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Rahman S, Cipriano LE, McDonald C, Cocco S, Hindi Z, Chakraborty D, French K, Siddiqi O, Brahmania M, Wilson A, Yan B, Guizzetti L, Jairath V, Sey M. Propofol sedation does not improve measures of colonoscopy quality but increase cost - findings from a large population-based cohort study. EClinicalMedicine 2024; 70:102503. [PMID: 38495522 PMCID: PMC10940905 DOI: 10.1016/j.eclinm.2024.102503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Background Propofol is often used for sedation during colonoscopy. We assessed the impact of propofol sedation on colonoscopy related quality metrics and cost in a population-based cohort study. Methods All colonoscopies performed at 21 hospitals in the province of Ontario, Canada, during an 18-month period, from April 1, 2017 to October 31, 2018, using either propofol or conscious sedation were evaluated. The primary outcome was adenoma detection rate (ADR) and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. Binary outcomes were assessed using a modified Poisson regression model adjusted for clustering and potential confounders based on patient, procedure, and physician characteristics. Findings A total of 46,634 colonoscopies were performed, of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation. Compared to conscious sedation, the use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p < 0.0001) but not ssPDR (5.0% vs. 4.7%, p = 0.26), PDR (40.5% vs 40.4%, p = 0.79), CIR (97.1% vs. 96.8%, p = 0.15) or perforation rate (0.04% vs. 0.06%, p = 0.45). On multi-variable analysis, propofol sedation was not associated with any differences in ADR (RR = 0.90, 95% CI 0.74-1.10, p = 0.30), ssPDR (RR = 1.20, 95% CI 0.90-1.60, p = 0.22), PDR (RR = 1.00, 95% CI 0.90-1.11, p = 0.99), or CIR (RR = 1.00, 95% CI 0.80-1.26, p = 0.99). The additional cost associated with propofol sedation was $12,730,496 for every 100,000 cases. Interpretation The use of propofol sedation was not associated with improved colonoscopy related quality metrics but increased costs. The routine use of propofol for colonoscopy should be reevaluated. Funding None.
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Affiliation(s)
- Sheikh Rahman
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
- Department of Medicine, Western University, Canada
| | - Lauren E. Cipriano
- Schulich School of Medicine & Dentistry, Western University, Canada
- Ivey Business School, Western University, Canada
- Department of Epidemiology and Biostatistics, Western University, Canada
- Department of Medicine, Western University, Canada
| | | | - Sarah Cocco
- Schulich School of Medicine & Dentistry, Western University, Canada
| | - Ziad Hindi
- Division of Gastroenterology, London Health Sciences Centre, Canada
| | | | | | - Omar Siddiqi
- The Royal College of Surgeons in Ireland, Medical University of Bahrain, Bahrain
| | - Mayur Brahmania
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
| | - Aze Wilson
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
- Lawson Health Research Institute, London Health Sciences Centre, Canada
| | - Brian Yan
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
| | | | - Vipul Jairath
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
- Department of Epidemiology and Biostatistics, Western University, Canada
- Lawson Health Research Institute, London Health Sciences Centre, Canada
| | - Michael Sey
- Division of Gastroenterology, London Health Sciences Centre, Canada
- Schulich School of Medicine & Dentistry, Western University, Canada
- Southwest Ontario Regional Cancer Program, Ontario Health, Canada
- Lawson Health Research Institute, London Health Sciences Centre, Canada
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Hakim AD, Awili M, O’Neal HR, Siddiqi O, Jaffrani N, Lee R, Overcash JS, Chauffe A, Hammond TC, Patel B, Waters M, Criner GJ, Pachori A, Junge G, Levitch R, Watts J, Koo P, Sengupta T, Yu L, Kiffe M, Pinck A, Stein RR, Bendrick-Peart J, Jenkins J, Rowlands M, Waldron-Lynch F, Matthews J. Efficacy and safety of MAS825 (anti-IL-1β/IL-18) in COVID-19 patients with pneumonia and impaired respiratory function. Clin Exp Immunol 2023; 213:265-275. [PMID: 37338154 PMCID: PMC10570997 DOI: 10.1093/cei/uxad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/02/2023] [Accepted: 06/19/2023] [Indexed: 06/21/2023] Open
Abstract
MAS825, a bispecific IL-1β/IL-18 monoclonal antibody, could improve clinical outcomes in COVID-19 pneumonia by reducing inflammasome-mediated inflammation. Hospitalized non-ventilated patients with COVID-19 pneumonia (n = 138) were randomized (1:1) to receive MAS825 (10 mg/kg single i.v.) or placebo in addition to standard of care (SoC). The primary endpoint was the composite Acute Physiology and Chronic Health Evaluation II (APACHE II) score on Day 15 or on the day of discharge (whichever was earlier) with worst-case imputation for death. Other study endpoints included safety, C-reactive protein (CRP), SARS-CoV-2 presence, and inflammatory markers. On Day 15, the APACHE II score was 14.5 ± 1.87 and 13.5 ± 1.8 in the MAS825 and placebo groups, respectively (P = 0.33). MAS825 + SoC led to 33% relative reduction in intensive care unit (ICU) admissions, ~1 day reduction in ICU stay, reduction in mean duration of oxygen support (13.5 versus 14.3 days), and earlier clearance of virus on Day 15 versus placebo + SoC group. On Day 15, compared with placebo group, patients treated with MAS825 + SoC showed a 51% decrease in CRP levels, 42% lower IL-6 levels, 19% decrease in neutrophil levels, and 16% lower interferon-γ levels, indicative of IL-1β and IL-18 pathway engagement. MAS825 + SoC did not improve APACHE II score in hospitalized patients with severe COVID-19 pneumonia; however, it inhibited relevant clinical and inflammatory pathway biomarkers and resulted in faster virus clearance versus placebo + SoC. MAS825 used in conjunction with SoC was well tolerated. None of the adverse events (AEs) or serious AEs were treatment-related.
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Affiliation(s)
- Alex D Hakim
- Providence Little Company of Mary Medical Center, Torrance, CA, USA
| | | | - Hollis R O’Neal
- Louisiana State University Health Sciences Center and Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | | | | | | | | | - Ann Chauffe
- Louisiana State University Health Sciences Center, Lafayette, LA, USA
| | | | - Bela Patel
- University of Texas McGovern Medical School, Houston, TX, US
| | | | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | | | | | | | - Philip Koo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Lili Yu
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Michael Kiffe
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Anne Pinck
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Richard R Stein
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Janet Jenkins
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | | | - Jesse Matthews
- Hospital Medicine, St Charles Health System, Bend, OR, USA
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3
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Prokaeva T, Joshi T, Klimtchuk ES, Gibson VM, Spencer B, Siddiqi O, Nedelkov D, Hu Y, Berk JL, Cuddy SAM, Dasari S, Chiu A, Choate LA, McPhail ED, Cui H, Chen H, Burks EJ, Sanchorawala V, Connors LH. A novel substitution of proline (P32L) destabilises β2-microglobulin inducing hereditary systemic amyloidosis. Amyloid 2022; 29:255-262. [PMID: 35575118 DOI: 10.1080/13506129.2022.2072199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND β2-microglobulin amyloidosis was first described in the 1980s as a protein deposition disease associated with long-term haemodialysis. More recently, two inherited forms resulting from separate point mutations in the β2-microglobulin gene have been identified. In this report, we detail a novel β2M variant, P32L, caused by a unique dinucleotide mutation that is linked to systemic hereditary β2-microglobulin amyloidosis. METHODS Three family members from a Portuguese kinship featured cardiomyopathy, requiring organ transplantation in one case, along with soft tissue involvement; other involvements included gastrointestinal, neuropathic and sicca syndrome. In vitro studies with recombinant P32L, P32G, D76N and wild-type β2-microglobulin were undertaken to compare the biophysical properties of the proteins. RESULTS The P32L variant was caused by the unique heterozygous dinucleotide mutation c.154_155delinsTT. Amyloid disease featured lowered serum β2-microglobulin levels with near equal amounts of circulating P32L and wild-type proteins; amyloid deposits were composed exclusively of P32L variant protein. In vitro studies of P32L demonstrated thermodynamic and chemical instability and enhanced susceptibility to proteolysis with rapid formation of pre-fibrillar oligomeric structures by N- and C-terminally truncated species under physiological conditions. CONCLUSIONS This work provides both clinical and experimental evidence supporting the critical role of P32 residue replacement in β2M amyloid fibrillogenesis.
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Affiliation(s)
- Tatiana Prokaeva
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Tracy Joshi
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Elena S Klimtchuk
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Victoria M Gibson
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Brian Spencer
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Omar Siddiqi
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | | | | | - John L Berk
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA
| | - Sarah A M Cuddy
- Amyloidosis Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - April Chiu
- Department of Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lauren A Choate
- Department of Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen D McPhail
- Department of Laboratory of Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Haili Cui
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hui Chen
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Eric J Burks
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Lawreen H Connors
- Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
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Sey M, Cocco S, McDonald C, Hindi Z, Rahman H, Chakraborty D, French K, Alsager M, Siddiqi O, Blier MA, Markandey B, Al Obaid S, Wong A, Siebring V, Brahmania M, Gregor J, Khanna N, Ott M, Qumosani K, Wilson A, Guizzetti L, Yan B, Jairath V. Association of Trainee Participation in Colonoscopy Procedures With Quality Metrics. JAMA Netw Open 2022; 5:e2229538. [PMID: 36044211 PMCID: PMC9434358 DOI: 10.1001/jamanetworkopen.2022.29538] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Trainees routinely participate in colonoscopy procedures, yet whether their involvement is positively or negatively associated with procedural quality is unknown because prior studies involved small number of trainees and/or supervisors, lacked generalizability, and/or failed to adjust for potential confounders. OBJECTIVE To assess the association between trainee participation and colonoscopy quality metrics. DESIGN, SETTING, AND PARTICIPANTS This multicenter population-based cohort study was conducted at 21 academic and community hospitals between April 1, 2017, and October 31, 2018, among consecutive adult patients undergoing colonoscopy. Procedures performed by endoscopists who did not supervise trainees were excluded. Statistical analysis was performed from April 3, 2017, to October 31, 2018. EXPOSURE Participation by a trainee, defined as a resident or fellow enrolled in a gastroenterology or general surgery training program. MAIN OUTCOMES AND MEASURES The primary outcome was the adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), cecal intubation rate (CIR), and perforation rate. RESULTS A total of 35 499 colonoscopies (18 989 women [53.5%]; mean [SD] patient age, 60.0 [14.1] years) were performed by 71 physicians (mean [SD] time in practice, 14.0 [9.3] years); 5941 colonoscopies (16.7%) involved trainees. There were no significant differences in the ADR (26.4% vs 27.3%; P = .19), CIR (96.7% vs 97.2%; P = .07), and perforation rate (0.05% vs 0.06%; P = .82) when trainees participated vs when they did not participate, whereas the the ssPDR (4.4% vs 5.2%; P = .009) and PDR (39.2% vs 42.0%; P < .001) were significantly lower when trainees participated vs when they did not. After adjustment for potential confounders, the ADR (risk ratio [RR], 0.97; 95% CI, 0.91-1.03; P = .30), PDR (RR, 0.98; 95% CI, 0.93-1.04; P = .47), and CIR (RR, 0.93; 95% CI, 0.78-1.10; P = .38) were not associated with trainee participation, although the ssPDR remained significantly lower (RR, 0.79; 95% CI, 0.64-0.98; P = .03). CONCLUSIONS AND RELEVANCE This study suggests that trainee involvement during colonoscopy was associated with reduced ssPDR but not other colonoscopy outcome measures. Extra care should be exercised when examining the right colon when trainees are involved.
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Affiliation(s)
- Michael Sey
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
- South West Ontario Regional Cancer Program, Ontario Health, London, Ontario, Canada
| | - Sarah Cocco
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Cassandra McDonald
- Lawson Health Research Institute, Western University, London, Ontario, Canada
| | - Zaid Hindi
- Department of Medicine, Western University, London, Ontario, Canada
| | - Hasibur Rahman
- Department of Medicine, Western University, London, Ontario, Canada
| | | | - Karissa French
- Department of Pathology, Western University, London, Ontario, Canada
| | - Mohammed Alsager
- Department of Medicine, Western University, London, Ontario, Canada
| | - Omar Siddiqi
- The Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | - Marc-Andre Blier
- Department of Medicine, Western University, London, Ontario, Canada
| | - Bharat Markandey
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sarah Al Obaid
- Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony Wong
- Department of Medicine, Western University, London, Ontario, Canada
| | - Victoria Siebring
- South West Ontario Regional Cancer Program, Ontario Health, London, Ontario, Canada
| | - Mayur Brahmania
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Jamie Gregor
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Michael Ott
- Department of Surgery, Western University, London, Ontario, Canada
| | - Karim Qumosani
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Aze Wilson
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
- Division of Clinical Pharmacology, Western University, London, Ontario, Canada
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | | | - Brian Yan
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Western University, London, Ontario, Canada
- Lawson Health Research Institute, Western University, London, Ontario, Canada
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5
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Schwartz B, Schou M, Ruberg FL, Rucker D, Choi J, Siddiqi O, Monahan K, Køber L, Gislason G, Torp-Pedersen C, Andersson C. Cardiovascular Morbidity in Monoclonal Gammopathy of Undetermined Significance: A Danish Nationwide Study. JACC CardioOncol 2022; 4:313-322. [PMID: 36213365 PMCID: PMC9537076 DOI: 10.1016/j.jaccao.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Monoclonal gammopathy of undetermined significance (MGUS) is associated with renal dysfunction, inflammation, and increased cardiovascular mortality, but the cardiovascular risks are not fully understood. Objectives The authors explored the association of MGUS with a spectrum of cardiovascular diseases using the Danish nationwide databases. Methods Between 1995 and 2018, patients 18 years and older with MGUS were age- and sex-matched (1:10) with control patients and followed prospectively until December 31, 2018, for the occurrence of cardiovascular diseases. Patients diagnosed with multiple myeloma, lymphoma, or amyloidosis were excluded. Multivariable adjusted hazard ratios (HRs) for cardiovascular outcomes were estimated using Cox proportional hazard regression. Results Patients with MGUS (n = 8,189; mean age 69.8 ± 11.7 years; 51.2% male) had higher prevalence of cardiovascular risk factors at baseline, including hypertension (48.0% vs 38.5%) and type 2 diabetes (13.0% vs 9.3%), compared with control patients. Outcomes included an increased risk of heart failure (HR: 1.55; 95% CI: 1.41-1.69), acute myocardial infarction (HR: 1.22; 95% CI: 1.06-1.40), ischemic stroke (HR: 1.16; 95% CI: 1.03-1.30), atrial fibrillation (HR: 1.32; 95% CI: 1.23-1.42), aortic aneurysm (HR: 1.55; 95% CI: 1.28-1.89), aortic stenosis (HR: 1.60; 95% CI: 1.41-1.82), aortic regurgitation (HR: 1.67; 95% CI: 1.34-2.07), heart block (HR: 1.32; 95% CI: 1.08-1.61), peripheral artery disease (HR: 1.69; 95% CI: 1.47-1.95), cor pulmonale (HR: 2.06; 95% CI: 1.55-2.73), and venous thromboembolism (HR: 1.43; 95% CI: 1.24-1.65). A sensitivity analysis including only patients without certain comorbidities (type 2 diabetes, hypertension, acute myocardial infarction, and chronic kidney disease) yielded similar results. Conclusions MGUS is associated with a broad spectrum of cardiovascular diseases, with greater relative risks observed for diseases previously associated with infiltrative and inflammatory disorders. Further studies are warranted to explore the underlying mechanisms.
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Affiliation(s)
- Brian Schwartz
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA,Address for correspondence: Dr Brian Schwartz, Department of Medicine, Section of Internal Medicine, 72 East Concord Street, Boston, Massachusetts 02118, USA. @BSchwarMD@ca_heart_dk
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - Frederick L. Ruberg
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dane Rucker
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jihoon Choi
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Omar Siddiqi
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Monahan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Hillerød Hospital, Hillerød, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Hellerup, Denmark,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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6
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Gustine JN, Staron A, Szalat R, Mendelson L, Joshi T, Ruberg FL, Siddiqi O, Gopal DM, Edwards CV, Havasi A, Kaku M, Lau KHV, Berk JL, Sloan JM, Sanchorawala V. Predictors of hematologic response and survival with stem cell transplantation in AL amyloidosis: a 25-year longitudinal study. Am J Hematol 2022; 97:1189-1199. [PMID: 35731907 DOI: 10.1002/ajh.26641] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
High-dose melphalan and stem cell transplantation (HDM/SCT) is an effective treatment for selected patients with AL amyloidosis. We report the long-term outcomes of 648 patients with AL amyloidosis treated with HDM/SCT over 25 years. Hematologic CR was achieved by 39% of patients. The median duration of hematologic CR was 12.3 years, and 45% of patients with a hematologic CR had no evidence of a recurrent plasma cell dyscrasia at 15 years after HDM/SCT. With a median follow-up interval of 8 years, the median event-free survival (EFS) and overall survival (OS) were 3.3 and 7.6 years, respectively. Patients with a hematologic CR had a median OS of 15 years, and 30% of these patients survived >20 years. On multivariable analysis, dFLC >180 mg/L and BM plasma cells >10% were independently associated with shorter EFS, whereas BNP >81 pg/mL, troponin I >0.1 ng/mL, and serum creatinine >2.0 mg/dL were independently associated with shorter OS. We developed a prognostic score for EFS, which incorporated dFLC >180 mg/L and BMPC% >10% as adverse risk factors. Patients with low-risk (0 factors), intermediate-risk (1 factor), and high-risk (2 factors) disease had median EFS estimates of 5.3, 2.8, and 1.0 years, respectively (p<0.001). The 100-day treatment-related mortality rate was 3% in the latest treatment period (2012-2021), and the 25-year risk of t-MDS/AML was 3%. We conclude that HDM/SCT induces durable hematologic responses and prolonged survival with improved safety in selected patients with AL amyloidosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joshua N Gustine
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Andrew Staron
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Raphael Szalat
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Lisa Mendelson
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Tracy Joshi
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Cardiovascular Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Omar Siddiqi
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Cardiovascular Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Deepa M Gopal
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Cardiovascular Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Camille V Edwards
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Andrea Havasi
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Michelle Kaku
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - K H Vincent Lau
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Neurology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - John L Berk
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Pulmonology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - J Mark Sloan
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.,Sections of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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7
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Alreshq R, Tugal D, Siddiqi O, Ruberg F. Conduction abnormalities and role of cardiac pacing in cardiac amyloidosis: A systematic review. Pacing Clin Electrophysiol 2021; 44:2092-2099. [PMID: 34632598 DOI: 10.1111/pace.14375] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/05/2023]
Abstract
Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure, characterized by extracellular deposition of insoluble protein fibrils leading to progressive myocardial dysfunction. The most common types of cardiac amyloidosis are immunoglobin light-chain (AL) and transthyretin (ATTR). Conduction abnormalities are commonly encountered among patients with cardiac amyloidosis and are an important cause of morbidity and mortality. Abnormalities range from infra-Hisian intraventricular conduction delay and bundle branch block to complete atrioventricular block. Pacemaker placement in CA patients follows established guidelines, similar to those for patients without CA, with generally good efficacy. The role and appropriate timing of pacemakers for primary prevention of brady-arrhythmias in CA remains uncertain. While biventricular (BiV) pacing has been shown to improve clinical outcomes in patients with systolic heart failure without CA, there are few data examining the utility of BiV pacing in patients with CA. With the advent of effective treatments for AL and ATTR, appropriate application of pacing is important to support patients with CA and conduction disease through therapeutic trials. This systematic review summarizes the current literature examining the utility of pacing in CA.
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Affiliation(s)
- Rabah Alreshq
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Derin Tugal
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Omar Siddiqi
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Frederick Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA.,Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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8
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Sey M, Siddiqi O, McDonald C, cocco S, Hindi Z, Rahman H, Chakraborti D, French K, Alsager M, Blier M, makandey B, Al-obaid S, Wong A, Siebring V, Brahmania M, Gregor JC, Khanna N, Teriaky A, Wilson A, Guizzetti L, Yan B, Jairath V. A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence.
Aims
The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics.
Methods
A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation.
Results
A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1).
Conclusions
Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate.
Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes.
Funding Agencies
None
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Affiliation(s)
- M Sey
- Western University, London, ON, Canada
| | - O Siddiqi
- SOM, Royal College of Surgeons in Ireland and Medical University of Bahrain, London, ON, Canada
| | - C McDonald
- Lawson Health Research Institute, London, ON, Canada
| | - S cocco
- Western University, London, ON, Canada
| | - Z Hindi
- Western University, London, ON, Canada
| | - H Rahman
- Western University, London, ON, Canada
| | | | - K French
- Western University, London, ON, Canada
| | - M Alsager
- Western University, London, ON, Canada
| | - M Blier
- Western University, London, ON, Canada
| | - b makandey
- Queen’s University, Kingston, ON, Canada
| | | | - A Wong
- Western University, London, ON, Canada
| | | | | | | | - N Khanna
- Western University, London, ON, Canada
| | - A Teriaky
- Western University, London, ON, Canada
| | - A Wilson
- Western University, London, ON, Canada
| | | | - B Yan
- Medicine, Gastroenterology, Western University, London, ON, Canada
| | - V Jairath
- Medicine, Western University, London, ON, Canada
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9
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Sey M, Yan B, Hindi Z, Brahmania M, Gregor JC, Jairath V, Wilson A, Khanna N, McDonald C, cocco S, Chakraborti D, French K, ALasseger M, Siddiqi O, Blier M, makandey B, Al-obaid S, wong A, Siebring V, Brackstone M, Teriaky A, Vinden C, Guizzetti L. A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain.
Aims
The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate.
Methods
The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform <50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed.
Results
A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p<0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p<0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p<0.0001) and detection of any adenoma (27.7% vs. 29.8%, p<0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99).
Conclusions
The use of propofol sedation does not improve colonoscopy quality metrics.
Funding Agencies
None
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Affiliation(s)
- M Sey
- Western University, London, ON, Canada
| | - B Yan
- Medicine, Gastroenterology, Western University, London, ON, Canada
| | - Z Hindi
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - M Brahmania
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - J C Gregor
- Medicine, Los Alamos National Laboratory, London, ON, Canada
| | - V Jairath
- Medicine, Western University, London, ON, Canada
| | - A Wilson
- Gastroenterology, University of Western Ontario, London, ON, Canada
| | - N Khanna
- Western University, London, ON, Canada
| | - C McDonald
- Medicine, Gastroenterology, Western University, London, ON, Canada
| | - S cocco
- Western University, London, ON, Canada
| | | | - K French
- Western University, London, ON, Canada
| | | | - O Siddiqi
- Western University, London, ON, Canada
| | - M Blier
- Western University, London, ON, Canada
| | | | | | - A wong
- Western University, London, ON, Canada
| | | | | | - A Teriaky
- Western University, London, ON, Canada
| | - C Vinden
- Western University, London, ON, Canada
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10
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Siddiqi O, Urquhart JC, Rasoulinejad P. A systematic review of metal ion concentrations following instrumented spinal fusion. Spine Deform 2021; 9:13-40. [PMID: 32780305 DOI: 10.1007/s43390-020-00177-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Metallic spinal implants undergo wear and corrosion which liberates ionic or particulate metal debris. The purpose of this study was to identify and review studies that report the concentration of metal ions following multi-level spinal fusion and to evaluate the impact on clinical outcomes. METHODS Databases (PubMed, EBSCO MEDLINE) were searched up to August 2019 for studies in English-language assessing metal ion levels [chromium (Cr), titanium (Ti), nickel (Ni)] in whole blood, serum, or plasma after spinal fusion using a specific search string. Study, patient, and implant characteristics, method of analysis, metal ion concentration, as well as clinical and radiographic results was extracted. RESULTS The systematic search yielded 18 studies encompassing 653 patients. 9 studies reported Ti ions, eight reported Cr, and six reported Ni. Ti levels were elevated compared to controls/reference range/preoperative baseline in seven studies with the other two reporting no difference. Cr levels were elevated compared to controls/reference range in seven studies with one reporting no difference. Ni levels showed no difference from controls/reference range in four studies with one reporting above normal and another elevated compared to controls. Radiographic evidence of corrosion, implant failure, pseudarthrosis, revision surgery and adverse reaction reporting was highly variable. CONCLUSION Metal ions are elevated after instrumented spinal fusion; notably Cr levels from stainless steel implants and Ti from titanium implants. The association between clinical and radiographic outcomes remain uncertain but is concerning. Further research with standardized reporting over longer follow-up periods is indicated to evaluate the clinical impact and minimizing risk.
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Affiliation(s)
| | - Jennifer C Urquhart
- Department of Surgery, London Health Sciences Center, E1-311, 800 Commissioners Road, East, London, ON, N6A 4G5, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Parham Rasoulinejad
- Department of Surgery, London Health Sciences Center, E1-311, 800 Commissioners Road, East, London, ON, N6A 4G5, Canada. .,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
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11
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Navis A, Siddiqi O, Chishimba L, Zimba S, Morgello S, Birbeck GL. Immune reconstitution inflammatory syndrome in the central nervous system: Limitations for diagnosis in resource limited settings. J Neurol Sci 2020; 416:117042. [PMID: 32712429 DOI: 10.1016/j.jns.2020.117042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The diagnosis of IRIS is based on evidence of clinical worsening and immune reconstitution in the setting of combined antiretroviral therapy (cART) initiation. While central nervous system IRIS (CNS IRIS) is thought to be prevalent in resource limited settings (RLS), its identification is constrained by limited data on pre-treatment HIV disease and diagnostic testing. A diagnosis can be improved with neuroimaging and cerebrospinal fluid (CSF) studies, which are not universally available in RLS. This study evaluated whether diagnoses of CNS IRIS could be achieved in a resource limited setting based on established criteria. METHODS A retrospective chart review of HIV+ individuals, on ARVs at the time of presentation in two cohort studies of suspected CNS opportunistic infection or tuberculous (TB) meningitis who were admitted to a tertiary care facility in Lusaka, Zambia. RESULTS Using currently validated criteria, none of the 254 participants evaluated could be diagnosed with CNS IRIS, as there was no information on post-treatment trajectory of HIV viral loads or CD4 counts. Only one participant had a definitive, non-IRIS infectious diagnosis based on comprehensive testing. Of the remaining 253 patients, 68 (27%) had an identified potential CNS pathogen, 92 (36%) had inflammatory CSF in the absence of a pathogen, and 94 (37%) had normal CSF despite presenting with CNS symptoms. CONCLUSION The absence of HIV disease trajectory data, and lack of comprehensive diagnostic testing, compounded by a high prevalence of infectious pathogens, substantially limits the ability to diagnose CNS IRIS in RLS.
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Affiliation(s)
- Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Omar Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Global Neurology Program, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America; Center for Virology and Vaccine Research, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Lorraine Chishimba
- Department of Neurology, University Teaching Hospital, University of Zambia, Zambia
| | - Stanley Zimba
- Department of Neurology, University Teaching Hospital, University of Zambia, Zambia
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Departments of Neuroscience and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gretchen L Birbeck
- University of Zambia School of Medicine, Lusaka, Zambia; University of Rochester School of Medicine, Rochester, NY, United States of America
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12
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Gandhi M, Cocco S, McDonald C, Hindi Z, Chakraborty D, French K, Siddiqi O, Blier M, Markandey B, Siebring V, Brahmania M, Khanna N, Jairath V, Yan B, Sey M. A276 CLINCAL PREDICTORS FOR SESSILE SERRATED ADENOMA DETECTION: AN ANALYSIS OF 17,524 COLONOSCOPIES. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Gandhi
- Department of Gastroenterology, Western University, London, ON, Canada
| | - S Cocco
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - C McDonald
- Department of Gastroenterology, Western University, London, ON, Canada
| | - Z Hindi
- Department of Medicine, Western University, London, ON, Canada
| | - D Chakraborty
- Department of Medicine, Western University, London, ON, Canada
| | - K French
- Department of Pathology, Western University, London, ON, Canada
| | | | - M Blier
- Department of Medicine, Western University, London, ON, Canada
| | - B Markandey
- Department of Medicine, Western University, London, ON, Canada
| | - V Siebring
- Southwest Ontario Regional Cancer Program, London, ON, Canada
| | - M Brahmania
- Department of Gastroenterology, Western University, London, ON, Canada
| | - N Khanna
- Department of Gastroenterology, Western University, London, ON, Canada
| | - V Jairath
- Department of Gastroenterology, Western University, London, ON, Canada
| | - B Yan
- Department of Gastroenterology, Western University, London, ON, Canada
| | - M Sey
- Department of Gastroenterology, Western University, London, ON, Canada
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13
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Affiliation(s)
- Tulip Jhaveri
- a Department of Internal Medicine , Lahey Hospital and Medical Center , Burlington , MA , USA
| | - Shayna Sarosiek
- b Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Frederick L Ruberg
- b Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Omar Siddiqi
- b Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - John L Berk
- b Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
| | - Vaishali Sanchorawala
- b Amyloidosis Center , Boston University School of Medicine and Boston Medical Center , Boston , MA , USA
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14
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Lohrmann G, Arun M, Brauneis D, Quillen K, Sanchorawala V, Sarosiek S, Siddiqi O, Ruberg F, Gopal D. ABNORMAL LEFT ATRIAL MECHANICS PREDICT INCIDENT ATRIAL FIBRILLATION IN AL CARDIAC AMYLOIDOSIS FOLLOWING AUTOLOGOUS STEM CELL TRANSPLANTATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Adan G, Babu A, Bonello M, Siddiqi O, Solomon T, Michael BD. NON-CONVULSIVE STATUS EPILEPTICUS ON THE ACUTE MEDICAL UNIT. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OPINION STATEMENT HIV(+) patients are at increased risk for developing seizures due to the vulnerability of the central nervous system to HIV-associated diseases, immune dysfunction, and metabolic disturbances. In patients with acute seizures, standard protocols still apply with urgent seizure cessation being the priority. Management of the person with established epilepsy who contracts HIV is challenging, but the decision to initiate chronic antiepileptic drug (AED) therapy in an HIV(+) patient is also difficult. Chronic treatment guidelines emphasize the interactions between AEDs and antiretroviral (ARV) medications, but provide no explicit advice regarding when to initiate an AED, what medication to select, and/or the duration of treatment. Epidemiologic data regarding seizure recurrence risk in HIV(+) individuals is not available. The risk of further seizures likely depends upon the underlying etiology for the seizure(s) and patients' immune status and may be increased by the use of efavirenz (an ARV). The issues for consideration include AED-ARV interactions, organ dysfunction, seizure type, and drug side effects, which may worsen or be confused with symptoms of HIV and/or epilepsy. Co-administration of enzyme inducing (EI)-AEDs and ARVs can result in virological failure, breakthrough seizure activity, AED toxicity, and/or ARV toxicity. Where available, the AED of choice in HIV(+) patients is levetiracetam due to its broad spectrum activity, ease of use, minimal drug interactions, and favorable side effect profile. Lacosamide, gabapentin, and pregabalin are also favored choices in patients with partial onset seizures and/or those failing levetiracetam. Where newer AEDs are not available, valproic acid may be the treatment of choice in terms of an AED, which will not cause enzyme induction-associated ARV failure, but its side effect profile causes other obvious problems. In resource-limited settings (RLS) where only EI-AEDs are available, there are no good treatment options and further pressure needs to be placed upon policymakers to address this care gap and public health threat.
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Affiliation(s)
- Omar Siddiqi
- Beth Israel Deaconess Medical Center, Boston, MA, USA,
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17
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O'Leary JM, Ferranti SD, Siddiqi O, Landzberg M, Opotowsky A. ADULT AND PEDIATRIC CONGENITAL HEART DISEASE HOSPITALIZATIONS IN THE UNITED STATES. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60541-0] [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: 10/27/2022]
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18
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Leutscher PDC, Behets F, Rousset D, Ramarokoto CE, Siddiqi O, Ravaoalimalala EV, Christensen NO, Migliani R. Sexual behavior and sexually transmitted infections in men living in rural Madagascar: implications for HIV transmission. Sex Transm Dis 2003; 30:262-5. [PMID: 12616148 DOI: 10.1097/00007435-200303000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
BACKGROUND Madagascar is in the midst of a large HIV epidemic. Therefore, it is important to obtain relevant epidemiologic data that can be used to develop a preventive strategy. GOAL The goal of the study was to assess sexual behavior and sexually transmitted infections (STIs) among men living in two coastal villages and one highland village with different levels of endemicity of urogenital schistosomiasis. STUDY DESIGN Data were obtained from cross-sectional studies on male reproductive health. All men aged 15 to 49 years were offered enrollment. RESULTS Of 401 men evaluated, 6.5% had used a condom and 45.6% reported having multiple partners in the previous 3 months. Symptoms of urethritis during the previous 7 days were reported by 128 men (31.9%). Urethritis was associated with the youngest age group (15-19 years) and the coastal villages, in which HIV antibodies were found in 0.9% and 2.5%, respectively. The prevalence of Schistosoma hematobium was 31.0% and 55.0% in these two villages, whereas none of the men in the highland village were infected. In bivariate analyses, urogenital schistosomiasis was associated with reported symptoms of urethritis, but it acted as a confounder in multivariate analyses. CONCLUSION Several risk factors for HIV propagation exist in these rural areas in Madagascar. Young men in particular should be targeted for HIV/STI prevention. Treatment of urogenital schistosomiasis could be considered part of the syndromic STI treatment in areas where S hematobium is endemic, for patients seeking primary care for urethritis.
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Abstract
Guido Pontecorvo was elected a Fellow of The Royal Society in 1955 for his contributions to the genetics of
Drosophila
and the fungus
Aspergillus nidulans
. Pontecorvo was a leading British geneticist, prominent in the decade preceding the discovery of DNA, who enriched our understanding of genes and whose pioneering work on the parasexual cycle in fungi found application in human somatic cell genetics.
Known to friends as Ponte, he had a strong personality. Somewhat irascible but warm, with a wry sense of humor, he made many lifelong friends and acquired a large body of admirers.
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Affiliation(s)
- O. Siddiqi
- National Centre for Biological SciencesBangalore 560 065India
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20
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Siddiqi O. Guido Pontecorvo, 29 November 1907 - 25 September 1999. Biogr Mem Fellows R Soc 2002; 48:377-90. [PMID: 13678073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Guido Pontecorvo was elected a Fellow of The Royal Society in 1955 for his contributions to the genetics of Drosophilia and the fungus Aspergillus nidulans. Pontecorvo was a leading British geneticist, prominent in the decade preceding the discovery of DNA, who enriched our understanding of genes and whose pioneering work on the parasexual cycle in fungi found application in human somatic cell genetics. Known to friends as Ponte, he had a strong personality. Somewhat irascible but warm, with a wry sense of humor, he made many lifelong friends and acquired a large body of admirers.
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Affiliation(s)
- O Siddiqi
- National Centre for Biological Sciences, Bangalore, India
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21
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Ayyub C, Rodrigues V, Hasan G, Siddiqi O. Genetic analysis of olfC demonstrates a role for the position-specific integrins in the olfactory system of Drosophila melanogaster. Mol Gen Genet 2000; 263:498-504. [PMID: 10821184 DOI: 10.1007/s004380051194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genetic analysis of olfC provides evidence for a role for integrins in the development and/or function of the olfactory system of Drosophila. The olfC gene was identified on the basis of mutations that result in specific defects in behavioural responses to acetate esters, and has been mapped to the cytogenetic interval 7D1;D5-6 on the X chromosome. The myospheroid (mys) gene maps to this region and encodes a beta subunit of integrins. Integrins are alpha(beta) heterodimers which are present on the cell surface and have been implicated in a variety of signalling roles. Mutations in mys fail to complement the olfactory deficits of olfC mutants. These defects can be rescued by misexpression of the mys+ gene under control of a hsp70 promoter. Mutations that affect the alpha subunit of the position-specific integrin PS2 show a dominant interaction with olfC. These results suggest that olfC is allelic to mys and functions together with alphaPS2 integrins in the olfactory pathway in Drosophila.
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Affiliation(s)
- C Ayyub
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India.
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Mistry Y, Mistri R, Siddiqi O. Evidence of age-related changes in the antennal glomeruli of Drosophila melanogaster using monoclonal antibodies. Arthropod Struct Dev 2000; 29:101-110. [PMID: 18088918 DOI: 10.1016/s1467-8039(00)00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/1999] [Accepted: 03/30/2000] [Indexed: 05/25/2023]
Abstract
As a tool to better understand the organization of the olfactory pathway three monoclonal antibodies have been isolated and characterized each having a unique staining pattern in the antenna and antennal lobe of Drosophila melanogaster. Monoclonal antibody F14-2D6 stains sensilla coeloconica and thick sensilla basiconica in the funiculus, Y1-3D10 stains only a few sensilla especially in and around the sacculus, while F15-12E8 stains all the sensilla. All three antibodies stain a subset of the glomeruli in the antennal lobe, of which 11 glomeruli are stained in common by all three antibodies. These antibodies could be used to study projection patterns of the sensilla into the antennal lobe. Glomerular staining was observed at different developmental times with the different antibodies. F15-12E8 stains all the glomeruli at eclosion, Y1-3D10 stains only a few glomeruli at eclosion but most glomeruli are stained by the first day after eclosion. F14-2D6 stains all glomeruli only after eclosion. F15-12E8 also stains the mushroom bodies. The antigen recognized by F14-2D6 in the glomeruli shows an increase with age of the flies, measured as increased intensity of staining. These observations suggest that age-related changes continue in the antennal lobe of the flies even after eclosion. These antibodies could therefore serve as unique markers for other studies on the development of the olfactory system.
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Affiliation(s)
- Y Mistry
- Molecular Biology Unit, Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai 400 005, India
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Siddiqi O. Guido Pontecorvo (1907-99). Nature 1999; 402:250. [PMID: 10580492 DOI: 10.1038/46201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Jayaram VC, Siddiqi O. Gust J, a salt-insensitive mutant ofDrosophila melanogaster. J Genet 1997. [DOI: 10.1007/bf02923557] [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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Abstract
Olfactory transduction in invertebrates seems to be similar to that in vertebrates. Three signalling systems involving activation of adenylate cyclase, phospholipase C and guanylate cyclase are present. A variety of second messengers, including cAMP, inositol 1,4,5-trisphosphate, diacylglycerol, nitric oxide and Ca2+, have been identified but their target sites and mode of action are not yet fully understood. The central projections of olfactory signals in invertebrates are relatively simple and perhaps more hard-wired than in vertebrates. Information about circuitry and functional mapping in the olfactory pathway is lacking. This is essential for understanding the sensory code and higher olfactory functions. Neurogenetic analysis has provided useful insights into olfaction and olfactory learning.
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Affiliation(s)
- N Shirsat
- Molecular Biology Unit, Tata Institute of Fundamental Research, Colaba, Bombay, India
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Rodrigues V, Sathe S, Pinto L, Balakrishnan R, Siddiqi O. Closely linked lesions in a region of the X chromosome affect central and peripheral steps in gustatory processing in Drosophila. Mol Gen Genet 1991; 226:265-76. [PMID: 2034219 DOI: 10.1007/bf00273612] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have analyzed a set of closely linked mutations on the X chromosome of Drosophila that lead to defects in gustatory behavior. The mutations map to a small region of the X chromosome between 10E1-4. Two distinct complementation groups, gustB and gustD, map to the ends of this region. These groups show complex complementation patterns with the mutations gustC and GT-1, which also map to this region. We describe the behavioral and electrophysiological properties of the mutants. These mutations affect peripheral receptor properties as well as more central processing steps in the gustatory pathway.
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Affiliation(s)
- V Rodrigues
- Molecular Biology Unit, Tata Institute of Fundamental Research, Bombay, India
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Abstract
We have used a behavioral genetic approach to identify six X-linked loci which specify olfaction in Drosophila melanogaster. Mutations in five of these genes lead to partial anosmias affecting responses either to aldehydes (olfA, olfB, olfE and olfF) or to acetate esters (olfC). Only one of the mutants obtained in our screening (olfD) resulted in a insensitivity to several different odorants. olfA, olfE and olfC map close together in a small region of the chromosome between 7C and 7D. The alleles at the olfC locus fall into two phenotypic classes according to their responses to different acetate esters. The two groups of olfC alleles interact in-trans.
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Affiliation(s)
- C Ayyub
- Molecular Biology Unit, Tata Institute of Fundamental Research, Bombay, India
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Abstract
The sensilla on the proboscis and tarsi of Drosophila contain five neurons, four chemosensory and one mechanosensory. The sugar-sensitive neuron, designated S, carries independent acceptor sites for pyranose, furanose and trehalose. Two others, L1 and L2, respond to salts. The fourth neuron, W, is inhibited by salts and sugars, and is believed to mediate detection of water. We describe here a gene in which mutations alter the neurons in such a way that the S cell is excited by salts. As a result, the mutant flies are strongly attracted by NaCl at concentrations which are repellent to the wild type. To our knowledge, this is the first instance of a mutation which changes the specificity of the chemosensory neurons.
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Affiliation(s)
- K Arora
- Molecular Biology Unit, Tata Institute of Fundamental Research, Bombay, India
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Stocker RF, Singh RN, Schorderet M, Siddiqi O. Projection patterns of different types of antennal sensilla in the antennal glomeruli of Drosophila melanogaster. Cell Tissue Res 1983; 232:237-48. [PMID: 6411344 DOI: 10.1007/bf00213783] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cobalt fills from small, defined regions of the antenna in D. melanogaster show that the three types of sensilla on the third segment, the flagellum, and a fourth sensillum located in the arista, project into the glomeruli of the antennal lobe. We have identified 19 glomeruli in each lobe, according to their location, shape, and size. At least ten of these represent major projection areas of flagellar or aristal sensilla. The large majority of glomeruli is innervated from both antennae, but a small group of five receive exclusively ipsilateral input. A particular sensory fiber appears to terminate only in one specific glomerulus, either in the ipsilateral or in both lobes. Fills from flagellar regions bearing a single type of sensillum, yield a specific pattern of glomeruli containing stained terminals. Aristal projections remain strictly ipsilateral, whereas those from the other sensilla consist of an ipsilateral and a bilateral component. When filling from different points in an area bearing one type of sensillum, similar projections are produced, suggesting that projection patterns observed reflect predominantly the type of sensillum rather than its location on the flagellum. Accordingly, individual glomeruli might represent functional units, each receiving antennal input in a characteristic combination.
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Abstract
Mutations in an X-linked gene, gust-A, block the responses of Drosophila melanogaster to a group of pyranose sugars. It is shown that the behavioural effects of this mutation are correlated with a loss of electrical responses in taste receptors. The mutation affects the chemoacceptors for pyranose sugars leaving the furanose acceptors intact.
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Abstract
A new temperature-sensitive paralytic locus on the X chromosome of Drosophila melanogaster called torpid is described. Mosaic analysis shows that the focus of defect in torp lies in the presumptive neural region of the blastoderm. Electrophysiological tests indicate that the excitability of the cervical axons is lowered at elevated temperatures.
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Bhavsar PN, Siddiqi O. Depression of alkaline phosphatase in Hfr of Escherichia coli during conjugation. Mol Gen Genet 1980; 180:357-60. [PMID: 7007813 DOI: 10.1007/bf00425848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In a mating mixture of Hfr and F- bacteria the gene for alkaline phosphatase undergoes a transient derepression at the time of transfer. It is shown that this escape from repression occurs in the donor cells and is probably connected with the synchronous duplication of the transferred genome.
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Siddiqi O, Benzer S. Neurophysiological defects in temperature-sensitive paralytic mutants of Drosophila melanogaster. Proc Natl Acad Sci U S A 1976; 73:3253-7. [PMID: 184469 PMCID: PMC430996 DOI: 10.1073/pnas.73.9.3253] [Citation(s) in RCA: 189] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A new temperature-sensitive paralytic mutant of Drosophila, comatose, is compared behaviorally and physiologically with the previously known types, para and shi. All three have different properties with respect to kinetics of paralysis at high temperature and recovery from paralysis; com is hypersensitive to paralysis by cooling. Neurophysiological experimeents indicate different mechanisms for paralysis in each of the mutants.
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Sarathy PV, Siddiqi O. Effect of mating on cell division in Escherichia coli Hfr. Mol Gen Genet 1973; 125:133-7. [PMID: 4590268 DOI: 10.1007/bf00268866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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