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Shah HH, Zehra SA, Shahrukh A, Waseem R, Hussain T, Hussain MS, Batool F, Jaffer M. Cardiac sarcoidosis: a comprehensive review of risk factors, pathogenesis, diagnosis, clinical manifestations, and treatment strategies. Front Cardiovasc Med 2023; 10:1156474. [PMID: 37273881 PMCID: PMC10235776 DOI: 10.3389/fcvm.2023.1156474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023] Open
Abstract
Cardiac Sarcoidosis (CS) is a deadly consequence of systemic sarcoidosis that inflames all three layers of the heart, especially the myocardium-clinical signs of CS range from asymptomatic disease to abrupt cardiac death. CS generally remains undiagnosed secondary to a lack of definitive diagnostic criteria, a high percentage of false negative results on endomyocardial biopsy, and ill-defining clinical manifestations of the disease. Consequently, there is a lack of evidence-based recommendations for CS, and the present diagnostic and therapeutic management depend on expert opinion. The aetiology, risk factors, clinical symptoms, diagnosis, and therapy of CS will be covered in this review. A particular emphasis will be placed on enhanced cardiovascular imaging and early identification of CS. We review the emerging evidence regarding the use of Electrocardiograms (ECGs), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) imaging of the heart to identify and quantify the extent of myocardial inflammation, as well as to guide the use of immunotherapy and other treatment regimens, such as ablation therapy, device therapy, and heart transplantation, to improve patient outcomes.
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Chen YC, Jaffer M, Zhou L, Moslehi J, Forsyth PA, Fecher LA. A Brain, A Heart, and the Courage: Balancing Benefit and Toxicity of Immunotherapy in Melanoma. Am Soc Clin Oncol Educ Book 2023; 43:e390594. [PMID: 37229626 DOI: 10.1200/edbk_390594] [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: 05/27/2023]
Abstract
The overall survival of advanced melanoma has improved dramatically. Immunotherapies, specifically checkpoint inhibitors, have played a large role in this improvement. These agents have also shown benefit in the adjuvant setting, are approved for treatment of resected stage II, III, and IV melanoma, and play an evolving role in the neoadjuvant setting. Although generally well tolerated, immune-related adverse events occur and can be severe. Here we focus on some severe and potentially long term toxicities, including cardiovascular and neurologic toxicities. Our understanding of the acute and long-term toxicities of immune checkpoint inhibitors continues to evolve. Oncologists must continue to balance cancer risk and treatment-related toxicities.
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Affiliation(s)
- Yen-Chou Chen
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Jaffer
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
| | - Lylybell Zhou
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
- Department of Oncology, Moffitt Cancer Center and University of South Florida, Tampa, FL
| | - Leslie A Fecher
- Rogel Cancer Center at the University of Michigan, Ann Arbor, MI
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Milner TD, Jaffer M, Iyer A. Temperature and luminosity outputs of endoscopes used in transcanal endoscopic ear surgery: an experimental study. J Laryngol Otol 2023; 137:368-372. [PMID: 35485834 DOI: 10.1017/s0022215122001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish the relationship between endoscope temperatures and luminosity with a variety of light source types, endoscope ages, endoscope sizes, angles and operative distance in transcanal endoscopic ear surgery. METHODS Transcanal endoscopic ear surgery was simulated in an operating theatre using 7 mm plastic suction tubing coated in insulating tape. An ATP ET-959 thermometer was used to record temperatures, and a Trotec BF06 lux meter was used to measure luminosity. Luminosity and temperature recordings were taken at 0 mm and 5 mm from the endoscope tip. RESULTS Thermal energy transfer from operating endoscopes is greatest when: the light intensity is high, there is a light-emitting diode light source and the endoscope is touching the surface. Additionally, larger-diameter endoscopes, angled endoscopes and new endoscopes generated greater heat. CONCLUSION It is recommended that operative light intensity is maintained at the lowest level possible, and that the surgeon avoids contact between patient tissues and the endoscope tip.
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Affiliation(s)
- T D Milner
- Department of Otolaryngology, University Hospital Monklands, NHS Lanarkshire, Airdrie, Scotland, UK
| | - M Jaffer
- Department of Otolaryngology, University Hospital Monklands, NHS Lanarkshire, Airdrie, Scotland, UK
| | - A Iyer
- Department of Otolaryngology, University Hospital Monklands, NHS Lanarkshire, Airdrie, Scotland, UK
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Abstract
The use of immune checkpoint inhibitors (iCPI) in the treatment of multiple cancers has gained prominence due to their high efficacy. However, neurological immune-related adverse events (irAEs) such as myasthenia gravis (MG) have been associated with iCPI therapy. Most of these neurological irAEs are rare, and in many cases, their diagnoses and management can be challenging. We present a case of a 70-year-old woman with stage IIIC melanoma who developed a new onset of gradually progressive dyspnea, diplopia, and bilateral ptosis following treatment with one cycle of nivolumab and ipilimumab (Nivo+Ipi). She was diagnosed with MG via positive serum acetylcholine receptor (AChR) antibodies. She had developed a severe dyspnea at rest, which was refractory to multiple immune-suppressive therapies including prednisone, pyridostigmine, and intravenous immunoglobulin (IVIG). Subsequently, she was treated with rituximab 375 mg/m2 monthly every four weeks with significant improvement of her symptoms within 48 hours each time. As the implementation of immunotherapy increases in medical practice, irAEs may become more apparent. When first-line therapies are not adequate, other alternative therapies should be explored. This case of MG as an irAE shows that rituximab can provide a potential benefit to treating patients with immunotherapy-induced MG who are refractory to other standard treatments. Prospective studies are needed to further evaluate the efficacy of rituximab in the management of irAEs.
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Affiliation(s)
- Neha Verma
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
| | - Muhammad Jaffer
- Neurology, Universty of South Florida Morsani College of Medicine, Tampa, USA
| | - Yolanda Pina
- Neuro-Oncology, Moffitt Cancer Center, Tampa, USA
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Jaffer M, Chung M, Sharda E, Ramsakal A, Peguero E, Verma N, Mokhtari S. Immunotherapy Induced Myasthenic-Like Syndrome in a Metastatic Melanoma Patient With Amyotrophic Lateral Sclerosis. Clin Med Insights Oncol 2020; 14:1179554920978024. [PMID: 33447124 PMCID: PMC7780164 DOI: 10.1177/1179554920978024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
Immunotherapy agents such as ipilimumab and nivolumab are immensely effective in the treatment of various malignancies. Despite this, neurologic immune-related sequelae (NIRS) have been observed. Prompt diagnosis and treatment is critical to improve patient outcomes. We present a case of a 63-year-old man with stage IV metastatic melanoma beginning treatment with ipilimumab and nivolumab. Gathered history from the patient showed that he had a 3-year presentation of bradykinesia, shuffling gait, and muscle cramping. After one dose, the patient began to have progressively worsening generalized weakness; after receiving the immunotherapy, there was a rapid decline in his health. In addition to weakness, the patient developed diplopia, impaired single breath count, lingual and upper/lower extremity fasciculations, and brisk reflexes. While the lumbar puncture and myasthenia panel were non-diagnostic, the electromyography (EMG) revealed axonal neuropathy and diffuse denervation/reinnervation changes. Furthermore, a magnetic resonance imaging (MRI) displayed fatty replacement of the tongue with a bright tongue sign. These results pointed to the diagnosis of amyotrophic lateral sclerosis (ALS) superimposed onto myasthenic-like syndrome. The patient was started on various treatments; however, unfortunately he died due to acute hypoxic respiratory failure. This case highlights important considerations that must be taken when using immunotherapy, especially in patients with pre-existing neurological deficits. Furthermore, it shows the importance of early diagnosis as treatment can potentially cure adverse sequelae.
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Affiliation(s)
| | - Matthew Chung
- University of South Florida, Tampa, FL, USA.,MD Anderson Cancer Center, Houston, TX, USA
| | | | - Asha Ramsakal
- University of South Florida, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Edwin Peguero
- University of South Florida, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Neha Verma
- University of South Florida, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Sepideh Mokhtari
- University of South Florida, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
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Awal D, Jaffer M, Charan G, Ball R, Kennedy G, Thomas S, Farook S, Mills C, Ayliffe P. Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases. Int J Oral Maxillofac Surg 2018; 47:1433-1438. [DOI: 10.1016/j.ijom.2018.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/04/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
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DeGasperis-Brigante C, Jaffer M, Rodger M, Rao V. Hospital Discharge After CABG: Why Don't Patients Go Home on Day 5? Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.353] [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: 10/26/2022] Open
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Jaffer M, Swanton R, Wilson J. The economic benefits of cell salvage in obstetric haemorrhage. Int J Obstet Anesth 2013; 22:256. [PMID: 23702183 DOI: 10.1016/j.ijoa.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/13/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
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Salazar L, Jaffer M, Burtis D, Isham R, Williamson J, Heilman K. Speed of Global Versus Focal Processing (P02.028). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.028] [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] Open
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Jaffer M, Burtis D, Salazar L, Williamson J, Heilman K, Isham R. The Effects of Monocular Viewing on Verbal Versus Figural Processing during Focal Versus Global Attention (P02.030). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.030] [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] Open
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Varsani A, Williamson AL, Rose RC, Jaffer M, Rybicki EP. Expression of Human papillomavirus type 16 major capsid protein in transgenic Nicotiana tabacum cv. Xanthi. Arch Virol 2003; 148:1771-86. [PMID: 14505089 DOI: 10.1007/s00705-003-0119-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The production of vaccine antigens in plants is a safe and potentially very cost-effective alternative to traditional expression systems. We investigated the possibility of transgenic plant expression of the Human papillomavirus (HPV) type 16 L1 major capsid protein, with and without nuclear localisation signals, in Nicotiana tabacum cv. Xanthi plants. The genes were stably integrated into the N. tabacum genome, and both the expressed proteins were capable of assembling into capsomers and virus-like particles. The proteins in concentrated leaf extracts (L1(Tr)) were tested for antigenicity using a panel of characterised monoclonal antibodies (Mabs). Neutralising and conformation-specific Mabs (H16:V5 and H16:E70) were shown to bind to both types of the plant-produced particles. We estimated the L1(Tr) product yield to be 2-4 microg per kg of fresh leaf material. Rabbits immunised with small doses of plant-produced particles elicited a weak anti-HPV-16 L1 immune response. Our results support the feasibility of using transgenic plants for the production of HPV vaccines.
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Affiliation(s)
- A Varsani
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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Piacentini J, Jaffer M, Gitow A, Graae F, Davies SO, Del Bene D, Liebowitz M. Psychopharmacologic treatment of child and adolescent obsessive compulsive disorder. Psychiatr Clin North Am 1992; 15:87-107. [PMID: 1549550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent evidence now suggests that OCD is much more common in young people than previously thought, affecting up to 200,000 children and adolescents in the United States alone. Unlike many childhood disorders, OCD appears remarkably similar for children and adults in terms of both clinical presentations and treatment response. The treatments of choice for OCD are antidepressants with potent serotonergic reuptake blocking effects such as fluoxetine and clomipramine. Both medications appear to be equally effective in terms of symptom remission, with different investigators reporting response rates in the range of 50% to 75%. Recent evidence suggests, however, that fluoxetine may be tolerated more easily than clomipramine and may be associated with less relapse upon discontinuation. Behavior therapy, either alone or in combination with medication, has been shown to be an effective alternative treatment. In spite of the increasing recognition of the disorder in both adults and children, only a handful of treatment outcome studies of child and adolescent OCD have been conducted and much work remains to be done in this area.
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Affiliation(s)
- J Piacentini
- College of Physicians and Surgeons of Columbia University, New York, New York
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Graae F, Gitow A, Piacentini J, Jaffer M, Liebowitz M. Response of obsessive-compulsive disorder and trichotillomania to serotonin reuptake blockers. Am J Psychiatry 1992; 149:149-50. [PMID: 1728180 DOI: 10.1176/ajp.149.1.aj1491149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Conn IG, Marshall AH, Yadav SN, Daly JC, Jaffer M. Transcutaneous electrical nerve stimulation following appendicectomy: the placebo effect. Ann R Coll Surg Engl 1986; 68:191-2. [PMID: 3538985 PMCID: PMC2498376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A controlled trial was undertaken to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) with standard intramuscular opiate analgesia in the management of postoperative pain following appendicectomy. Consecutive patients undergoing emergency appendicectomy were randomised into control, sham TENS and active TENS groups. There was a significant decrease in pain severity and analgesic intake in both active and sham TENS groups when compared with the control group (P less than 0.01). No difference was demonstrated in pain severity between active and sham TENS groups but the active TENS group required slightly less analgesia. These results suggest that the major benefit of TENS in the postappendicectomy patient is due to its 'placebo effect' and its use in this situation cannot be recommended.
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