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Schneider C, Bogatu D, Leahy J, Zen Y, Ross P, Sarker D, Suddle A, Agarwal K, Srinivasan P, Prachalias AA, Heaton N, Menon K. Predictors of recurrence following laparoscopic minor hepatectomy for hepatocellular carcinoma in the UK. Surg Oncol 2023; 49:101965. [PMID: 37348195 DOI: 10.1016/j.suronc.2023.101965] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
AIMS Minor hepatectomy, which is increasingly carried out laparoscopically (LLR), is a cornerstone of curative treatment for hepatocellular carcinoma (HCC). The majority of relevant publications however originate from regions with endemic viral hepatitis. Although the incidence of HCC in the UK is increasing, little is known about outcomes following LLR. METHODS Consecutive patients undergoing minor (involving ≤2 segments) LLR or open resection (OLR) at our institute between 2014 and 2021 were compared. Selection from a plethora of factors potentially impacting on overall (OS) and disease free survival (DFS) was optimised with Lasso regression. To enable analysis of patients having repeat resection, multivariate frailty modelling was utilised to calculate hazard ratios (HR). RESULTS The analysis of 111 liver resections included 55 LLR and 56 OLR. LLR was associated with a shorter hospital stay (5 ± 2 vs. 7 ± 2 days; p < 0.001) and a lower comprehensive complication index (4.43 vs. 9.96; p = 0.006). Mean OS (52.3 ± 2.3 vs. 49.9 ± 3.0 months) and DFS (33.9 ± 3.4 vs. 36.5 ± 3.6 months; p = 0.59) were comparable between LLR and OLR, respectively (median not reached). Presence of mixed cholangiocarcinoma/HCC, satellite lesions and AFP level predicted OS and DFS. In addition tumour size was predictive of DFS. CONCLUSIONS In the studied population minor LLR was associated with shorter hospital stay and fewer complications while offering non-inferior long-term outcomes. A number of predictors for disease free survival have been elucidated that may aid in identifying patients with a high risk of disease recurrence and need for further treatment.
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Affiliation(s)
- C Schneider
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - D Bogatu
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - J Leahy
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - Y Zen
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Ross
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - D Sarker
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - A Suddle
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Srinivasan
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - A A Prachalias
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - N Heaton
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom
| | - K Menon
- Department of Hepatopancreatico-biliary Surgery, King's College Hospital, London, United Kingdom.
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Yadav PD, Kumar S, Agarwal K, Jain M, Patil DR, Maithal K, Mathapati B, Giri S, Mohandas S, Shete A, Sapkal G, Patil DY, Dey A, Chandra H, Deshpande G, Gupta N, Abraham P, Kaushal H, Sahay RR, Tripathy A, Nyayanit D, Jain R, Kumar A, Sarkale P, Baradkar S, Rajanathan C, Raju HP, Patel S, Shah N, Dwivedi P, Singh D. Needle-free injection system delivery of ZyCoV-D DNA vaccine demonstrated improved immunogenicity and protective efficacy in rhesus macaques against SARS-CoV-2. J Med Virol 2023; 95:e28484. [PMID: 36625386 DOI: 10.1002/jmv.28484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
The apprehension of needles related to injection site pain, risk of transmitting bloodborne pathogens, and effective mass immunization have led to the development of a needle-free injection system (NFIS). Here, we evaluated the efficacy of the NFIS and needle injection system (NIS) for the delivery and immunogenicity of DNA vaccine candidate ZyCoV-D in rhesus macaques against SARS-CoV-2 infection. Briefly, 20 rhesus macaques were divided into 5 groups (4 animals each), that is, I (1 mg dose by NIS), II (2 mg dose by NIS), III (1 mg dose by NFIS), IV (2 mg dose by NFIS) and V (phosphate-buffer saline [PBS]). The macaques were immunized with the vaccine candidates/PBS intradermally on Days 0, 28, and 56. Subsequently, the animals were challenged with live SARS-CoV-2 after 15 weeks of the first immunization. Blood, nasal swab, throat swab, and bronchoalveolar lavage fluid specimens were collected on 0, 1, 3, 5, and 7 days post infection from each animal to determine immune response and viral clearance. Among all the five groups, 2 mg dose by NFIS elicited significant titers of IgG and neutralizing antibody after immunization with enhancement in their titers postvirus challenge. Besides this, it also induced increased lymphocyte proliferation and cytokine response. The minimal viral load post-SARS-CoV-2 challenge and significant immune response in the immunized animals demonstrated the efficiency of NFIS in delivering 2 mg ZyCoV-D vaccine candidate.
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Affiliation(s)
- Pragya D Yadav
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Sanjay Kumar
- Department of Neurosurgery, Command Hospital [Southern Command], Armed Forces Medical College [AFMC], Pune, India
| | - Kshitij Agarwal
- Department of Respiratory Medicine, University college of Medical Scieneces and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India
| | - Mukul Jain
- Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Dilip R Patil
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Kapil Maithal
- Vaccine Technology Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Basavaraj Mathapati
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Suresh Giri
- Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Sreelekshmy Mohandas
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Anita Shete
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Gajanan Sapkal
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Deepak Y Patil
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Ayan Dey
- Vaccine Technology Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Harish Chandra
- Vaccine Technology Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Gururaj Deshpande
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | | | - Priya Abraham
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Himanshu Kaushal
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Rima R Sahay
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Anuradha Tripathy
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Dimpal Nyayanit
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Rajlaxmi Jain
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Abhimanyu Kumar
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Prasad Sarkale
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | - Shreekant Baradkar
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
| | | | - Hari Prasad Raju
- Vaccine Technology Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Satish Patel
- Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Niraj Shah
- Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Pankaj Dwivedi
- Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, Gujarat, India
| | - Dharmendra Singh
- Indian Council of Medical Research-National Institute of Virology, Pune, Maharashtra, India
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Agarwal K, Kumar R, Ramachandaran R, Tandon N. Abdominopelvic paragangliomas: A cohort review of 15-year experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01137-5] [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: 02/12/2023]
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Agarwal K, Bhati G, Gupta P, Verma AK. Role of Aspergillus Specific IgG Titres as a Therapeutic Target for Chronic Pulmonary Aspergillosis: A Longitudinal Study. J Clin Diagn Res 2023. [DOI: 10.7860/jcdr/2023/59250.17385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Chronic Pulmonary Aspergillosis (CPA) continues to be an enigma to clinicians in regions with a high prevalence of pulmonary tuberculosis and is often misdiagnosed as the latter, attributable to the significant overlap in symptoms and radiology. Moreover, although the diagnostic criteria for CPA have been standardised, the role of serological markers in monitoring disease activity and response to therapy is still not well characterised. Aim: To understand the characteristics, risk factors and treatment outcomes in patients developing CPA and to determine the role of serological markers as indicators of disease activity. Materials and Methods: The present longitudinal study was conducted in the Department of Respiratory Medicine, University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, India from February 2021 to June 2022. Study included 46 patients suspected of harbouring CPA attributable to their clinico-radiological presentation. The diagnosis of CPA was made using the established criteria. Patients with a confirmed diagnosis of CPA received oral azole antifungals for 6 months and were monitored at 3-monthly intervals for reduction in baseline parameters to determine treatment success/failure. Paired and unpaired parametric variables were compared using the t-test and non parametric methods were compared using the Chisquare test. Results: The diagnosis of CPA was established in 31 (67.4%) patients of whom 77.6% were males and the mean age was 47.3±2.2 years. These patients had been symptomatic for 5.8±1.2 years. Underlying risk factors (such as the history of tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, history of long-term glucocorticoid use etc.) had been present for 6.9±1.3 years. Patients harboured an average of two risk factors with tuberculosis and diabetes mellitus being the most common local and systemic affliction, respectively. Patients with tuberculosis (p-value=0.001) and chronic steroid use (p-value=0.029) were significantly at higher risk of developing CPA. 6 months of azole therapy led to significant reduction in specific IgG titres (p-value=0.001), and serum precipitins (p-value=0.004). Two patients on itraconazole relapsed within 12 months but were successfully treated with voriconazole. Conclusion: Tuberculosis was the most significant local risk factor leading to the development of CPA, which developed soon after diagnosis of another systemic risk factor. Six months of azole therapy was adequate to induce remission of the disease, activity of which can be monitored though the measurement of serum IgG antibody titres.
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Huth S, Pang PTH, Tews I, Dietrich T, Le Fèvre A, Schwenk A, Trautmann W, Agarwal K, Bulla M, Coughlin MW, Van Den Broeck C. Constraining neutron-star matter with microscopic and macroscopic collisions. Nature 2022; 606:276-280. [PMID: 35676430 PMCID: PMC9177417 DOI: 10.1038/s41586-022-04750-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 07/13/2021] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
Interpreting high-energy, astrophysical phenomena, such as supernova explosions or neutron-star collisions, requires a robust understanding of matter at supranuclear densities. However, our knowledge about dense matter explored in the cores of neutron stars remains limited. Fortunately, dense matter is not probed only in astrophysical observations, but also in terrestrial heavy-ion collision experiments. Here we use Bayesian inference to combine data from astrophysical multi-messenger observations of neutron stars1-9 and from heavy-ion collisions of gold nuclei at relativistic energies10,11 with microscopic nuclear theory calculations12-17 to improve our understanding of dense matter. We find that the inclusion of heavy-ion collision data indicates an increase in the pressure in dense matter relative to previous analyses, shifting neutron-star radii towards larger values, consistent with recent observations by the Neutron Star Interior Composition Explorer mission5-8,18. Our findings show that constraints from heavy-ion collision experiments show a remarkable consistency with multi-messenger observations and provide complementary information on nuclear matter at intermediate densities. This work combines nuclear theory, nuclear experiment and astrophysical observations, and shows how joint analyses can shed light on the properties of neutron-rich supranuclear matter over the density range probed in neutron stars.
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Affiliation(s)
- Sabrina Huth
- Department of Physics, Technische Universität Darmstadt, Darmstadt, Germany.
- ExtreMe Matter Institute EMMI, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
| | - Peter T H Pang
- Nikhef, Amsterdam, The Netherlands.
- Institute for Gravitational and Subatomic Physics (GRASP), Utrecht University, Utrecht, The Netherlands.
| | - Ingo Tews
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Tim Dietrich
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam, Germany
- Max Planck Institute for Gravitational Physics (Albert Einstein Institute), Potsdam, Germany
| | - Arnaud Le Fèvre
- GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - Achim Schwenk
- Department of Physics, Technische Universität Darmstadt, Darmstadt, Germany
- ExtreMe Matter Institute EMMI, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - Kshitij Agarwal
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Mattia Bulla
- The Oskar Klein Centre, Department of Astronomy, Stockholm University, AlbaNova, Stockholm, Sweden
| | - Michael W Coughlin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - Chris Van Den Broeck
- Nikhef, Amsterdam, The Netherlands
- Institute for Gravitational and Subatomic Physics (GRASP), Utrecht University, Utrecht, The Netherlands
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6
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Agarwal K, Chitranshi J. Covid-19 pandemic: impact and opportunities for education in India. CM 2022. [DOI: 10.18137/cardiometry.2022.22.215222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The sudden breakout of COVID-19 has created a major crisis in almost every sector like Travel and Tourism, Entertainment, Sports, Corporates, Financials, Manufacturing, Education, and Service sectors. We cannot identify any sector which remained unaffected by the crisis. The magnitude of the impact may vary from sector to sector. The same happened to the Indian education system. It has faced a worldwide lockdown estimating to impact almost 320 million learners across the country. India has a robust education structure, with a huge chain of more than 1.4 million schools, 799 Universities, 39071 Colleges, and 11923 Stand Alone Institutions as per data available on the sixth report of ‘All India Survey on Higher Education on the web portal, are all affected by the pandemic situation. Our Indian education system was badly impacted due to pandemics, mostly based on traditional or classroom teaching. Though most of the school and colleges, for the benefit of students, had opted for online teaching, yet some of the low income private and government teaching institutes and students from a remote location could not opt to online teaching due to the unavailability of the internet, Laptop, Desktop or Smartphones persistent with a survey by EY-Parthenon.
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7
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Joy E, Skorupskaite K, Balen A, Cauldwell M, Agarwal K, English K. Outcomes of fertility treatment in patients with cardiac disease: a multi-centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2897] [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
Risks of pregnancy in women with cardiac disease are well described, but data regarding the risks of assisted conception in this cohort is limited. As increasing numbers of older women seek fertility treatment, more women with congenital heart disease desire to have children of their own, and pre-implantation genetic testing (PGT) becomes more widely adopted, increasing numbers of women at risk of cardiac complications are likely to undergo fertility treatment.
Aims
To assess safety of fertility treatment in women with cardiac disease.
Methods
Multi-centre retrospective review of outcomes and complications in women with cardiac disease undergoing fertility treatment.
Results
34 women with cardiac disease who underwent fertility treatment were identified, with 50 cycles undertaken. 24 patients (71%) received pre-pregnancy counselling. Four patients underwent assisted conception with PGT and two patients underwent IVF and egg collection for the purposes of surrogacy (both mWHO class III). The mean age at the start of an assisted conception cycle was 32 years. Cardiac disease was identified pre-pregnancy in 31 patients. Those diagnosed during pregnancy included a restrictive cardiomyopathy (presumed long standing), and pulmonary stenosis (PS) with an atrial septal defect (ASD). The Modified WHO (mWHO) risk category for the 34 women is seen in table 1.
Those in mWHO class III include patients with mechanical valves, Fontan circulation, moderate LV systolic impairment, cyanotic heart disease due to previously undiagnosed PS and ASD, and a patient with Eisenmengers syndrome seeking surrogacy using her own eggs.
Live births: 50 cycles resulted in 31 pregnancies; There were 31 live births, (including two sets of twins). One pregnancy lost a twin, and there were two first trimester miscarriages.
Complications: Eight patients developed complications; four during fertility treatment and four during pregnancy (table 2). There was a correlation between higher mWHO class and higher rates of complications. No patients in mWHO class I experienced complications compared to 43% of mWHO class III. Of the 31 live births, five babies were delivered pre-term (<37/40).
Conclusion
The potential cardiac risks of assisted conception in patients with known cardiac disease, or older patients with risk factors for acquired cardiac disease should be considered by both reproductive medicine specialists and cardiologists before treatment commences. Formal pre-treatment / pre-pregnancy counselling is of paramount importance and should involve dialogue between both specialties and the patient to ensure all are aware of the potential risks, and action can be taken to minimise these. However, the presence of cardiac disease per se should not necessarily prevent patients accessing fertility treatment, as in many cases it can be used safely and successfully.
Funding Acknowledgement
Type of funding sources: None. Table 1. mWHO classificationsTable 2. Complications
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Affiliation(s)
- E Joy
- Leeds General Infirmary, Adult Congenital Heart Disease, Leeds, United Kingdom
| | - K Skorupskaite
- Leeds Teaching Hospitals NHS Trust, Reproductive Medicine and Surgery, Seacroft Hospital, Leeds, United Kingdom
| | - A Balen
- Leeds Teaching Hospitals NHS Trust, Reproductive Medicine and Surgery, Seacroft Hospital, Leeds, United Kingdom
| | - M Cauldwell
- St George's University Hospital NHS Foundation Trust, Obstetrics and Maternal Medicine, London, United Kingdom
| | - K Agarwal
- Nottingham University Hospitals NHS Trust, Obstetrics and Gynaecology, Nottingham, United Kingdom
| | - K English
- Leeds General Infirmary, Adult Congenital Heart Disease, Leeds, United Kingdom
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Agarwal K, Easter J. 399 Geographical Training of Emergency Physicians Working in Academic Emergency Departments in the United States. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.414] [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: 11/15/2022]
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Noamani A, Agarwal K, Vette A, Rouhani H. Predicted Threshold for Seated Stability: Estimation of Margin of Stability Using Wearable Inertial Sensors. IEEE J Biomed Health Inform 2021; 25:3361-3372. [PMID: 33857004 DOI: 10.1109/jbhi.2021.3073352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individuals with spinal cord injury suffer from seated instability due to impaired trunk neuromuscular function. Monitoring seated stability toward the development of closed-loop controlled neuroprosthetic technologies could be beneficial for restoring trunk stability during sitting in affected individuals. However, there is a lack of (1) a biomechanical characterization to quantify the relationship between the trunk kinematics and sitting balance; and (2) a validated wearable biomedical device for assessing dynamic sitting posture and fall-risk in real-time. This study aims to: (a) determine the limit of dynamic seated stability as a function of the trunk center of mass (COM) position and velocity relative to the base of support; (b) experimentally validate the predicted limit of stability using traditional motion capture; (c) compare the predicted limit of stability with that predicted in the literature for standing and walking; and (d) validate a wearable device for assessing dynamic seated stability and risk of loss of balance. First, we used a six-segment model of the seated human body for simulation. To obtain the limit of stability, we applied forward dynamics and optimization to obtain the maximum feasible initial velocities of the trunk COM that would bring the trunk COM position to the front-end of the base-of-support for a set of initial COM positions. Second, experimental data were obtained from fifteen able-bodied individuals who maintained sitting balance while base-of-support perturbations were applied with three different amplitudes. A motion capture system and four inertial measurement units (IMUs) were used to estimate the trunk COM motion states (i.e., trunk COM position and velocity). The margin of stability was calculated as the shortest distance of the instantaneous COM motion states to those obtained as the limit of stability in the state-space plane. All experimentally obtained trunk COM motion states fell within the limit of stability. A high correlation and small root-mean-square difference were observed between the estimated trunk COM states obtained by the motion capture system and IMUs. IMU-based wearable technology, along with the predicted limit of dynamic seated stability, can estimate the margin of stability during perturbed sitting. Therefore, it has the potential to monitor the seated stability of wheelchair users affected by trunk instability.
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Chidharla A, Rabbani R, Agarwal K, Abdelwahed S, Bhandari R, Manaktala P, Singh A, Patel K, Singh P, Mehta D, Malik P, Patel U, Pillai S, Koritala T. 1825P Prevalence of cancer among e-cigarette smokers compared to non-smokers: A retrospective cross-sectional survey study of NHANES-CDC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.713] [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: 11/28/2022] Open
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11
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Tieges Z, MacLullich AMJ, Anand A, Cassaroni M, O'Connor M, Ryan D, Saller T, Arora R, Chang Y, Agarwal K, Taffet G, Quinn T, Shenkin S, Galvin R. 33 Diagnostic Test Accuracy of the 4AT for Delirium Detection: Systematic Review and Meta-Analysis. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.12] [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
Introduction
Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT; www.the4AT.com) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection.
Methods
We searched the following electronic databases through Ovid: MEDLINE, Embase, and PsycINFO. Additional databases were searched: CINAHL (EBSCOhost), clinicaltrials.gov and Cochrane Central Register of Controlled Trials from 2011 (4AT publication) until 21 December 2019. Inclusion criteria: older adults (≥65) across any setting of care except critical care; validation study of the 4AT against a delirium reference standard (standard diagnostic criteria or validated tool). Two reviewers independently screened abstracts and papers and performed the data extraction. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.
Results
17 studies (n = 3,701 observations) were included. Various settings including acute medicine, surgery, stroke wards and the emergency department were represented. The overall prevalence of delirium was 24.2% (95% CI 17.8–32.1%; range 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). The methodological quality of studies was mostly good.
Conclusions
The 4AT is now supported by a substantial evidence base comparable to other well-studied tools such as the Confusion Assessment Method (CAM). The strong pooled sensitivity and specificity findings for the 4AT in this meta-analysis along with its brevity and lack of need for specific training provide support for its use as an effective assessment tool for delirium.
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Affiliation(s)
- Z Tieges
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - A M J MacLullich
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - A Anand
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - M Cassaroni
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - M O'Connor
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - D Ryan
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - T Saller
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - R Arora
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - Y Chang
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - K Agarwal
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - G Taffet
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - T Quinn
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - S Shenkin
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
| | - R Galvin
- Geriatric Medicine, University of Edinburgh; Cardiovascular Sciences, University of Edinburgh; Health Research Institute, University of Limerick; Ageing & Therapeutics, University Hospital Limerick; Emergency Department, University Hospital Limerick; Max Rady College of Medicine, University of Manitoba; Section of Geriatrics, Baylor College of Medicine, Houston, USA; Houston Methodist Hospital, H
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Yadav PD, Ella R, Kumar S, Patil DR, Mohandas S, Shete AM, Vadrevu KM, Bhati G, Sapkal G, Kaushal H, Patil S, Jain R, Deshpande G, Gupta N, Agarwal K, Gokhale M, Mathapati B, Metkari S, Mote C, Nyayanit D, Patil DY, Sai Prasad BS, Suryawanshi A, Kadam M, Kumar A, Daigude S, Gopale S, Majumdar T, Mali D, Sarkale P, Baradkar S, Gawande P, Joshi Y, Fulari S, Dighe H, Sharma S, Gunjikar R, Kumar A, Kalele K, Srinivas VK, Gangakhedkar RR, Ella KM, Abraham P, Panda S, Bhargava B. Immunogenicity and protective efficacy of inactivated SARS-CoV-2 vaccine candidate, BBV152 in rhesus macaques. Nat Commun 2021; 12:1386. [PMID: 33654090 PMCID: PMC7925524 DOI: 10.1038/s41467-021-21639-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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: 08/28/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is a global health crisis that poses a great challenge to the public health system of affected countries. Safe and effective vaccines are needed to overcome this crisis. Here, we develop and assess the protective efficacy and immunogenicity of an inactivated SARS-CoV-2 vaccine in rhesus macaques. Twenty macaques were divided into four groups of five animals each. One group was administered a placebo, while three groups were immunized with three different vaccine candidates of BBV152 at 0 and 14 days. All the macaques were challenged with SARS-CoV-2 fourteen days after the second dose. The protective response was observed with increasing SARS-CoV-2 specific IgG and neutralizing antibody titers from 3rd-week post-immunization. Viral clearance was observed from bronchoalveolar lavage fluid, nasal swab, throat swab and lung tissues at 7 days post-infection in the vaccinated groups. No evidence of pneumonia was observed by histopathological examination in vaccinated groups, unlike the placebo group which exhibited interstitial pneumonia and localization of viral antigen in the alveolar epithelium and macrophages by immunohistochemistry. This vaccine candidate BBV152 has completed Phase I/II (NCT04471519) clinical trials in India and is presently in phase III, data of this study substantiates the immunogenicity and protective efficacy of the vaccine candidates.
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Affiliation(s)
- Pragya D Yadav
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Raches Ella
- Bharat Biotech International Limited, Genome Valley, Hyderabad, 500 078, Telangana, India
| | - Sanjay Kumar
- Department of Neurosurgery, Command Hospital (Southern Command), Armed Forces Medical College (AFMC), Pune, 411040, Maharashtra, India
| | - Dilip R Patil
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Sreelekshmy Mohandas
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Anita M Shete
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Krishna M Vadrevu
- Bharat Biotech International Limited, Genome Valley, Hyderabad, 500 078, Telangana, India
| | - Gaurav Bhati
- Army Institute of Cardio-Thoracic Sciences, Pune, 411040, Maharashtra, India
| | - Gajanan Sapkal
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Himanshu Kaushal
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Savita Patil
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Rajlaxmi Jain
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Gururaj Deshpande
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Nivedita Gupta
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, 110029, India
| | - Kshitij Agarwal
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, 110029, India
| | - Mangesh Gokhale
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Basavaraj Mathapati
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Siddhanath Metkari
- ICMR-National Institute for Research in Reproductive Health, Mumbai, 400012, Maharashtra, India
| | - Chandrashekhar Mote
- Department of Veterinary Pathology, Krantisinh Nana Patil College of Veterinary Science, Shirwal, 412801, Maharashtra, India
| | - Dimpal Nyayanit
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Deepak Y Patil
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - B S Sai Prasad
- Bharat Biotech International Limited, Genome Valley, Hyderabad, 500 078, Telangana, India
| | - Annasaheb Suryawanshi
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Manoj Kadam
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Abhimanyu Kumar
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Sachin Daigude
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Sanjay Gopale
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Triparna Majumdar
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Deepak Mali
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Prasad Sarkale
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Shreekant Baradkar
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Pranita Gawande
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Yash Joshi
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Sidharam Fulari
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Hitesh Dighe
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Sharda Sharma
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Rashmi Gunjikar
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Abhinendra Kumar
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Kaumudi Kalele
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Vellimedu K Srinivas
- Bharat Biotech International Limited, Genome Valley, Hyderabad, 500 078, Telangana, India
| | - Raman R Gangakhedkar
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, 110029, India
| | - Krishna M Ella
- Bharat Biotech International Limited, Genome Valley, Hyderabad, 500 078, Telangana, India
| | - Priya Abraham
- Indian Council of Medical Research-National Institute of Virology, Pune, 411021, Maharashtra, India
| | - Samiran Panda
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, 110029, India
| | - Balram Bhargava
- Indian Council of Medical Research, V. Ramalingaswami Bhawan, New Delhi, 110029, India.
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Surya N, Someshwar H, Agarwal K. Serum homocysteine- A predictor for acute stroke in a territary care hospital in Mumbai. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.458] [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: 10/25/2022]
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Agarwal K, Dhirawani RB, Singha S, Agrawal A. High-Density Polyethylene Material versus Autogenous Grafts in Craniofacial Augmentation Procedures. Ann Maxillofac Surg 2019; 9:10-14. [PMID: 31293924 PMCID: PMC6585212 DOI: 10.4103/ams.ams_245_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: The objective was to do a comparative study and to evaluate the outcome in overall acceptance for correction of residual facial deformity with autogenous graft versus porous polyethylene implants. Materials and Methods: A total of 16 patients in the age group of ≥15 years irrespective of sex, caste, religion, and socioeconomic status presenting with signs and symptoms of residual facial deformities and who were declared fit for surgery were included in the study. The study patients were further divided into two groups, of eight each. Deformity correction using autogenous grafts was performed in Group A and using high-density polyethylene (HDPE) alloplastic implants was performed in Group B. During the follow-up period, patients’ and doctor rating of overall acceptance between autogenous and alloplastic (HDPE) bone grafts was recorded on 100-mm visual analog scale (VAS) on the 2nd day and 7th day and at 3, 6, and 12 weeks. Results: The unpaired t-test is used for evaluation. VAS score at all the follow-up periods above stated was significantly higher in alloplastic group than in the autogenous group for both in patients and doctor evaluation. Conclusion: From the present study, it can be concluded that porous HDPE implants are an effective alternative to autogenous grafts in accordance of overall acceptance for correction of residual facial deformity when proper case selection, exclusion of negative prognostic factors, and meticulous surgical procedure are followed.
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Affiliation(s)
- Kshitij Agarwal
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Rajesh B Dhirawani
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Sauvik Singha
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
| | - Anshalika Agrawal
- Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
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Agarwal K, Ahn SH, Elkhashab M, Lau AH, Gaggar A, Bulusu A, Tian X, Cathcart AL, Woo J, Subramanian GM, Andreone P, Kim HJ, Chuang WL, Nguyen MH. Safety and efficacy of vesatolimod (GS-9620) in patients with chronic hepatitis B who are not currently on antiviral treatment. J Viral Hepat 2018; 25:1331-1340. [PMID: 29851204 DOI: 10.1111/jvh.12942] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Abstract
Vesatolimod is an oral agonist of toll-like receptor 7 designed to minimize systemic exposure and side effects. We assessed the safety and efficacy of vesatolimod in viremic chronic hepatitis B (CHB) patients not currently on oral antiviral treatment (OAV) in a phase 2, multicentre, double-blind, randomized, placebo-controlled study. A total of 192 patients stratified by HBeAg status and alanine aminotransferase level were randomized 2:2:2:1 to receive oral vesatolimod (1-, 2- or 4-mg) or placebo once weekly for 12 weeks; tenofovir disoproxil fumarate (300-mg daily) was administered daily for 48 weeks. Efficacy was assessed by quantitative serum HBsAg decline at Week 24 from baseline. In addition to safety assessments, changes in whole-blood interferon-stimulated gene (ISG) transcripts and serum cytokines were explored. Most patients were male (64.1%) and HBeAg-negative (60.9%) at baseline. Among vesatolimod-treated patients, most (60.4%-69.1%) experienced ≥1 treatment-emergent adverse event; the majority were mild or moderate in severity. No clinically meaningful differences in HBsAg changes from baseline were observed between treatment groups. No patients experienced HBsAg loss, while 3 patients experienced HBeAg loss and hepatitis B e-antibody seroconversion at week 48. HBV DNA suppression rates were similar across all treatment arms at Week 24. ISG15 induction was dose-dependent and did not correlate with HBsAg changes. A small proportion of patients exhibited dose-dependent interferon-α induction that correlated with grade of influenza-like adverse events. Overall, vesatolimod is safe and well tolerated in CHB patients. Although consistent dose-dependent pharmacodynamic induction of ISGs was demonstrated, it did not result in clinically significant HBsAg decline.
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Affiliation(s)
- K Agarwal
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - S H Ahn
- Brain Korea 21 Project of Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | | | - A H Lau
- Gilead Sciences, Inc., Foster City, CA, USA
| | - A Gaggar
- Gilead Sciences, Inc., Foster City, CA, USA
| | - A Bulusu
- Gilead Sciences, Inc., Foster City, CA, USA
| | - X Tian
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - J Woo
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - P Andreone
- Center for the Study and Research on Hepatitis, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - H J Kim
- Chung-Ang University Hospital, Seoul, South Korea
| | - W L Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M H Nguyen
- Stanford University Medical Center, Palo Alto, CA, USA
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Carey I, Byrne R, Childs K, Horner M, Bruce M, Wang B, Dusheiko G, Agarwal K. Serum NGAL can act as an early renal safety biomarker during long-term nucleos(t)ide analogue antiviral therapy in chronic hepatitis B. J Viral Hepat 2018; 25:1139-1150. [PMID: 29660209 DOI: 10.1111/jvh.12916] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/20/2018] [Indexed: 12/26/2022]
Abstract
Tubular renal toxicity is a side-effect of long-term therapy with nucleos(t)ide analogue(s) (NA) in chronic hepatitis B (CHB). There are no established surrogate markers in plasma of early NA-related toxicity. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein produced by tubular cells following renal damage. We aimed therefore to retrospectively compare conventional renal markers (estimated glomerular filtration rates (eGFR) and urinary protein/creatinine ratio uPCR) with a sensitive biomarker (NGAL) in CHB patients on long-term NA therapy and assess the ability of new markers to predict NA-related renal toxicity (new onset of nonalbumin proteinuria). A total of 192 naïve CHB patients (median age 41 years, 78% males, 25% HBeAg+, 35% cirrhosis) were NA treated for at least 5 years (median 8.34 years, range 5.54-11.1 years). The eGFR and uPCR were compared at baseline and last clinical visit with serum NGAL concentrations measured by ELISA at same time-points and assessed according to the presence/absence of nonalbumin proteinuria at last visit. While baseline and last visit eGFR were similar (median:78 vs 84 mL/min), serum NGAL concentrations increased during therapy (median:9.4 vs 16.4 ng/mL, P < .05). The proportion of patients with proteinuria (uPCR > 15) increased between baseline and last visit (4.6% vs 21.4%, P < .05), with 30 (16%) patients having de novo nonalbumin proteinuria at last visit. High baseline NGAL concentrations were exclusive to patients with de novo nonalbumin proteinuria (median:31.7 vs 7.8 ng/mL, P < .01) and baseline NGAL levels >25 mg/mL were predictive of nonalbumin proteinuria at last visit (AUROC = 0.813). In conclusion, serum NGAL can act as a surrogate marker of early renal injury (de novo nonalbumin proteinuria) in CHB on long-term NA therapy.
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Affiliation(s)
- I Carey
- Institute of Liver Studies, King's College Hospital, London, UK
| | - R Byrne
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Childs
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Horner
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Bruce
- Institute of Liver Studies, King's College Hospital, London, UK
| | - B Wang
- Institute of Liver Studies, King's College Hospital, London, UK
| | - G Dusheiko
- Institute of Liver Studies, King's College Hospital, London, UK
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
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17
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Agarwal K, Sahu S, Shera S, Banik R. Partitioning of bromelain enzyme extracted from Ananas comosus in different PEG–salt–water aqueous two phase system. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Berenguer M, Agarwal K, Burra P, Manns M, Samuel D. The road map toward an hepatitis C virus-free transplant population. Am J Transplant 2018; 18:2409-2416. [PMID: 29935050 DOI: 10.1111/ajt.14976] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/14/2018] [Accepted: 06/15/2018] [Indexed: 01/25/2023]
Abstract
Antiviral therapy to eradicate hepatitis C virus (HCV) infection improves outcomes in patients undergoing liver transplantation (LT) for advanced chronic HCV with or without hepatocellular carcinoma. Traditionally, antiviral therapy focused on the use of interferon (IFN)-based regimens, with antiviral treatment initiated in the posttransplant period once recurrent HCV disease with fibrosis in the allograft was identified. The use of IFN-based therapy was limited in pretransplant patients with advanced liver disease. Earlier intervention, either before transplantation or early after LT, is now feasible with the advent of second-generation direct-acting antiviral agents (DAAs) with superior tolerability and efficacy to IFN-based therapy. These agents have the potential to reduce the number of patients developing HCV-related complications requiring LT and retransplantation, as well as reducing the demand for donor organs. We discuss the pros and cons of pretransplant, peritransplant, and posttransplant therapy with current DAAs, citing available data from clinical trials and real-world experience.
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Affiliation(s)
- M Berenguer
- Liver Transplantation & Hepatology Unit, Hospital Universitario La Fe, University of Valencia-CIBEReHD, Valencia, Spain
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
| | - P Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - M Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - D Samuel
- Inserm-Paris Sud Unit 1193, Centre Hepatobiliaire, Hopital Paul Brousse, Villejuif, France
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Wang B, Carey I, Bruce M, Montague S, Dusheiko G, Agarwal K. HBsAg and HBcrAg as predictors of HBeAg seroconversion in HBeAg-positive patients treated with nucleos(t)ide analogues. J Viral Hepat 2018. [PMID: 29532589 DOI: 10.1111/jvh.12889] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
HBeAg seroconversion marks an important spontaneous change and treatment end-point for HBeAg-positive patients and is a pre-requisite for HBsAg loss or functional cure. In this retrospective analysis, we aimed to identify predictors of seroconversion using serum quantitative HBsAg and HBcrAg, in HBeAg-positive patients treated with nucleos(t)ide analogues (NA). Data and samples from 118 HBeAg-positive adults (genotypes A-G) started on NA between Jan 2005 and Sept 2016 were retrospectively analysed at several time-points. The predictive power of on-treatment levels of HBsAg and HBcrAg was determined using receiver operating curve (ROC) analysis and cut-off values determined by maximized Youden's index. About 36.4% of patients achieved HBeAg seroconversion after a median of 39 months' treatment. On treatment kinetics of HBV DNA, HBsAg and HBcrAg differed between HBeAg seroconverters and nonseroconverters. A combination of HBsAg and HBcrAg had the greatest predictive value for HBeAg seroconversion: at 6 months, HBsAg of 3.9 log10 IU/mL and HBcrAg of 5.7 log10 U/mL had a sensitivity of 71.4%, specificity of 79.5%, positive predictive value (PPV) of 65.2% and negative predictive value (NPV) of 83.8%, with AUROC of 0.769 (0.668, 0.869; 95%CI), and at 12 months, HBsAg 3.8 log10 IU/mL and HBcrAg 5.5 log10 U/mL had a sensitivity of 73.7%, specificity of 79.5%, PPV of 63.6% and NPV of 86.1%, with AUROC 0.807 (0.713, 0.901; 95% CI). In conclusion, our results may be used to identify patients who are unlikely to achieve treatment end-points, which will be important as the future management of chronic hepatitis B looks to therapies that offer functional cure.
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Affiliation(s)
- B Wang
- Institute of Liver Studies, King's College Hospital, London, UK
| | - I Carey
- Institute of Liver Studies, King's College Hospital, London, UK
| | - M Bruce
- Institute of Liver Studies, King's College Hospital, London, UK
| | - S Montague
- Institute of Liver Studies, King's College Hospital, London, UK
| | - G Dusheiko
- Institute of Liver Studies, King's College Hospital, London, UK.,University College London Medical School, London, UK
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
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Agarwal K. New Onset Diabetes after Transplantation (NODAT) – The incidence and effectiveness of tacrolimus levels as a marker of predicting NODAT after renal transplantation. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agarwal K, Hanchanale V. Patients do not need hospital admission following a Transrectal Ultrasound (TRUS) guided prostate biopsy – A quality improvement project. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sinharoy P, Banerjee D, Sharma JN, Kaushik CP, Shah JG, Agarwal K. Separation of Sr(II) from Eu(III) across a supported liquid membrane using TEHDGA and 18-crown-6. J Radioanal Nucl Chem 2018. [DOI: 10.1007/s10967-018-5982-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Tolofari S, Agarwal K, Mikhail M, Calvert R. Ureteric pyogenic granuloma: A peculiar case of ureteric obstruction. Urol Case Rep 2018; 18:1-2. [PMID: 29511640 PMCID: PMC5834647 DOI: 10.1016/j.eucr.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
- S.K. Tolofari
- Royal Liverpool & Broadgreen NHS Trust, Prescot Road, Liverpool, United Kingdom
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Wong F, Khan M, Agarwal K, Furusyo N, Hwang J, Flaherty J, Kim K. A180 IMPROVED RENAL LABORATORY PARAMETERS IN CHB PATIENTS TREATED WITH TAF COMPARED WITH TDF. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.181] [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)
- F Wong
- Medicine, 9N/983 Toronto General Hospital, Toronto, ON, Canada
| | - M Khan
- Gilead Sciences Canada, Inc, Mississauga, ON, Canada
| | - K Agarwal
- Kings College Hospital NHS Trust, London, United Kingdom
| | - N Furusyo
- Kyushu Medical Center, Fukuoka, Japan
| | - J Hwang
- Keimyung University Dongsan Medical Center, Daegu, Korea (the Republic of)
| | | | - K Kim
- Gilead Sciences, Inc., Foster City, CA
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Foster GR, Zeuzem S, Gane EJ, Stedman C, Feld J, Mangia A, Agarwal K, Swain M, Mir H, Troke P, Llewellyn J, Natha M, Kreter B, Zhang J, McNally J, Brainard D, Strasser S, Pianko S. A183 SOFOSBUVIR-BASED ALL-ORAL REGIMENS FOR PATIENTS WITH CHRONIC HEPATITIS C GENOTYPE 3 INFECTION: INTEGRATED ANALYSIS OF FIVE CLINICAL STUDIES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.184] [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: 11/12/2022] Open
Affiliation(s)
- G R Foster
- Queen Mary University, London, United Kingdom
| | - S Zeuzem
- Johann Wolfgang goethe University Medical Center, Frankfurt, Germany
| | - E J Gane
- Auckland Clinical Studies, Auckland, New Zealand
| | - C Stedman
- Christchurch Hospital, Christchurch, New Zealand
| | - J Feld
- Medicine, University Health Network University of Toronto, Toronto, ON, Canada
| | - A Mangia
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - K Agarwal
- Institute of Liver Studies, Kings College Hospital, London, United Kingdom
| | - M Swain
- Univ Calgary, Calgary, AB, Canada
| | - H Mir
- Gilead Sciences, Inc., Foster City, CA
| | - P Troke
- Gilead Sciences, Inc., Foster City, CA
| | | | - M Natha
- Gilead Sciences, Inc., Foster City, CA
| | - B Kreter
- Gilead Sciences, Inc., Foster City, CA
| | - J Zhang
- Gilead Sciences, Inc., Foster City, CA
| | - J McNally
- Gilead Sciences, Inc., Foster City, CA
| | | | - S Strasser
- Royal Prince Alfred Hospital, Sydney, Queensland, Australia
| | - S Pianko
- Monash Health, Melbourne, Queensland, Australia
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Williams AD, Boser QA, Kumawat AS, Agarwal K, Rouhani H, Vette AH. Design and Evaluation of an Instrumented Wobble Board for Assessing and Training Dynamic Seated Balance. J Biomech Eng 2018; 140:2666620. [DOI: 10.1115/1.4038747] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 11/08/2022]
Abstract
Methods that effectively assess and train dynamic seated balance are critical for enhancing functional independence and reducing risk of secondary health complications in the elderly and individuals with neuromuscular impairments. The objective of this research was to devise and validate a portable tool for assessing and training dynamic seated balance. An instrumented wobble board was designed and constructed that (1) elicits multidirectional perturbations in seated individuals, (2) quantifies seated balance proficiency, and (3) provides real-time, kinematics-based vibrotactile feedback. After performing a technical validation study to compare kinematic wobble board measurements against a gold-standard motion capture system, 15 nondisabled participants performed a dynamic sitting task using the wobble board. Our results demonstrate that the tilt angle measurements were highly accurate throughout the range of wobble board dynamics. Furthermore, the posturographic analyses for the dynamic sitting task revealed that the wobble board can effectively discriminate between the different conditions of perturbed balance, demonstrating its potential to serve as a clinical tool for the assessment and training of seated balance. Vibrotactile feedback decreased the variance of wobble board tilt, demonstrating its potential for use as a balance training tool. Unlike similar instrumented tools, the wobble board is portable, requires no laboratory equipment, and can be adjusted to meet the user's balance abilities. While future work is warranted, obtained findings will aid in effective translation of assessment and training techniques to a clinical setting, which has the potential to enhance the diagnosis and prognosis for individuals with seated balance impairments.
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Affiliation(s)
- Andrew D. Williams
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Quinn A. Boser
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Animesh Singh Kumawat
- Faculty of Kinesiology and Physical Education, University of Toronto, WS2021F, 55 Harbord Street, Toronto, ON M5S 2W6, Canada e-mail:
| | - Kshitij Agarwal
- Department of Biomedical Engineering, Research Transition Facility, University of Alberta, 8308-114 Street, Edmonton, AB T6G 2V2, Canada e-mail:
| | - Hossein Rouhani
- Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail:
| | - Albert H. Vette
- Mem. ASME Department of Mechanical Engineering, Donadeo Innovation Centre for Engineering, University of Alberta, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail:
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Shafran SD, Shaw D, Charafeddine M, Agarwal K, Foster GR, Abunimeh M, Pilot-Matias T, Pothacamury RK, Fu B, Cohen E, Cohen DE, Gane E. Efficacy and safety results of patients with HCV genotype 2 or 3 infection treated with ombitasvir/paritaprevir/ritonavir and sofosbuvir with or without ribavirin (QUARTZ II-III). J Viral Hepat 2018; 25:118-125. [PMID: 28833938 DOI: 10.1111/jvh.12782] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
The efficacy and safety of an investigational combination of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) plus sofosbuvir (SOF) ± ribavirin (RBV) in patients with HCV genotype 2 or 3 infection with or without cirrhosis was evaluated. Patients with HCV genotype 3 infection without cirrhosis were randomized to receive OBV/PTV/r + SOF ± RBV for 12 weeks; OBV/PTV/r + SOF + RBV was administered to genotype 3-infected patients with cirrhosis for 12 weeks and to genotype 2-infected patients without cirrhosis for either 6 or 8 weeks. Efficacy was assessed by sustained virologic response [HCV RNA <25 IU/mL] 12 weeks post-treatment (SVR12). Safety was assessed in all treated patients. In patients with genotype 3 infection with or without cirrhosis treated with 12 weeks of OBV/PTV/r + SOF ± RBV, the overall SVR12 rate was 98% (50/51), with no virologic failures. Patients with genotype 2 infection treated with OBV/PTV/r + SOF + RBV had SVR12 rates of 90% (9/10) and 44% (4/9) following 8- and 6-week treatment durations, respectively; failure to achieve SVR12 for these patients was due to relapse without baseline or treatment-emergent resistance-associated substitutions. Thus, the investigational combination of OBV/PTV/r with SOF ± RBV was well tolerated and achieved high SVR rates with no virologic failures in patients with genotype 3 infection. Combining direct-acting antivirals with complementary mechanisms of action and different viral targets may be an effective treatment strategy that may allow for shorter durations of therapy.
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Affiliation(s)
- S D Shafran
- Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - D Shaw
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - K Agarwal
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - G R Foster
- Queen Mary University of London, Barts Health, London, UK
| | | | | | | | - B Fu
- AbbVie Inc., North Chicago, IL, USA
| | - E Cohen
- AbbVie Inc., North Chicago, IL, USA
| | | | - E Gane
- Liver Unit, Auckland City Hospital, Auckland, New Zealand
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28
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Wang B, Agarwal K, Joshi D. Management of chronic hepatitis B before and after liver transplantation. Frontline Gastroenterol 2018; 9:79-84. [PMID: 29484165 PMCID: PMC5824762 DOI: 10.1136/flgastro-2016-100768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 02/04/2023] Open
Abstract
Chronic hepatitis B infection is a global public health problem associated with significant morbidity and mortality. Persistent infection may evolve to liver cirrhosis and hepatocellular carcinoma, and hepatitis B-related liver disease is a common indication for liver transplantation. Patients with advanced liver disease should be treated with antiviral therapy which may result in clinical improvement. The management of patients after liver transplant then focuses on preventing hepatitis B recurrence in the graft. With the introduction of prophylactic treatment, patient and graft survival has improved significantly. In this review, we will discuss the management of patients with hepatitis B-related cirrhosis, both compensated and decompensated. We also review the management of hepatitis B after liver transplantation.
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Affiliation(s)
- B Wang
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - D Joshi
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
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Sharma A, Agarwal K, Agarwal S, Kumar S, Bharti A. Study of immunohistochemical expression of VEGF and its association with HPV E6 And E7 oncoproteins in oral and oropharyngeal squamous cell carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Potts J, Maybury C, Salam A, Barker J, Agarwal K, Smith C. Diagnosing liver fibrosis: a narrative review of current literature for dermatologists. Br J Dermatol 2017; 177:637-644. [DOI: 10.1111/bjd.15246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/14/2022]
Affiliation(s)
- J.R. Potts
- Institute of Liver Studies King's College Hospital NHS Foundation Trust London U.K
| | - C.M. Maybury
- St John's Institute of Dermatology Division of Genetics and Molecular Medicine Faculty of Life Sciences and Medicine King's College London London U.K
| | - A. Salam
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London U.K
| | - J.N. Barker
- St John's Institute of Dermatology Division of Genetics and Molecular Medicine Faculty of Life Sciences and Medicine King's College London London U.K
| | - K. Agarwal
- Institute of Liver Studies King's College Hospital NHS Foundation Trust London U.K
| | - C.H. Smith
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London U.K
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31
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Saumya A, Agarwal K. Serum Intercelllular adhesion molecule -1 level in patients of breast cancer and its association with Carbohydrate antigen 15-3 and TNM stage. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx141.009] [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: 11/12/2022] Open
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32
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Deepak D, Prasad A, Atwal SS, Agarwal K. Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled. J Clin Diagn Res 2017; 11:TE01-TE05. [PMID: 28511478 DOI: 10.7860/jcdr/2017/19920.9478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.
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Affiliation(s)
- Desh Deepak
- Chief Medical Officer, Department of Medicine, Respiratory Division, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Akhila Prasad
- Associate Professor, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Swapndeep Singh Atwal
- Ex-Senior Resident, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kshitij Agarwal
- Consultant, QRG Health City, Faridabad SR, Respiratory Medicine, VP Chest Institute, New Delhi, India
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Choudhary A, Parashar V, Gupta P, Agarwal K. Anaesthetic management of intracranial aneurysm in patient with coarctation of aorta. Journal of Neuroanaesthesiology and Critical Care 2017. [DOI: 10.1055/s-0038-1646212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- A. Choudhary
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - V. Parashar
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - P. Gupta
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
| | - K. Agarwal
- Department of Anaesthesiology and Critical Care, Santokba Durlabhji Memorial Hospital, Cum Medical Research Institute, Jaipur, Rajasthan, India
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34
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Mishra A, Purvar R, Malik S, Agarwal K, Gera R, Sridhar S. McCune Albright Syndrome from Gynaecological Perspective. J Obstet Gynaecol India 2016; 66:672-674. [DOI: 10.1007/s13224-016-0864-4] [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] [Received: 01/03/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
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35
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Marcellin P, Ahn SH, Chuang WL, Hui AJ, Tabak F, Mehta R, Petersen J, Lee CM, Ma X, Caruntu FA, Tak WY, Elkhashab M, Lin L, Wu G, Martins EB, Charuworn P, Yee LJ, Lim SG, Foster GR, Fung S, Morano L, Samuel D, Agarwal K, Idilman R, Strasser SI, Buti M, Gaeta GB, Papatheodoridis G, Flisiak R, Chan HLY. Predictors of response to tenofovir disoproxil fumarate plus peginterferon alfa-2a combination therapy for chronic hepatitis B. Aliment Pharmacol Ther 2016; 44:957-966. [PMID: 27629859 DOI: 10.1111/apt.13779] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Received: 05/27/2016] [Revised: 06/17/2016] [Accepted: 08/04/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with chronic hepatitis B, tenofovir disoproxil fumarate (TDF) plus pegylated interferon (PEG-IFN) for 48-weeks results in higher rates of hepatitis B surface antigen (HBsAg) loss than either monotherapy. AIM To identify baseline and on-treatment factors associated with HBsAg loss at Week 72 and provide a model for predicting HBsAg loss in patients receiving combination therapy for 48 weeks. METHODS A secondary analysis of data from an open-label study where patients were randomised to TDF (300 mg/day, oral) plus PEG-IFN (PI, 180 μg/week, subcutaneous) for 48 weeks (TDF/PI-48w); TDF plus PEG-IFN for 16 weeks, TDF for 32 weeks (TDF/PI-16w+TDF-32w); TDF for 120 weeks (TDF-120w) or PEG-IFN for 48 weeks (PI-48w). Logistic regression methods were used to identify models that best predicted HBsAg loss at Week 72. RESULTS Rates of HBsAg loss at Week 72 were significantly higher in the TDF/PI-48w group (6.5%) than in the TDF/PI-16w+TDF-32w (0.5%), TDF-120w (0%) and PI-48w (2.2%) groups (P = 0.09). The only baseline factor associated with response was genotype A. HBsAg decline at Week 12 or 24 of treatment was associated with HBsAg loss at Week 72 (P < 0.001). HBsAg decline >3.5 log10 IU/mL at Week 24 in the TDF/PI-48w group resulted in a positive predictive value of 85% and a negative predictive value of 99% for HBsAg loss at Week 72. CONCLUSIONS HBsAg decline at Week 24 of TDF plus PEG-IFN combination therapy may identify patients who, after completing 48 weeks of treatment, have a better chance of achieving HBsAg loss at Week 72.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - L Lin
- Gilead Sciences, Inc., Foster City, CA, USA
| | - G Wu
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - L J Yee
- Gilead Sciences, Inc., Foster City, CA, USA
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36
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Mishra A, Malik S, Agarwal K, Yadav A, Gautam A. Benign Cystic Mesothelioma of Uterus: An Unusual Cause of Pelvic Pain. J Obstet Gynaecol India 2016; 66:720-722. [PMID: 27803554 DOI: 10.1007/s13224-016-0917-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/30/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- A Mishra
- Department of Obstetrics and Gynaecology, V.M.M.C. and Safdarjung Hospital, Delhi, 110029 India ; House No. 26-A, Pocket 4, Mayur Vihar Phase-1, Delhi, 110091 India
| | - S Malik
- Department of Obstetrics and Gynaecology, V.M.M.C. and Safdarjung Hospital, Delhi, 110029 India
| | - K Agarwal
- Department of Obstetrics and Gynaecology, V.M.M.C. and Safdarjung Hospital, Delhi, 110029 India
| | - A Yadav
- Department of Pathology, V.M.M.C. and Safdarjung Hospital, Delhi, 110029 India
| | - A Gautam
- Department of Obstetrics and Gynaecology, V.M.M.C. and Safdarjung Hospital, Delhi, 110029 India
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- * E-mail: (AC); (JFM)
| | - Kshitij Agarwal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
- * E-mail: (AC); (JFM)
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38
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Prasad A, Agarwal K, Deepak D, Atwal SS. Pulmonary Aspergillosis: What CT can Offer Before it is too Late! J Clin Diagn Res 2016; 10:TE01-5. [PMID: 27190919 DOI: 10.7860/jcdr/2016/17141.7684] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/22/2016] [Indexed: 01/15/2023]
Abstract
Aspergillus is a large genus of saprophytic fungi which are present everywhere in the environment. However, in persons with underlying weakened immune response this innocent bystander can cause fatal illness if timely diagnosis and management is not done. Chest infection is the most common infection caused by Aspergillus in human beings. Radiological investigations particularly Computed Tomography (CT) provides the easiest, rapid and decision making information where tissue diagnosis and culture may be difficult and time-consuming. This article explores the crucial role of CT and offers a bird's eye view of all the radiological patterns encountered in pulmonary aspergillosis viewed in the context of the immune derangement associated with it.
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Affiliation(s)
- Akhila Prasad
- Associate Professor, Department of Radiodiagnosis, PGIMER & Dr Ram Manohar Lohia Hospital , New Delhi, India
| | - Kshitij Agarwal
- Senior Resident, Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi , Delhi, India
| | - Desh Deepak
- Chief Medical Officer, Respiratory Division, Department of Medicine, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital , New-Delhi, India
| | - Swapndeep Singh Atwal
- Ex-Senior Resident, Department of Radiodiagnosis, PGIMER & Dr Ram Manohar Lohia Hospital , New Delhi, India
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39
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Agüero F, Rimola A, Stock P, Grossi P, Rockstroh JK, Agarwal K, Garzoni C, Barcan LA, Maltez F, Manzardo C, Mari M, Ragni MV, Anadol E, Di Benedetto F, Nishida S, Gastaca M, Miró JM. Liver Retransplantation in Patients With HIV-1 Infection: An International Multicenter Cohort Study. Am J Transplant 2016; 16:679-87. [PMID: 26415077 DOI: 10.1111/ajt.13461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 01/25/2023]
Abstract
Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents.
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Affiliation(s)
- F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Rimola
- Liver Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain, and CIBEREHD, Spain
| | - P Stock
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA
| | - P Grossi
- Infectious Diseases Section, Department of Surgical and Morphological Sciences, University of Insubria, Varese and National Center for Transplantation, Rome, Italy
| | - J K Rockstroh
- Department of Medicine, University of Bonn, Bonn, Germany
| | - K Agarwal
- Institute of Liver Studies, Kings College Hospital, London, United Kingdom
| | - C Garzoni
- Institute for Infectious Diseases, Bern University Hospital, Berne, Switzerland and Department of Infectious Diseases, Inselspital, Bern and University Hospital and University of Bern, Bern, Switzerland
| | - L A Barcan
- Infectious Disease Section, Internal Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - F Maltez
- Department of Infectious Diseases, Hospital Curry Cabral, Lisbon, Portugal
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Mari
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M V Ragni
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - E Anadol
- Department of Medicine, University of Bonn, Bonn, Germany
| | - F Di Benedetto
- HPB Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - S Nishida
- Miami Transplant Institute, Department of Surgery, University of Miami, Miami, FL
| | - M Gastaca
- Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Raj A, Singh N, Gupta KB, Chaudhary D, Yadav A, Chaudhary A, Agarwal K, Varma-Basil M, Prasad R, Khuller GK, Mehta PK. Comparative Evaluation of Several Gene Targets for Designing a Multiplex-PCR for an Early Diagnosis of Extrapulmonary Tuberculosis. Yonsei Med J 2016; 57:88-96. [PMID: 26632387 PMCID: PMC4696977 DOI: 10.3349/ymj.2016.57.1.88] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/21/2015] [Accepted: 05/02/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Diagnosis of extrapulmonary tuberculosis (EPTB) poses serious challenges. A careful selection of appropriate gene targets is essential for designing a multiplex-polymerase chain reaction (M-PCR) assay. MATERIALS AND METHODS We compared several gene targets of Mycobacterium tuberculosis, including IS6110, devR, and genes encoding MPB-64 (mpb64), 38kDa (pstS1), 65kDa (hsp65), 30kDa (fbpB), ESAT-6 (esat6), and CFP-10 (cfp10) proteins, using PCR assays on 105 EPTB specimens. From these data, we chose the two best gene targets to design an M-PCR. RESULTS Among all gene targets tested, mpb64 showed the highest sensitivity (84% in confirmed cases and 77.5% in clinically suspected cases), followed by IS6110, hsp65, 38kDa, 30kDa, esat6, cfp10, and devR. We used mpb64+IS6110 for designing an M-PCR assay. Our M-PCR assay demonstrated a high sensitivity of 96% in confirmed EPTB cases and 88.75% in clinically suspected EPTB cases with a high specificity of 100%, taking clinical diagnosis as the gold standard. CONCLUSION These M-PCR results along with the clinical findings may facilitate an early diagnosis of EPTB patients and clinical management of disease.
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Affiliation(s)
- Ankush Raj
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Netrapal Singh
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India
| | - Krishna B Gupta
- Department of TB & Respiratory Medicine, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care Medicine, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Aparna Yadav
- Department of Microbiology, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, India
| | - Anil Chaudhary
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), Delhi, India
| | - Kshitij Agarwal
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), Delhi, India
| | | | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Gopal K Khuller
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak, India.
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Beloukas A, King S, Childs K, Papadimitropoulos A, Hopkins M, Atkins M, Agarwal K, Nelson M, Geretti A. Detection of the NS3 Q80K polymorphism by Sanger and deep sequencing in hepatitis C virus genotype 1a strains in the UK. Clin Microbiol Infect 2015; 21:1033-9. [DOI: 10.1016/j.cmi.2015.07.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/14/2015] [Accepted: 07/19/2015] [Indexed: 01/27/2023]
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Agarwal K, Gaur SN, Chowdhary A. The role of fungal sensitisation in clinical presentation in patients with chronic obstructive pulmonary disease. Mycoses 2015. [DOI: 10.1111/myc.12352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Kshitij Agarwal
- Department of Pulmonary Medicine; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Shailendra Nath Gaur
- Department of Pulmonary Medicine; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Anuradha Chowdhary
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
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Agarwal K, Saji M, Lazaroff SM, Palmer AF, Ringel MD, Paulaitis ME. Analysis of exosome release as a cellular response to MAPK pathway inhibition. Langmuir 2015; 31:5440-8. [PMID: 25915504 PMCID: PMC4589192 DOI: 10.1021/acs.langmuir.5b00095] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Exosome size distributions and numbers of exosomes released per cell are measured by asymmetric flow-field flow fractionation/multi-angle light scattering (A4F/MALS) for three thyroid cancer cell lines as a function of a treatment that inhibits MAPK signaling pathways in the cells. We show that these cell lines release exosomes with well-defined morphological features and size distributions that reflect a common biological process for their formation and release into the extracellular environment. We find that those cell lines with constitutive activation of the MAPK signaling pathway display MEK-dependent exosome release characterized by increased numbers of exosomes released per cell. Analysis of the measured exosome size distributions based on a generalized extreme value distribution model for exosome formation in intracellular multivesicular bodies highlights the importance of this experimental observable for delineating different mechanisms of vesicle formation and predicting how changes in exosome release can be modified by pathway inhibitors in a cell context-dependent manner.
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Kathuria S, Sharma C, Singh PK, Agarwal P, Agarwal K, Hagen F, Meis JF, Chowdhary A. Molecular epidemiology and in-vitro antifungal susceptibility of Aspergillus terreus species complex isolates in Delhi, India: evidence of genetic diversity by amplified fragment length polymorphism and microsatellite typing. PLoS One 2015; 10:e0118997. [PMID: 25781896 PMCID: PMC4363790 DOI: 10.1371/journal.pone.0118997] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/08/2015] [Indexed: 11/19/2022] Open
Abstract
Aspergillus terreus is emerging as an etiologic agent of invasive aspergillosis in immunocompromised individuals in several medical centers in the world. Infections due to A. terreus are of concern due to its resistance to amphotericin B, in vivo and in vitro, resulting in poor response to antifungal therapy and high mortality. Herein we examined a large collection of molecularly characterized, geographically diverse A. terreus isolates (n = 140) from clinical and environmental sources in India for the occurrence of cryptic A. terreus species. The population structure of the Indian A. terreus isolates and their association with those outside India was determined using microsatellite based typing (STR) technique and Amplified Fragment Length Polymorphism analysis (AFLP). Additionally, in vitro antifungal susceptibility of A. terreus isolates was determined against 7 antifungals. Sequence analyses of the calmodulin locus identified the recently described cryptic species A. hortai, comprising 1.4% of Aspergillus section Terrei isolates cultured from cases of aspergilloma and probable invasive aspergillosis not reported previously. All the nine markers used for STR typing of A. terreus species complex proved to be highly polymorphic. The presence of high genetic diversity revealing 75 distinct genotypes among 101 Indian A. terreus isolates was similar to the marked heterogeneity noticed in the 47 global A. terreus population exhibiting 38 unique genotypes mainly among isolates from North America and Europe. Also, AFLP analysis showed distinct banding patterns for genotypically diverse A. terreus isolates. Furthermore, no correlation between a particular genotype and amphotericin B susceptibility was observed. Overall, 8% of the A. terreus isolates exhibited low MICs of amphotericin B. All the echinocandins and azoles (voriconazole, posaconazole and isavuconazole) demonstrated high potency against all the isolates. The study emphasizes the need of molecular characterization of A. terreus species complex isolates to better understand the ecology, acquisition and transmission of this species.
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Affiliation(s)
- Shallu Kathuria
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Cheshta Sharma
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pradeep Kumar Singh
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Puneet Agarwal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Kshitij Agarwal
- Department of Pulmonary Medicine, Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, Delhi, India
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- * E-mail:
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Millwood Hargrave J, Agarwal K, Ahmed A, Toh CH, Downey C, Welters ID. SEVERE HYPOPHOSPHATEMIA IN THE CRITICALLY ILL: ARE WE REPLACING ENOUGH? Intensive Care Med Exp 2015. [PMCID: PMC4796375 DOI: 10.1186/2197-425x-3-s1-a913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- E Orrin
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, U.K.
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Abstract
Filamentous basidiomycetes (BM) are common environmental fungi that have recently emerged as important human pathogens, inciting a wide array of clinical manifestations that include allergic and invasive diseases. We reviewed 218 reported global cases of BM fungi. The most common etiologic agent was Schizophyllum commune in 52.3% (114/218) of the cases followed by Hormographiella aspergillata (n = 13; 5.9%), Ceriporia lacerata (n = 11; 5%), and, rarely, Volvariella volvacea, Inonotus tropicalis, Irpex lacteus, Phellinus undulates, Perenniporia species, Bjerkandera adusta, Sporotrichum pruinosum, Phanerochaete steroids, and Cyclomyces tabacinus. These fungi are present in the environment as gilled mushrooms, shelf fungi, and bracket fungi. However, in clinical settings, they usually present as nonsporulating white moulds that are difficult to identify. Moreover, the GenBank database of these fungi is limited. Regarding the country-wise distribution of cases, Japan topped the list with about 43% (n = 94) of globally reported cases, followed by India (57; 26%), the United States (4%), Austria (3.2%), Iran (3.2%), France (2.8%), and the remaining one-third from 16 other countries. The respiratory tract was the most commonly afflicted site (n = 71), with the majority of the cases (42; 59.1%) being allergic in etiology and comprising 34 cases of allergic bronchopulmonary mycosis. Also, B. adusta has been implicated in a recently described clinical entity, that is, fungus associated chronic cough, reported exclusively from Japan. BM fungi-incited diseases are currently underdiagnosed due to lack of awareness and expertise, warranting comprehensive epidemiological and susceptibility studies to determine their prevalence and to predict a more appropriate therapy.
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Affiliation(s)
| | - Shallu Kathuria
- Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Kshitij Agarwal
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis, Delhi, India
| | - Jacques F Meis
- Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Chowdhary A, Kathuria S, Agarwal K, Sachdeva N, Singh PK, Jain S, Meis JF. Voriconazole-Resistant Penicillium oxalicum: An Emerging Pathogen in Immunocompromised Hosts. Open Forum Infect Dis 2014; 1:ofu029. [PMID: 25734109 PMCID: PMC4281804 DOI: 10.1093/ofid/ofu029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/05/2014] [Indexed: 11/22/2022] Open
Abstract
Penicillium species are rarely reported agents of infections in immunocompromised patients. We report 3 cases of invasive mycosis caused by voriconazole-resistant Penicillium oxalicum in patients with acute myeloid leukemia, diabetes mellitus, and chronic obstructive pulmonary disease, while on voriconazole therapy. Penicillium oxalicum has not been previously recognized as a cause of invasive mycoses.
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Affiliation(s)
| | - Shallu Kathuria
- Vallabhbhai Patel Chest Institute , University of Delhi , Delhi , India
| | - Kshitij Agarwal
- Rajan Babu Institute of Pulmonary Medicine and Tuberculosis , Delhi , India
| | - Neelam Sachdeva
- Rajiv Gandhi Cancer Institute & Research Centre , Delhi , India
| | - Pradeep K Singh
- Vallabhbhai Patel Chest Institute , University of Delhi , Delhi , India
| | - Sandeep Jain
- Rajiv Gandhi Cancer Institute & Research Centre , Delhi , India
| | - Jacques F Meis
- Canisius-Wilhelmina Hospital , Nijmegen , The Netherlands ; Radboud University Medical Centre , Nijmegen , The Netherlands
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Miller MH, Agarwal K, Austin A, Brown A, Barclay ST, Dundas P, Dusheiko GM, Foster GR, Fox R, Hayes PC, Leen C, Millson C, Ryder SD, Tait J, Ustianowski A, Dillon JF. Review article: 2014 UK consensus guidelines - hepatitis C management and direct-acting anti-viral therapy. Aliment Pharmacol Ther 2014; 39:1363-75. [PMID: 24754233 DOI: 10.1111/apt.12764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Received: 02/11/2014] [Revised: 03/03/2014] [Accepted: 04/01/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Therapeutic options for the management of hepatitis C virus (HCV) infection have evolved rapidly over the past two decades, with a consequent improvement in cure rates. Novel therapeutic agents are an area of great interest in the research community, with a number of these agents showing promise in the clinical setting. AIMS To assess and present the available evidence for the use of novel therapeutic agents for the treatment of HCV, updating previous guidelines. METHODS All Phase 2 and 3 studies, as well as abstract presentations from international Hepatology meetings were identified and reviewed for suitable inclusion, based on studies of new therapies in HCV. Treatment-naïve and experienced individuals, as well as cirrhotic and co-infected individuals were included. RESULTS Sofosbuvir, simeprevir and faldaprevir, along with pegylated interferon and ribavirin, have a role in the treatment of chronic HCV infection. The precise regimens are largely dependent on the patient characteristics, patient and physician preferences, and cost implication. CONCLUSIONS Therapies for chronic HCV have evolved dramatically in recent years. Interferon-free regimens are now possible without compromise in the rate of sustained viral response. The decision as to which regimen is most appropriate is multifactorial, and based on efficacy, safety and cost.
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Affiliation(s)
- M H Miller
- Gut Group, Medical Research Institute, NHS Tayside Ninewells Hospital, University of Dundee, Dundee, UK
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Gane EJ, Agarwal K. Directly acting antivirals (DAAs) for the treatment of chronic hepatitis C virus infection in liver transplant patients: "a flood of opportunity". Am J Transplant 2014; 14:994-1002. [PMID: 24730431 DOI: 10.1111/ajt.12714] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [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: 12/17/2013] [Revised: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C virus (HCV) is the leading cause of liver transplantation (LT) in adults. However, infection of the allograft is universal and associated with reduced graft and patient survival. Although successful eradication improves posttransplant outcome, current antiviral therapies have poor efficacy and tolerability. Direct acting antiviral agents (DAAs) provide new opportunities for treatment of HCV recurrence. The addition of a first-generation NS3/4A protease inhibitor (PI) has increased the efficacy of pegylated interferon and ribavirin in patients with chronic HCV genotype 1 infection. Preliminary efficacy results from open-labeled studies of PI-based triple therapy in LT recipients are encouraging. However, the tolerability of triple therapy is reduced following LT, because of increased anemia and drug-drug interactions. The use of PI-based triple therapy in LT recipients seems best suited to larger centers, experienced with management of PI toxicity. Fortunately, other classes of DAAs targeting different steps of HCV replication are in clinical trials, including nucleotide polymerase (NUC-NS5B) inhibitors, nonnucleotide polymerase (non-NUC-NS5B) inhibitors and NS5A inhibitors. Several dual and triple DAA regimens are in clinical development. Phase II studies conducted in patients before and after LT suggest that these regimens will dramatically reduce the impact of recurrent HCV. There is a tide in the affairs of men. Which, taken at the flood, leads on to fortune (Shakespeare: J Caesar Act 4, scene 3).
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Affiliation(s)
- E J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
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