Results Program (SEER Research Data, 18 Registries from 2000-2018) and data was cleaned and analyzed in STATA 16. 363,517 records were included in analysis from which baseline characteristics and median were obtained for survival time and survival analysis was done by Cox regression method to compare survival time between different groups. Pearson correlation was calculated to look for association between survival time and Breslow thickness. Results: Mean age group was 55-64 years, with 58% males and 42% females. 95% were White, 0.43% were Black, 0.63% were Asian and 3.79% were other races. 87% were localized, whereas 13% were metastatic. Mean Breslow thickness was 1.27mm (1.26-1.28). Overall median survival time was 62 months for malignant melanoma and 27 months for metastatic malignant melanoma. 42.63% were diagnosed before 2009 and 57.37% were diagnosed from 2009 to 2018. Cumulative incidence rate of melanoma increased from 4.78 to 6.57 per 100,000 persons whereas mortality rate increased from 0.29 to 2.23 per 100,000 persons from years 2000 to 2012 respectively. With contrast to age below 65, patients with age 65 and above had lower survival time (HR 4.78 95% CI 4.71-4.85, p < 0.01). There seemed to be an increase in incidence of melanoma among patients above 65 compared to below 65. When compared to males, females had significantly higher survival time (HR 0.62 95% CI 0.61-0.63, p < 0.01). Similarly, when compared to White population, Black and Asian population had lower survival time (HR 2.27 95% CI 2.11-2.43, p < 0.01 & HR 1.57 95% CI 1.14-1.68, p > 0.01) respectively. Comparing to localized disease, both regional and distant involvement had significantly lower survival time (HR 3.21 95% CI 3.15-3.28, p < 0.01 & HR 11.34 95% CI 11.07-11.61, p < 0.01) respectively. Breslow thickness had a negative correlation with survival months [regression coefficient (R) of -2.21 p < 0.01 (95% CI -2.35 to -2.07)]. Compared to patients who died before 2012, patients who died in 2012 or after had significantly better survival (HR 0.46, 95% CI 0.46-0.47, p < 0.01). Conclusions: Both, the incidence, and mortality of melanoma are rising, with more increase in age above 65 years. There appears to be an improvement in survival among patients who died after 2012, which may be an indirect indicator of the effectiveness of newer therapies. Risk factors for lower survival time were male sex, Black & Asian race, metastatic disease, and higher Breslow thickness.
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Affiliation(s)
| | | | | | - Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Kunnal Batra
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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13
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Shah M, Kumi DD, Deenadayalan V, Ahuja K, Abate E, Goyal A, Gupta S. Frequency of loco-regional complications and their IMPACT on hospitalization outcomes in patients with pancreatic cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16278] [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
e16278 Background: Despite advances in medicine, pancreatic cancer continues to have a grim prognosis. It is not well studied if certain loco-regional complications pose higher prognostic risk than others and thus may be useful in estimating longevity and targeting care. Methods: National Inpatient Sample (NIS) was queried to identify adult patients with underlying pancreatic cancer between 2016-2018. Relative frequency and diagnosis of locoregional complications as principal diagnosis in these patients were identified and top 5 loco-regional complications were studied and compared for all-cause mortality, mean length of stay (LOS), mean total hospital charges (THC). Statistics were performed using the t-test, univariate and multinomial logistic regression. Results: There were 112,230 adult hospitalizations for pancreatic cancer. Top 5 loco-regional complications were cancer pain (8.6%), upper GI bleeding (UGIB) (8.4%), gastroduodenal obstruction (5.7%), failure to thrive (5%) and acute liver failure (2.8%). Mortality rate of all pancreatic cancer admissions was 7% and all loco-regional complications studied were associated with significant increased odds of mortality, the highest in patients with acute liver failure (AOR- 5.33, p < 0.001). All Loco-regional complications studied were associated with statistically significant increased LOS with the highest among patients admitted with UGIB (p < 0.001). UGIB was also associated with the highest THC whiles cancer pain admissions had a lower charge (p < 0.001). Conclusions: Among Loco-regional complications in pancreatic cancer that were studied, cancer associated pain was the most frequent while acute liver failure was the most fatal (5x higher odds of mortality). UGIB was associated with the longest hospital LOS (6 more days) and the highest THC (over $100,000 extra per admission) whereas cancer associated pain was associated with the shortest length of stay and lowest total charge. Further efforts are needed to improve outpatient pain management in pancreatic cancer patients to prevent these admissions.[Table: see text]
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Affiliation(s)
- Mihir Shah
- John H. Stroger Hospital of Cook County, Chicago, IL
| | | | | | - Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Elias Abate
- John H. Stroger Hospital of Cook County, Chicago, IL
| | | | - Shweta Gupta
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL
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14
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Rodriguez P, Baral B, Ahuja K, Tariq M, Zia M. Optic Nerve Infiltration in Systemic Lymphoma in an HIV Patient. Cureus 2021; 13:e18041. [PMID: 34671528 PMCID: PMC8520654 DOI: 10.7759/cureus.18041] [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] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Different mechanisms have been proposed in lymphomatous involvement of the optic nerve. They include isolated optic nerve lymphoma, optic nerve lymphoma associated with primary central nervous system (CNS) lymphoma, or with systemic lymphoma. We present one case of non-Hodgkin lymphoma of the optic nerve in a Human Immunodeficiency Virus (HIV) patient and discuss the mechanism of metastasis, classification of optic nerve involvement with clinical and radiologic features as well as treatment options. Despite the uncommon nature of optic nerve infiltration by lymphoma, prompt evaluation should be considered in patients with a history of lymphoma and visual symptoms as delays in treatment can result in permanent vision loss. The recommended initial workup includes neuroimaging and cerebrospinal fluid evaluation. Treatment options are not standardized but include intravenous and intrathecal chemotherapy, corticosteroids, and radiation.
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Affiliation(s)
- Pierre Rodriguez
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Binav Baral
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Kriti Ahuja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Muhammad Tariq
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Maryam Zia
- Hematology and Medical Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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15
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Saurav S, Tanwar J, Ahuja K, Motiani RK. Dysregulation of host cell calcium signaling during viral infections: Emerging paradigm with high clinical relevance. Mol Aspects Med 2021; 81:101004. [PMID: 34304899 PMCID: PMC8299155 DOI: 10.1016/j.mam.2021.101004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/18/2021] [Accepted: 07/16/2021] [Indexed: 12/22/2022]
Abstract
Viral infections are one of the leading causes of human illness. Viruses take over host cell signaling cascades for their replication and infection. Calcium (Ca2+) is a versatile and ubiquitous second messenger that modulates plethora of cellular functions. In last two decades, a critical role of host cell Ca2+ signaling in modulating viral infections has emerged. Furthermore, recent literature clearly implicates a vital role for the organellar Ca2+ dynamics (influx and efflux across organelles) in regulating virus entry, replication and severity of the infection. Therefore, it is not surprising that a number of viral infections including current SARS-CoV-2 driven COVID-19 pandemic are associated with dysregulated Ca2+ homeostasis. The focus of this review is to first discuss the role of host cell Ca2+ signaling in viral entry, replication and egress. We further deliberate on emerging literature demonstrating hijacking of the host cell Ca2+ dynamics by viruses. In particular, a variety of viruses including SARS-CoV-2 modulate lysosomal and cytosolic Ca2+ signaling for host cell entry and replication. Moreover, we delve into the recent studies, which have demonstrated the potential of several FDA-approved drugs targeting Ca2+ handling machinery in inhibiting viral infections. Importantly, we discuss the prospective of targeting intracellular Ca2+ signaling for better management and treatment of viral pathogenesis including COVID-19. Finally, we highlight the key outstanding questions in the field that demand critical and timely attention.
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Affiliation(s)
- Suman Saurav
- Laboratory of Calciomics and Systemic Pathophysiology, Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Jyoti Tanwar
- CSIR-Institute of Genomics and Integrative Biology (IGIB), New Delhi-110025, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad-201002, India
| | - Kriti Ahuja
- Laboratory of Calciomics and Systemic Pathophysiology, Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India
| | - Rajender K Motiani
- Laboratory of Calciomics and Systemic Pathophysiology, Regional Centre for Biotechnology (RCB), Faridabad-121001, Delhi-NCR, India.
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16
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Pataia V, Nair S, Wolska M, Linara-Demakakou E, Shah T, Macklon N, Ahuja K. P–136 Factors predicting clinical outcomes of 511 recipients of vitrified oocyte donation from an UK-regulated egg bank. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Do established donor and recipient clinical markers predict recipient clinical pregnancy and live birth rates (LBRs) in a vitrified oocyte donation programme?
Summary answer
Recipient BMI and previous miscarriages predicted cumulative LBR. Likelihood of clinical pregnancy and LBR was higher in recipients of donors aged 23–29 than donors 18–22.
What is known already
The influence of age on ovarian reserve underlies the upper limit of 35 years for UK donors. However, recent evidence suggests that oocyte aneuploidy rates follow an inverse U-shaped curve in relation to a woman’s age. Conflicting evidence exists regarding the impact of other donor-related factors including BMI, AMH, oocyte yield and prior reproductive history on recipient outcomes. Moreover, the effect of recipient age, BMI, and reproductive history on oocyte donation outcome remains unclear.
Study design, size, duration
Retrospective cohort study of 325 altruistic oocyte donors matched to a total of 511 recipients. Only first donations taking place between January 2017 and December 2019 were included.
Participants/materials, setting, methods
All oocyte donors were altruistic volunteers aged 18–35 with no prior infertility diagnosis. Donor and recipient screening for suitability and safety was carried out according to the Human Fertilisation Embryology Authority guidelines. Backward stepwise logistic regression was used to identify donor, recipient and embryology parameters predictive of recipient primary outcomes defined as clinical pregnancy and live birth, either cumulative or after the first embryo transfer (ET).
Main results and the role of chance
A total of 705 fresh and frozen/thawed ETs were performed, of which 76% were elective single embryo transfers (eSETs) of blastocysts (96.5%), resulting in a cumulative clinical pregnancy and LBR of 83.5% and 70.5% respectively after 3 ETs. Recipient BMI and previous miscarriages were predictors of cumulative LBR (p < 0.05). The ratio of transferrable embryos per oocytes received/fertilised and the number of ETs needed to achieve the intended primary outcome were predictors of cumulative clinical pregnancy and LBR (p < 0.05). Donor age 18–22 was associated with lower incidence of recipient clinical pregnancy and live birth after the first ET, as compared to donor age 23–29 (p < 0.05).
Limitations, reasons for caution
The present study included only healthy oocyte donors, thus conclusions may not apply to subfertile or less healthy women. Male factors were not accounted for.
Wider implications of the findings: We demonstrate the efficacy of vitrified oocyte donation treatment and identify recipient BMI, previous miscarriages and embryology parameters as predictors of cumulative LBR. Additionally, the choice of donors aged 18–22 instead of older donors is found not to be advantageous for increasing the chance of clinical pregnancy and live birth.
Trial registration number
Not applicable
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Affiliation(s)
- V Pataia
- London Egg Bank, London Egg Bank, London, United Kingdom
| | - S Nair
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - M Wolska
- London Egg Bank, London Egg Bank, London, United Kingdom
| | | | - T Shah
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - N Macklon
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - K Ahuja
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
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17
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Garratt J, Raikundalia B, Rimington M, Ahuja K, Macklon N, Linara-Demakakou E. P–690 Clinical predictors of a high oocyte maturation rate in IVF treatment cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.689] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Which clinical parameters predict a high oocyte maturation rate in patients undergoing IVF treatment?
Summary answer
Time between oocyte collection and insemination demonstrated significant association with oocyte maturation and represents a parameter that could be optimised in IVF cycles.
What is known already
Oocyte maturation is an important factor determining IVF outcomes and can be a rate-limiting step for patients undergoing treatment. A number of clinical and laboratory variables may affect this process, including the choice of trigger prior to oocyte collection, and certain laboratory procedures. Identification of which of these are predictors of maturation in individual centres enables local protocols to be optimised.
Study design, size, duration
This is a retrospective study of 714 oocyte collections from 661 women between January 2020 to November 2020 treated in a large, single centre in the UK. Subsequent fertilisation on fresh oocytes consisted of 371 IVF and 343 ICSI cycles.
Participants/materials, setting, methods
Patient and treatment data was collected by clinical staff at time of treatment. Either GnRH agonist, hCG or double trigger were administered 36 hours before collection. Prior to ICSI, oocyte maturation was assessed by visualisation of polar body (PB) extrusion. After IVF, the number of 2PNs plus unfertilised oocytes with PB extrusion were assessed. Univariate analyses consisted of Mann-Whitney test, t-test, Fisher’s Exact test or ANOVA. Potential predictors were investigated by logistic regression.
Main results and the role of chance
The end point was maturation rate, defined as high (greater or equal to 70%) or low (less than 70%). Factors predictive of a high rate included insemination more than 4 hours after collection. Oocytes inseminated over 4 hours post-collection displayed significantly higher maturation rates than oocytes inseminated less than 2 hours after collection (69% and 61% respectively; P = 0.01). Oocytes inseminated between 2–4 hours also had higher maturation than those inseminated less than 2 hours post-collection, but this did not reach significance (67% and 61%, respectively; P = 0.06). Further, oocytes fertilised by ICSI had significantly higher maturation than conventional IVF (77% and 67%, respectively, P < 0.001). No significant difference in oocyte maturation between triggers was observed. Similarly, neither age, AMH, a diagnosis of PCOS or number of oocytes collected predicted oocyte maturation in univariate analysis. Logistic regression analysis showed only time between oocyte collection and insemination (aOR 2.12; 95% CI 1.03–4.38; P = 0.04) to be a significant independent predictor.
Limitations, reasons for caution
Varying means of data collection across clinics and between clinical staff inevitably leads to provision of incomplete data and should be taken into consideration alongside interpretation. Prescription bias of specific triggers to certain patient demographics should be noted.
Wider implications of the findings: Collectively, these results suggest that greater time between oocyte collection and insemination could be recommended to IVF clinics that wish to optimise their oocyte maturation. Triggering final maturation with GnRH agonist versus hCG or dual trigger did not have a significant effect on oocyte maturation when adjusted for confounders.
Trial registration number
Not applicable
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Affiliation(s)
- J Garratt
- University of Kent, School of Biosciences, Canterbury, United Kingdom
| | - B Raikundalia
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - M Rimington
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - K Ahuja
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
| | - N Macklon
- London Women’s Clinic, London Women’s Clinic, London, United Kingdom
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18
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Delikari O, Linara-Demakakou E, Mclaughlin A, Porta C, Macklon N, Ahuja K. P–226 Failure of blastocoele expansion within the first two hours post thawing could halve the chances of implantation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.225] [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: 11/12/2022] Open
Abstract
Abstract
Study question
The aim of this study was to evaluate the influence of blastocoele re-expansion time of warmed vitrified blastocysts on clinical pregnancy outcome.
Summary answer
Clinical pregnancy rate was significantly higher after transfer of warmed vitrified blastocysts that were fully expanded within 2 hours post thaw.
What is known already
The number of blastocysts being vitrified worldwide has increased dramatically over recent years. A combination of factors has led to this including the introduction of vitrification, an increase in freeze-all policies, single embryo transfer and an increase in preimplantation genetic testing. Currently, blastocyst re-expansion after thawing is used to indicate the survival status of the blastocyst and when combined with the morphology of blastocyst can predict its reproductive potential. While time taken for blastocoele re-expansion has been proposed to be a biomarker of viability, its value in clinical practice remains unclear.
Study design, size, duration
This retrospective study analysed outcomes in patients who had frozen embryo transfers between June-December 2020. 233 embryos were reviewed with time-lapse to assess their blastocoele expansion post-warming and three groups were identified. The first included fully expanded blastocysts post-warming. The second group included partially expanded blastocysts and the third non-expanded blastocysts. In addition, the groups were subcategorised into two further categories depending on whether they took less or more than 2 hours to complete expansion.
Participants/materials, setting, methods
233 vitrified/warmed embryos from 216 patients were analysed using time-lapse incubators. The first group included 134 blastocysts, of which 70 were fully expanded within 2 hours and 64 after 2 hours post thaw. The second group had 70 embryos of which 45 expanded partially within 2 hours and 25 after 2 hours. The third had 28 embryos that had no expansion within the first 2 hours (n = 20) or after 2 hours (n = 8).
Main results and the role of chance
Blastocysts were collapsed by laser prior to vitrification. Single blastocyst transfer was performed for all patients. The mean transferred embryo age was 32.1± 5.5 and the recipient’s was 37.5± 5.9. Fully expanded blastocysts (n = 70) within 2 hours demonstrated a clinical pregnancy rate (CPR) of 57% compared with 38% from those that expanded fully after 2 hours (n = 64) (p = 0.02). Blastocysts with some form of expansion (full or partial) within 2 hours post-warming (n = 115) were associated a significantly higher CPR compared to those expanding after 2 hours (n = 89). The CPR was 55% and 39% respectively (p = 0.02). Embryos that showed no expansion (n = 20) within the first 2 hours post thaw resulted in CPR of 28%. Interestingly, embryos that showed no expansion after 2 hours resulted in no pregnancy. When combining morphology as a selection criterion, expansion within 2 hours of thawing was associated with a CPR of 62.5% for ≥4AB embryos, 50% for BB embryos and 45% for poorer embryos ≤CB.In conclusion, failure of blastocoele expansion post 2 hours reduced by half the chances of clinical pregnancy (p = 0.03). Combination of the degree of re-expansion and embryo morphology is an important predictor tool to improve clinical outcomes in frozen embryo transfers.
Limitations, reasons for caution
This study uses a small sample size of patients. The data are observational and were retrospectively analysed so unknown confounders could not be assessed. The addition of more cycles and further multivariate analysis, is essential for confirmation of the findings. However, initial results are very reassuring.
Wider implications of the findings: The degree of speed of re-expansion post warming should be used as a predictor for prioritisation of embryos for transfer. Owing to these preliminary findings there is rationale for a larger scale study combining other morphological indicators that could further assess implantation indicators and assist patient counselling
Trial registration number
Not applicable
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Affiliation(s)
- O Delikari
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
| | - E Linara-Demakakou
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
| | - A Mclaughlin
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
| | - C Porta
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
| | - N Macklon
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
| | - K Ahuja
- London Women’s Clinic, Clinical Embryology Department, London, United Kingdom
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19
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Baral B, Ahuja K, Chhabra N, Tariq MJ, Zia M. Life-Threatening Fungal Infection in Richter Transformation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Brief Review of Literature. Cureus 2021; 13:e15924. [PMID: 34277298 PMCID: PMC8285100 DOI: 10.7759/cureus.15924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/05/2022] Open
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma is an indolent B cell lymphoproliferative malignancy typically affecting the elderly. Clinical outcomes of this condition have steadily improved as a result of advances in therapy. However, an increase in survival is accompanied by increased incidence of Richter transformation into an aggressive lymphoma. We present one such case and delve into its risk factors and associated complications. Exposure to increased lines of treatment appears to be a contributing factor in transformation, such that those with fewer than two lines of treatment are considered to have a lower risk of transformation. Fever, rapid lymph node involvement and drastic increases in lactate dehydrogenase, as seen in our patient, are concerning for transformation and treatment options include chemotherapy versus novel agent therapy. However, patients receiving therapy are at risk for adverse outcomes such as invasive infections, particularly in those receiving consolidation chemotherapy. Fungal infections such as Aspergillus and Candida are gaining prominence in the setting of neutropenia which adversely impact survival, but are underreported. Efforts to improve outcomes may include consideration of growth factor therapy in neutropenic patients and continuing to be vigilant for early signs of infection.
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Affiliation(s)
- Binav Baral
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Kriti Ahuja
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Navika Chhabra
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Muhammad J Tariq
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
- Hematology and Oncology, University of Arizona, Tucson, USA
| | - Maryam Zia
- Hematology and Medical Oncology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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20
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Ahuja K, Lingamaneni P, laswi H, Kumi DD, Chhabra N, Darweesh O, Batra K. Inpatient outcomes of pathological fractures in metastatic prostate cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17007] [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
e17007 Background: Bone is a frequent site of metastasis in prostate cancer and is involved in 88% of patients with metastatic prostate cancer. Metastasis to bone increases the risk of pathological fractures, which are associated with increased morbidity and mortality. We performed a retrospective analysis on inpatient outcomes of pathological fractures in prostate cancer metastatic to bone in comparison to men with osteoporotic fractures. We also examined the disposition of these patients. Methods: We queried the Nationwide Inpatient Sample between 2016 and 2018 to retrospectively identify adult males with osteoporotic fractures and those with pathological fractures secondary to metastatic prostate cancer. We used T-test and chi-square test to compare means of continuous variables and compare proportions of categorical variables respectively. Multivariate analysis of predictors of mortality, length of stay, hospitalization costs and disposition in this group were performed. Results: A total of 22,800 fractures, combining osteoporotic fractures and pathological fractures due to metastatic prostate cancer were identified, of which the latter accounted for 13.6%. Patients with pathological fractures secondary to metastatic prostate cancer were younger (mean age 73.5 vs 77.5 years, p < 0.0001) and more likely to be black (16.4% vs 4.6%, p < 0.0001) or Hispanic (8.4% vs 5.1%, p < 0.0001). Adjusting for demographic variables and comorbidity burden, pathological fractures in patients with prostate cancer metastasis to the bone were not associated with a significant increase in mortality (aOR 1.46, 95% CI 0.82-2.60, p = 0.20) or length of hospital stay. However, they did have higher hospitalization costs by $2,610 per admission (p = 0.01). Patients with pathological fractures secondary to prostate cancer are less likely to be discharged to a nursing facility (aOR 0.50, 95% CI 0.40-0.62, p < 0.001) and are more likely to be transitioned to home health care (aOR 1.49, 95% CI 1.20-1.84, p < 0.001). Conclusions: Pathological fractures secondary to prostate cancer are less frequent than osteoporotic fractures in men and are not independent predictors of mortality or length of stay. This is in keeping with the relatively indolent course of prostate cancer. However, there is an increased cost of hospital stay associated with pathological fractures in metastatic prostate cancer. Interestingly, these patients are more likely to be discharged with home health care and are less likely to go to a nursing facility, making disposition a crucial aspect in the care of these patients.
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Affiliation(s)
- Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - hisham laswi
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Navika Chhabra
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Kunnal Batra
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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21
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Ahuja K, Lingamaneni P, Weir C, Elsebaie MA, Rodriguez Alarcon PA, Aguilera-Astudillo M, Tamkus D. Comparison of inpatient outcomes of pathological fractures in metastatic breast cancer and osteoporosis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12115] [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
12115 Background: In the United States, an estimated 1 in 8 women will be diagnosed with breast cancer during her lifetime. Of those with metastasis, over half have bone metastases leading to risk for pathological fractures. Further, approximately 1 in 4 women over 65 years have osteoporosis of the femur neck or lumbar spine. We performed a retrospective analysis on outcomes in pathological fractures secondary to breast cancer metastasis in comparison to osteoporosis, including disposition at discharge. Methods: The Nationwide Inpatient Sample (NIS) database was queried to include all adult women admitted with osteoporotic fractures and pathological fractures due to metastatic breast cancer between 2016 and 2018. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Multivariate analysis of predictors of pathological fractures in women with breast cancer metastatic to bone, as well as mortality, resource utilization and disposition in this group were performed. Results: A total of 91,494 fractures, combining osteoporosis and pathological fractures secondary to metastatic breast cancer were identified, of which the latter accounted for 4.9%. Patients with pathologic fractures secondary to metastatic breast cancer were younger (mean age 62.8 vs 79.5 years, p < 0.0001) and were more likely to be black (14.6% vs 3.1%, p < 0.0001) or Hispanic (8.3% vs 4.7%, p < 0.0001). Adjusting for demographic variables and comorbidity burden, pathological fractures secondary to metastatic breast cancer were not associated with a significant increase in inpatient mortality (aOR 1.57, 95% CI 0.84-2.95, p = 0.16), but were independently associated with increased length of hospital stay by 0.7 days per admission (p = 0.01) and higher hospitalization costs by $3,381 USD per admission (p < 0.01). Regarding disposition, patients with pathological fractures secondary to breast cancer were less likely to be discharged to a nursing facility (aOR 0.57, 95% CI 0.48-0.68, p < 0.001) and were more likely to be transitioned to home health care (aOR 1.46, 95% CI 1.20-1.78, p < 0.001). Conclusions: In adult women, pathological fractures secondary to breast cancer are less frequent than osteoporotic fractures and were not independent predictors of inpatient mortality. They do however prolong length of stay and increase healthcare costs. Further efforts should focus on risk prediction and prophylactic management of high risk bone lesions in order to enhance patient’s quality of life, decrease hospitalization admissions, stay and cost.
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Affiliation(s)
- Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | | | - Catherine Weir
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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22
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Kumi DD, Shrivastava T, Elsebaie MA, laswi H, Ahuja K, Batra K. Hypercalcemia as a predictor of adverse treatment outcomes in DLBCL during chemotherapy: A national inpatient database study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19571] [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
e19571 Background: Hypercalcemia occurs in up to 7% of NHL and up to 18% in diffuse large B-cell lymphoma (DLBCL) representing about 60% of cases. Thus far, there are only a few studies that have established the poor prognosis between hypercalcemia and outcomes in DLBCL. We sought to outline specific acute complications that can during admission for chemotherapy in patients with hypercalcemia. Methods: This is a retrospective analysis of hospital admission using the National Inpatient Sample database (2018), including 15,636 adult patients with DLBCL admitted for chemotherapy. We obtained descriptive data, conducted chi-square test, and stratified logistic regression to look for possible chemotherapy related acute medical complications & predictors of mortality in DLBCL with & without hypercalcemia. Study limitations included lack of long term follow up, variations in chemotherapy and possible under-reporting of test subjects. Results: The mean age among DLBCL patients with & without hypercalcemia were 65.41 and 58.52 years respectively and the mean length of stay were 6.56 and 4.98 days respectively. Patient’s race, type of insurance and Charlson’s comorbidity index were found to be significant predictors of mortality in patients with DLBCL admitted for chemotherapy. Among race, Hispanics & Asian or Pacific islanders were found to be at higher risk for mortality, while patients who had private insurance were found to be associated with higher mortality risk (p<0.01). Similarly, Native Americans (aOR 8.72, 1.93-39.34, p<0.01) and patients with Charlson comorbidity index of 4 or more were at higher risk of mortality (aOR 4.34, 2.30-8.18, p<0.01). In regard to acute medical complications, DLBCL patients with hypercalcemia were at higher risk for tumor lysis syndrome (TLS) (aOR 3.86, p<0.01), acute kidney injury (AKI) (aOR 4.28, p<0.01) and hyperuricemia (aOR 9.74, p<0.01). There was no significant association of hypercalcemia in DLBCL with hyperkalemia, fluid overload, ICU admission, mortality, total cost, or length of stay. Conclusions: Hypercalcemia is associated with higher adverse outcomes during chemotherapy treatment in patients with DLBCL including TLS, hyperuricemia, and AKI during chemotherapy admission. This confirms to the overall accession of poor outcomes as published by other studies.[Table: see text]
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Affiliation(s)
| | | | | | - hisham laswi
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Kunnal Batra
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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23
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Gauto E, Del Cid Fratti J, Salazar M, Macchi H, Upadhyay Banskota SU, Baral B, Weir C, Ahuja K, Cattoni JA. In-hospital outcomes of percutaneous coronary intervention with drug-eluting stent in patients with localized and metastatic cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18631] [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
e18631 Background: Patients with localized and advanced malignancy are usually excluded from randomized clinical trials of drug-eluting stents and anti-platelet therapy. We aimed to evaluate short term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with localized and metastatic malignancy. Methods: Analysis from the Nationwide inpatient sample January 2016 to December 2018 of patients with localized and advanced malignancy admitted for a percutaneous coronary intervention with drug-eluting stents. Primary outcome was in-hospital mortality. Secondary outcomes were post-procedural complications and healthcare-utilization. Multivariate regression analysis was performed to adjust for confounders. Results: During 2016 – 2018 a total of weighted 1, 244, 550 PCI with DES were performed. 97.9 % in patients without cancer, 1.6% (n=21,125) patients with localized cancer and 0.3 % (n=4,765) with metastatic cancer. During hospitalization patient with cancer were more likely to develop respiratory failure, need for mechanical ventilation, AKI, and to receive blood products. After multivariate regression analysis patients with localized malignancy did not have any difference in-hospital mortality, total charges, cost, cardiac arrest or post procedural bleeding but had less LOS, respiratory failure, AKI requiring HD, post-procedural CVA and higher post-procedural blood transfusion when compared with patients without cancer. Conclusions: Patients with metastatic malignancy have higher in-hospital mortality when compared to patients without cancer. Patients with localized or advanced malignancy do not have higher in hospital complications. Blood transfusion is higher in patients with malignancy but is not related to procedure.[Table: see text]
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Affiliation(s)
| | - Juan Del Cid Fratti
- OSF Saint Francis Medical Center Cardiovascular Disease Department, Peoria, IL
| | | | - Hugo Macchi
- Advocate Masonic Medical Center, Chicago, IL
| | | | - Binav Baral
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Catherine Weir
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Kriti Ahuja
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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24
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Velagapudi S, Murthi M, Atluri R, Ahuja K, Shaka H, Velazquez G. IS HYPOCALCAEMIA A POTENTIAL MARKER FOR INCREASED MORTALITY IN HOSPITALIZED PATIENTS WITH ATRIAL FIBRILLATION?: A NATIONAL INPATIENT SAMPLE ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01769-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Murthi M, Abdala HM, Atluri R, Velagapudi S, Ahuja K, Velazquez G. IMPACT OF HYPOCALCEMIA ON THE OUTCOMES OF PATIENTS HOSPITALIZED WITH PULMONARY EMBOLISM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03178-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Murthi M, Ahuja K, Atluri R, Velagapudi S, Velazquez G, Sharma B. ALZHEIMER’S DISEASE NOT ASSOCIATED WITH INCREASED RISK OF IN-HOSPITAL MORTALITY IN PULMONARY EMBOLISM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03200-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Shrivastava T, Hwang JL, Munshi L, Batra KK, Ahuja K. A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia. Radiol Case Rep 2021; 16:989-993. [PMID: 33664928 PMCID: PMC7900011 DOI: 10.1016/j.radcr.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/20/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
A 46-year-old Asian male with history of atraumatic fracture of femur (requiring the use of a walker), muscle cramps and loosening teeth presents to Endocrine clinic. He had elevated parathyroid hormone, severely low phosphorus, elevated bone-specific ALP, with normal serum and urine calcium. He was found to have elevated FGF 23 levels, but initial functional and anatomic imaging was negative for any localizing tumor. With persistent follow-up and serial imaging, after 3 years, a 2.2 cm right scapular mass was found on MRI. Since it was also visualized on PET/CT, this was suspected to be the cause of his severe hypophosphatemia. He underwent surgical excision and pathology revealed a phosphaturic mesenchymal tumor after excision. Tumor induced osteomalacia is a rare, acquired paraneoplastic syndrome in which a tumor that secretes FGF23 leads to decreased renal phosphate reabsorption, resulting in hypophosphatemia, and bone demineralization. Diagnosis is challenging as common presenting symptoms are nonspecific, but when followed up closely with proper diagnostic modalities, identification & removal of the culprit lesion is usually curative.
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Affiliation(s)
- Trilok Shrivastava
- John H. Stroger Hospital of Cook County, Chicago, IL, USA
- Corresponding author.
| | | | | | | | - Kriti Ahuja
- John H. Stroger Hospital of Cook County, Chicago, IL, USA
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28
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Vadgaonkar R, Ahuja K, Deepak Khemlani L, Tonse M, Murlimanju BV. Unique case of duplex interventricular branching from the left coronary artery. Morphologie 2021; 106:61-65. [PMID: 33509707 DOI: 10.1016/j.morpho.2020.12.011] [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: 10/06/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
We report a rare morphological variant of the left coronary artery in this case of a female embalmed cadaver, where in the heart was nourished by double anterior and posterior interventricular arteries. These were branches of the left coronary artery and it was also observed that distribution of right coronary artery was very limited. The deceased may have been without symptoms in her life, but a prior knowledge of this kind of presentation would be very much informative to the interventional cardiologist and cardiothoracic surgeons in their protocol of treatment. This has implications for the coronary angiography and subsequent management of the ischemic heart disease.
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Affiliation(s)
- R Vadgaonkar
- Department of Anatomy, Kasturba Medical College, Mangalore-575001, Manipal Academy of Higher Education, 575004 Manipal, Karnataka, India
| | - K Ahuja
- First Year MBBS Students, Kasturba Medical College, Mangalore-575001, Manipal Academy of Higher Education, 575004 Manipal, Karnataka, India
| | - L Deepak Khemlani
- First Year MBBS Students, Kasturba Medical College, Mangalore-575001, Manipal Academy of Higher Education, 575004 Manipal, Karnataka, India
| | - M Tonse
- Department of Anatomy, Kasturba Medical College, Mangalore-575001, Manipal Academy of Higher Education, 575004 Manipal, Karnataka, India
| | - B V Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore-575001, Manipal Academy of Higher Education, 575004 Manipal, Karnataka, India.
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29
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Parashar K, Gandhi D, Nepal P, Sapire J, Ahuja K, Siddiqui I. Abdominal aortic aneurysm and its association with duodenal obstruction: aortoduodenal syndrome. BJR Case Rep 2020; 6:20200040. [PMID: 33299591 PMCID: PMC7709076 DOI: 10.1259/bjrcr.20200040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 03/25/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 01/24/2023] Open
Abstract
Proximal small bowel obstruction in the region of the duodenum is an uncommon clinical entity. Our case, which involves obstruction of the third portion of the duodenum due to an abdominal aortic aneurysm (AAA), is even more unusual. A review of the relevant literature regarding duodenal obstruction due to extrinsic compression includes features that differentiate aortoduodenal syndrome from superior mesenteric artery syndrome. Management of these conditions range from conservative to surgical, of which now includes a more recent role of metallic stents in some instances.
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Affiliation(s)
- Kalind Parashar
- Department of Radiology, St. Vincent's Medical Center at Hartford Healthcare 2800 Main Street, Bridgeport, CT 06606, USA
| | | | - Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center at Hartford Healthcare 2800 Main Street, Bridgeport, CT 06606, USA
| | - Joshua Sapire
- Department of Radiology, St. Vincent's Medical Center at Hartford Healthcare 2800 Main Street, Bridgeport, CT 06606, USA
| | - Kriti Ahuja
- Maulana Azad Medical College, New Delhi, Delhi 110002, India
| | - Imran Siddiqui
- Department of General Surgery and Surgical oncology, St. Vincent's Medical Center at Hartford Healthcare 2800 Main Street, Bridgeport, CT 06606, USA
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30
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Gandhi D, Sharma P, Parashar K, Kochar PS, Ahuja K, Sawhney H, Sharma S. Solid pseudopapillary Tumor of the Pancreas: Radiological and surgical review. Clin Imaging 2020; 67:101-107. [PMID: 32559679 DOI: 10.1016/j.clinimag.2020.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022]
Abstract
Solid Pseudopapillary Neoplasms of the pancreas are rare pancreatic tumors with low-grade malignant potential, typically affecting young females. In this review, we discuss the surgical anatomy; the imaging characteristics, and image reporting essentials for proper surgical planning along with the atypical features which should caution the physician regarding the risk of malignancy. We also discuss the common surgical procedures and organ preservation surgeries along with a comprehensive review of the literature.
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Affiliation(s)
- Darshan Gandhi
- St Vincent's Medical Center, Hartford Healthcare, CT, USA
| | - Pranav Sharma
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA.
| | | | - Puneet S Kochar
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA
| | | | - Harpreet Sawhney
- Yale New Haven Health Bridgeport Hospital, Radiology Department, 267 Grant Street, Bridgeport, CT 06610, USA
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Gandhi D, Ahuja K, Quade A, Batts KP, Patel L. Kratom induced severe cholestatic liver injury histologically mimicking primary biliary cholangitis: A case report. World J Hepatol 2020; 12:863-869. [PMID: 33200023 PMCID: PMC7643221 DOI: 10.4254/wjh.v12.i10.863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/02/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kratom is a psychoactive substance that is isolated from the plant Mitragyna speciosa. The leaves can be chewed fresh or dried, smoked, or infused similar to herbal teas. The plant leaves have been used by natives of Southeast Asia for centuries. The substance has been used for its stimulant activity at low doses, and as an opium substitute at higher doses due to a morphine like effect.
CASE SUMMARY A 37-year-old female with a history of depression and obesity (body mass index: 32) presented to emergency room with a week-long history of nausea, decreased appetite, fatigue, and two days of jaundice. On admission bilirubin was markedly elevated. Her condition was thought to be due to consumption of Kratom 2 wk before onset of symptoms. Liver biopsy showed changes mimicking primary biliary cholangitis. Patient’s symptoms and jaundice improved quickly.
CONCLUSION The use of Kratom has been on the rise in recent years across the United States and Europe. Several case reports have associated adverse health impact of Kratom-containing products including death due to its ability to alter levels of consciousness. Only a few case reports have highlighted the hepatotoxic effects of Kratom. Even fewer reports exist describing the detailed histopathological changes.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Kriti Ahuja
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi 110002, Delhi, India
| | - Alexis Quade
- Internal Medicine-Pediatrics, University of California-San Diego and Rady Children's Hospital San Diego, San Diego, CA 92103, United States
| | - Kenneth P Batts
- Department of Pathology, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
| | - Love Patel
- Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
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Gandhi D, Ahuja K, Grover H, Sharma P, Solanki S, Gupta N, Patel L. Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic. World J Radiol 2020; 12:195-203. [PMID: 33033574 PMCID: PMC7523085 DOI: 10.4329/wjr.v12.i9.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/22/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, United States
| | - Kriti Ahuja
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hemal Grover
- Department of Diagnostic Radiology, Icahn School of Medicine at Mount Sinai West, New York, NY 10029, United States
| | - Pranav Sharma
- Department of Diagnostic Radiology, Vascular and Interventional Radiology, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Shantanu Solanki
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
| | - Nishant Gupta
- Department of Radiology, Bassett Healthcare, Cooperstown, NY 13326, United States
| | - Love Patel
- Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
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Gandhi D, Ahuja K, Nepal P, Sawhney H, Sharma P, Kier R. Clear cell hidradenoma of the foot: a case report with literature review. ACTA ACUST UNITED AC 2020. [DOI: 10.21037/amj-20-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ahuja K, Gandhi D, Hernandez-Delima FJ, Sharma P, Gupta N, Kier R. Osteochondroses of the bilateral metacarpal heads: Dieterich disease. A case report with review of the literature. Clin Imaging 2020; 67:7-10. [PMID: 32497998 DOI: 10.1016/j.clinimag.2020.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Osteochondroses is a well-known entity and typically affecting immature skeleton with few common locations involved are femoral head epiphysis, tibial tubercle apophysis, calcaneal apophysis, humeral capitellum and anterior vertebral end plates. We report a rare case of osteochondroses showing avascular necrosis involving metacarpal heads known as Dieterich disease, involving the head of the third metacarpal and probably the first case with a history of rock climbing as an etiology. Chronic repetitive microtrauma plays a significant role in the disease, as is seen in our patient. Imaging plays a crucial role in diagnosing, as well as monitoring progress, with MRI being a critical modality. The fact that this entity is rare does not necessarily make it difficult to detect. It may be clinical underdiagnosed due to lack of familiarity with this entity and radiographic findings may be subtle or inapparent. Bone scan is likely sensitive but not specific. MRI also likely has a role for early detection. This article is written with educational intent for the reader for the benefit of the patients with this rare disease.
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Affiliation(s)
- Kriti Ahuja
- Maulana Azad Medical College, 2, Bahadur Shah Zafar Marg, New Delhi, Delhi 110002, India
| | - Darshan Gandhi
- Department of Diagnostic Radiology, St. Vincent's Medical Center at Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA.
| | - Fabricio J Hernandez-Delima
- Department of Internal Medicine, St. Vincent's Medical Center at Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA
| | - Pranav Sharma
- Department of Diagnostic Radiology, Bridgeport Hospital at Yale New Haven Health, Bridgeport, CT 06610, USA
| | - Nishant Gupta
- Department of Radiology, Bassett Healthcare, 1 Atwell Road, Cooperstown, NY 13326, USA
| | - Ruben Kier
- Department of Diagnostic Radiology, St. Vincent's Medical Center at Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA
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Ahuja K, Sotoudeh H, Galgano SJ, Singh R, Gupta N, Gaddamanugu S, Choudhary G. 18F-Sodium Fluoride PET: History, Technical Feasibility, Mechanism of Action, Normal Biodistribution, and Diagnostic Performance in Bone Metastasis Detection Compared with Other Imaging Modalities. J Nucl Med Technol 2019; 48:9-16. [PMID: 31811067 DOI: 10.2967/jnmt.119.234336] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
The skeleton is the third most common site for metastasis overall, after the lungs and liver. Accurate diagnosis of osseous metastasis is critical for initial staging, treatment planning, restaging, treatment monitoring, and survival prediction. Currently, 99mTc-methylene diphosphonate whole-body scanning is the cornerstone of imaging to detect osseous metastasis. Although 18F-sodium fluoride (18F-NaF) was one of the oldest medical tracers for this purpose, it was replaced by other tracers because of their better physical properties, until recently. Continued development of PET scanners has opened a new era for 18F-NaF, and given its higher sensitivity, there have been increasing applications in imaging. In this review, we will discuss the history, technical aspects, radiobiology, and biodistribution of this tracer. Finally, we compare the accuracy of 18F-NaF PET with other conventional imaging methods for detection of osseous metastasis.
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Affiliation(s)
- Kriti Ahuja
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Houman Sotoudeh
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Nishant Gupta
- Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, New York
| | | | - Gagandeep Choudhary
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Karrthik A, Gad M, Bazarbashi N, Ahuja K, Kaur M, Sammour Y, Kapadia S, Abdallah M. P6438Trends of acute kidney injury following percutaneous coronary interventions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1032] [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
Acute kidney injury (AKI) is a significant in-hospital complication in patients undergoing percutaneous coronary interventions (PCI) and has been shown to be associated with poor outcomes. Prior studies have shown an upward trend of AKI post PCI which may be related to a multitude of factors. In this study, we aim to discern whether the recent changes in AKI definition, awareness of risk calculators, and preventive measures have been effective in changing the inclining trend.
Methods
Patients who underwent PCI during hospitalization were identified retrospectively in the Nationwide Readmission Database (NRD) from January 2010 to December 2014. All patients older than 18 years were included in the current study. Patient demographics and comorbidities were identified using appropriate ICD-9 codes. The primary outcome is the temporal trends of AKI following PCI and secondary outcomes are temporal trends in mortality, length of stay and hospitalization cost in patients with AKI. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided.
Results
Among the 2,712,473 patients who underwent PCI from 2010 to 2014, 162,286 (6%) patients developed AKI post PCI. Mean age was 69.22±12.34 years and 65% of them were males. The percentage of cases with AKI rose almost twofold from 2010 to 2014 (4.8% to 8.1%, p-value <0.005), despite the lack of a significant change in patient's demographics and comorbidities over the years. Among patients with a history of Chronic Kidney Disease (CKD) the incidence of AKI increased from 20.3% to 24.2%, and in patients without CKD history the incidence of AKI almost doubled (2.6% to 5.0%) from 2010 to 2014. There was a slight decrease in in-hospital mortality (9.4% to 8.8%) and median length of stay (7 days to 5 days), and a slight increase in the mean cost of hospitalization ($124,755.1 to $133,902.17) from 2010 to 2014.
AKI Incidence and mortality trend
Conclusion
This large cohort study shows a consistent uptrend of AKI in patients undergoing PCI from 2010 to 2014. Despite this, the mortality and length of stay are decreasing while the cost of hospitalization only slightly increased in patients with AKI. Thus, future drives to implement renal protective measures and advanced studies to identify new preventive therapies are needed to reduce the incidence of AKI post-PCI.
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Affiliation(s)
- A Karrthik
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Gad
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - N Bazarbashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Ahuja
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Kaur
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Sammour
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Abdallah
- Cleveland Clinic Foundation, Cleveland, United States of America
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Karrthik A, Gad M, Bazarbashi N, Ahuja K, Sammour Y, Kaur M, Ahmed H, Kapadia S. P5331Aspirin use for prevention of cardiovascular events in patients with high lipoprotein(a): a population-based study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background
High lipoprotein(a) [Lp(a)] levels have been shown to increase Myocardial Infarction (MI) and all-cause mortality. However, studies evaluating the optimal preventive measures for that subset of cardiac patients are scarce. This study aims to study the outcomes of aspirin use versus no aspirin for the prevention of all-cause mortality and myocardial infarction in patients with high Lp(a) levels.
Purpose
We sought to determine the effect of Aspirin in reducing the rate of MI and all-cause mortality among patients with high lipoprotein(a) [Lp(a) ≥50mg/dL]
Methods
Patients who attended the preventive cardiology clinic from 2005 to 2016 and included in the Preventive Cardiology Database were included in the current single-center, retrospective, observational cohort study that was conducted according to the guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) checklist. The primary outcome was the incidence of myocardial infarction and the secondary outcome was all-cause mortality. Patients were excluded in cases of I) Lp(a)a <50mg/dL, II) history of malignancy, or III) being on anticoagulation/ dual antiplatelet therapy. The median duration of follow-up was 92 months from time of Lp(a) measurement to the last follow-up. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided. A propensity score-matched analysis was performed with 1:1 nearest match for Age, Gender, Race, Smoking status, BMI, Diabetes, Peripheral artery disease, Carotid artery disease, coronary artery disease, chronic kidney disease, Heart failure, Hypertension, Dyslipidemia, Stroke, family history of coronary artery disease, Lp (a), LDL, HDL, Triglycerides, glucose and total cholesterol.
Results
1,805 patients fulfilled the inclusion and exclusion criteria out of 7,410 patients initially identified with recorded Lp(a) levels in the Preventive Cardiology Database. Of these, 376 patients were taking aspirin, and 1429 patients were not receiving aspirin. After propensity score matching for different baseline characteristics and comorbidities as mentioned above, 316 patients were matched in each group. Patients who were on Aspirin had a significantly lower rate of MI events compared to patients who were not on aspirin (6.96% vs 12.02%, P=0.03) and a lower rate, however statistically non-significant, of all-cause mortality (2.84% vs 4.11%, P=0.385).
Conclusion
The use of aspirin in patients with elevated Lp(a) levels significantly lowers the rate of myocardial infarction events. Larger randomized clinical trials are warranted to evaluate the use of aspirin for primary and secondary prevention of major adverse cardiovascular events in patients with high Lp(a) levels.
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Affiliation(s)
- A Karrthik
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Gad
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - N Bazarbashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Ahuja
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Y Sammour
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Kaur
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Ahmed
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Kapadia
- Cleveland Clinic Foundation, Cleveland, United States of America
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Karrthik A, Gad M, Ahuja K, Bazarbashi N, Abderrehman K, Ahmed H. P6525Impact of acute arrhythmias on in-hospital mortality in patients undergoing angioplasty. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1115] [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
Arrhythmia is one of the most common complications in patients undergoing percutaneous coronary interventions (PCI). Prior attempts to address these arrhythmias “aggressively” did not show improvement in survival. This study aims to investigate the impact of acute arrhythmias on in-hospital mortality in patients undergoing angioplasty in the United States.
Methods
Data about patients undergoing PCI between January 2010 and December 2014 on the Nationwide Readmission Database (NRD) was queried from the Healthcare Cost and Utilization Project (HCUP). All patients undergoing PCI were identified with the appropriate ICD-9 procedure codes. Binominal logistic regression testing was utilized to perform a multivariate analysis and different patient baseline characteristics were adjusted for including age, gender, LOS, diabetes mellitus, hypertension, renal failure, and cancer diagnosis. Odds Ratio (OR) of in-hospital mortality following acute arrhythmia were reported alongside 95% Confidence Intervals (CI).
Results
A total of 2,712,078 patients underwent PCI during hospitalization from January 2010 to December 2014. Out of those, 56,985 (2.1%) patients died while hospitalized. Most of the patients who died were older (mean age 70.73±12.9) and males (59.3%). After adjusting for age, female gender, hypertension, diabetes, heart failure, anemia, malignancy, psychiatric disorder, and longer length of stay; ventricular and supraventricular arrhythmias were found to be predictors of in-hospital mortality. Atrial fibrillation had an OR of 1.588 (95% CI: 1.551–1.626), ventricular tachycardia an OR of 2.191 (95% CI: 2.133–2.250), and ventricular fibrillation an OR of 4.143 (95% CI: 4.031–4.258).
Conclusions
Ventricular and supraventricular arrhythmias are independent predictors of in-hospital mortality following angioplasty. Further studies are warranted to evaluate the optimal management for patients with acute arrhythmia following PCI.
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Affiliation(s)
- A Karrthik
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M Gad
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Ahuja
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - N Bazarbashi
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K Abderrehman
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - H Ahmed
- Cleveland Clinic Foundation, Cleveland, United States of America
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Choudhary G, Ahuja K, Khan R, Kubal W. Bilateral persistent primitive hypoglossal artery presenting with hemiplegia ✰. Radiol Case Rep 2018; 13:1072-1075. [PMID: 30228846 PMCID: PMC6137901 DOI: 10.1016/j.radcr.2018.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
The manuscript describes an unusual vascular anomaly. Persistence of carotid-vertebrobasilar anastomosis is a rare occurrence with presence of bilateral hypoglossal arteries (HAs) rarer still. We present a case of bilateral persistent HAs with hypoplastic vertebral arteries which end into posterior inferior cerebellar arteries. The computed tomography and magnetic resonance imaging appearance, course, and other associations are discussed. A review of 6 cases of bilateral HA published in the world literature is also discussed.
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Affiliation(s)
- Gagandeep Choudhary
- Department of Radiology, University of Alabama in Birmingham, 619 19th Street South, JT 779, Birmingham, AL 35249-6835, USA
| | - Kriti Ahuja
- Department of Radiology, University of Alabama in Birmingham, 619 19th Street South, JT 779, Birmingham, AL 35249-6835, USA
| | - Rihan Khan
- Department of Radiology, Banner University Medical Center, Tucson, AZ, USA
| | - Wayne Kubal
- Department of Radiology, Banner University Medical Center, Tucson, AZ, USA
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Sato K, Kumar A, Ala C, Ahuja K, Verma B, Xu B, Klein A. P694Higher inflammation and recovery of tissue Doppler velocity ratio predicts resolution of constrictive pericarditis by anti-inflammatory medications. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p694] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Sato
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - A Kumar
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - C Ala
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - K Ahuja
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - B Verma
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - B Xu
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - A Klein
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
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Ahuja K, Bhandari T, Banait-Deshmane S, Crowe DR, Sonavane SK. Incidentally detected ectopic thyroid in juxta cardiac location-Imaging and pathology. Radiol Case Rep 2018; 13:909-913. [PMID: 30008980 PMCID: PMC6043872 DOI: 10.1016/j.radcr.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023] Open
Abstract
Ectopic thyroid gland is a developmental anomaly that results from the arrest of thyroid tissue along its path of descent from the floor of mouth to the pre tracheal position in the lower neck. It is typically found along the thyroglossal duct with the base of the tongue being the most common site. Apart from mediastinal extension of goiter, the incidence of true intrathoracic ectopic thyroid tissue is rare. Presence of ectopic thyroid has been reported not only in the chest but also in the abdomen and pelvis. Pericardial and intracardiac locations are extremely uncommon and right ventricle location is predominant among the described cases. We describe a case of incidentally detected ectopic thyroid tissue in a rarer location-adjacent to the left atrium. The patient, who had undergone a nephrectomy for renal oncocytoma 5 years ago, presented with unintentional weight loss and left sided flank pain, prompting a workup to rule out abdominal malignancy. Findings on the computed tomography (CT) scan of the abdomen and pelvis prompted further investigation including a chest CT which showed a heterogeneously enhancing mass near the left atrium. Given its location, further radiological investigations played an important role in eliminating the differential diagnosis of paraganglioma. The mass was surgically resected and discovered to be a hyperplastic thyroid nodule on histologic examination.
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Affiliation(s)
- Kriti Ahuja
- Department of Radiology, University of Alabama in Birmingham, Birmingham, AL, USA
| | - Tarun Bhandari
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | | | - David R Crowe
- Department of Pathology, University of Alabama in Birmingham, Birmingham, AL, USA
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Fell J, Lis D, Kitic C, Ahuja K, Stellingwerff T. FODMAP removal in athletes: An online survey of specific food avoidance and associated symptoms in athletes. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.024] [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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Byrne L, Ogden K, Fell J, Watson G, Lee S, Ahuja K, Bauman A. The effects of a community-wide, multi-strategy intervention on physical activity participation in Launceston, Tasmania. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.210] [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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Beckett J, Murray S, Ball M, Ahuja K. Generic label versus popular branded products: How does the sodium stack-up? Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.242] [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: 11/27/2022] Open
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45
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Liu J, Linara E, Zhao W, Ma H, Ahuja K, Wang J. Neonatal and obstetric outcomes of in vitro fertilization (IVF) and natural conception at a Chinese reproductive unit. CLIN EXP OBSTET GYN 2015. [DOI: 10.12891/ceog1863.2015] [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: 11/01/2022]
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46
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Liu J, Linara E, Zhao W, Ma H, Ahuja K, Wang J. Neonatal and obstetric outcomes of in vitro fertilization (IVF) and natural conception at a Chinese reproductive unit. CLIN EXP OBSTET GYN 2015; 42:452-456. [PMID: 26411210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In vitro fertilization (lVF) has been associated with an increased risk of preterm delivery, caesarean delivery, low and very low birth-weight infants. The authors investigated the possible high risks of adverse health outcomes in infants conceived using IVF and intracytoplasmic sperm injection (ICSI). The present study includes 443 infants born to 424 women who conceived naturally and 694 infants born to 536 women that had IVF or ICSI. The study was conducted in the Department of Obstetrics at the Yu Huang Ding Hospital from 2008 to 2009. The main outcome measures were:gestational age, birth weight, mode of delivery, multiple pregnancy rates, and baby gender. The results showed significant differences between the neonatal and obstetric outcomes of IVF/ICSI and natural conception pregnancies. When referred to singletons only, there were no major differences seen in the neonatal and obstetric outcomes between the IVF and the control group.When the IVF group was divided into two sub-groups according to the patient's age (< 35 and > or = 35 years), there was no statistically significant difference between the two groups in the observed outcomes.
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Gonzalez D, Thackeray H, Lewis PD, Mantani A, Brook N, Ahuja K, Margara R, Joels L, White JO, Conlan RS. Loss of WT1 expression in the endometrium of infertile PCOS patients: a hyperandrogenic effect? J Clin Endocrinol Metab 2012; 97:957-66. [PMID: 22238403 DOI: 10.1210/jc.2011-2366] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT In fertile patients the endometrial Wilms tumor suppressor gene (WT1) is expressed during the window of implantation. Polycystic ovary syndrome (PCOS) patients suffer from hyperandrogenemia and infertility and have elevated endometrial androgen receptor (AR) expression. WT1 is known to be down-regulated by AR. Therefore, the expression of WT1 and its targets may be altered in PCOS endometrium. OBJECTIVE The objective of the study was to assess the expression and regulation of WT1 and selected downstream targets in secretory endometrium from ovulatory PCOS (ovPCOS) and fertile women. DESIGN AND PATIENTS Endometrial samples were obtained from 25 ovPCOS and 25 fertile patients. MAIN OUTCOME MEASURE Endometrial expression of WT1 and selected downstream targets were assessed by immunohistochemistry and RT-PCR. The androgen effect on WT1 expression was determined in vitro by immunoblots and RT-PCR. The expression of WT1 and its targets was quantified in fertile and ovPCOS stromal cells in the presence of androgens by RT-PCR. Caspase-3/7 activity was measured to evaluate sensitivity to drug-induced apoptosis. RESULTS WT1 expression was down-regulated in secretory-phase ovPCOS endometrium. Stromal expression of Bcl-2 and p27 was higher, and epidermal growth factor receptor was lower in ovPCOS than in fertile patients. Endometrial stromal expression of WT1, Bcl-2, Bcl-2-associated X protein, and β-catenin was regulated by androgens. Apoptosis levels were reduced in ovPCOS samples and androgen-treated fertile samples. CONCLUSION WT1 expression is down-regulated in ovPCOS endometrium during the window of implantation. Androgens regulate the expression of WT1 and its targets during endometrial decidualization. The altered balance between WT1 and AR in the endometrium of PCOS patients may jeopardize the success of decidualization and endometrial receptivity.
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Affiliation(s)
- D Gonzalez
- Institute of Life Science, Swansea University, College of Medicine, and Singleton Hospital, Swansea SA2 8PP, United Kingdom
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Ball M, Ahuja K, Green N, Adams M, Robertson I. 674 POTENTIAL BENEFITS OF CHILLI PEPPER IN A MEAL AND A CAPSULE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70675-4] [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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Ball M, Robertson I, Harvey N, Ahuja K. MS275 POTENTIAL METABOLIC BENEFITS OF ADDING CHILLI PEPPER TO A MEAL. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ball M, Robertson I, Ahuja K. MS235 EFFECTS OF FOOD ON POSTPRANDIAL BLOOD PRESSURE AND ARTERIAL STIFFNESS MEASUREMENT. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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