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Alloah Q, Misra N, Kwon E, Jhaveri S, Rajagopal H, Gasparis C, Meyer DB. Hypoplastic Circumflex Aorta With Anomalous Left Pulmonary Artery: Uncrossing Operation in a Neonate. World J Pediatr Congenit Heart Surg 2024:21501351241237955. [PMID: 38656246 DOI: 10.1177/21501351241237955] [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: 04/26/2024]
Abstract
Circumflex aortic arch with coarctation and anomalous origin of the left pulmonary artery from the aorta are rare cardiovascular anomalies. These conditions can lead to early pulmonary hypertension and challenging management. Early diagnosis and surgical intervention are beneficial for optimal outcome. We present a case where both anomalies coexisted and were repaired with aortic uncrossing, arch augmentation, and reimplantation of the left pulmonary artery. To our knowledge, this is the first documented instance of these anomalies coexisting and being repaired in the neonatal period.
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Affiliation(s)
- Qais Alloah
- Division of Pediatric Cardiology, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Elena Kwon
- Division of Pediatric Cardiology, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Simone Jhaveri
- Division of Pediatric Cardiology, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Hari Rajagopal
- Division of Pediatric Cardiology, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | | | - David B Meyer
- Division of Cardiovascular and Thoracic Surgery, Cohen Children's Heart Center, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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2
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Cheong D, Jhaveri S, Smerling J, Rajagopal H, Misra N, Meyer DB. Association and Repair of Right Aortic Arch With Aberrant Left Subclavian Artery With Subclavian Stenosis. World J Pediatr Congenit Heart Surg 2024; 15:133-136. [PMID: 37728165 DOI: 10.1177/21501351231194256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Surgical repair of right aortic arch and aberrant left subclavian artery has traditionally involved ligamentum division. Such patients can have stenosis at the origin of the aberrant subclavian artery either at the time of presentation or later. The more recently popularized repair involving resection of Kommerell diverticulum with transfer of the subclavian artery to the left carotid artery allows resection of the stenotic segment and serves as an effective treatment for subclavian stenosis as well. We present three cases of early repair of this arch anomaly with associated subclavian stenosis repaired successfully in that manner.
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Affiliation(s)
- Daniel Cheong
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Simone Jhaveri
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Jonathan Smerling
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Hari Rajagopal
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
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3
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Walton M, Raghuveer G, Harahsheh A, Portman MA, Lee S, Khoury M, Dahdah N, Fabi M, Dionne A, Harris TH, Choueiter N, Garrido-Garcia LM, Jain S, Dallaire F, Misra N, Hicar MD, Giglia TM, Truong DT, Tierney ESS, Thacker D, Nowlen TT, Szmuszkovicz JR, Norozi K, Orr WB, Farid P, Manlhiot C, McCrindle BW. Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023:10.1007/s00246-023-03338-z. [PMID: 38157048 DOI: 10.1007/s00246-023-03338-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
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Affiliation(s)
- Mollie Walton
- Children's Mercy Hospital, Kansas City, MO, USA.
- Division of Pediatric Cardiology, Ward Family Heart Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 61408, USA.
| | | | - Ashraf Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Supriya Jain
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Mark D Hicar
- Jacobs School of Medicine and BioMedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Elif Seda Selamet Tierney
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | | | | | | | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, ON, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Pedrom Farid
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
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4
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Lin J, Harahsheh AS, Raghuveer G, Jain S, Choueiter NF, Garrido-Garcia LM, Dahdah N, Portman MA, Misra N, Khoury M, Fabi M, Elias MD, Dionne A, Lee S, Tierney ESS, Ballweg JA, Manlhiot C, McCrindle BW. Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children. Can J Cardiol 2023; 39:793-802. [PMID: 36626979 PMCID: PMC9824951 DOI: 10.1016/j.cjca.2023.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has emerged as a rare delayed hyperinflammatory response to SARS-CoV-2 infection and causes severe morbidity in the pediatric age group. Although MIS-C shares many clinical similarities to Kawasaki disease (KD), important differences in epidemiologic, clinical, immunologic, and potentially genetic factors exist and suggest potential differences in pathophysiology and points to be explored and explained. Epidemiologic features include male predominance, peak age of 6 to12 years, and specific racial or ethnicity predilections. MIS-C is characterized by fever, prominent gastrointestinal symptoms, mucocutaneous manifestations, respiratory symptoms, and neurologic complaints, and patients often present with shock. Cardiac complications are frequent and include ventricular dysfunction, valvular regurgitation, pericardial effusion, coronary artery dilation and aneurysms, conduction abnormalities, and arrhythmias. Emerging evidence regarding potential immunologic mechanisms suggest that an exaggerated T-cell response to a superantigen on the SARS-CoV-2 spike glycoprotein-as well as the formation of autoantibodies against cardiovascular, gastrointestinal, and endothelial antigens-are major contributors to the inflammatory milieu of MIS-C. Further studies are needed to determine both shared and distinct immunologic pathway(s) that underlie the pathogenesis of MIS-C vs both acute SARS-CoV-2 infection and KD. There is evidence to suggest that the rare risk of more benign mRNA vaccine-associated myopericarditis is outweighed by a reduced risk of more severe MIS-C. In the current review, we synthesize the published literature to describe associated factors and potential mechanisms regarding an increased risk of MIS-C and cardiac complications, provide insights into the underlying immunologic pathophysiology, and define similarities and differences with KD.
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Affiliation(s)
- Justin Lin
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ashraf S Harahsheh
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Supriya Jain
- Division of Pediatric Cardiology, Maria Fareri Children's Hospital of Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Nadine F Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte Justine University Hospital Center, University of Montreal, Montréal, Québec, Canada
| | | | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, New York, New York, USA
| | - Michael Khoury
- Stollery Children's Hospital, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matthew D Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Lee
- Children's Nationwide Hospital, Columbus, Ohio, USA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jean A Ballweg
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Cedric Manlhiot
- Johns Hopkins University School of Medicine, Division of Cardiology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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5
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Mitchell EC, Romano A, Capone CA, Cooper R, Epstein S, Hayes DA, Parness IA, Schleien C, Misra N. Multisystem inflammatory syndrome in children: Salient echocardiogram findings in the acute phase and longitudinal follow-up. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Aeschlimann FA, Misra N, Hussein T, Panaioli E, Soslow JH, Crum K, Steele JM, Huber S, Marcora S, Brambilla P, Jain S, Navallas M, Giuli V, Rücker B, Angst F, Patel MD, Azarine A, Caro-Domínguez P, Cavaliere A, Di Salvo G, Ferroni F, Agnoletti G, Bonnemains L, Martins D, Boddaert N, Wong J, Pushparajah K, Raimondi F. Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study-the CARDOVID registry. J Cardiovasc Magn Reson 2021; 23:140. [PMID: 34969397 PMCID: PMC8717054 DOI: 10.1186/s12968-021-00841-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort. METHODS AND RESULTS Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0-13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19-47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87-23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18-21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction. CONCLUSION No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage. CLINICAL TRIAL REGISTRATION The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.
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Affiliation(s)
- Florence A Aeschlimann
- Department of Pediatric Immunology-Hematology and Rheumatology, Hôpital Necker Enfants Malades, Paris, France
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Zucker School of Medicine, Cohen Children's Medical Center of NY, Northwell Health, New York, USA
| | | | - Elena Panaioli
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
- Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Thomas P Graham Jr, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Crum
- Division of Pediatric Cardiology, Thomas P Graham Jr, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy M Steele
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Steffen Huber
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Simona Marcora
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Brambilla
- Radiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Supriya Jain
- Division of Pediatric Cardiology, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Maria Navallas
- Radiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Beate Rücker
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
| | - Mehul D Patel
- Division of Pediatric Cardiology, University of Texas Health Science Center, Houston, TX, USA
| | - Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Francesca Ferroni
- Cardiology Department, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Laurent Bonnemains
- Paediatric Cardiology, University Hospital of Strasbourg, Strasbourg, France
- ICube, Équipe MecaFlu, UMR 7357, University of Strasbourg, Strasbourg, France
| | - Duarte Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Nathalie Boddaert
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
- Institut Imagine, Paris, France
| | - James Wong
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Francesca Raimondi
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France.
- Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France.
- Institut Imagine, Paris, France.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France.
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Jain SS, Steele JM, Fonseca B, Huang S, Shah S, Maskatia SA, Buddhe S, Misra N, Ramachandran P, Gaur L, Eshtehardi P, Anwar S, Kaushik N, Han F, Chaudhuri NR, Grosse-Wortmann L. COVID-19 Vaccination-Associated Myocarditis in Adolescents. Pediatrics 2021; 148:peds.2021-053427. [PMID: 34389692 DOI: 10.1542/peds.2021-053427] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [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] [Accepted: 08/10/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In this study, we aimed to characterize the clinical presentation, short-term prognosis, and myocardial tissue changes as noted on cardiovascular magnetic resonance (CMR) or cardiac MRI in pediatric patients with coronavirus disease 2019 vaccination-associated myocarditis (C-VAM). METHODS In this retrospective multicenter study across 16 US hospitals, patients <21 years of age with a diagnosis of C-VAM were included and compared with a cohort with multisystem inflammatory syndrome in children. Younger children with C-VAM were compared with older adolescents. RESULTS Sixty-three patients with a mean age of 15.6 years were included; 92% were male. All had received a messenger RNA vaccine and, except for one, presented after the second dose. Four patients had significant dysrhythmia; 14% had mild left ventricular dysfunction on echocardiography, which resolved on discharge; 88% met the diagnostic CMR Lake Louise criteria for myocarditis. Myocardial injury as evidenced by late gadolinium enhancement on CMR was more prevalent in comparison with multisystem inflammatory syndrome in children. None of the patients required inotropic, mechanical, or circulatory support. There were no deaths. Follow-up data obtained in 86% of patients at a mean of 35 days revealed resolution of symptoms, arrhythmias, and ventricular dysfunction. CONCLUSIONS Clinical characteristics and early outcomes are similar between the different pediatric age groups in C-VAM. The hospital course is mild, with quick clinical recovery and excellent short-term outcomes. Myocardial injury and edema are noted on CMR. Close follow-up and further studies are needed to understand the long-term implications and mechanism of these myocardial tissue changes.
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Affiliation(s)
- Supriya S Jain
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | | | | | - Sihong Huang
- College of Human Medicine, Michigan State University and Helen DeVos Children's Hospital, Spectrum Health, Grand Rapids, Michigan
| | - Sanket Shah
- Children's Mercy Hospital, Kansas City, Missouri
| | - Shiraz A Maskatia
- School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
| | - Sujatha Buddhe
- Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, Queens, New York
| | | | - Lasya Gaur
- School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Parham Eshtehardi
- Northside Heart and Vascular Institute, Northside Hospital, Atlanta, Georgia
| | - Shafkat Anwar
- University of California, San Francisco, San Francisco, California
| | - Neeru Kaushik
- University of California, San Francisco Benioff Children's Hospitals, Oakland, California
| | - Frank Han
- College of Medicine, University of Illinois, Peoria, Illinois
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8
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Capone CA, Misra N, Ganigara M, Epstein S, Rajan S, Acharya SS, Hayes DA, Kearney MB, Romano A, Friedman RA, Blaufox AD, Cooper R, Schleien C, Mitchell E. Six Month Follow-up of Patients With Multi-System Inflammatory Syndrome in Children. Pediatrics 2021; 148:peds.2021-050973. [PMID: 34326176 DOI: 10.1542/peds.2021-050973] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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] [Accepted: 07/23/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Myocardial dysfunction and coronary abnormalities are prominent features of multisystem inflammatory syndrome in children (MIS-C). In this study we aim to evaluate the early and midterm outcomes of MIS-C. METHODS This is a longitudinal 6-month cohort study of all children admitted and treated for MIS-C from April 17 to June 20, 2020. Patients were followed ∼2 weeks, 8 weeks, and 6 months postadmission, with those with coronary aneurysms evaluated more frequently. RESULTS Acutely, 31 (62%) patients required intensive care with vasoactive support, 26 (52%) had left ventricular (LV) systolic dysfunction, 16 (32%) had LV diastolic dysfunction, 8 (16%) had coronary aneurysms (z score ≥2.5), and 4 (8%) had coronary dilation (z score <2.5). A total of 48 patients (96%) received immunomodulatory treatment. At 2 weeks, there was persistent mild LV systolic dysfunction in 1 patient, coronary aneurysms in 2, and dilated coronary artery in 1. By 8 weeks through 6 months, all patients returned to functional baseline with normal LV systolic function and resolution of coronary abnormalities. Cardiac MRI performed during recovery in select patients revealed no myocardial edema or fibrosis. Some patients demonstrated persistent diastolic dysfunction at 2 weeks (5, 11%), 8 weeks (4, 9%), and 6 months (1, 4%). CONCLUSIONS Children with MIS-C treated with immunomodulators have favorable early outcomes with no mortality, normalization of LV systolic function, recovery of coronary abnormalities, and no inflammation or scarring on cardiac MRI. Persistence of diastolic dysfunction is of uncertain significance and indicates need for larger studies to improve understanding of MIS-C. These findings may help guide clinical management, outpatient monitoring, and considerations for sports clearance.
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Affiliation(s)
- Christine A Capone
- Divisions of Pediatric Cardiology .,Pediatric Critical Care Medicine.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Feinstein Institute for Medical Research, Northwell Health Manhasset, Manhasset, New York
| | - Nilanjana Misra
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Shilpi Epstein
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sujatha Rajan
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Infectious Disease
| | - Suchitra S Acharya
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Hematology and Oncology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Denise A Hayes
- Divisions of Pediatric Cardiology.,Pediatric Critical Care Medicine
| | - Mary Beth Kearney
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Angela Romano
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | | | - Rubin Cooper
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Charles Schleien
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Elizabeth Mitchell
- Divisions of Pediatric Cardiology.,Department of Pediatrics, Cohen Children's Medical Center, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Beroukhim RS, Ghelani S, Ashwath R, Balasubramanian S, Biko DM, Buddhe S, Campbell MJ, Cross R, Festa P, Griffin L, Grotenhuis H, Hasbani K, Hashemi S, Hegde S, Hussain T, Jain S, Kiaffas M, Kutty S, Lam CZ, Liberato G, Merlocco A, Misra N, Mowers KL, Muniz JC, Nutting A, Parra DA, Patel JK, Perez-Atayde AR, Prasad D, Rosental CF, Shah A, Samyn MM, Sleeper LA, Slesnick T, Valsangiacomo E, Geva T. Accuracy of Cardiac Magnetic Resonance Imaging Diagnosis of Pediatric Cardiac Masses: A Multicenter Study. JACC Cardiovasc Imaging 2021; 15:1391-1405. [PMID: 34419404 DOI: 10.1016/j.jcmg.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goals of this study were to: 1) evaluate the cardiac magnetic resonance (CMR) characteristics of pediatric cardiac masses from a large international cohort; 2) test the accuracy of previously developed CMR-based diagnostic criteria; and 3) expand diagnostic criteria using new information. BACKGROUND After diagnosis of a cardiac mass, clinicians must weigh the benefits and risks of ascertaining a tissue diagnosis. Limited data are available on the accuracy of previously developed noninvasive pediatric CMR-based diagnostic criteria. METHODS CMR studies (children 0-18 years of age) with confirmatory histological and/or genetic diagnosis were analyzed by 2 reviewers, without knowledge of prior diagnosis. Diagnostic accuracy was graded as: 1) single correct diagnosis; 2) correct diagnosis among a differential; or 3) incorrect diagnosis. RESULTS Of 213 cases, 174 (82%) had diagnoses that were represented in the previously published diagnostic criteria. In 70% of 174 cases, both reviewers achieved a single correct diagnosis (94% of fibromas, 71% of rhabdomyomas, and 50% of myxomas). When ≤2 differential diagnoses were included, both reviewers reached a correct diagnosis in 86% of cases. Of 29 malignant tumors, both reviewers indicated malignancy as a single diagnosis in 52% of cases. Including ≤2 differential diagnoses, both reviewers indicated malignancy in 83% of cases. Of 6 CMR sequences examined, acquisition of first-pass perfusion and late gadolinium enhancement were independently associated with a higher likelihood of a single correct diagnosis. CONCLUSIONS CMR of cardiac masses in children leads to an accurate diagnosis in most cases. A comprehensive imaging protocol is associated with higher diagnostic accuracy.
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Affiliation(s)
| | - Sunil Ghelani
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ravi Ashwath
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | | | - David M Biko
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Russell Cross
- Children's National Medical Center, Washington, DC, USA
| | - Pierluigi Festa
- Fondazione G. Monasterio C.N.R. Regione Toscana, Pisa, Italy
| | - Lindsay Griffin
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | | | | | - Sanjeet Hegde
- Rady Children's Hospital San Diego, San Diego, California, USA
| | | | - Supriya Jain
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
| | - Maria Kiaffas
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Shelby Kutty
- Johns Hopkins Children's Center, Baltimore, Maryland, USA; Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | | | | | | | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, New Hyde Park, New York, USA
| | - Katie L Mowers
- CS Mott Children's Hospital, Ann Arbor, Michigan, USA; St Louis Children's Hospital, St Louis, Missouri, USA
| | | | - Arni Nutting
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Parra
- Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Jyoti K Patel
- Riley Children's Hospital, Indianapolis, Indiana, USA
| | | | | | | | - Amee Shah
- Children's Hospital of New York, New York, New York, USA
| | - Margaret M Samyn
- Medical Collect of Wisconsin/Children's Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | - Tal Geva
- Boston Children's Hospital, Boston, Massachusetts, USA
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10
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Al-Ghafry M, Vagrecha A, Malik M, Levine C, Uster E, Aygun B, Appiah-Kubi A, Vlachos A, Capone CA, Rajan S, Palumbo N, Misra N, Mitchell EC, Wolfe LC, Lipton JM, Shore-Lesserson L, Acharya SS. Multisystem inflammatory syndrome in children (MIS-C) and the prothrombotic state: Coagulation profiles and rotational thromboelastometry in a MIS-C cohort. J Thromb Haemost 2021; 19:1764-1770. [PMID: 33872443 PMCID: PMC9906141 DOI: 10.1111/jth.15340] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have had high rates of thrombosis. A novel condition in children infected with SARS-CoV-2, multisystem inflammatory syndrome in children (MIS-C), has limited data on their prothrombotic state or need for thromboprophylaxis. OBJECTIVES We aimed to analyze the prothrombotic state using coagulation profiles, rotational thromboelastometry (ROTEM) parameters and clinical outcomes, to determine if this could aid in risk stratification for thromboprophylaxis. METHODS This analysis included patients (<21 years of age) with a diagnosis of MIS-C (n = 40) and controls (presenting with suspicion of MIS-C but later ruled out; n = 26). RESULTS MIS-C patients had higher levels of inflammatory markers including D-dimer (p < .0001), compared with controls, along with evidence of hypercoagulability on ROTEM with elevated evaluation of fibrinogen activity (FIBTEM) maximum clot firmness (MCF) (p < .05). For MIS-C patients with D-dimers >1000 ng/ml, there was a significant correlation of FIBTEM MCF (p < .0001) with a mean value of 37.4 (standard deviation 5.1). D-dimer >2144 ng/ml was predictive of intensive care unit admission (area under the curve [AUC] 0.80; 95% confidence interval, 0.60-0.99; p < .01; sensitivity: 82%, specificity: 75%), and elevated FIBTEM MCF (AUC 1 for >2500 ng/ml). MIS-C patients (50%) received enoxaparin thromboprophylaxis (in addition to aspirin) with significant improvement in their inflammatory and ROTEM parameters upon outpatient follow-up; none developed symptomatic thrombosis. CONCLUSIONS Despite an observed prothrombotic state, none of the MIS-C patients (on aspirin alone or in combination with enoxaparin) developed symptomatic thrombosis. ROTEM, in addition to coagulation profiles, may be helpful to tailor thromboprophylaxis in critically ill MIS-C patients.
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Affiliation(s)
- Maha Al-Ghafry
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Anshul Vagrecha
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Marium Malik
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Chana Levine
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Eliza Uster
- Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Banu Aygun
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Abena Appiah-Kubi
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Adrianna Vlachos
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Christine A Capone
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
- Division of Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Sujatha Rajan
- Division of Pediatric Infectious Disease, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Nancy Palumbo
- Division of Pediatric Hospital Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Elizabeth C Mitchell
- Division of Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Lawrence C Wolfe
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Jeffrey M Lipton
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Suchitra S Acharya
- Division of Pediatric Hematology/Oncology and Cellular Therapy, Cohen Children's Medical Center, New Hyde Park, NY, USA
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11
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Dahiya A, Chao C, Younger J, Kar J, Baldwin BM, Cohen MV, Joseph S, Chowdhry A, Figarola MS, Malozzi C, Nasser MF, Nabeel Y, Shah R, Kennen JM, Aneja A, Khalil S, Ragab S, Mohammed O, Moustafa T, Hamdy A, Ahmed S, Heny A, Taher M, Ganigara M, Dhar A, Misra N, Alzubi J, Pannikottu K, Jabri A, Hedge V, Kanaa'n A, Lahorra J, de Waard D, Horne D, Dhillon S, Sweeney A, Hamilton-Craig C, Katikireddi VS, Wesley AJ, Hammet C, Johnson JN, Chen SSM. Society for Cardiovascular Magnetic Resonance 2019 Case of the Week series. J Cardiovasc Magn Reson 2021; 23:44. [PMID: 33794918 PMCID: PMC8015162 DOI: 10.1186/s12968-020-00671-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site ( https://www.scmr.org ) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.
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Affiliation(s)
- Arun Dahiya
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Griffith University School of Medicine, Gold Coast, QLD, Australia
| | - Charles Chao
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - John Younger
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Bryant M Baldwin
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Michael V Cohen
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Shane Joseph
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Anam Chowdhry
- Department of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Maria S Figarola
- Department of Radiology, University of South Alabama, Mobile, AL, USA
| | | | - M Farhan Nasser
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Yassar Nabeel
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rajiv Shah
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J Michael Kennen
- Department of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ashish Aneja
- Department of Internal Medicine, Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sameh Khalil
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Sara Ragab
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Omnia Mohammed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Taher Moustafa
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Hamdy
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Shimaa Ahmed
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Ahmed Heny
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Maha Taher
- Alfa Scan Radiology Center, Cardiovascular Imaging Department, Cairo, Egypt
| | - Madhusudan Ganigara
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Arushi Dhar
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York-Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Jafar Alzubi
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kurian Pannikottu
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ahmad Jabri
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Vinayak Hedge
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Anmar Kanaa'n
- Department of Cardiology, Cleveland Clinic Akron General, Akron, OH, USA
| | - Joseph Lahorra
- Department of Cardiothoracic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | | | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Santokh Dhillon
- Isaac Walton Killam Children's Hospital, Halifax, NS, Canada
| | - Aoife Sweeney
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - V S Katikireddi
- Department of Rheumatology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Allan J Wesley
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Chris Hammet
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Sylvia S M Chen
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia.
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12
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Niaz T, Hope K, Fremed M, Misra N, Altman C, Glickstein J, Sanchez-de-Toledo J, Fraisse A, Miller J, Snyder C, Johnson JN, Chowdhury D. Role of a Pediatric Cardiologist in the COVID-19 Pandemic. Pediatr Cardiol 2021; 42:19-35. [PMID: 33015722 PMCID: PMC7533115 DOI: 10.1007/s00246-020-02476-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has affected patients across all age groups, with a wide range of illness severity from asymptomatic carriers to severe multi-organ dysfunction and death. Although early reports have shown that younger age groups experience less severe disease than older adults, our understanding of this phenomenon is in continuous evolution. Recently, a severe multisystem inflammatory syndrome in children (MIS-C), with active or recent COVID-19 infection, has been increasingly reported. Children with MIS-C may demonstrate signs and symptoms of Kawasaki disease, but also have some distinct differences. These children have more frequent and severe gastrointestinal symptoms and are more likely to present with a shock-like presentation. Moreover, they often present with cardiovascular involvement including myocardial dysfunction, valvulitis, and coronary artery dilation or aneurysms. Here, we present a review of the literature and summary of our current understanding of cardiovascular involvement in children with COVID-19 or MIS-C and identifying the role of a pediatric cardiologist in caring for these patients.
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Affiliation(s)
- Talha Niaz
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kyle Hope
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Michael Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Carrie Altman
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Julie Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, New York, USA
| | | | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton and Harefield Hospitals Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Jacob Miller
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA
| | - Christopher Snyder
- Pediatric Cardiology, Rainbow Babies and Children's Hospital, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Devyani Chowdhury
- Cardiology Care for Children, 1834 Oregon Pike, Ste 20, Lancaster, PA, 17601, USA.
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13
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Joshi K, Sharma C, Misra N, Kholwadwala D, Georgekutty J, Friedman R, Parnell V. A unique approach to Fontan revision in a cyanotic patient. Progress in Pediatric Cardiology 2020. [DOI: 10.1016/j.ppedcard.2020.101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Rabinowitz EJ, Rubin LG, Desai K, Hayes DA, Tugertimur A, Kwon EN, Dhanantwari P, Misra N, Stoffels G, Blaufox AD, Mitchell E. Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease. Pediatr Cardiol 2019; 40:147-153. [PMID: 30196380 DOI: 10.1007/s00246-018-1971-z] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In 2017, the AHA published revised guidelines for the diagnosis of Kawasaki disease (KD). In the absence of compelling data supporting or refuting the utility of lack of tapering (LT) and perivascular brightness (PB), expert panel consensus removed LT and PB from consideration. We hypothesize that LT and PB are unreliable, subjective findings, non-specific to KD, which can be seen in systemic febrile illnesses without KD and in normal controls. METHODS We performed a single-center retrospective study from 1/2008 to 12/2016. De-identified coronary artery (CA) echocardiographic clips from patients 0-10 years old were interpreted blindly by six pediatric cardiologists. Subjects were grouped as follows: (1) healthy: afebrile with benign murmur, (2) KD: IVIG treatment, 4-5 clinical criteria at presentation, (3) incomplete KD (iKD): IVIG, 1-3 clinical criteria, (4) Febrile: ≥3 days of fever, no IVIG, KD not suspected. The presence or absence of LT and PB was recorded. Inter-rater and intra-rater reliabilities were analyzed using intra-class correlation coefficient, Fleiss' Kappa and Cohen's Kappa coefficients. RESULTS We interpreted 117 echocardiograms from healthy (27), KD (30), iKD (32), and febrile (28) subjects. Analysis showed moderate agreement in CA z score measurements. LT and PB were observed by most readers in control groups. LT exhibited fair inter-reader agreement (reliability coefficient 0.36) and PB slight inter-reader agreement (reliability coefficient 0.13). Intra-rater reliability was inconsistent for both parameters. CONCLUSIONS LT and PB are subjective, poorly reproducible features that can be seen in febrile patients without KD and in healthy children.
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Affiliation(s)
- Edon J Rabinowitz
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
| | - Lorry G Rubin
- Division of Pediatric Infectious Disease, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Kinjal Desai
- Department of Pediatrics, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Denise A Hayes
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Aykut Tugertimur
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Elena N Kwon
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Preeta Dhanantwari
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Guillaume Stoffels
- Feinstein Institute Department of Biostatistics, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Andrew D Blaufox
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Elizabeth Mitchell
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
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15
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Desai K, Rabinowitz EJ, Mitchell E, Hayes D, Tugertimur A, Kwon E, Dhanantwari P, Misra N, Rubin L. 643. Coronary Artery Aneurysms Are Found on Blindly Read Echocardiograms From Febrile Patients with and Without Kawasaki Disease. Open Forum Infect Dis 2018. [PMCID: PMC6253784 DOI: 10.1093/ofid/ofy210.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In 2017, the American Heart Association published new Kawasaki disease (KD) guidelines including echocardiographic (echo) criteria for diagnosis of incomplete KD (iKD). Echo is positive if 1 or more coronary arteries (CA) show aneurysmal dilation (Z score of ≥ 2.5), or if a CA has milder dilation (Z score of 2–2.49) plus ≥2 of the following: decreased left ventricular function, mitral regurgitation, and pericardial effusion. While CA dilation is seen commonly in KD and iKD, specificity of this finding is unclear because patients with systemic febrile illnesses may have CA dilation. To assess specificity of the American Heart Association criteria, blinded readers measured CA dimension in patients with KD and iKD and in febrile and healthy patient controls. Methods This is a single-center retrospective study. De-identified echo clips of CA from patients age 0–10 years were interpreted blindly and independently by six pediatric cardiologists. KD and iKD diagnoses were based on clinical data and IVIG treatment. Control groups were healthy patients evaluated for a benign murmur and febrile patients with fever ≥72 hours without a KD diagnosis or IVIG treatment. Detection of left ventricular dysfunction, mitral regurgitation and effusion was recorded. An echo was considered positive if the reading from at least one reader met AHA criteria for iKD. Results Echos from 29 KD, 30 iKD, 28 febrile, and 27 healthy patients were reviewed. The initial echo of 41% of KD and 43% of iKD groups met echo criteria for diagnosis of iKD and 55% and 57%, respectively, had CA dilation or aneurysm. Among febrile patients, 7 (25%) had an abnormal CA size of which 4 (14%) met echo criteria for iKD. In the healthy patients, four (15%) had abnormal CA of which two (7.4%) met echo criteria for iKD. Among patients with a positive echo read, the median number of readers who read a CA as dilated was similar for each group. Furthermore, of all patients meeting echo criteria for iKD, 90% had aneurysmal CA dilatation. Conclusion Although CA abnormalities diagnostic of KD were commonly present at time of diagnosis in patients with KD or iKD, these findings were also present in some healthy and some febrile patients. Diagnosis of iKD in febrile children using echo criteria may result in an over-diagnosis of KD. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kinjal Desai
- Pediatrics, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Edon J Rabinowitz
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Elizabeth Mitchell
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Denise Hayes
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Aykut Tugertimur
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Elena Kwon
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Preeta Dhanantwari
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, New York
| | - Lorry Rubin
- Cohen Children’s Medical Center of New York, Northwell Health, New Hyde Park, New York
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16
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Hasan T, Ghalib RM, Mehdi SH, Singh PK, Kumar A, Misra N. Vibrational Spectra, NBO and NLO Analyses, and A Molecular Docking Study of 3a,8a-Dihydroxy-2-Thioxo-1,3,3a,8a-Tetrahydroindeno[1,2-d]Imidazol-8(2H)-One Using DFT. J STRUCT CHEM+ 2018. [DOI: 10.1134/s0022476618050098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Misra N, Wines TF, Knopp CL, Hermann R, Bond L, Mitchell B, McGuire MA, Tinker JK. Immunogenicity of a Staphylococcus aureus-cholera toxin A 2/B vaccine for bovine mastitis. Vaccine 2018; 36:3513-3521. [PMID: 29739718 DOI: 10.1016/j.vaccine.2018.04.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/02/2017] [Revised: 04/09/2018] [Accepted: 04/22/2018] [Indexed: 01/10/2023]
Abstract
Staphylococcus aureus causes a chronic, contagious disease of the udder, or mastitis, in dairy cows. This infection is often refractory to antibiotic treatment, and has a significant economic impact on milk production worldwide. An effective vaccine to prevent S. aureus mastitis would improve animal health, reduce antibiotic dependence and inform human vaccine approaches. The iron-regulated surface determinant A (IsdA) and clumping factor A (ClfA) are conserved S. aureus extracellular-matrix adhesins and target vaccine antigens. Here we report the results of two bovine immunogenicity trials using purified IsdA and ClfA-cholera toxin A2/B chimeras (IsdA-CTA2/B and ClfA-CTA2/B). Cows were intranasally inoculated with IsdA-CTA2/B + ClfA-CTA2/B at dry off and followed for 70 days. Trial 1 utilized three groups with one or two booster doses at a total concentration of 600 or 900 μg. Trial 2 utilized two groups with one booster at a total concentration of 1200 μg. Humoral immune responses in serum and milk were examined by ELISA. Responses in serum were significant between groups and provide evidence of antigen-specific IgG induction after vaccination in both trials. Cellular proliferation was detected by flow cytometry using antigen-stimulated PBMCs from day 60 of Trial 2 and revealed an increase in CD4+ T cells from vaccinated cows. IsdA and ClfA stimulation induced IL-4 expression, but not IFN-γ or IL-17, in PBMCs from day 60 as determined by cytokine expression analysis. Opsonophagocytosis of S. aureus confirmed the functional in vitro activity of anti-IsdA antibodies from Trial 2 serum and milk. The vaccine was well tolerated and safe, and results support the potential of mucosally-delivered CTA2/B chimeras to protect cows from mastitis caused by S. aureus.
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Affiliation(s)
- N Misra
- Biomolecular Ph.D. Program, Boise State University, Boise, ID, USA
| | - T F Wines
- Department of Biological Sciences, Boise State University, Boise, ID, USA
| | - C L Knopp
- Department of Biological Sciences, Boise State University, Boise, ID, USA
| | - R Hermann
- Department of Biological Sciences, Boise State University, Boise, ID, USA; Biomolecular Ph.D. Program, Boise State University, Boise, ID, USA
| | - L Bond
- Biomolecular Research Center, Boise State University, Boise, ID, USA
| | - B Mitchell
- DairyTeam Nutrition and Veterinary Consulting, Boise, ID, USA
| | - M A McGuire
- Department of Animal and Veterinary Science, University of Idaho, Moscow, ID, USA
| | - J K Tinker
- Department of Biological Sciences, Boise State University, Boise, ID, USA; Biomolecular Ph.D. Program, Boise State University, Boise, ID, USA.
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Misra N, Pu X, Holt DN, McGuire MA, Tinker JK. Immunoproteomics to identify Staphylococcus aureus antigens expressed in bovine milk during mastitis. J Dairy Sci 2018; 101:6296-6309. [PMID: 29729920 DOI: 10.3168/jds.2017-14040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/24/2017] [Accepted: 03/18/2018] [Indexed: 12/31/2022]
Abstract
Staphylococcus aureus is an opportunistic pathogen affecting both human and animal species. An effective vaccine to prevent S. aureus bovine disease and transmission would have positive effects on animal well-being, food production, and human health. The objective of this study was to identify multiple antigens that are immunoreactive during udder colonization and disease for exploration as vaccine antigens to prevent bovine mastitis. Staphylococcus aureus produces several cell wall-anchored and surface-associated virulence factors that play key roles in the pathogenesis of mastitis. Many of these proteins are conserved between different strains of S. aureus and represent promising vaccine candidates. We used an immunoproteomics approach to identify antigenic proteins from the surface of S. aureus. The expression of cell wall and surface proteins from S. aureus was induced under low iron conditions, followed by trypsin extraction and separation by 2-dimensional electrophoresis. The separated proteins were blotted with antibodies from mastitic bovine milk and identified by liquid chromatography-mass spectrometry. Thirty-eight unique proteins were identified, of which 8 were predicted to be surface exposed and involved in S. aureus virulence. Two surface proteins, iron-regulated surface determinant protein C (IsdC) and ESAT-6 secretion system extracellular protein (EsxA), were cloned, expressed, and purified from Escherichia coli for confirmation of immune reactivity by ELISA. A PCR of 37 bovine S. aureus isolates indicated that the presence of esxA and isdC is conserved, and amino acid alignments revealed that IsdC and EsxA sequences are highly conserved. The immunoproteomics technique used in this study generated reproducible results and identified surface exposed and reactive antigens for further characterization.
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Affiliation(s)
- N Misra
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID 83725
| | - X Pu
- Biomolecular Research Center, Boise State University, Boise, ID 83725
| | - D N Holt
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID 83725
| | - M A McGuire
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
| | - J K Tinker
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID 83725; Department of Biological Sciences, Boise State University, Boise, ID 83725.
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Sharma S, Brahmachari G, Kumar A, Misra N, Kant R, Gupta VK. Molecular Modeling, Spectroscopic Investigations, and Computational Studies of DMSO solvated 7′-amino-1′,3′-dimethyl-2,2′,4′-trioxo-1′,2′,3′,4′,4a′,8a′-tetrahydrospiro[indoline-3,5′-pyrano[2,3-d]pyrimidine]-6′-carbonitrile. J STRUCT CHEM+ 2018. [DOI: 10.1134/s0022476618010389] [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: 11/23/2022]
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Klimach S, Spiteri N, Misra N. Traumatic Intra-Thoracic Displacement of the Humeral Head. A Case Report and Systematic Review of Management. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.433] [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]
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Abdulal S, Spiteri N, Bessant G, Taylor J, Misra N. Fatal Road Traffic Accidents in Merseyside, England; A Descriptive Study of Factors Invovled. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saxena R, Mittal P, Hegde P, Veeranagaiah M, Roy N, Breton L, Misra N, Clavaud C, Gueniche A, Sharma V. 157 The microbial and functional diversity of the microflora present on the scalps of Indian subjects with and without dandruff. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.467] [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: 11/26/2022]
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Dhar A, Aronowitz D, Misra N, Meyer DB. Surgical Angioplasty of Stenotic Left Main Coronary Artery 15 Years After ALCAPA Repair. Ann Thorac Surg 2017; 104:e269-e270. [PMID: 28838525 DOI: 10.1016/j.athoracsur.2017.03.031] [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] [Received: 02/10/2017] [Revised: 02/28/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Abstract
Studies regarding long-term results after repair of anomalous left main coronary artery from the pulmonary artery (ALCAPA) have mainly focused on survival rates, left ventricular function, and mitral valve function. The development of left main coronary stenosis following repair has been infrequently reported and its incidence unknown. Optimal therapy is also not known. Here we report the use of surgical angioplasty to achieve revascularization of a stenotic left main coronary artery in a patient with ALCAPA who had undergone coronary transfer 15 years earlier.
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Affiliation(s)
- Arushi Dhar
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York.
| | | | - Nilanjana Misra
- Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - David Benjamin Meyer
- Department of Pediatric Cardiothoracic Surgery, Cohen Children's Medical Center of New York, New Hyde Park, New York
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Rabinowitz EJ, Misra N, Meyer DB. A Case of Persistent Left Superior Vena Cava and Left Pulmonary Venous Drainage to the Coronary Sinus. World J Pediatr Congenit Heart Surg 2017; 11:NP57-NP59. [PMID: 28825383 DOI: 10.1177/2150135117701377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of a persistent left superior vena cava draining to the right atrium via the coronary sinus in conjunction with partial anomalous pulmonary venous return of the left pulmonary veins to the coronary sinus. Although a persistent left superior vena cava is typically of little clinical consequence, in this case, it complicated surgical repair of the congenital heart disease. Successful repair of this unusual combination of systemic and pulmonary venous anomalies required a combination of two well-described surgical techniques.
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Affiliation(s)
- Edon J Rabinowitz
- Cohen Children's Heart Center, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, Queens, NY, USA
| | - Nilanjana Misra
- Cohen Children's Heart Center, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, Queens, NY, USA
| | - David B Meyer
- Division of Cardiovascular and Thoracic Surgery, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, Queens, NY, USA
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Zablah JE, Misra N, Gruber D, Kholwadwala D, Epstein S. Comparison of Patients Undergoing Surgical Versus Transcatheter Pulmonary Valve Replacement: Criteria for Referral and Mid-Term Outcome. Pediatr Cardiol 2017; 38:603-607. [PMID: 28236163 DOI: 10.1007/s00246-016-1554-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/02/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
Pulmonary regurgitation and/or stenosis (PS) is challenging in patients with congenital heart defects. Our aim was to identify if criteria for referral were different between surgical (SPVR) and transcatheter pulmonary valve replacement (TPVR) populations, and to further assess if any baseline differences influence the resultant ventricular remodeling at medium-term follow-up. Retrospective chart review of patients post-SPVR or TPVR at our center from 2013 to 2015 was conducted. Volumetric data from cardiac magnetic resonance (CMR), 1 year before and 1 year after PVR was obtained. PS was defined as peak-peak gradient ≥35 mmHg by catheterization or peak gradient ≥50 mmHg by echocardiography. Thirty patients underwent PVR: 15 SPVR and 15 TPVR (1 hybrid). The indications for SPVR referral were: 2+ CMR parameters in 80% of patients; decreased left ventricular ejection fraction and hemodynamic findings and/or abnormal exercise stress test in 20%. The indications for TPVR referral were predominantly symptoms ± hemodynamic findings in 66% of patients, 2+ CMR findings in 44% of patients. At referral, SPVR group had significantly larger right ventricular (RV) volumes than TPVR group. Biventricular function was not significantly different. Post-PVR, both groups had significantly decreased RV volumes and increased LV diastolic volumes. The SPVR group improved LV cardiac output and biventricular function whereas TPVR group had no significant improvement. The patients in the SPVR group were mostly referred based on CMR volumetric criteria, whereas the patients in the TPVR group were mostly referred due to exercise intolerance with only occasional abnormalities on CMR. 1 year after PVR, both groups had near-normal biventricular volumes and function irrespective of characteristics at referral.
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Affiliation(s)
- Jenny E Zablah
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA. .,Children's Hospital of Colorado, 13123 East 16th Avenue, Box 100, Aurora, CO, 80045, USA.
| | - Nilanjana Misra
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Dorota Gruber
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Dipak Kholwadwala
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
| | - Shilpi Epstein
- Pediatric Cardiology, Cohen Children's Medical Center of NY, Northwell Health, 269-01 76th Avenue, Suite 139, New Hyde Park, NY, 11040, USA
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Tandon A, Sunderland G, Nunes QM, Misra N, Shrotri M. Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre. Ann R Coll Surg Engl 2016; 98:329-33. [PMID: 27087326 DOI: 10.1308/rcsann.2016.0125] [Citation(s) in RCA: 8] [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] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Symptomatic gall stones may require laparoscopic cholecystectomy (LC), which is one of the most commonly performed general surgical operations in the western world. Patients with a high body mass index (BMI) are at increased risk of having gall stones, and are often considered at high risk of surgical complications due to their increased BMI. We believe that day case surgery could nevertheless have significant benefits in terms of potential cost savings and patient satisfaction in this population. We therefore compared the outcomes of day case patients undergoing LC stratified by BMI, with a specific focus on the safety and success of the procedure in obese and morbidly obese groups. METHODS We reviewed a database of day case procedures performed between January 2004 and December 2012, including all patients with symptomatic gall stone disease who underwent LC. The patients were divided in four BMI groups: less than 25 kg/m(2), 25-29 kg/m(2), 30-39 kg/m(2) and 40 kg/m(2) or above. RESULTS The overall success rate for day case surgery was 78%. There were no significant differences in rates of intra-abdominal collection or readmission with increasing BMI. However, increasing BMI was associated with a significant increase in the rate of wound infection. CONCLUSIONS LC in patients with a high BMI is safe and can be performed effectively as a day case procedure.
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Affiliation(s)
- A Tandon
- Aintree University Hospital , Liverpool , UK
| | | | - Q M Nunes
- Aintree University Hospital , Liverpool , UK.,Royal Liverpool & Broadgreen University Hospitals NHS Trust , UK
| | - N Misra
- Aintree University Hospital , Liverpool , UK
| | - M Shrotri
- Aintree University Hospital , Liverpool , UK
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Hikmat D, Chawla S, Curtis J, Misra N. Bouveret's syndrome. Assoc Med J 2014. [DOI: 10.1136/bmj.g6480] [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: 11/04/2022]
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Misra N. Structural, Vibrational and Electronic properties of cis and trans conformers of 4-hydroxy-l-proline: A density functional approach. JAMS 2014. [DOI: 10.4208/jams.022214.041814a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Misra N. Theoretical study of small niobium sulphide clusters, Nb<sub>n</sub>S<sub>m</sub> (<em>n</em>, <em>m</em>=1, 2). JAMS 2014. [DOI: 10.4208/jams.040214.062114a] [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: 11/23/2022]
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Staettner S, Jones R, Misra N, Yip V, Dunne D, Fenwick S, Malik H, Poston G. 439. Surgical Management of Stage 4 Neuroendocrine Disease - a Single Centre Experience. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Staettner S, Jones R, Yip V, Misra N, Malik H, Grünberger T, Fenwick S, Poston G. 95. Neoadjuvant chemoembolisation of Colorectal Liver Metastases (CRLM) with Drug Eluting Beads Trans-arterial Chemo-embolization (DEBIRI-TACE); a Multi-institute phase 2 study in resectable metastases. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.095] [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: 11/25/2022] Open
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Misra N, Grimes N, Stattner S, Yip V, Poston G. 108. Continuing changes in the epidemiology of gastric and oesophageal cancer – An analysis of trends in national incidence in England between 1971 and 2008. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Beroukhim RS, Prakash A, Buechel ERV, Cava JR, Dorfman AL, Festa P, Hlavacek AM, Johnson TR, Keller MS, Krishnamurthy R, Misra N, Moniotte S, Parks WJ, Powell AJ, Soriano BD, Srichai MB, Yoo SJ, Zhou J, Geva T. Characterization of cardiac tumors in children by cardiovascular magnetic resonance imaging: a multicenter experience. J Am Coll Cardiol 2011; 58:1044-54. [PMID: 21867841 DOI: 10.1016/j.jacc.2011.05.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [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: 12/28/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to report the results of an international multicenter experience of cardiac magnetic resonance imaging (MRI) evaluation of cardiac tumors in children, each with histology correlation or a diagnosis of tuberous sclerosis, and to determine which characteristics are predictive of tumor type. BACKGROUND Individual centers have relatively little experience with diagnostic imaging of cardiac tumors in children, because of their low prevalence. The accuracy of cardiac MRI diagnosis on the basis of a pre-defined set of criteria has not been tested. METHODS An international group of pediatric cardiac imaging centers was solicited for case contribution. Inclusion criteria comprised: 1) age at diagnosis ≤18 years; 2) cardiac MRI evaluation of cardiac tumor; and 3) histologic diagnosis or diagnosis of tuberous sclerosis. Data from the cardiac MRI images were analyzed for mass characteristics. On the basis of pre-defined cardiac MRI criteria derived from published data, 3 blinded investigators determined tumor type, and their consensus diagnoses were compared with histologic diagnoses. RESULTS Cases (n = 78) submitted from 15 centers in 4 countries had the following diagnoses: fibroma (n = 30), rhabdomyoma (n = 14), malignant tumor (n = 12), hemangioma (n = 9), thrombus (n = 4), myxoma (n = 3), teratoma (n = 2), and paraganglioma, pericardial cyst, Purkinje cell tumor, and papillary fibroelastoma (n = 1, each). Reviewers who were blinded to the histologic diagnoses correctly diagnosed 97% of the cases but included a differential diagnosis in 42%. Better image quality grade and more complete examination were associated with higher diagnostic accuracy. CONCLUSIONS Cardiac MRI can predict the likely tumor type in the majority of children with a cardiac mass. A comprehensive imaging protocol is essential for accurate diagnosis. However, histologic diagnosis remains the gold standard, and in some cases malignancy cannot be definitively excluded on the basis of cardiac MRI images alone.
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Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Misra N, Shah AM, Lai WW. Correction of phase offset errors in cardiovascular magnetic resonance using background subtraction from stationary tissue. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106695 DOI: 10.1186/1532-429x-13-s1-p213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Misra N, Ansari M, Misra R. Exogenous treatment with salicylic acid attenuates salinity stress in lentil. N Biotechnol 2009. [DOI: 10.1016/j.nbt.2009.06.903] [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: 11/25/2022]
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Siddiqui SA, Dwivedi A, Singh PK, Hasan T, Jain S, Prasad O, Misra N. Molecular structure, vibrational spectra and potential energy distribution of protopine using ab initio and density functional theory. J STRUCT CHEM+ 2009. [DOI: 10.1007/s10947-009-0062-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
SUMMARY Although much general information has accumulated about ocular myiasis, there are very few reports about the same amongst the Indian population. We present a case series, comprising of 13 documented cases of external ophthalmomyiasis due to Oestrus ovis, detected at regular intervals in a small geographical area of rural central India, which strongly indicated the presence of a previously unknown endemic eye disease of this region.
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Affiliation(s)
- S Misra
- Department of Ophthalmology, Rural Medical College, Pravara Medical Trust, Loni 413736, Maharastra, India
| | - N Misra
- Department of Ophthalmology, Rural Medical College, Pravara Medical Trust, Loni 413736, Maharastra, India
| | - B Reddy
- Department of Ophthalmology, Rural Medical College, Pravara Medical Trust, Loni 413736, Maharastra, India
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Ephrem A, Misra N, Hassan G, Dasgupta S, Delignat S, Duong Van Huyen JP, Chamat S, Prost F, Lacroix-Desmazes S, Kavery SV, Kazatchkine MD. Immunomodulation of autoimmune and inflammatory diseases with intravenous immunoglobulin. Clin Exp Med 2006; 5:135-40. [PMID: 16362793 DOI: 10.1007/s10238-005-0079-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 01/02/2023]
Abstract
Intravenous immunoglobulin (IVIg) has been used in the treatment of primary and secondary antibody deficiencies for over two decades. Since the early 1980s, the therapeutic efficacy of IVIg has been established in idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, dermatomyositis and Kawasaki syndrome, and the prevention of graft versus host disease in recipients of allogeneic bone marrow transplants. Its use has also been reported in a large number of other autoimmune and systemic inflammatory conditions. In this review, we discuss the mechanisms by which IVIg exerts immunomodulatory effects in immune pathologies.
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Affiliation(s)
- A Ephrem
- INSERM U430 and Université Pierre et Marie Curie (UPMC-Paris 6), Hôpital Broussais, 96 Rue Didot, 75014, Paris, France
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Prasad O, Sinha L, Gupta G, Agnihotri R, Misra N, Lal J. Theoretical study of temperature induced phase transitions in poly(β-benzyl-l-aspartate) and it's copolymer. POLYMER 2005. [DOI: 10.1016/j.polymer.2005.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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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Bayry J, Thirion M, Misra N, Thorenoor N, Delignat S, Lacroix-Desmazes S, Bellon B, Kaveri S, Kazatchkine MD. Mechanisms of action of intravenous immunoglobulin in autoimmune and inflammatory diseases. Neurol Sci 2003; 24 Suppl 4:S217-21. [PMID: 14598046 DOI: 10.1007/s10072-003-0081-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [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: 11/30/2022]
Abstract
Intravenous immunoglobulins (IVIg) exert a broad range of immunoregulatory functions that provide a basis for the beneficial effects of IVIg in autoimmune and systemic inflammatory disorders. This review focuses on the effects f IVIg on humoral and cellular immunity that may be of relevance for the treatment of inflammatory neurological diseases.
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Affiliation(s)
- J Bayry
- INSERM U430 and Université Pierre et Marie Curie, Institut des Cordeliers, Paris
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Bayry J, Misra N, Latry V, Prost F, Delignat S, Lacroix-Desmazes S, Kazatchkine MD, Kaveri SV. Mechanisms of action of intravenous immunoglobulin in autoimmune and inflammatory diseases. Transfus Clin Biol 2003; 10:165-9. [PMID: 12798851 DOI: 10.1016/s1246-7820(03)00035-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [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: 10/27/2022]
Abstract
Therapeutic polyclonal intravenous immunoglobulin (IVIg) consists of normal IgG obtained from the pools of plasma of several thousand healthy blood donors. IVIg is used as substitutive treatment of primary and secondary immunodeficiences. Since the first study of Paul Imbach who demonstrated the beneficial effect in idiopathic thrombocytopenic purpura, IVIg is also used in a number of autoimmune and inflammatory diseases. The immunoregulatory effects of IVIg in autoimmune diseases depend on the interaction of Fc portion of immunoglobulins with Fc receptors and on the selection of lymphocyte repertoires of patients through variable regions of infused immunoglobulins. IVIg modulates the activation and effector functions of B and T lymphocytes, neutralizes pathogenic autoantibodies, interferes with antigen presentation and has a strong anti-inflammatory effect which depends on its interaction with the complement system, cytokines and endothelial cells. The immunomodulatory potential of IVIg in patients is thus a result of a variety of complex mechanisms that act in a synergy.
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Affiliation(s)
- J Bayry
- INSERM U430, Institut des Cordeliers, Université Pierre et Marie Curie, 15, rue de l'Ecole de Médecine, 75006, Paris, France
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Lim E, Callaghan C, Motalleb-Zadeh R, Wallard M, Misra N, Ali A, Halstead JC, Tsui S. A prospective study on clinical outcome following pleurotomy during cardiac surgery. Thorac Cardiovasc Surg 2002; 50:287-91. [PMID: 12375185 DOI: 10.1055/s-2002-34574] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 10/27/2022]
Abstract
BACKGROUND Due to conflicting reports on pleurotomy-associated morbidity following internal mammary artery (IMA) harvesting, we conducted a prospective study to assess the clinical significance and outcome of pleurotomy during cardiac surgery. METHODS We included patients undergoing cardiac surgery from November 2000 until January 2001. Participants were divided into two groups: one with routine or incidental left pleurotomy and the other with intact left pleurae. RESULTS Of the 218 patients registered for this study, 12 were excluded (7 deaths occurred, 5 patients were transferred prior to study completion). Of the 206 remaining, 138 had isolated CABG, 39 had valve surgery and 29 had a combined procedure. Although patients with a left pleurotomy (n= 164) had a higher incidence of left lung atelectasis (67.7% vs. 45.2%; p = 0.007), neither radiographic consolidation (7.5% vs. 7.3%; p = 0.96), effusion (42.5%vs. 46.3%; p - 0.66), nor hospital stay (9 days in both groups; p - 0.83) increased. CONCLUSIONS Left pleurotomy was found to increase the rate of atelectasis. However, this was not associated with an adverse clinical outcome. Pleurotomy during IMA harvesting can be performed according to operator preference.
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Affiliation(s)
- E Lim
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge CB3 8RE, United Kingdom.
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Lacroix-Desmazes S, Misra N, Bayry J, Artaud C, Drayton B, Kaveri SV, Kazatchkine MD. Pathophysiology of inhibitors to factor VIII in patients with haemophilia A. Haemophilia 2002; 8:273-9. [PMID: 12010423 DOI: 10.1046/j.1365-2516.2002.00624.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The occurrence of factor VIII (FVIII) inhibitors is one of the major complications of the treatment of haemophilia A. We present this review as a description of the major players of the antiFVIII immune response, with particular emphasis on the nature and properties of the different antiFVIII antibodies, their mechanisms of action in inhibiting FVIII activity, their potential neutralization by anti-idiotypic antibodies, and the importance of the T cell in participating in the induction of FVIII inhibitors. We briefly conclude on the avenues that remain to be explored in order to establish efficient therapeutic approaches aimed at eliminating FVIII inhibitors in patients with haemophilia A.
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