1
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Bandino F, Thota R, Pendolino AL, Chaidas K, Jeyaretna S, Lawrence T, Martinez-Devesa P, Qureishi A. A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature. Rhinology 2022; 60:357-367. [PMID: 35726849 DOI: 10.4193/rhin22.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes. METHODOLOGY Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020. RESULTS Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks. CONCLUSIONS In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.
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Affiliation(s)
- F Bandino
- ENT Department, Oxford University Hospital, Oxford, UK
| | - R Thota
- ENT Department, Oxford University Hospital, Oxford, UK
| | | | - K Chaidas
- ENT Department, Oxford University Hospital, Oxford, UK
| | - S Jeyaretna
- Neurosurgical Department, Oxford University Hospital, Oxford, UK
| | - T Lawrence
- Neurosurgical Department, Oxford University Hospital, Oxford, UK
| | | | - A Qureishi
- ENT Department, Oxford University Hospital, Oxford, UK
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2
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Cowman K, Rossi J, Gendlina I, Guo Y, Liu S, Szymczak W, Forest SK, Wolgast L, Orner E, Bao H, Cervera-Hernandez ME, Ceniceros A, Thota R, Pirofski LA, Nori P. Elucidating the role of procalcitonin as a biomarker in hospitalized COVID-19 patients. Diagn Microbiol Infect Dis 2022; 103:115721. [PMID: 35635888 PMCID: PMC9065691 DOI: 10.1016/j.diagmicrobio.2022.115721] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 01/08/2023]
Abstract
Our objectives were to evaluate the role of procalcitonin in identifying bacterial co-infections in hospitalized COVID-19 patients and quantify antibiotic prescribing during the 2020 pandemic surge. Hospitalized COVID-19 patients with both a procalcitonin test and blood or respiratory culture sent on admission were included in this retrospective study. Confirmed co-infection was determined by an infectious diseases specialist. In total, 819 patients were included; 335 (41%) had an elevated procalcitonin (>0.5 ng/mL) and of these, 42 (13%) had an initial bacterial co-infection. Positive predictive value of elevated procalcitonin for co-infection was 13% while the negative predictive value was 94%. Ninety-six percent of patients with an elevated procalcitonin received antibiotics (median 6 days of therapy), compared to 82% with low procalcitonin (median 4 days of therapy) (adjusted OR:3.3, P < 0.001). We observed elevated initial procalcitonin in many COVID patients without concurrent bacterial co-infections which potentially contributed to antibiotic over-prescribing.
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Affiliation(s)
- Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Network Performance Group, Montefiore Medical Center, Bronx, NY, USA.
| | - James Rossi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yi Guo
- Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA
| | - Sichen Liu
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy Szymczak
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stefanie K Forest
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lucia Wolgast
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erika Orner
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA
| | - Miguel E Cervera-Hernandez
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ashley Ceniceros
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, NY, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Microbiology and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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3
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Lee M, Quinn R, Pradhan K, Fedorov K, Levitz D, Fromowitz A, Thakkar A, Shapiro LC, Kabarriti R, Ruiz RE, Andrews EM, Thota R, Chu E, Kalnicki S, Goldstein Y, Loeb D, Racine A, Halmos B, Mehta V, Verma A. Impact of COVID-19 on case fatality rate of patients with cancer during the Omicron wave. Cancer Cell 2022; 40:343-345. [PMID: 35219358 PMCID: PMC8860706 DOI: 10.1016/j.ccell.2022.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Matthew Lee
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryann Quinn
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kith Pradhan
- Department of Epidemiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kateryna Fedorov
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Levitz
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ariel Fromowitz
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Astha Thakkar
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lauren C Shapiro
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; MECC Cancer Therapeutics Program, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafael E Ruiz
- Department of Network Performance Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erin M Andrews
- Department of Network Performance Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Raja Thota
- Department of Network Performance Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Edward Chu
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA; MECC Cancer Therapeutics Program, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; MECC Cancer Therapeutics Program, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yitz Goldstein
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Loeb
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Racine
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA; MECC Cancer Therapeutics Program, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Vikas Mehta
- Department of Otolaryngology and Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; MECC Cancer Epidemiology Prevention and Control Program, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center, Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA; MECC Stem Cell Cancer Biology Program Montefiore Einstein Cancer Center (MECC), Albert Einstein College of Medicine, Bronx, NY, USA.
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4
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Cowman K, Guo Y, Pirofski LA, Wong D, Bao H, Chen V, Hopkins U, Andrews E, Hamel J, Keller M, Bellin E, Thota R, Davis P, Rodriguez ET, Suthar P, Allen L, Rossi J, Haviland A, Orner E, Szymczak W, Shujauddin S, McCarthy J, Binder B, Pushparaj V, Bard L, Pierino VF, Alsina L, Esses D, McCaskie A, Campbell C, Madzura T, Wollowitz A, Basset K, White D, Ruiz R, Sosnowski F, Nori P. Post-severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Treatment Hospitalizations as a Sentinel for Emergence of Viral Variants in New York City. Open Forum Infect Dis 2021; 8:ofab313. [PMID: 34458391 PMCID: PMC8391090 DOI: 10.1093/ofid/ofab313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
We partnered with the US Department of Health and Human Services to treat high-risk, nonadmitted coronavirus disease 2019 (COVID-19) patients with bamlanivimab in the Bronx, New York per Emergency Use Authorization criteria. Increasing posttreatment hospitalizations were observed monthly between December 2020 and March 2021 in parallel to the emergence of severe acute respiratory syndrome coronavirus 2 variants in New York City.
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Affiliation(s)
- Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Yi Guo
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - David Wong
- Medical Officer, COVID-19 Therapeutics Team, US Department of Health and Human Services, Rockville, MD, USA
| | - Hongkai Bao
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Victor Chen
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Una Hopkins
- Department of Nursing, Montefiore Medical Center, Bronx, New York, USA
| | - Erin Andrews
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Joseph Hamel
- Office of Strategy, Planning, Policy and Requirements, Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC, USA
| | - Marla Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Eran Bellin
- Department of Epidemiology, Population Health and Medicine Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York, USA
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Patricia Davis
- Department of Nursing, Montefiore Medical Center, Bronx, New York, USA
| | - Edwin Torres Rodriguez
- Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Pooja Suthar
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Lauren Allen
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - James Rossi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Adam Haviland
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Erika Orner
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wendy Szymczak
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sadahf Shujauddin
- Department of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - James McCarthy
- Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Barbara Binder
- Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Vanitha Pushparaj
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | - Linda Bard
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | | | - Leslie Alsina
- Faculty Practice Group, Montefiore Health System, Bronx, New York, USA
| | - David Esses
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Alicia McCaskie
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Caron Campbell
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Tabitha Madzura
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Andrew Wollowitz
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Kelly Basset
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Deborah White
- Department of Emergency Medicine Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Rafael Ruiz
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Frank Sosnowski
- Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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5
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Yoon HA, Bartash R, Gendlina I, Rivera J, Nakouzi A, Bortz RH, Wirchnianski AS, Paroder M, Fehn K, Serrano-Rahman L, Babb R, Sarwar UN, Haslwanter D, Laudermilch E, Florez C, Dieterle ME, Jangra RK, Fels JM, Tong K, Mariano MC, Vergnolle O, Georgiev GI, Herrera NG, Malonis RJ, Quiroz JA, Morano NC, Krause GJ, Sweeney JM, Cowman K, Allen S, Annam J, Applebaum A, Barboto D, Khokhar A, Lally BJ, Lee A, Lee M, Malaviya A, Sample R, Yang XA, Li Y, Ruiz R, Thota R, Barnhill J, Goldstein DY, Uehlinger J, Garforth SJ, Almo SC, Lai JR, Gil MR, Fox AS, Chandran K, Wang T, Daily JP, Pirofski LA. Treatment of severe COVID-19 with convalescent plasma in Bronx, NYC. JCI Insight 2021; 6:142270. [PMID: 33476300 PMCID: PMC7934933 DOI: 10.1172/jci.insight.142270] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as a treatment for coronavirus disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200 mL of CCP with a spike protein IgG titer ≥ 1:2430 (median 1:47,385) within 72 hours of admission with propensity score-matched controls cared for at a medical center in the Bronx, between April 13 and May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroid use, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared with matched controls, CCP recipients less than 65 years had 4-fold lower risk of mortality and 4-fold lower risk of deterioration in oxygenation or mortality at day 28. For CCP recipients, pretransfusion spike protein IgG, IgM, and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients less than 65 years, but data from controlled trials are needed to validate this finding and establish the effect of aging on CCP efficacy.
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Affiliation(s)
- Hyun ah Yoon
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Johanna Rivera
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology and
| | - Antonio Nakouzi
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology and
| | | | - Ariel S. Wirchnianski
- Department of Microbiology and Immunology and
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen Fehn
- Department of Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | | | - Rachelle Babb
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology and
| | - Uzma N. Sarwar
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | | | | | - Catalina Florez
- Department of Microbiology and Immunology and
- Department of Chemistry and Life Science, United States Military Academy at West Point, West Point, New York, USA
| | | | | | | | - Karen Tong
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Margarette C. Mariano
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Olivia Vergnolle
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - George I. Georgiev
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Natalia G. Herrera
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ryan J. Malonis
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jose A. Quiroz
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas C. Morano
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gregory J. Krause
- Department of Developmental & Molecular Biology
- Institute for Aging Research, and
| | - Joseph M. Sweeney
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | | | | | | | - Daniel Barboto
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ahmed Khokhar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Audrey Lee
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Max Lee
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Reise Sample
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiuyi A. Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yang Li
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rafael Ruiz
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York, USA
| | - Jason Barnhill
- Department of Chemistry and Life Science, United States Military Academy at West Point, West Point, New York, USA
| | | | | | - Scott J. Garforth
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven C. Almo
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jonathan R. Lai
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Johanna P. Daily
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology and
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Microbiology and Immunology and
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6
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Yoon HA, Bartash R, Gendlina I, Rivera J, Nakouzi A, Bortz RH, Wirchnianski AS, Paroder M, Fehn K, Serrano-Rahman L, Babb R, Sarwar UN, Haslwanter D, Laudermilch E, Florez C, Dieterle ME, Jangra RK, Fels JM, Tong K, Mariano MC, Vergnolle O, Georgiev GI, Herrera NG, Malonis RJ, Quiroz JA, Morano NC, Krause GJ, Sweeney JM, Cowman K, Allen S, Annam J, Applebaum A, Barboto D, Khokhar A, Lally BJ, Lee A, Lee M, Malaviya A, Sample R, Yang XA, Li Y, Ruiz R, Thota R, Barnhill J, Goldstein DY, Uehlinger J, Garforth SJ, Almo SC, Lai JR, Gil MR, Fox AS, Chandran K, Wang T, Daily JP, Pirofski LA. Treatment of Severe COVID-19 with Convalescent Plasma in the Bronx, NYC. medRxiv 2020:2020.12.02.20242909. [PMID: 33300012 PMCID: PMC7724683 DOI: 10.1101/2020.12.02.20242909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) may hold promise as treatment for Coronavirus Disease 2019 (COVID-19). We compared the mortality and clinical outcome of patients with COVID-19 who received 200mL of CCP with a Spike protein IgG titer ≥1:2,430 (median 1:47,385) within 72 hours of admission to propensity score-matched controls cared for at a medical center in the Bronx, between April 13 to May 4, 2020. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroids, and anticoagulation use. There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared to matched controls, CCP recipients <65 years had 4-fold lower mortality and 4-fold lower deterioration in oxygenation or mortality at day 28. For CCP recipients, pre-transfusion Spike protein IgG, IgM and IgA titers were associated with mortality at day 28 in univariate analyses. No adverse effects of CCP were observed. Our results suggest CCP may be beneficial for hospitalized patients <65 years, but data from controlled trials is needed to validate this finding and establish the effect of ageing on CCP efficacy.
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Affiliation(s)
- Hyun ah Yoon
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Inessa Gendlina
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Johanna Rivera
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Antonio Nakouzi
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Robert H. Bortz
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Ariel S. Wirchnianski
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Monika Paroder
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Karen Fehn
- Department of Oncology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Leana Serrano-Rahman
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Rachelle Babb
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Uzma N. Sarwar
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Denise Haslwanter
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Ethan Laudermilch
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Catalina Florez
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
- Department of Chemistry and Life Science, United States Military Academy at West Point, NY
| | - M. Eugenia Dieterle
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Rohit K. Jangra
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - J. Maximilian Fels
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Karen Tong
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | | | - Olivia Vergnolle
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - George I. Georgiev
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Natalia G. Herrera
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Ryan J. Malonis
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Jose A. Quiroz
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas C. Morano
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Gregory J. Krause
- Department of Developmental and Molecular Biology. Albert Einstein College of Medicine, Bronx, NY
- Institute of Aging Studies. Albert Einstein College of Medicine, Bronx, NY
| | - Joseph M. Sweeney
- Department Physiology and Biophysics. Albert Einstein College of Medicine, Bronx, NY
| | - Kelsie Cowman
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | | | | | | | | | | | - Audrey Lee
- Albert Einstein College of Medicine, Bronx, NY
| | - Max Lee
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Yang Li
- Department of Epidemiology and Population Health. Albert Einstein College of Medicine, Bronx, NY
| | - Rafael Ruiz
- Network Performance Group. Montefiore Medical Center, Bronx, NY
- Division of Hospital Medicine, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Raja Thota
- Network Performance Group. Montefiore Medical Center, Bronx, NY
| | - Jason Barnhill
- Department of Chemistry and Life Science, United States Military Academy at West Point, NY
| | - Doctor Y. Goldstein
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Joan Uehlinger
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Scott J. Garforth
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Steven C. Almo
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
- Department Physiology and Biophysics. Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan R. Lai
- Department of Biochemistry. Albert Einstein College of Medicine, Bronx, NY
| | - Morayma Reyes Gil
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Amy S. Fox
- Department of Pathology. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Kartik Chandran
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Tao Wang
- Department of Epidemiology and Population Health. Albert Einstein College of Medicine, Bronx, NY
| | - Johanna P. Daily
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine. Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
- Department of Microbiology and Immunology. Albert Einstein College of Medicine, Bronx, NY
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Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, Pradhan K, Thota R, Reissman S, Sparano JA, Gartrell BA, Smith RV, Ohri N, Garg M, Racine AD, Kalnicki S, Perez-Soler R, Halmos B, Verma A. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discov 2020; 10:935-941. [PMID: 32357994 PMCID: PMC7334098 DOI: 10.1158/2159-8290.cd-20-0516] [Citation(s) in RCA: 550] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Patients with cancer in a New York hospital system were much more vulnerable to COVID-19 death than the general population, with a case fatality rate that varied by cancer type and was 28% overall. Patients with cancer are presumed to be at increased risk from COVID-19 infection–related fatality due to underlying malignancy, treatment-related immunosuppression, or increased comorbidities. A total of 218 COVID-19–positive patients from March 18, 2020, to April 8, 2020, with a malignant diagnosis were identified. A total of 61 (28%) patients with cancer died from COVID-19 with a case fatality rate (CFR) of 37% (20/54) for hematologic malignancies and 25% (41/164) for solid malignancies. Six of 11 (55%) patients with lung cancer died from COVID-19 disease. Increased mortality was significantly associated with older age, multiple comorbidities, need for ICU support, and elevated levels of D-dimer, lactate dehydrogenase, and lactate in multivariate analysis. Age-adjusted CFRs in patients with cancer compared with noncancer patients at our institution and New York City reported a significant increase in case fatality for patients with cancer. These data suggest the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. Significance: COVID-19 in patients with cancer is associated with a significantly increased risk of case fatality, suggesting the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. This article is highlighted in the In This Issue feature, p. 890
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Affiliation(s)
- Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Sanjay Goel
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Daniel Cole
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mendel Goldfinger
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Kith Pradhan
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Stan Reissman
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin A Gartrell
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Andrew D Racine
- Department of Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
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8
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Adelman JS, Applebaum JR, Schechter CB, Berger MA, Reissman SH, Thota R, Racine AD, Vawdrey DK, Green RA, Salmasian H, Schiff GD, Wright A, Landman A, Bates DW, Koppel R, Galanter WL, Lambert BL, Paparella S, Southern WN. Effect of Restriction of the Number of Concurrently Open Records in an Electronic Health Record on Wrong-Patient Order Errors: A Randomized Clinical Trial. JAMA 2019; 321:1780-1787. [PMID: 31087021 PMCID: PMC6518341 DOI: 10.1001/jama.2019.3698] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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]
Abstract
IMPORTANCE Recommendations in the United States suggest limiting the number of patient records displayed in an electronic health record (EHR) to 1 at a time, although little evidence supports this recommendation. OBJECTIVE To assess the risk of wrong-patient orders in an EHR configuration limiting clinicians to 1 record vs allowing up to 4 records opened concurrently. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 3356 clinicians at a large health system in New York and was conducted from October 2015 to April 2017 in emergency department, inpatient, and outpatient settings. INTERVENTIONS Clinicians were randomly assigned in a 1:1 ratio to an EHR configuration limiting to 1 patient record open at a time (restricted; n = 1669) or allowing up to 4 records open concurrently (unrestricted; n = 1687). MAIN OUTCOMES AND MEASURES The unit of analysis was the order session, a series of orders placed by a clinician for a single patient. The primary outcome was order sessions that included 1 or more wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder measure (an electronic query that identifies orders placed for a patient, retracted, and then reordered shortly thereafter by the same clinician for a different patient). RESULTS Among the 3356 clinicians who were randomized (mean [SD] age, 43.1 [12.5] years; mean [SD] experience at study site, 6.5 [6.0] years; 1894 females [56.4%]), all provided order data and were included in the analysis. The study included 12 140 298 orders, in 4 486 631 order sessions, placed for 543 490 patients. There was no significant difference in wrong-patient order sessions per 100 000 in the restricted vs unrestricted group, respectively, overall (90.7 vs 88.0; odds ratio [OR], 1.03 [95% CI, 0.90-1.20]; P = .60) or in any setting (ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P = .96; inpatient: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P = .86; or outpatient: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P = .71). The effect did not differ among settings (P for interaction = .99). In the unrestricted group overall, 66.2% of the order sessions were completed with 1 record open, including 34.5% of ED, 53.7% of inpatient, and 83.4% of outpatient order sessions. CONCLUSIONS AND RELEVANCE A strategy that limited clinicians to 1 EHR patient record open compared with a strategy that allowed up to 4 records open concurrently did not reduce the proportion of wrong-patient order errors. However, clinicians in the unrestricted group placed most orders with a single record open, limiting the power of the study to determine whether reducing the number of records open when placing orders reduces the risk of wrong-patient order errors. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02876588.
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Affiliation(s)
- Jason S. Adelman
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Departmentof Quality and Patient Safety, NewYork-Presbyterian Hospital, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Jo R. Applebaum
- Departmentof Quality and Patient Safety, NewYork-Presbyterian Hospital, New York
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Matthew A. Berger
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York
| | | | - Raja Thota
- Montefiore Health System, Bronx, New York
| | - Andrew D. Racine
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York
| | - David K. Vawdrey
- Departmentof Quality and Patient Safety, NewYork-Presbyterian Hospital, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Robert A. Green
- Departmentof Quality and Patient Safety, NewYork-Presbyterian Hospital, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Hojjat Salmasian
- Division of Internal Medicine, Department of Medicine, Harvard Medical School, and Department of Quality and Safety, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gordon D. Schiff
- Primary Care Center, Harvard Medical School, Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Adam Wright
- Division of General Internal Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Adam Landman
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
| | - David W. Bates
- Division of General Internal Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ross Koppel
- Departments of Sociology and Biomedical Informatics, University of Pennsylvania, Philadelphia
- Department of Biomedical Informatics, University at Buffalo (SUNY), Buffalo, New York
| | - William L. Galanter
- Department of Medicine, Division of Academic Medicine and Geriatrics, and Departments of Pharmacy Practice and Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago
| | - Bruce L. Lambert
- Department of Communication Studies, Center for Communication and Health, Northwestern University, Evanston, Illinois
| | - Susan Paparella
- Institute for Safe Medication Practices, Horsham, Pennsylvania
| | - William N. Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, New York
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Abbott K, Thota R, Burrows T, Acharya S, Garg M. Sex-dependent relationship between n -3 long-chain polyunsaturated fatty acids and insulin resistance: A systematic review. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.182] [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: 10/21/2022] Open
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10
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Tiwana J, Ortman S, Davies T, Gonsalves W, Tashi T, Krishnamurthy J, Thota R, Abu Hazeem M, Ganta A, Sama AR, Aldoss IT, Ganti AK, Silberstein PT, Subbiah S. Long-standing diabetes and its effects on outcomes in colon cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Krishnamurthy J, Tashi T, Gonsalves W, Thota R, Silberstein PT, Subbiah S. Hodgkin lymphoma of the elderly veterans: Veterans Affairs Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9138] [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: 11/20/2022] Open
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12
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Subbiah S, Tashi T, Thota R, Sama AR, Silberstein PT, Gonsalves W. Malignant pleural mesothelioma (MPM): Retrospective analysis of clinicopathologic and survival data of the Veterans Affairs Cancer Registry (VACCR). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18002] [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: 11/20/2022] Open
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13
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Thota R, Birdsong S, Tashi T, Gonsalves W, Tiwana J, Sama AR, Krishnamurthy J, Fang X, Townley PM, Silberstein PT, Subbiah S. Clinicopathologic features and survival outcomes of primary signet ring cell carcinoma of colon: Retrospective analysis of VACCR database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14097] [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: 11/20/2022] Open
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14
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Wilkes A, Tashi T, Wolpert J, Goshgarian A, Gonsalves W, Thota R, Krishnamurthy J, Aldoss IT, Sama AR, Townley P, Didwaniya N, Ganti AK, Silberstein PT, Subbiah S. Primary non-Hodgkin lymphoma of the colon: A Veterans Affairs Central Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18525] [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: 11/20/2022] Open
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15
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Gonsalves W, Tashi T, Davies T, Ortman S, Thota R, Krishnamurthy J, Aldoss IT, Kalaiah M, Ganta A, Didwaniya N, Eberle C, Ganti AK, Subbiah S, Silberstein PT. Aggressiveness of end-of-life care before and after the utilization of a palliative care service. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9135] [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: 11/20/2022] Open
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16
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Birdsong S, Thota R, Tashi T, Gonsalves W, Silberstein PT, Subbiah S. Surgical outcomes of colorectal cancer in octogenarians: Survival analysis of the Veteran's Affairs population. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14024] [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: 11/20/2022] Open
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17
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Abu Hazeem M, Wolpert J, Tashi T, Gonsalves W, Krishnamurthy J, Thota R, Sama AR, Aldoss IT, AL-Howaidi I, Townley P, Silberstein PT, Subbiah S. The impact of lymph node ratio (LNR) on survival in patients with stage IV colon cancer: A Veteran’s Affairs Central Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14092] [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: 11/20/2022] Open
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18
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Thota R, Birdsong S, Subbiah S. Primary genitourinary small cell carcinoma: Clinicopathologic and survival outcomes from SEER database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
200 Background: Small cell carcinoma of genitourinary system (SCC) is a highly aggressive and rare entity. The aim of the study is to characterize the clinicopathologic characteristics and evaluate the treatment outcomes of SCC in adult patients. Methods: Retrospective analysis of 732 patents diagnosed with small cell carcinoma of bladder from 1973 to 2007 was done via SEER database. Demographics, stage, type of treatment received and cancer-specific mortality were examined. Results: 732 patients were identified with SCC of genitourinary tract of which 341 were small cell bladder cancer, 336 were small cell prostate cancer and 55 were small cell renal cancer. Of these 644 patients were males and 88 were females. Median age of diagnosis is 73 years for bladder, 72 years for prostate and 70 years for renal cancer. Majority of the patients were Caucasians (89%) followed by African Americans (6%) and other races (4.98%). Grading of the tumor revealed that 12 patients had well differentiated tumor, 18 patients had moderately differentiated tumor, 191 patients had poorly differentiated, 292 patients had undifferentiated tumor and 219 patients had unknown grade. Pathological T-stages were as follows: T1= 34 (4.6%), T2= 102 (14%), T3= 43 (9%), T4= 41 (5.6%), 38.4% unknown T stage and 67 (9%) patients had metastatic disease. In majority of the patients the treatment received was unknown (565), 90 patients received external beam radiation, and 76 patients received surgery. Cancer-specific mortality was 54% in bladder cancer, 71% in prostate cancer and 78.6% in renal cancer. Median overall survival for all stages was 15.8 months in bladder cancer, 11.3 months in prostate cancer and 8 months in renal cancer. Conclusions: Results show that SCC is a highly aggressive tumor with poor prognosis. Clinical trials involving multiple institutes are needed to accrue enough patients so that treatment paradigms for this uncommon disease can be developed. No significant financial relationships to disclose.
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Thota R, Tashi T, Gonsalves W, Murukesan V, Townley P, Ganti A, Silberstein PT, Subbiah S. Primary signet ring cell carcinoma of colon: Retrospective analysis of VACCR database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
58 Background: Signet ring cell carcinoma accounts for less than 1% of all colon cancers. We examined the clinical pathological features and prognosis of signet ring cell carcinoma of colon and compare it with mucinous and non-mucinous adenocarcinoma of colon. Methods: A total of 206 patients diagnosed with signet ring cell carcinoma from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. Age, race, histology, grade, lymph node status, stage and type of treatment received data were collected. Results: Out of 206 patients, 173 (83.9%) were white, 31 (15%) were black, and 2 patients were listed as unknown. Median age of diagnosis was 67 years as compared to 70 years for both mucinous and non-mucinous adenocarcinoma of colon. Pathological T-stages were as follows: T1 = 2.9%, T2=5.3%, T3=33.9%, T4= 25.7%, and unknown 32%. Of the total, 22.3% were located in caecum, 21.8% in ascending colon, 15.5% in sigmoid colon, 7.7% in appendix and hepatic flexure of colon, 11.1% in transverse colon, 2.9% in splenic flexure and 4.4% in descending colon. 33.5% were lymph node positive, 34.6% were lymph node negative, and 31.8% were unknown. Histologically grade 3 (55.4%) was most commonly reported followed by grade 2 (7.3%), grade 1 (2.5%), grade 4 (1.9%)and in 33% grade was unknown. 41.3% patients received only surgery while 34% received surgery with adjuvant chemotherapy, 7.3% received chemotherapy alone and 7.8% patients received either chemotherapy, radiation or hormonal therapy alone, 9% did not receive any therapy. 1 year, 3 year and 5 year survivals for signet ring cell cancer compared to adeno carcinoma was 60% vs 80%, 33% vs 60%, and 24% vs 47% respectively. Median survival of signet ring cell carcinoma compared to mucinous and non mucinous adenocarcinoma was 19 months, 48 months and 62 months respectively. Conclusions: Signet ring cell carcinoma of colon has poor survival rates than the other histological subtypes. Signet ring cell carcinoma presents at an earlier age, higher tumor grade and advanced stage at diagnosis when compared to mucinous and non-mucinous adenocarcinoma of colon. Due to rarity of this disease further multi-institute studies are required for in-depth understanding and analysis of this disease. No significant financial relationships to disclose.
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Affiliation(s)
- R. Thota
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - T. Tashi
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - W. Gonsalves
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - V. Murukesan
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. Townley
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. Ganti
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. T. Silberstein
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - S. Subbiah
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
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20
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Thota R, Tashi T, Gonsalves W, Sama AR, Silberstein PT, Townley P, Subbiah S. Prognostic significance of positive lymph node ratio in resected esophageal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
100 Background: Nodal involvement in esophageal cancer is associated with poor survival. We aim to determine whether the ratio of metastatic to examined lymph nodes (the lymph node ratio [LNR]) is a better predictor of survival as compared to the number of positive lymph nodes in resected esophageal cancer. Methods: 1,149 patients with resected esophageal cancer from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. The patients were further characterized to 3 lymph node quartiles based on LNR and their median survivals were calculated using the Kaplan-Meier method. Results: Out of 1149 patients 26.4% patients (303) had squamous cell carcinoma and 73.6% (846) were of adenocarcinoma histology. Median age of diagnosis is 63 years. 353 (31%) are stage 1, 384 (33%) are stage 2, and 412 (36%) are stage 3. Majority of them 71% arise in lower third of esophagus followed by 13% in middle third, 4% in upper third and 12 % had unknown site of origin. The group was subdivided into 3 quartiles with 62.7% in LNR1 (0.0-0.1), 25.6% in LNR2 (0.1-0.5) and 11.7% in LNR3 (0.5-1.0). 13.7% had less than 2 nodes removed, 29.3% had 3-6 nodes and 57% had >7 nodes examined. 28% of them had tumor invading sub mucosa, 23.5% had tumor invading muscularis mucosa, 43.2% had involvement of adventitia and 5.3% had penetrating tumor at the time of diagnosis The 5 year survivals based on number of lymph nodes examined, number of positive lymph nodes and positive lymph node ratio are listed in the table. The median overall survival for resected esophageal cancer based on LNR quartiles was 37 vs 14 vs 11.5 months (p<0.0001). Conclusions: Number of positive lymph nodes and positive lymph node ratio correlated with survival outcomes but number of lymph nodes retrieved did not predict any survival differences. However LNR was a better predictor of survival when compared to number of positive nodes. Further validation of this observation needs to done in large multicenter studies. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- R. Thota
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - T. Tashi
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - W. Gonsalves
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - A. R. Sama
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - P. T. Silberstein
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - P. Townley
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - S. Subbiah
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
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Tashi T, Thota R, Krishnamurthy J, Sama AR, Aldoss IT, Gonsalves W, Ganti A, Townley P, Silberstein PT, Subbiah S. Primary non-Hodgkin lymphoma of the colon among patients in the Veterans Affairs Health System. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
554 Background: Primary non-Hodgkin lymphoma (NHL) of the colon is rare. There are no randomized controlled trials describing treatment outcomes for this tumor. We provide the largest descriptive study of this tumor to date. Methods: Retrospective analysis of 109 patients diagnosed with primary non-Hodgkin lymphoma of the colon from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. By definition, all cases presented with a lymphomatous involvement of the colon as the first manifestation of their disease with no previous diagnosis of NHL of any type or site. Demographic, staging, histology, treatment, and outcome data was recorded. Lymphomas were classified as aggressive versus indolent based on their histology. Results: There were 36,260 colon cancers diagnosed in 1995-2008 of which 109 (0.3%) were primary non-Hodgkin colon lymphomas. The median age of diagnosis was 67 years. 55 pts had aggressive disease, 27 pts had indolent disease, and 27 pts had inadequate histological data. Diffuse large B cell lymphoma (73%) was the most common aggressive lymphoma whereas it was marginal zone (56%) in the indolent group. The indolent group had 5- year survival rate of 76.9% compared to 48.6% for the aggressive group. Both groups had received different treatment regimens as seen in the Table with variable mean survival outcomes. Conclusions: Our data suggests addition of postoperative adjuvant chemotherapy appears superior to surgery alone in the treatment of aggressive disease whereas it does not appear to provide any benefit in the treatment of indolent disease. However, patient numbers are too small to draw definite conclusions and warrant future investigation in multinational randomized fashion. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. Tashi
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - R. Thota
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - J. Krishnamurthy
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. R. Sama
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - I. T. Aldoss
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - W. Gonsalves
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. Ganti
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. Townley
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. T. Silberstein
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - S. Subbiah
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
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Kalaiah M, Gonsalves W, Townley P, Tashi T, Aldoss I, Didwaniya N, Ganta A, Thota R, AL-Howaidi I, Subbiah S. Genitourinary small cell carcinoma: Analysis of clinical and treatment factors associated with survival among patients in the Veterans Affairs Health System. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Subbiah S, Tashi T, Gonsalves W, Kalaiah M, Didwaniya N, Thota R, Kanuri S, Townley P, Aldoss I, Silberstein PT. Male breast cancer in veteran population: Retrospective analysis of VACCR database. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1031] [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: 11/20/2022] Open
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