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Dhannoon A, Atukoralalage U, Dhannoon A, Sehgal R, Collins CG. Challenges associated with Global Bariatric Medical Tourism. Ir Med J 2023; 116:809. [PMID: 37606236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Adejuyigbe EA, Agyeman I, Anand P, Anyabolu HC, Arya S, Assenga EN, Badhal S, Brobby NW, Chellani HK, Chopra N, Debata PK, Dube Q, Dua T, Gadama L, Gera R, Hammond CK, Jain S, Kantumbiza F, Kawaza K, Kija EN, Lal P, Mallewa M, Manu MK, Mehta A, Mhango T, Naburi HE, Newton S, Nyanor I, Nyako PA, Oke OJ, Patel A, Phlange-Rhule G, Sehgal R, Singhal R, Wadhwa N, Yiadom AB. Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study. Trials 2023; 24:265. [PMID: 37038239 PMCID: PMC10088121 DOI: 10.1186/s13063-023-07192-5] [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: 07/28/2022] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.
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Affiliation(s)
- E A Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - I Agyeman
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P Anand
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - H C Anyabolu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - S Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - E N Assenga
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Badhal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - N W Brobby
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - H K Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India.
| | - N Chopra
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - P K Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Q Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - L Gadama
- Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - R Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - C K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - F Kantumbiza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - K Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - E N Kija
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - P Lal
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - M Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - M K Manu
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - A Mehta
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - T Mhango
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - H E Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - I Nyanor
- Research and Development, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P A Nyako
- Department of Psychiatry, Child And Adolescent Mental Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - O J Oke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - A Patel
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - G Phlange-Rhule
- Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, Faridabad, 121001, India
| | - R Sehgal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - R Singhal
- Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, 121001, Faridabad, India
| | - N Wadhwa
- Faridabad-Gurgaon Expressway, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd MilestonePost Box #04, Faridabad, Haryana, 121001, India.
| | - A B Yiadom
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Yadav P, Trehanpati N, Maiwall R, Sehgal R, Singh R, Islam M, Jagdish RK, Vijayaraghavan R, Maheshwari D, Bhat S, Kale P, Kumar A, Baweja S, Kumar G, Ramakrishna G, Sarin SK. Soluble factors and suppressive monocytes can predict early development of sepsis in acute-on-chronic liver failure. Hepatol Commun 2022; 6:2105-2120. [PMID: 35502507 PMCID: PMC9315131 DOI: 10.1002/hep4.1949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 01/08/2023] Open
Abstract
Patients with acute-on-chronic liver failure (ACLF) have a high probability of developing systemic inflammation and sepsis due to immune dysregulation. Fifty-nine patients with ACLF (12 without and 19 with systemic inflammation, and 28 with sepsis) were serially monitored for clinical and immunological changes at baseline, 6 hours, 24 hours, day 3, and day 7 following hospitalization. Ten healthy controls were also included. At all time points, soluble plasma factors and monocyte functions were studied. Patients with ACLF and systemic inflammation showed higher interleukin (IL)-6, vascular endothelial growth factor-a, monocyte chemoattractant protein 1, and macrophage inflammatory protein 1β than patients with no systemic inflammation. Patients with ACLF with sepsis had raised (p < 0.001) levels of IL-1Ra, IL-18, and triggering receptor expressed on myeloid cells 1 (TREM1) compared to patients with ACLF-systemic inflammation. Five of the 19 (26.3%) patients with systemic inflammation developed sepsis within 48-72 hours with a rapid rise in plasma levels of IL-1Ra (1203-35,000 pg/ml), IL-18 (48-114 pg/ml), and TREM1 (1273-4865 pg/ml). Monocytes of patients with ACLF with systemic inflammation and sepsis showed reduced human leukocyte antigen-DR but increased programmed death ligand 1 (PD-L1) and T-cell immunoglobulin and mucin domain-containing protein 3 (TIM3) (p < 0.04) expression with increased ETosis by monocytes at baseline and until day 7. Conclusion: High and rising levels of plasma IL-1Ra, IL-18, TREM1 soluble factors, and increased suppressive monocytes (PDL1+ve , TIM3+ve ) at baseline can stratify patients with ACLF at high risk of developing sepsis within 48-72 hours of hospitalization.
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Affiliation(s)
- Pushpa Yadav
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Nirupama Trehanpati
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Rakhi Maiwall
- 80402Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Rashi Sehgal
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Ravinder Singh
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Mojahidul Islam
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Rakesh Kumar Jagdish
- 80402Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Rajan Vijayaraghavan
- 80402Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Deepanshu Maheshwari
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Sadam Bhat
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Pratibha Kale
- 80402Department of MicrobiologyInstitute of Liver and Biliary SciencesNew DelhiIndia
| | - Anupam Kumar
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Sukriti Baweja
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Guresh Kumar
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Gayatri Ramakrishna
- Laboratory of Molecular ImmunologyDepartment of Molecular and Cellular MedicineInstitute of Liver and Biliary Sciences New DelhiNew DelhiIndia
| | - Shiv K Sarin
- 80402Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia
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Sen B, Aggarwal S, Nath R, Sehgal R, Singh R, Agrawal K, Shashidhara AN, Rastogi A, Bajpai M, Pamecha V, Trehanpati N, Ramakrishna G. Secretome of senescent hepatoma cells modulate immune cell fate by macrophage polarization and neutrophil extracellular traps formation. Med Oncol 2022; 39:134. [PMID: 35726030 DOI: 10.1007/s12032-022-01732-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/09/2022] [Indexed: 01/07/2023]
Abstract
Presence of dysfunctional senescent hepatocytes is a hallmark feature of liver cirrhosis which finally culminates in liver cancer. We now report the presence of senescent hepatocytes (p21 and p53 positive) in the vicinity of infiltrated immune cells in hepatocellular carcinoma tissue specimens by immunohistochemistry. Hence, we evaluated in vitro, the relevance of senescent hepatoma cells in altering the fate of monocytes and neutrophils by assaying for macrophage polarization and extracellular trap (NETs) formation, respectively. Premature senescence was induced in hepatoma cells (HepG2 and Huh7 cells) by treating cells with doxorubicin. Senescent hepatoma cells showed strong inflammatory phenotype with induced expression of cytokines (IL1β, IL6, IL8 and IL13) as evaluated by flow cytometry. The senescent secretome from hepatoma cells when incubated with healthy monocytes caused it to differentiate predominantly towards M2 fate (CD80low CD86low CD163high CD206high) when analysed by flow cytometry. This was corroborated by the finding in clinical samples where human hepatocellular carcinoma harbouring senescent hepatocytes showed presence of M2 macrophages, while M1 macrophages were predominant in non-tumorous region. Additionally, the senescent secretome from Huh7 cells enhanced the NETs formation, while HepG2 secretome had an inhibitory effect. In conclusion, the "pro-inflammatory" senescent secretome drives non-inflammatory type M2 macrophage polarization and modulated neutrophil traps which in turn can influence the tumor microenvironment.
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Affiliation(s)
- Bijoya Sen
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India.,Buck Institute for Research on Aging, Novato, CA, USA
| | - Savera Aggarwal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Rhisita Nath
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Ravinder Singh
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Khushboo Agrawal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | | | - Archana Rastogi
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Meenu Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepatopancreatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), D1 Block, Vasant Kunj, New Delhi, 110070, India.
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Sehgal R, Maiwall R, Rajan V, Islam M, Baweja S, Kaur N, Kumar G, Ramakrishna G, Sarin SK, Trehanpati N. Granulocyte-Macrophage Colony-Stimulating Factor Modulates Myeloid-Derived Suppressor Cells and Treg Activity in Decompensated Cirrhotic Patients With Sepsis. Front Immunol 2022; 13:828949. [PMID: 35720398 PMCID: PMC9205181 DOI: 10.3389/fimmu.2022.828949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Decompensated cirrhosis patients are more prone to bacterial infections. Myeloid-derived suppressor cells (MDSCs) expand in sepsis patients and disrupt immune cell functions. Granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy helps in restoring immune cell functions and resolving infections. Its role in MDSC modulation in cirrhosis with sepsis is not well understood. Methods A total of 164 decompensated cirrhotic—62 without (w/o), 72 with sepsis, and 30 with sepsis treated with GM-CSF—and 15 healthy were studied. High-dimensional flow cytometry was performed to analyze MDSCs, monocytes, neutrophils, CD4 T cells, and Tregs at admission and on days 3 and day 7. Ex vivo co-cultured MDSCs with T cells were assessed for proliferation and apoptosis of T cells and differentiation to Tregs. Plasma factors and mRNA levels were analyzed by cytokine-bead assay and qRT-PCR. Results Frequencies of MDSCs and Tregs were significantly increased (p = 0.011 and p = 0.02) with decreased CD4 T cells (p = 0.01) in sepsis than w/o sepsis and healthy controls (HCs) (p = 0.000, p = 0.07, and p = 0.01) at day 0 and day 7. In sepsis patients, MDSCs had increased IL-10, Arg1, and iNOS mRNA levels (p = 0.016, p = 0.043, and p = 0.045). Ex vivo co-cultured MDSCs with T cells drove T-cell apoptosis (p = 0.03, p = 0.03) with decreased T-cell proliferation and enhanced FOXP3+ expression (p = 0.044 and p = 0.043) in sepsis compared to w/o sepsis at day 0. Moreover, blocking the MDSCs with inhibitors suppressed FOXP3 expression. GM-CSF treatment in sepsis patients significantly decreased MDSCs and FOXP3+ Tregs but increased CD4 T-cell functionality and improved survival. Conclusion MDSCs have an immunosuppressive function by expanding FOXP3+ Tregs and inhibiting CD4+ T-cell proliferation in sepsis. GM-CSF treatment suppressed MDSCs, improved T-cell functionality, and reduced Tregs in circulation.
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Affiliation(s)
- Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vijayaraghavan Rajan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mojahidul Islam
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sukriti Baweja
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Navkiran Kaur
- Amity Institute of Biotechnology, Amity University, Noida, India
| | - Guresh Kumar
- Department of Clinical Research and Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence: Nirupma Trehanpati, ; ; Shiv K. Sarin, ;
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence: Nirupma Trehanpati, ; ; Shiv K. Sarin, ;
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Maheshwari D, Kumar D, Jagdish RK, Nautiyal N, Hidam A, Kumari R, Sehgal R, Trehanpati N, Baweja S, Kumar G, Sinha S, Bajpai M, Pamecha V, Bihari C, Maiwall R, Sarin SK, Kumar A. Bioenergetic Failure Drives Functional Exhaustion of Monocytes in Acute-on-Chronic Liver Failure. Front Immunol 2022; 13:856587. [PMID: 35747140 PMCID: PMC9210982 DOI: 10.3389/fimmu.2022.856587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The monocyte–macrophage system is central to the host’s innate immune defense and in resolving injury. It is reported to be dysfunctional in acute-on-chronic liver failure (ACLF). The disease-associated alterations in ACLF monocytes are not fully understood. We investigated the mechanism of monocytes’ functional exhaustion and the role of umbilical cord mesenchymal stem cells (ucMSCs) in re-energizing monocytes in ACLF. Design Monocytes were isolated from the peripheral blood of ACLF patients (n = 34) and matched healthy controls (n = 7) and patients with compensated cirrhosis (n = 7); phagocytic function, oxidative burst, and bioenergetics were analyzed. In the ACLF mouse model, ucMSCs were infused intravenously, and animals were sacrificed at 24 h and day 11 to assess changes in monocyte function, liver injury, and regeneration. Results Patients with ACLF (alcohol 64%) compared with healthy controls and those with compensated cirrhosis had an increased number of peripheral blood monocytes (p < 0.0001) which displayed significant defects in phagocytic (p < 0.0001) and oxidative burst capacity (p < 0.0001). ACLF patients also showed a significant increase in the number of liver macrophages as compared with healthy controls (p < 0.001). Bioenergetic analysis showed markedly reduced oxidative phosphorylation (p < 0.0001) and glycolysis (p < 0.001) in ACLF monocytes. Patients with monocytes having maximum mitochondrial respiration of <37.9 pmol/min [AUC = 0.822, hazard ratio (HR) = 4.5] and baseline glycolysis of ≤42.7 mpH/min (AUC = 0.901, HR = 9.1) showed increased 28-day mortality (p < 0.001). Co-culturing ACLF monocytes with ucMSC showed improved mitochondrial respiration (p < 0.01) and phagocytosis (p < 0.0001). Furthermore, ucMSC therapy increased monocyte energy (p < 0.01) and phagocytosis (p < 0.001), reduced hepatic injury, and enhanced hepatocyte regeneration in ACLF animals. Conclusion Bioenergetic failure drives the functional exhaustion of monocytes in ACLF. ucMSCs resuscitate monocyte energy and prevent its exhaustion. Restoring monocyte function can ameliorate hepatic injury and promote liver regeneration in the animal model of ACLF.
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Affiliation(s)
- Deepanshu Maheshwari
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Dhananjay Kumar
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakesh Kumar Jagdish
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nidhi Nautiyal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ashinikumar Hidam
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rekha Kumari
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupama Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sukriti Baweja
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Swati Sinha
- Department of Obstetrics and Gynaecology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Meenu Bajpai
- Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepato-Pancreato-Biliary (HPB) Surgery and Liver Transplant, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence: Anupam Kumar, ; Shiv Kumar Sarin,
| | - Anupam Kumar
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence: Anupam Kumar, ; Shiv Kumar Sarin,
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Wong S, Sehgal R, Birks T, Allen D, Goyal A, Kucheria R, Ajayi L, Ellis G. 1191 The Use of CT Urography to Diagnose Upper Tract Urothelial Carcinomas (UTUC); Managing Surgical Resources During The COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1103] [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: 11/13/2022]
Abstract
Abstract
Introduction
Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre.
Method
A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database.
Results
57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis.
Conclusions
A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
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Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - T Birks
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - R Kucheria
- Royal Free Hospital, London, United Kingdom
| | - L Ajayi
- Royal Free Hospital, London, United Kingdom
| | - G Ellis
- Royal Free Hospital, London, United Kingdom
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Wong S, Sehgal R, Goyal A, Allen D. 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.764] [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: 11/13/2022]
Abstract
Abstract
Introduction
Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents.
Method
A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up.
Results
Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%.
Conclusions
Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.
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Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
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Sehgal R, Kaur N, Ramakrishna G, Trehanpati N. Immune Surveillance by Myeloid-Derived Suppressor Cells in Liver Diseases. Dig Dis 2021; 40:301-312. [PMID: 34157708 DOI: 10.1159/000517459] [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] [Received: 01/08/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) are immunosuppressive in nature, originate in the bone marrow, and are mainly found in the blood, spleen, and liver. In fact, liver acts as an important organ for induction and accumulation of MDSCs, especially during infection, inflammation, and cancer. In humans and rodents, models of liver diseases revealed that MDSCs promote regeneration and drive the inflammatory processes, leading to hepatitis, fibrogenesis, and cirrhosis, ultimately resulting in hepatocellular carcinoma. SUMMARY This brief review is focused on the in-depth understanding of the key molecules involved in the expansion and regulation of MDSCs and their underlying immunosuppressive mechanisms in liver diseases. KEY MESSAGE Modulated MDSCs can be used for therapeutic purposes in inflammation, cancer, and sepsis.
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Affiliation(s)
- Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.,Amity Institute of Biotechnology (AIB), Amity University, Noida, India
| | - Navkiran Kaur
- Amity Institute of Biotechnology (AIB), Amity University, Noida, India
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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Sehgal R, Wong S, Abu-Ghanem Y, Birks T, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. What part does ureteroscopy play in the diagnostic pathway of upper tract urothelial carcinoma? A two-year review in a high volume institution. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01175-1] [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: 10/20/2022]
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11
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Rakholiya J, Koster M, Langenfeld H, Crowson CS, Abril A, Bansal P, Mertz L, Rodriguez-Pla A, Sehgal R, Wang B, Warrington KJ. POS0805 TREATMENT OF GIANT CELL ARTERITIS WITH TOCILIZUMAB: A RETROSPECTIVE COHORT STUDY OF 119 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant cell arteritis (GCA) is an inflammatory condition of medium- and large-sized arteries. Prospective clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for treatment of patients with GCA (1). However, there is a limited data on the use of TCZ in routine clinical practice.Objectives:To evaluate the efficacy and safety of TCZ in a retrospective cohort study of patients with GCA treated with TCZ.Methods:Patients with GCA treated with TCZ at 4 clinical centers of a single tertiary care institution (2000-2020) were identified. The diagnosis of GCA was confirmed by at least one of the following modalities: 1. Arterial biopsy 2. Large vessel imaging 3. Clinical diagnosis of GCA meeting ACR classification criteria and established by a rheumatologist. Patient demographics, clinical presentation, laboratory studies, treatment course and adverse events were abstracted from the medical record; only patients with at least 6 months of follow-up after TCZ initiation were included. Kaplan-Meier methods were used to estimate time to TCZ discontinuation and time to first relapse after TCZ discontinuation. Poisson regression models were used to compare relapse rates before and after TCZ initiation.Results:The study cohort included 119 patients [61% female; mean (SD) age at GCA diagnosis 70.3 (8.2) years]. The majority of patients (89%) had a biopsy-proven and/or imaging-based diagnosis of GCA, while 13 (11%) had a clinical diagnosis of GCA. In addition to glucocorticoids, 40 (34%) patients received other immunosuppressive agents prior to TCZ. The method of initial TCZ administration was subcutaneous (162mg/ml) weekly in 48 (41%), subcutaneous every other week in 20 (17%), monthly 4mg/kg infusions in 34 (29%), monthly 8mg/kg infusions in 14 (12%) and non-standard dosing in 3 remaining patients. The median (IQR) duration from GCA diagnosis to TCZ initiation was 4.8 (1.2-22.0) months and the median (IQR) duration of TCZ treatment was 18 (11-28) months. The mean (SD) dose of prednisone at TCZ initiation was 31 (19) mg/day and was reduced to a mean (SD) dose of 3.9 (6.7) mg/day at TCZ discontinuation/last follow-up visit. The relapse rate per year decreased 43% from 0.77 to 0.44 after the initiation of TCZ (RR=0.57; 95% CI: 0.44-0.75; p<0.001). The mean (SD) ESR and CRP decreased from 22 (20) mm/hour to 6 (9.2) mm/hour and from 19.1 (25) mg/L to 5.4 (16.6) mg/L, respectively from TCZ initiation to TCZ discontinuation/last follow-up visit. At 2 years of follow-up, 67% of patients had discontinued glucocorticoids. At last follow up, 46 patients had discontinued TCZ, only 14 of which were due to adverse events. The median time to TCZ discontinuation was 2.9 years. Only 17% (95%CI: 10-24%) had discontinued by 1 year after TCZ initiation and 38% (95% CI: 26-47%) had discontinued by 2 years. The most common adverse events were infections and cytopenias. While on TCZ, 1 patient developed new onset vision loss related to GCA and 1 patient, without history of diverticulitis, had bowel perforation. Among those discontinuing TCZ, 61% had relapsed at least once by 1 year after TCZ discontinuation.Conclusion:In this large single institution cohort of patients with GCA, TCZ use resulted in a significantly reduced relapse rate and reduction in glucocorticoid dosage. Overall, patients tolerated long-term use with only 12% discontinuing due to adverse events. However, over half of patients stopping TCZ had a subsequent flare; highlighting ongoing use may be required beyond two years in several patients with GCA to maintain remission.References:[1]Stone JH, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017 Jul 27;377(4):317-328. doi: 10.1056/NEJMoa1613849. PMID: 28745999.[2]Calderón-Goercke M, et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum. 2019 Aug;49(1):126-135. doi: 10.1016/j.semarthrit.2019.01.003. Epub 2019 Jan 5. PMID: 30655091.Disclosure of Interests:Jigisha Rakholiya: None declared, Matthew Koster: None declared, Hannah Langenfeld: None declared, Cynthia S. Crowson: None declared, Andy Abril: None declared, Pankaj Bansal: None declared, Lester Mertz: None declared, Alicia Rodriguez-Pla: None declared, Rahul Sehgal: None declared, Benjamin Wang: None declared, Kenneth J Warrington Grant/research support from: Research support: Kiniksa, Eli Lilly
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12
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Sehgal R, Bedi O, Trehanpati N. Role of Microbiota in Pathogenesis and Management of Viral Hepatitis. Front Cell Infect Microbiol 2020; 10:341. [PMID: 32850467 PMCID: PMC7431464 DOI: 10.3389/fcimb.2020.00341] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 03/12/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
Hepatitis is a condition that can be self-limiting or can progress to fibrosis (scarring), cirrhosis, or liver cancer. These days, gut microbiota becomes an important part of our immune system, which is important for disease progression or recovery. Translocation of gut microbial and metabolic products causes intestinal inflammation by modulating immune cells leading to impairment of the primary barrier. But there are limited studies discussing pathogenesis and management of hepatitis with gut microbiota. In this review, we have discussed the role of gut microbiota in pathogenesis and management of various hepatitis, especially hepatitis B and C. We have discussed the role of bacterial products, LPS-TLR4 pathway, and unmethylated CpG DNA, which ultimately affects downstream NF-kB signaling in hepatitis. Finally, we have discussed the role of fecal microbiota transplantation in the management of hepatitis.
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Affiliation(s)
- Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Onkar Bedi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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13
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Sehgal R, Birks T, Pindoria N, Grant L, Ajayi L, Ellis G. Computed tomography urography (CTU) findings as a predictor of the presence and grade of upper tract urothelial cancer (UTUC). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Sehgal R, Birks T, Pindoria N, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. The vital role of diagnostic ureteroscopy in the diagnosis of upper tract urothelial carcinoma: Review of a high-volume centre over a 12-month period. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)30090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Sehgal R, Kaur S, Shasthry SM, Agrawal T, Dwivedi V, Seth D, Ramakrishna G, Sarin SK, Trehanpati N. Natural Killer Cells Contribute to Pathogenesis of Severe Alcoholic Hepatitis by Inducing Lysis of Endothelial Progenitor Cells. Alcohol Clin Exp Res 2019; 44:78-86. [PMID: 31746472 DOI: 10.1111/acer.14242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endothelial progenitor cells (EPCs) help in neovascularization and endothelial repair during injury. Patients with cirrhosis show increased number and function of EPCs in circulation. METHODS Since natural killer (NK) cells regulate EPCs, we investigated the relationship between the 2 in alcoholic cirrhosis (AC, n = 50) and severe alcoholic hepatitis (SAH, n = 18) patients and compared with nonalcoholic cirrhosis (n = 15) and healthy controls (HC, n = 30). Levels of systemic inflammatory cytokines were measured, and coculture assays were performed between EPCs and NK cells in contact-dependent and contact-independent manner. NK cell-mediated killing of EPCs was evaluated, and expression of receptors including fractalkine (FKN) on EPCs and its cognate receptor CX3CR1 on NK cells was studied by RT-PCR assays. RESULTS Patients with SAH had higher regulated on activation, normal T cell expressed and secreted (RANTES) (p = 0.01), vascular endothelial growth factor (VEGF) (p = 0.04), IL-1β (p = 0.04), and IL-6 (p = 0.00) growth factors and proinflammatory cytokines as compared to AC and HC. Distinct populations of CD31+ CD34+ EPCs with low and high expression of CD45 were significantly lower in SAH than HC (CD45low , p = 0.03; CD45hi , p = 0.04) and AC (CD45low , p = 0.05; CD45hi , p = 0.02). SAH patients, however, showed increased functional capacity of EPCs including colony formation and LDL uptake. NK cells were reduced in SAH compared with AC (p = 0.002), however with higher granzyme ability (p < 0.001 and p = 0.04, respectively). In SAH, EPC-NK cell interaction assays showed that NK cells lysed the EPCs in both contact-dependent and contact-independent assays. Expression of interaction receptor CX3CR1 was significantly higher on NK cells (p = 0.0005), while its cognate receptor, FKN, was increased on EPCs in SAH patients as compared to HC (p = 0.0055). CONCLUSION We conclude that in SAH, NK cells induce killing of EPCs via CX3CR1/FKN axis that may be one of the key events contributing to disease severity and proinflammatory responses in SAH.
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Affiliation(s)
- Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Savneet Kaur
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Tanvi Agrawal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Varsha Dwivedi
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Devanshi Seth
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Centenary Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Gayatri Ramakrishna
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
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16
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Gautam S, Chauhan A, Sharma R, Sehgal R, Shirkot CK. Potential of Bacillus amyloliquefaciens for biocontrol of bacterial canker of tomato incited by Clavibacter michiganensis ssp. michiganensis. Microb Pathog 2019; 130:196-203. [PMID: 30878620 DOI: 10.1016/j.micpath.2019.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/26/2022]
Abstract
A total of 150 rhizobacteria and endorhizobacteria previously isolated from three different horticultural crops; strawberry, apple and apricot were screened for antagonistic activitiy against Clavibacter michiganensis ssp. michiganensis. Among them strain S1, exhibiting significantly higher antagonistic and plant growth promoting ability was characterized as Bacillus amyloliquefaciens based on morphological, biochemical and partial gene sequence analysis of 16S rRNA. B. amyloliquefaciens strain S1 showed maximum growth inhibition of C. michiganensis (12 mm). Moreover, B. amyloliquefaciens strain S1 exhibit significant phosphorus solubilization (94.16 %SEl) and indole acetic acid (27 μg ml-1) production under in vitro conditions. Antagonistic activity of Bacillus amyloliquefaciens strain S1 was compared with other four strains KU2S1, R2S(1), RG1(3) and AG1(7) against bacterial canker of tomato under net house conditions. Minimum bacterial canker disease incidence (30.0%) was recorded in B. amyloliquefaciens S1 followed by RG1(3) after 30 days of inoculation. The bio-control efficacy was higher in B. amyloliquefaciens S1 treated plants, followed by RG1(3).
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Affiliation(s)
- S Gautam
- Department of Basic Sciences, Dr YS P University of Horticulture and Forestry, Nauni, Solan, 173 230, HP, India.
| | - A Chauhan
- Department of Soil Science and Water Management , Dr YS P University of Horticulture and Forestry, Nauni, Solan, 173 230, HP, India
| | - R Sharma
- Department of Microbiology, DAV University, Jalandhar, Punjab, 144012, India
| | - R Sehgal
- Department of Basic Sciences, Dr YS P University of Horticulture and Forestry, Nauni, Solan, 173 230, HP, India
| | - C K Shirkot
- Department of Basic Sciences, Dr YS P University of Horticulture and Forestry, Nauni, Solan, 173 230, HP, India
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Abstract
We present a rare and previously undocumented potential complication of computed tomography (CT) colonography. CT colonography is a commonly performed investigation with a relatively low risk of complications. While splenic injury is a well-documented complication after colonoscopy, it has never been reported following CT colonography. A 64-year-old man presented with severe abdominal pain four hours after CT colonography. CT of his abdomen and pelvis revealed appearances consistent with intra-abdominal bleeding secondary to splenic injury. The patient immediately underwent an emergency laparotomy and splenectomy, revealing a grade III splenic capsular tear. Histological evaluation of splenic tissue showed normal morphology with no evidence of malignancy. While the aetiology of the patient's splenic injury remains uncertain, normal histopathology and the chronology of events represents an almost certain link to CT colonography.
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Affiliation(s)
- R Sehgal
- Department of Emergency Surgery, Kingston Hospital NHS Foundation Trust , Kingston upon Thames , UK
| | - T Whitehead-Clarke
- Department of Emergency Surgery, Kingston Hospital NHS Foundation Trust , Kingston upon Thames , UK
| | - V Tudyka
- Department of Emergency Surgery, Kingston Hospital NHS Foundation Trust , Kingston upon Thames , UK
| | - S Evans
- Radiology Department, Kingston Hospital NHS Foundation Trust , Kingston upon Thames , UK
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18
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Sarmah NP, Sarma K, Bhattacharyya DR, Sultan AA, Bansal D, Singh N, Bharti PK, Sehgal R, Mohapatra PK, Parida P, Mahanta J. Antifolate drug resistance: Novel mutations and haplotype distribution in dhps and dhfr from Northeast India. J Biosci 2018; 42:531-535. [PMID: 29229871 DOI: 10.1007/s12038-017-9706-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malaria is a major public health concern in Northeast India with a preponderance of drug-resistant strains. Until recently the partner drug for artemisinin combination therapy (ACT) was sulphadoxine pyrimethamine (SP). Antifolate drug resistance has been associated with the mutations at dihydropteroate synthase (dhps) and dihydrofolatereductase (dhfr) genes. This study investigated antifolate drug resistance at the molecular level. A total of 249 fever cases from Arunachal Pradesh, NE India, were screened for malaria, and of these, 75 were found to be positive for Plasmodium falciparum. Samples were sequenced and analysed with the help of BioEdit and ClustalW. Three novel point mutations were found in the dhps gene with 10 haplotypes along with the already reported mutations. A single haplotype having quadruple mutation was found in the dhfr gene. The study reports higher degree of antifolate drug resistance as evidenced by the presence of multiple point mutations in dhps and dhfr genes. The findings of this study strongly discourage the use SP as a partner drug in ACT.
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Affiliation(s)
- N P Sarmah
- Regional Medical Research Centre (Indian Council of Medical Research), Dibrugarh, Assam 786 001, India
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Sehgal R, Whitehead-Clarke T, Tudyka V. CT colonography - A new threat to the spleen? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Delisle T, Dalrymple J, Sehgal R, Gerogiannis I. Acute diverticulitis admissions warrant prompt consultant review. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Sehgal R, Dalrymple J, Husada G, O'Carroll-Kuehn B. Improving outcomes of patients undergoing emergency laparotomy in a district general hospital. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Kaur S, Sehgal R, Shastry SM, McCaughan G, McGuire HM, Fazekas St de Groth B, Sarin S, Trehanpati N, Seth D. Circulating Endothelial Progenitor Cells Present an Inflammatory Phenotype and Function in Patients With Alcoholic Liver Cirrhosis. Front Physiol 2018; 9:556. [PMID: 29872403 PMCID: PMC5972283 DOI: 10.3389/fphys.2018.00556] [Citation(s) in RCA: 12] [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: 02/09/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
Background and Aim: Endothelial progenitor cells (EPCs) have been implicated in liver injury and repair. However, the phenotype and potential of these heterogenous EPCs remain elusive. In particular, their involvement in the pathogenesis of alcoholic liver cirrhosis (ALC) remains unclear. The current study extensively characterized the phenotype and functions of EPCs to understand their role in ALC pathogenesis. Methods: Circulating EPCs were identified as CD34+CD133+CD31+ cells by flow cytometer in ALC patients (n = 7) and healthy controls (HC, n = 7). A comprehensive characterization of circulating EPCs using more than 30 phenotype markers was performed by mass cytometer time of flight (CyTOF) in an independent cohort of age and gender matched ALC patients (n = 4) and controls (n = 5). Ex vivo cultures of circulating EPCs from ALC patients (n = 20) and controls (n = 18) were also tested for their functions, including colony formation, LDL uptake, lectin binding and cytokine secretion (ELISA). Results: Three distinct populations of circulating EPCs (CD34+CD133+CD31+) were identified, classified on their CD45 expression (negative: CD45-; intermediate: CD45int; high: CD45hi). CD45int and CD45hi EPCs significantly increased in ALC patients compared to controls (p-val = 0.006). CyTOF data showed that CD45hi EPCs were distinct from CD45- and CD45int EPCs, with higher expression of T cell and myeloid markers, including CD3, CD4, HLA-DR, and chemokine receptors, CCR2, CCR5, CCR7, and CX3CR1. Similar to circulating EPCs, percentage of CD45hiCD34+CD31+ EPCs in ex-vivo cultures from patients, were significantly higher compared to controls (p < 0.05). Cultured EPCs from patients also showed increased LDL uptake, lectin binding and release of TNF-alpha, RANTES, FGF-2, and VEGF. Conclusions: We report the first extensive characterization of circulating human EPCs with distinct EPC subtypes. Increase in CD45hi EPC subtype in ALC patients with enhanced functions, inflammatory cytokines and angiogenic mediators in patients suggests an inflammatory role for these cells in ALC.
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Affiliation(s)
- Savneet Kaur
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rashi Sehgal
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Saggere M. Shastry
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Geoffrey McCaughan
- Liver Injury and Cancer, Centenary Institute of Cancer Medicine and Cell Biology, Camperdown, NSW, Australia
| | - Helen M. McGuire
- Liver Injury and Cancer, Centenary Institute of Cancer Medicine and Cell Biology, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Ramaciotti Facility for Human Systems Biology, University of Sydney, Sydney, NSW, Australia
| | - Barbara Fazekas St de Groth
- Ramaciotti Facility for Human Systems Biology, University of Sydney, Sydney, NSW, Australia
- Discipline of Pathology, University of Sydney, Sydney, NSW, Australia
| | - Shiv Sarin
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Devanshi Seth
- Liver Injury and Cancer, Centenary Institute of Cancer Medicine and Cell Biology, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
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Aggarwal H, Nair J, Sharma P, Sehgal R, Naeem U, Rajora P, Mathur R. Aegle marmelos differentially affects hepatic markers of glycolysis, insulin signalling pathway, hypoxia, and inflammation in HepG2 cells grown in fructose versus glucose-rich environment. Mol Cell Biochem 2017; 438:1-16. [PMID: 28766170 DOI: 10.1007/s11010-017-3108-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/07/2017] [Accepted: 07/01/2017] [Indexed: 01/06/2023]
Abstract
Fructose consumption is responsible for the onset of insulin resistance (IR), and metabolic syndrome. It possesses no functional utility in body and its detrimental effects on hepatic metabolic milieu are beyond those produced by glucose. The need of the hour is to identify fructose-induced IR as an unique pathological state to be managed differentially. The effect of aqueous leaf extract of Aegle marmelos (AM) on hepatic markers of insulin resistance using HepG2 cells cultured in either fructose or glucose-rich environment is investigated. Human hepatocellular carcinoma cells (HepG2) were grown under standard conditions in either-DMEM without glucose (NC), DMEM with high glucose 25 mM (Glu), DMEM-glucose+0.55 mM fructose (FC1), DMEM-glucose+1 mM fructose (FC2) or DMEM-glucose+1 mM fructose+0.1 µM insulin (FC3). The cells were treated with either AM, rutin, quercetin, metformin or pioglitazone and assessed for levels of hexokinase, phosphofructokinase (PFK), aldehyde dehydrogenase, phosphatidylinositol kinase (PI3K), signal transducer and activator of transcription-3 (STAT-3), mitochondrial target of rapamycin (mTOR), hypoxia-induced factor (HIF-1α), vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF-α). Summarily, when results from fructose- and glucose-rich environment were compared, then (1) IR was more pronounced in former; (2) AM performed better in former; (3) metformin and pioglitazone were equivocal in either; (4) rutin and quercetin showed deviant effects from AM; and lastly (5) effects of rutin were closer to AM than quercetin. We hypothesize that AM ameliorates fructose-induced IR through a mechanism which is distinct from standard drugs and not shared by individual phytoconstituents in toto.
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Affiliation(s)
- H Aggarwal
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - J Nair
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - P Sharma
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - R Sehgal
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - U Naeem
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - P Rajora
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India
| | - R Mathur
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Pushp Vihar, Sector-3, MB Road, New Delhi, 110017, India.
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Trehanpati N, Sehgal R, Patra S, Vyas A, Vasudevan M, Khosla R, Khanam A, Kumar G, Maiwall R, Ramakrishna G, Kottilil S, Sarin SK. miRNA signatures can predict acute liver failure in hepatitis E infected pregnant females. Heliyon 2017; 3:e00287. [PMID: 28413835 PMCID: PMC5384411 DOI: 10.1016/j.heliyon.2017.e00287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 02/07/2023] Open
Abstract
Background Acute viral hepatitis E (AVH-E) can often result in acute liver failure (ALF) during pregnancy. microRNAs serve as mediators in drug induced liver failure. We investigated their role as a biomarker in predicting ALF due to HEV (ALF-E). Methods We performed next generation sequencing and subsequent validation studies in PBMCs of pregnant (P) self limiting AVH-E, ALF due to HEV (ALF-E) and compared with AVH-E in non-pregnant (NP) females and healthy controls. Findings Eleven microRNAs were significantly expressed in response to HEV infection; importantly, miR- 431, 654, 1468 and 4435, were distinctly expressed in pregnant self-limiting AVH-E and healthy females (p = 0.0005), but not in ALF-E. Sixteen exclusive microRNAs differentiated ALF-E from self limiting AVH-E in pregnant females. miR-450b which affects cellular proliferation and metabolic processes through RNF20 and SECB was predominanlty upregulated and correlated with poor outcome (ROC 0.958, p = 0.001). Interpretation Our results reveal that a specific microRNA profile can predict fatality in ALF-E in pregnancy. These microRNAs could be exploited as prognostic biomarkers and help in the development of new therapeutic interventions.
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Affiliation(s)
- Nirupma Trehanpati
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Rashi Sehgal
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Sharda Patra
- Departrment of Gynaecology and Obstetrics, Lady Harding Medical College, New Delhi, India
| | - Ashish Vyas
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | | | - Ritu Khosla
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Arshi Khanam
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Guresh Kumar
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gayatri Ramakrishna
- Laboratory Of Molecular Immunology, Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences New Delhi, India
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Yachoui R, Kreidy M, Siorek M, Sehgal R. Successful treatment with ustekinumab for corticosteroid- and immunosuppressant-resistant Takayasu's arteritis. Scand J Rheumatol 2017; 47:246-247. [PMID: 28276951 DOI: 10.1080/03009742.2017.1278788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- R Yachoui
- a Department of Rheumatology , Marshfield Clinic , Marshfield , WI , USA
| | - M Kreidy
- b Department of Pulmonary/Critical Care , Marshfield Clinic , Marshfield , WI , USA
| | - M Siorek
- c Department of Radiology , Marshfield Clinic , Marshfield , WI , USA
| | - R Sehgal
- a Department of Rheumatology , Marshfield Clinic , Marshfield , WI , USA
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Sehgal R, Cheung CX, Alradadi R, Healy DA, Landers R, O'Donoghue GT. University Hospital Waterford: 5-year experience of cutaneous melanoma. Ir J Med Sci 2016; 186:309-314. [PMID: 27873142 DOI: 10.1007/s11845-016-1531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010. AIM To summarize 5-year experience (2010-2015) of primary CM presenting to UHW. METHODS Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis. RESULTS 592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78 ± 18.29 years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4 ± 3.7 mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%). CONCLUSION There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.
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Affiliation(s)
- R Sehgal
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland.
| | - C X Cheung
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Alradadi
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - D A Healy
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Landers
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - G T O'Donoghue
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
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Bhardwaj N, Pereda B, Kriplani A, Sehgal R, Espey E, Singh R. Perceptions of reversible and permanent contraception in India. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.127] [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]
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Gupta SK, Gamangatti S, Farooque K, Sehgal R. Morphometry of lumbar pedicle using CT scans and digital images. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.08.092] [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: 10/20/2022]
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29
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Megha K, Khurana S, Sehgal R. Genotyping of acanthamoeba spp causing granulomatous amoebic encephalitis. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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30
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Khurana S, Biswal M, Kaur H, Malhotra P, Arora P, Megha K, Taneja N, Sehgal R. Free living amoebae in water sources of critical units in a tertiary care hospital in India. Indian J Med Microbiol 2016; 33:343-8. [PMID: 26068332 DOI: 10.4103/0255-0857.158543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Isolation of free-living amoebae (FLA) is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. OBJECTIVE To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT) intensive care unit (ICU), transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. MATERIALS AND METHODS A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR) and sequencing was performed in culture positive samples. RESULTS Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. CONCLUSION The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.
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Affiliation(s)
- S Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE The diagnosis of toxoplasmosis is challenging since conventional methods like culture and immunofluorescence are not universally available. Serology, which is used regularly might be negative during early phase of infection and in immunosuppressed patients or may remain positive for a long time. Several molecular tests have been used for the diagnosis of toxoplasmosis, but none of them have an internal control which would inform us regarding the presence of polymerase chain reaction (PCR) inhibitors thus, undermining the confidence of a laboratory physician. MATERIALS AND METHODS We designed a multiplex PCR containing primers targeting human beta globin gene which would act as internal control and two primers against the B1 gene and 5s gene which aid in sensitive detection of T. gondii. RESULTS Multiplex PCR had a sensitivity of 83.3% and specificity of 100%. CONCLUSION Multiplex PCR may provide a sensitive and specific tool for diagnosis of human toxoplasmosis.
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Affiliation(s)
| | | | - S Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
We report two cases of fatal chronic meningoencephalitis caused by Balamuthia mandrillaris in immunocompetent men. Diagnosis of amoebic meningoencephalitis was made ante-mortem in one case and postmortem in another by histopathological examination and confirmed by demonstration of B. mandrillaris deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR).
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Affiliation(s)
| | | | | | | | - B D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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33
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Sehgal R, Patra S, David P, Vyas A, Khanam A, Hissar S, Gupta E, Kumar G, Kottilil S, Maiwall R, Sarin SK, Trehanpati N. Impaired monocyte-macrophage functions and defective Toll-like receptor signaling in hepatitis E virus-infected pregnant women with acute liver failure. Hepatology 2015; 62:1683-96. [PMID: 26331854 DOI: 10.1002/hep.28143] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Acute viral hepatitis resulting due to hepatitis E viral infection (AVH-E) is often serious in pregnancy and could result in acute liver failure (ALF). The role of monocytes and macrophages (mono-macs) in the pathogenesis of AVH-E and development of ALF-E in pregnancy is unclear. We investigated the functions of mono-macs in pregnant (P), AVH-E (n = 44), ALF-E (n = 12), healthy controls (HC; n = 20) and compared with nonpregnant (NP) AVH-E (n = 10), ALF-E (n = 5), and HC (n = 10). We also recruited non-hepatitis E virus-related pregnant (P), ALF-NE (n = 5) and non-pregnant (NP), ALF-NE (n = 12) patients with ALF. Mono-macs, dendritic cell (DC) phenotypes, and Toll-like receptor (TLR) expressions were studied by flow cytometry and reverse-transcriptase polymerase chain reaction. Mono-macs functionality was determined by analyzing their phagocytic activity and reactive oxygen species (ROS) generation by using flow cytometry. Frequency of mono-macs and DCs was increased during HEV infection compared to HC (P < 0.001). Macrophages were increased (P < 0.002) in ALF-E(P) compared to ALF-NE(P). The macrophage phagocytic activity and Escherichia coli-induced ROS production was significantly impaired in ALF-E(P) compared to AVH-E(P) (P < 0.001), ALF-E(NP), and ALF-NE(P) patients (P < 0.02). TLR3 and TLR9 expression and downstream MYD88 signalling molecules IRF3 and IRF7 were significantly down-regulated in ALF-E(P) (P < 0.00) compared to AVH-E(P) and ALF-NE(P). CONCLUSION Functionality of mono-macs is impaired in pregnant ALF-E patients compared to AVH-E(P). Reduced TLR3 and TLR7 expression and TLR downstream-signaling molecules in pregnant ALF-E patients suggests inadequate triggers for the innate immune responses contributing to development and severity of ALF-E. Studies using TLR agonists to activate mono-macs may be of use and in vitro studies should be undertaken using patient samples.
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Affiliation(s)
- Rashi Sehgal
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sharda Patra
- Gynecology and Obstetrics, Lady Harding Medical College, New Delhi, India
| | - Paul David
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ashish Vyas
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arshi Khanam
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Syed Hissar
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shyam Kottilil
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Rakhi Maiwall
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nirupama Trehanpati
- Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India
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Sharma M, Beke N, Khurana S, Bhatti HS, Sehgal R, Malla N. An ocular cysticercosis case: Caused by Asian genotype of Taenia solium. Indian J Med Microbiol 2015; 33:583-5. [DOI: 10.4103/0255-0857.167319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shankar H, Kumar N, Rao DN, Chandhiok N, Sandhir R, Kriplani A, Dhaliwal L, Sehgal R, Jindal VL, Maithi L, Kandpal S, Kumar A, Kurra S. Comparison of haematological and biochemical changes between non-anaemic and anaemic primigravid women in a north Indian population to establish normative values. J OBSTET GYNAECOL 2014; 35:221-4. [PMID: 25153118 DOI: 10.3109/01443615.2014.948817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pregnancy is accompanied by several haemodynamic, biochemical and haematological changes, which may lead to severe problems, if they are not suitably addressed. The current study highlights the haematological and biochemical differences observed in anaemic (AP) and non-anaemic primigravida (NAP), in the 2nd trimester, in a north Indian population. There were significant differences (p < 0.05) in the body weight and body temperature of NAP compared with AP. A significant decrease (p < 0.001) in haematological parameters including haemoglobin, haematocrit, erythrocyte count, MCH and MCHC, was observed in AP; however, MCV was found to be significantly higher (p = 0.038). Many biochemical parameters viz. potassium, albumin, total protein and calcium levels were significantly reduced (p < 0.01) in AP, except alkaline phosphatase whose level was found significantly increased (p < 0.01). The findings of the study suggest that haematological and biochemical changes take place in anaemia during pregnancy. Further, the results obtained should be used for establishing normative values for similar populations.
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Affiliation(s)
- H Shankar
- All India Institute of Medical Sciences , Ansari Nagar, New Delhi , India
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Coffey JC, Sehgal R, Culligan K, Dunne C, McGrath D, Lawes N, Walsh D. Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy. Tech Coloproctol 2014; 18:789-94. [DOI: 10.1007/s10151-014-1184-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022]
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Sehgal R, Coffey JC. Comprehensive standardization of complete mesocolic surgery is now possible. Tech Coloproctol 2014; 18:675-6. [DOI: 10.1007/s10151-014-1135-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/15/2014] [Indexed: 11/28/2022]
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Moftah M, Sehgal R, Cahill RA. Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting. MINERVA GASTROENTERO 2012; 58:213-225. [PMID: 22971632] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.
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Affiliation(s)
- M Moftah
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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Sharma P, Khurana S, Sharma A, Sehgal R, Malla N. Molecular epidemiology of Cryptosporidium isolates from humans in North India. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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40
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Affiliation(s)
- R Sehgal
- Division of Pediatric Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
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Johnson G, Payne J, Hooks MA, Johnson S, Vyas H, Saunders D, Kadis GN, Fredericks CA, Sehgal R, McHayleh WM. Gamma knife surgery for non-small cell lung cancer patients with brain metastasis: A community cancer center experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18054] [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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42
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Sehgal R, Krug CE, Reifer J, Tirona MRBT, Douglas WG, Edwards P, Gress TW. Are there differences in chemotherapy (CT) administration and outcomes in elderly patients diagnosed with colorectal cancer (CRC)? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19521] [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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43
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Malla N, Kaul P, Sehgal R, Gupta I. The presence of dsRNA virus in Trichomonas vaginalis isolates from symptomatic and asymptomatic Indian women and its correlation with in vitro metronidazole sensitivity. Indian J Med Microbiol 2011; 29:152-7. [DOI: 10.4103/0255-0857.81801] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sehgal R, Krug CE, Reifer J, Tria Tirona M, Douglas WG, Edwards P, Gress TW. Are there differences in chemotherapy (CT) administration and outcomes in elderly patients (pts) diagnosed with colorectal cancer (CRC)? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.557] [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
557 Background: CRC is the third most common cancer in men and women in the United States. The median age at diagnosis is 70 years (yrs). Controversy exists in the literature regarding benefit from CT in elderly pts with CRC. We performed a retrospective study to evaluate CT rate and its benefit in different age groups of pts with CRC. Methods: Data on pts diagnosed with CRC from 1993-2008 were collected from the Cancer Information Resource File. Complete data on age, gender, stage, tumor characteristics, treatment, and overall survival (OS) were available on 32,177 pts and were analyzed by age in four categories: < 50, 50-69, 70-79, and ≥ 80 yrs. Results: Of 32,177 pts, 7% were < 50, 35% were 50-69, 32% were 70-78, and 26% were ≥ 80 yrs. The table reports pt demographics, median OS (MOS) by age and stage, and rates of CT by age and stage. As reported in the table, use of CT declined with advancing age, regardless of stage. Multivariate Cox regression analysis simultaneously adjusted for age at diagnosis, gender, race, stage, and grade revealed that CT was associated with reduced mortality in all age categories: < 50 yrs, HR 0.75; 50-69, HR 0.61; 70-79, HR 0.53; and ≥ 80, HR 0.55 (all p < 0.01). Conclusions: Older pts receive CT less frequently than younger pts. The use of CT in the elderly was associated with a reduced mortality, similar to that seen in younger pts. Younger pts were more likely to present with stage IV disease when compared to the elderly. Randomized, prospective trials are required to explore the differences noted. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- R. Sehgal
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - C. E. Krug
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - J. Reifer
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - M. Tria Tirona
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - W. G. Douglas
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - P. Edwards
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
| | - T. W. Gress
- Edwards Comprehensive Cancer Center, Marshall University School of Medicine, Huntington, WV; Marshall University School of Medicine, Huntington, WV; Marshall University, Huntington, WV
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Sehgal R, Berg A, Polinski J, Hegarty J, Kelly A, Lin Z, Poritz L, Koltun W. Correlation Of Gene Haplotypes With Complications After Ileal Pouch Anal Anastomosis. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.566] [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: 10/18/2022]
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Nawal RR, Parande M, Sehgal R, Naik A, Rao NR. A comparative evaluation of antimicrobial efficacy and flow properties for Epiphany, Guttaflow and AH-Plus sealer. Int Endod J 2011; 44:307-13. [DOI: 10.1111/j.1365-2591.2010.01829.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malla N, Sehgal R, Kaul P, Gupta I. The presence of dsRNA virus in Trichomonas vaginalis isolates from symptomatic and asymptomatic Indian women and its correlation with in vitro metronidazole sensitivity. Indian J Med Microbiol 2011. [DOI: 10.4103/0255-0857.90178] [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: 11/04/2022]
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48
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Sehgal R, Lark C. Abstract P1-09-03: A Pharmaco-Economic Analysis of Tamoxifen (T) vs. Aromatase Inhibitors (AI) in Adjuvant Treatment of Postmenopausal (PoM) Women (W) with Hormone Receptor Positive (HRP) Breast Cancer (BC). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-09-03] [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: 11/16/2022]
Abstract
Abstract
Background: Endocrine Therapy (ET) is an important component of adjuvant therapy in PoM W with HRP BC.AI are the preferred modality of ET despite higher cost. We performed an analysis to determine the cost of the difference in BC specific survival benefit when using AI compared to T in the adjuvant treatment of HRP BC in PoM W. Methods: Prices of medications were obtained through First Data Bank Blue Book. Annual incidence of BC globally was taken as reported in GLOBOCAN 2008. Incidence of non-metastatic, HRP BC in PoM W was calculated using data on incidence of metastatic BC (6%), HRP BC (80%) and W with PoM status (75%) from Cancer Statistics 2009 and Anderson WF et al, 2002 respectively. Meta-analysis of ATAC and BIG-98 trials comparing 5 years (yrs) of T and AI (T and anastrozole/letrozole), in the adjuvant setting presented by Dowsett et al, JCO, Vol 28, No 3 (January 20), 2010: 509-518 was used for calculating BC specific survival benefit of AI over T.
Results: Annually, 780,307 W globally would be eligible for 5 yrs of adjuvant ET. The cost of 5 yrs treatment for these W with T vs. AI is $5.4 billion (B) United States dollars (USD) vs. $22.5 B USD, respectively. The absolute BC specific survival benefit of treating W with AI over T for 5 yrs was 1.1%. Therefore, treating 780,307 women with AI rather than T for 5 yrs would benefit about 8583 W from BC specific mortality. The cost for saving one woman from BC related mortality, if treated with AI rather than T would be $1,992310.38 USD [(22.5 B USD — 5.4 B USD/8583]. AI use was associated with fewer endometrial cancers and thromboembolic events than T but with more arthralgias and fractures. Conclusion: AIs have shown benefit over T, but applying those results en-mass to all patients with HRP BC might be a substantial economic burden on society with relatively small benefits. Target markers for subset of patients who might preferentially benefit from AIs more than T need to be identified to best optimize the benefit from these drugs. Each class of drugs have different side effect profiles which should help individualize treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-09-03.
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Affiliation(s)
- R Sehgal
- Marshall University, Huntington, WV
| | - C Lark
- Marshall University, Huntington, WV
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Sehgal R, Larck CC, Dementieva Y, Tria Tirona MR, Edwards P, McHayleh WM, Lembersky BC. Race and colon cancer: Unanswered questions. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1525] [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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Tamta A, Chaudhary M, Sehgal R. Sub-Acute Toxicity Profile of Fixed Dose Combination of Pirotum (Cefpirome-Sulbactam)
in Swiss Albino Mice and Wistar Rat. INT J PHARMACOL 2010. [DOI: 10.3923/ijp.2010.111.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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