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Kilic SS, Halima A, Zhang Z, Cho YB, Magnelli A, Kalaycio M, Sauter CS, Sobecks R, Hamilton B, Rotz SJ, Hanna R, Murphy ES, Cherian S, Xia P, Guo B. Clinical Outcomes of Image-Guided Volumetric Modulated Arc Therapy for Total Body Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:S89. [PMID: 37784597 DOI: 10.1016/j.ijrobp.2023.06.415] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Volumetric modulated arc therapy (VMAT)-based total body irradiation (TBI) with image guidance is a novel technique that is increasing in implementation. Compared to conventional TBI, VMAT-TBI offers favorable dose homogeneity, better organ-at-risk sparing, and enhanced patient comfort. However, whether these dosimetric advantages translate to improved clinical outcomes that justify the increased planning and delivery burden is not well understood. Only a single study of clinical outcomes of VMAT-TBI exists in the literature. We present the largest study to date of clinical outcomes of VMAT-TBI. MATERIALS/METHODS In this IRB-approved retrospective single-institution study, all patients treated with VMAT-TBI conditioning for allogeneic stem cell transplant, per the institution's published protocol, were identified. Dosimetric data were abstracted from the radiation oncology treatment planning system. Clinical data were abstracted from the electronic medical record. The primary outcome was six-month overall survival (6M OS) from the last day of TBI by Kaplan-Meier method. RESULTS Fifty-five patients (47 adult and 8 pediatric) were treated with VMAT-TBI between June 2020 and December 2022. All patients received conditioning chemotherapy with standard-dose TBI of 12 or 13.2 Gy in 8 twice-daily fractions. The PTV coverage (V95%) mean was 95.3% ± 1.2%. Mean lung dose was 9.5 Gy ± 0.6 for adult patients and 8.4 Gy ± 0.9 for pediatric patients. Mean lung dose rate was 18.0 cGy/min ± 4.4. Mean kidney dose was 5.9 Gy ± 0.6. Mean skin dose measured by MOSFET was 12.7 Gy ± 1.2. Median treatment time was 63 minutes (range: 53-104). Median follow-up was 7.7 months. At most recent follow-up, 78% of patients were alive. 6M OS was 82%. Common acute toxicities were fatigue (90.9% of patients, all grade 1-2), diarrhea (70.9%, all grade 1-2), nausea (76.4%, all grade 1-2), mucositis (60% grade 1-2, 12.7% grade 3, 1.8% grade 4, no grade 5), and xerostomia (54.5%, all grade 1). Mean pretreatment FEV1 was 98.3 percent of predicted (%p) ± 11.9%p and mean posttreatment FEV1 was 94.7%p ± 13.8%p. Mean pretreatment GFR was 101.4mL/min/1.73m² ± 17.4, mean 3-month posttreatment GFR was 92.4 ± 20.0, and mean 6-month posttreatment GFR was 97.5 ± 26.48. One patient experienced grade 2 pneumonitis; there were no other cases of pneumonitis. There were no acute grade 3+ toxicities aside from mucositis. Observed late toxicities were cataracts (7.3%, all grades 1-3) and hypothyroidism (12.7%, all grades 1-2). There were no grade 3+ late toxicities. Mild acute graft-versus-host disease (GVHD) was noted in 27.2% of patients and mild chronic GVHD was noted in 14.5% of patients, with no other cases of GVHD. CONCLUSION In the largest series to date, VMAT-TBI had excellent oncologic and toxicity outcomes. A randomized trial of VMAT-TBI versus standard TBI is warranted.
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Affiliation(s)
- S S Kilic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z Zhang
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Y B Cho
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - A Magnelli
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - M Kalaycio
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Sauter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - R Sobecks
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - B Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - S J Rotz
- Department of Pediatric, Hematology, Oncology, and Blood and Marrow Transplantation, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - R Hanna
- Department of Pediatric Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E S Murphy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - P Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - B Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Fane L, Halima A, Parker SM, Obi E, Hall EF, Cherian S, Al-Hilli Z, Tendulkar RD, Shah CS. Outcomes with Five Fraction Image-Guided Partial Breast Irradiation to Reduced Target Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e174. [PMID: 37784786 DOI: 10.1016/j.ijrobp.2023.06.1019] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of 5-fraction partial breast irradiation has been shown in a randomized trial to provide comparable rates of local control and reduced toxicities as compared to standard fractionation whole breast irradiation. The initial technique utilized a 2 cm expansion on the lumpectomy cavity (1 cm for clinical target volume [CTV], and 1 cm planning target volume [PTV]) without consistent image guidance (ex. cone beam computed tomography [CBCT]) or motion management recommendations. We present clinical outcomes using a 5-fraction image guided PBI technique (IG-PBI) to reduced target volumes for patients with early-stage breast cancer. MATERIALS/METHODS A retrospective review of an IRB approved institutional registry was performed to identify patients treated with IG-PBI. A total of 258 patients with early-stage breast cancer (Stage 0-IIA) receiving IG-PBI were identified. Patients received a dose of 30 Gy in 5 fractions delivered daily or every other day. An expansion of 1 cm on the lumpectomy cavity was used for those patients using deep inspiration breath hold (DIBH) while an expansion of 1.5 cm was utilized for those not using DIBH. All patients received daily CBCT. Plans were delivered using intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) technique; while the prescription isodose line covered the PTV, the 26 Gy line was allowed to expand beyond the PTV. Kaplan-Meier analyses were used to assess rates of local control and survival. Patient demographics, stage, hormone therapy use, recurrence, mortality, and toxicity data were collected. Survival was analyzed with Kaplan-Meier curve. RESULTS Median age at diagnosis was 67 years (range 40-87) with a median follow-up of 29 months (IQR 22-40). Forty-six (18%) patients had in situ disease, 200 (78%) patients T1 tumors, and 12 (5%) patients had T2 tumors. Two hundred thirty-four (91%) patients were White, 15 (6%) were Black, and 9 (4%) were other races. One hundred ninety-six (76%) patients received endocrine therapy, and 16 (6%) patients received chemotherapy. Thirty-two (12%) patients developed grade 1 dermatitis and no grade 2 events were observed. One (0.4%) patient had a cardiac event (aortic stenosis) 19 months after breast radiotherapy. At last follow-up, one (0.4%) patient had a local recurrence and one (0.4%) developed a distant metastasis, with no regional nodal failures. Overall, 4 (1.5%) patients had died, all due to other causes. At 3 years, locoregional control was 99.4%. CONCLUSION Outcomes with IG-PBI demonstrate low rates of local recurrence and limited toxicity. The use of reduced target volumes is not associated with increased rates of local recurrence.
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Affiliation(s)
- L Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | - A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - E Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E F Hall
- Cleveland Clinic Foundation, Cleveland, OH
| | - S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z Al-Hilli
- Department of Surgery, Division of Breast Services, Cleveland, OH
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Halima A, Parker SM, Fane L, Hall EF, Obi E, Al-Hilli Z, Valente S, Gentle C, Cherian S, Tendulkar RD, Shah CS. Five Fraction Accelerated Partial Breast Irradiation vs. Intraoperative Radiation Therapy for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e177. [PMID: 37784793 DOI: 10.1016/j.ijrobp.2023.06.1025] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accelerated partial breast irradiation (APBI) represents an alternative to whole breast irradiation (WBI), reducing the target volume and potentially treatment duration. APBI delivered in 5 fractions with intensity modulated radiation therapy (IMRT) has been shown to have comparable outcomes to WBI with reduced toxicity profiles. In contrast, intraoperative radiation therapy (IORT) offers patients the potential to complete adjuvant radiation therapy in a single treatment. While early data were initially promising, concerns regarding long-term rates of local recurrence exist. We present a comparison of 5 fraction APBI versus IORT. MATERIALS/METHODS We performed a retrospective review of 473 patients with early-stage breast cancer (Stage 0-IIA) treated at a single institution with 258 receiving APBI and 215 IORT from October 2011 to May 2021. APBI patients received 30 Gy in 5 fractions delivered with IMRT daily or every other day. IORT patients received 20 Gy in 1 fraction prescribed to the applicator surface delivered at the time of surgery. Kaplan-Meier analysis was used to estimate locoregional control rates and overall survival among the 2 groups. RESULTS Mean age was 70.7 years old (IQR:67-74) for the IORT patients and 66.6 years old (IQR:62-72) for the APBI patients (p<0.001). Median follow up was 5.7 years for IORT patients and 2.4 years for APBI patients (p<0.001). For IORT patients, 11%/83.5%/5.5% of patients and for APBI 17.8%/77.5%/4.7% of patients had Tis/T1/T2 disease (p = 0.005). With regards to adjuvant therapies, 79%/76% of IORT/APBI patients were offered endocrine therapy (p = 0.50) and 1.4%/6.2% chemotherapy (p = 0.008). Recurrence at any time was seen in 7.9% (n = 17) of patients receiving IORT as compared to 0.8% (n = 2) of patients receiving APBI. APBI was however no differences in recurrence free survival (92.6% vs. 98.5%, p = .079) or overall survival were noted (92.8% vs. 95.1%, p = 0.99). CONCLUSION In a series of almost 500 patients with stage 0-IIA breast cancer, IORT was associated with higher rates of locoregional recurrence compared to APBI with no survival difference at 5 years. These outcomes, consistent with other series and current guidelines, suggest a limited role for IORT as monotherapy following breast conserving surgery.
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Affiliation(s)
- A Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - L Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E F Hall
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Z Al-Hilli
- Department of Surgery, Division of Breast Services, Cleveland, OH
| | - S Valente
- Department of Breast Surgery, Cleveland Clinic, Cleveland, OH
| | - C Gentle
- Department of Breast Surgery, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH
| | - S Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - R D Tendulkar
- Dept of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Majoni SW, Nelson J, Graham J, Abeyaratne A, Fernandes DK, Cherian S, Rathnayake G, Ashford J, Hocking L, Cain H, McFarlane R, Lawton PD, Barzi F, Taylor S, Cass A. Comparison of two ferritin assay platforms to assess their level of agreement in measuring serum and plasma ferritin levels in patients with chronic kidney disease. BMC Nephrol 2023; 24:198. [PMID: 37391713 PMCID: PMC10314376 DOI: 10.1186/s12882-023-03255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Ferritin levels are used to make decisions on therapy of iron deficiency in patients with chronic kidney disease (CKD). Hyperferritinaemia, common among patients with CKD from the Northern Territory (NT) of Australia, makes use of ferritin levels as per clinical guidelines challenging. No gold standard assay exists for measuring ferritin levels. Significant variability between results from different assays creates challenges for clinical decision-making regarding iron therapy. In the NT, different laboratories use different methods. In 2018, Territory Pathology changed the assay from Abbott ARCHITECT i1000 (AA) to Ortho-Clinical Diagnostics Vitros 7600 (OCD). This was during the planning of the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. The trial design was based on AA assay ferritin levels. We compared the two assays' level of agreement in measuring ferritin levels in CKD patients. METHODS Samples from INFERR clinical trial participants were analysed. Other samples from patients whose testing were completed the same day on OCD analyzers and run within 24 h on AA analyzers were added to ensure wide range of ferritin levels, adding statistical strength to the comparison. Ferritin levels from both assays were compared using Pearson's correlation, Bland-Altman, Deming and Passing-Bablok regression analyses. Differences between sample types, plasma and serum were assessed. RESULTS Sixty-eight and 111 (179) samples from different patients from Central Australia and Top End of Australia, respectively, were analyzed separately and in combination. The ferritin levels ranged from 3.1 µg/L to 3354 µg/L and 3 µg/L to 2170 µg/L for AA and OCD assays respectively. Using Bland-Altman, Deming and Passing-Bablok regression methods for comparison, ferritin results were consistently 36% to 44% higher with AA than OCD assays. The bias was up to 49%. AA ferritin results were the same in serum and plasma. However, OCD ferritin results were 5% higher in serum than plasma. CONCLUSIONS When making clinical decisions, using ferritin results from the same assay in patients with CKD is critical. If the assay is changed, it is essential to assess agreement between results from the new and old assays. Further studies to harmonize ferritin assays are required.
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Affiliation(s)
- Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia.
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.
| | - Jane Nelson
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Jessica Graham
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
| | - David Kiran Fernandes
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sajiv Cherian
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Geetha Rathnayake
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Jenna Ashford
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
| | - Lynn Hocking
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Heather Cain
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Robert McFarlane
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Paul Damian Lawton
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sean Taylor
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
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Patil P, Alagarasu K, Chowdhury D, Kakade M, Cherian S, Kaushik S, Yadav J, Kaushik S, Parashar D. In-vitro antiviral activity of Carica papaya formulations against dengue virus type 2 and chikungunya viruses. Heliyon 2022; 8:e11879. [PMCID: PMC9723942 DOI: 10.1016/j.heliyon.2022.e11879] [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] [Received: 09/01/2022] [Revised: 10/12/2022] [Accepted: 11/18/2022] [Indexed: 12/07/2022] Open
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Gray T, Cherian S, Amarnath S, Wilkinson D. Do HDR Tandem and Ring Interfractional Displacements Predict the Need to Re-Plan? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2138] [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: 10/31/2022]
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Moncaliano M, Billena C, Obi E, Parker S, Halima A, Kim S, Cherian S, Tendulkar R, Shah C. Comparison of Acute and Chronic Toxicities with Daily vs. QOD Partial Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.747] [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: 10/31/2022]
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Halima A, Parker S, Asha W, Mayo Z, Kilic S, Obi E, Kim S, Gentle C, Valente S, Cherian S, Tendulkar R, Shah C. Accelerated Partial Breast Irradiation vs. Intraoperative Radiation Therapy for Early-Stage Breast Cancer and Ductal Carcinoma In Situ. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.708] [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: 10/31/2022]
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Vuong W, Smile T, Asha W, Reddy C, Amarnath S, Stephans K, Woody N, Balagamwala E, AlHilli M, Michener C, Mahdi H, DeBernardo R, Rose P, Cherian S. Local Control and Safety of Abdominopelvic Stereotactic Body Radiotherapy (SBRT) Following Bevacizumab for Oligometastatic Gynecologic Malignancies. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Obi E, Parker S, Asha W, Moncaliano M, Kim S, Al-Hilli Z, Cherian S, Tendulkar R, Shah C. Trends in the Delivery of Accelerated Partial Breast Irradiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.975] [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: 12/01/2022]
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Barraclough KA, Metz D, Staatz CE, Gorham G, Carroll R, Majoni SW, Cherian S, Swaminathan R, Holford N. Important lack of difference in tacrolimus and mycophenolic acid pharmacokinetics between Aboriginal and Caucasian kidney transplant recipients. Nephrology (Carlton) 2022; 27:771-779. [PMID: 35727904 DOI: 10.1111/nep.14080] [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: 02/09/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
AIM To examine whether differences in tacrolimus and mycophenolic acid (MPA) pharmacokinetics contribute to the poorer kidney transplant outcomes experienced by Aboriginal Australians. METHODS Concentration-time profiles for tacrolimus and MPA were prospectively collected from 43 kidney transplant recipients: 27 Aboriginal and 16 Caucasian. Apparent clearance (CL/F) and distribution volume (V/F) for each individual were derived from concentration-time profiles combined with population pharmacokinetic priors, with subsequent assessment for between-group difference in pharmacokinetics. In addition, population pharmacokinetic models were developed using the prospective dataset supplemented by previously developed structural models for tacrolimus and MPA. The change in NONMEM objective function was used to assess improvement in goodness of model fit. RESULTS No differences were found between Aboriginal and Caucasian groups or empirical Bayes estimates, for CL/F or V/F of MPA or tacrolimus. However, a higher prevalence of CYP3A5 expressers (26% compared with 0%) and wider between-subject variability in tacrolimus CL/F (SD = 5.00 compared with 3.25 L/h/70 kg) were observed in the Aboriginal group, though these differences failed to reach statistical significance (p = .07 and p = .08). CONCLUSION There were no differences in typical tacrolimus or MPA pharmacokinetics between Aboriginal and Caucasian kidney transplant recipients. This means that Bayesian dosing tools developed to optimise tacrolimus and MPA dosing in Caucasian recipients may be applied to Aboriginal recipients. In turn, this may improve drug exposure and thereby transplant outcomes in this group. Aboriginal recipients appeared to have greater between-subject variability in tacrolimus CL/F and a higher prevalence of CYP3A5 expressers, attributes that have been linked with inferior outcomes.
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Affiliation(s)
- Katherine A Barraclough
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Metz
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christine E Staatz
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Robert Carroll
- Department of Nephrology, Central Northern Adelaide Renal Transplantation Services, Adelaide, South Australia, Australia.,Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Northern Territory Renal Services, Darwin, Northern Territory, Australia.,School of Medicine, Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - Sajiv Cherian
- Renal Services, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | | | - Nick Holford
- Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
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Majoni SW, Nelson J, Germaine D, Hoppo L, Long S, Divakaran S, Turner B, Graham J, Cherian S, Pawar B, Rathnayake G, Heron B, Maple-Brown L, Batey R, Morris P, Davies J, Fernandes DK, Sundaram M, Abeyaratne A, Wong YHS, Lawton PD, Taylor S, Barzi F, Cass A. INFERR-Iron infusion in haemodialysis study: INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis-a protocol for a prospective open-label blinded endpoint randomised controlled trial. Trials 2021; 22:868. [PMID: 34857020 PMCID: PMC8641231 DOI: 10.1186/s13063-021-05854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background The effectiveness of erythropoiesis-stimulating agents, which are the main stay of managing anaemia of chronic kidney disease (CKD), is largely dependent on adequate body iron stores. The iron stores are determined by the levels of serum ferritin concentration and transferrin saturation. These two surrogate markers of iron stores are used to guide iron replacement therapy. Most Aboriginal and/or Torres Islander Australians of the Northern Territory (herein respectfully referred to as First Nations Australians) with end-stage kidney disease have ferritin levels higher than current guideline recommendations for iron therapy. There is no clear evidence to guide safe and effective treatment with iron in these patients. We aim to assess the impact of intravenous iron treatment on all-cause death and hospitalisation with a principal diagnosis of all-cause infection in First Nations patients on haemodialysis with anaemia, high ferritin levels and low transferrin saturation Methods In a prospective open-label blinded endpoint randomised controlled trial, a total of 576 participants on maintenance haemodialysis with high ferritin (> 700 μg/L and ≤ 2000 μg/L) and low transferrin saturation (< 40%) from all the 7 renal units across the Northern Territory of Australia will be randomised 1:1 to receive intravenous iron polymaltose 400 mg once monthly (200 mg during 2 consecutive haemodialysis sessions) (Arm A) or no IV iron treatment (standard treatment) (Arm B). Rescue therapy will be administered when the ferritin levels fall below 700 μg/L or when clinically indicated. The primary outcome will be the differences between the two study arms in the risk of hospitalisation with all-cause infection or death. An economic analysis and several secondary and tertiary outcomes analyses will also be performed. Discussion The INFERR clinical trial will address significant uncertainty on the safety and efficacy of iron therapy in First Nations Australians with CKD with hyperferritinaemia and evidence of iron deficiency. This will hopefully lead to the development of evidence-based guidelines. It will also provide the opportunity to explore the causes of hyperferritinaemia in First Nations Australians from the Northern Territory. Trial registration This trial is registered with The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000705987. Registered 29 June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05854-w.
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Affiliation(s)
- Sandawana William Majoni
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia. .,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.
| | - Jane Nelson
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Darren Germaine
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Libby Hoppo
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie Long
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Shilpa Divakaran
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Brandon Turner
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jessica Graham
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sajiv Cherian
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Basant Pawar
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Geetha Rathnayake
- Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Chemical Pathology-Territory Pathology, Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Bianca Heron
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Robert Batey
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,New South Wales Health, St Leonards, NSW, Australia
| | - Peter Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Pediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jane Davies
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - David Kiran Fernandes
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Madhivanan Sundaram
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Asanga Abeyaratne
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
| | - Yun Hui Sheryl Wong
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Paul D Lawton
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,The Central Clinical School, Monash University & Alfred Health, Melbourne, Australia
| | - Sean Taylor
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Queensland, 4067, Australia
| | - Alan Cass
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Potdar V, Vipat V, Jadhav S, Saha U, Jadhav SY, Bhardwaj S, Choudhary ML, Cherian S, Abraham P. Correction to: Detection of SARS‑CoV‑2 variants in India from UK returnees. Infection 2021; 49:1361. [PMID: 34331264 PMCID: PMC8323960 DOI: 10.1007/s15010-021-01660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Varsha Potdar
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India.
| | - V Vipat
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Jadhav
- Bioinformatics Group, Indian Council of Medical Research, National Institute of Virology, Pune, India
| | - U Saha
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Y Jadhav
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Bhardwaj
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - M L Choudhary
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Cherian
- Bioinformatics Group, Indian Council of Medical Research, National Institute of Virology, Pune, India
| | - P Abraham
- Indian Council of Medical Research, National Institute of Virology, Pune, India
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Talukder MR, Clauss CS, Cherian S, Woodman R, Einsiedel L. Risk factors for HTLV-1, acute kidney injury, and urinary tract infection among aboriginal adults with end stage kidney disease in central Australia. J Med Virol 2021; 93:6362-6370. [PMID: 34173977 DOI: 10.1002/jmv.27163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 12/25/2022]
Abstract
Central Australia is a human T-cell leukemia virus type 1c (HTLV-1c) endemic region and has the highest incidence of chronic kidney disease (CKD) in Australia. The factors associated with HTLV-1 seropositivity among Aboriginal Australian adults with CKD receiving hemodialysis (HD) were determined. A retrospective observational study of Aboriginal adults (≥ 18 years) who were receiving regular HD at the two main dialysis units in Alice Springs, December 1, 2010 to December 31, 2015. Demographic and clinical data before commencing HD were extracted from hospital records from the first presentation to Alice Springs Hospital (ASH) to HD commencement and associations were determined using logistic regression. Among 373 patients receiving HD, 133 (35.9%) were HTLV-1 infected. Identifiable factors associated with HTLV-1 status included increasing age, male gender, and diabetes before HD. The odds of diabetes mellitus were significantly higher among patients with HTLV-1 (adjusted odds ratio [aOR]: 2.76, 95% confidence interval [CI]: 1.19, 6.39; p = 0.017). More than one-fifth of participants had an acute kidney injury, the risk of which was increased among those with a previous blood stream infection (aOR: 3.02, 95% CI: 1.71, 5.34, p < 0.001). Men with a high HTLV-1 proviral load (≥500 copies per 105 peripheral blood leukocytes) had an increased risk of urinary tract infection (UTI) before HD (aOR: 5.15, 95% CI: 1.62, 16.40; p = 0.006). A strong association between HTLV-1 and diabetes, and an increased risk of UTI among men with a high HTLV-1 PVL, suggest that interactions between HTLV-1 infection and conventional risk factors may increase the risk for CKD in this population.
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Affiliation(s)
- Mohammad R Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Cornelia S Clauss
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sajiv Cherian
- Central Australia Renal Services, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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15
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Potdar V, Vipat V, Jadhav S, Saha U, Jadhav SY, Bhardwaj S, Choudhary ML, Cherian S, Abraham P. Detection of SARS-CoV-2 variants in India from UK returnees. Infection 2021; 49:1355-1359. [PMID: 34160788 PMCID: PMC8220361 DOI: 10.1007/s15010-021-01617-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Varsha Potdar
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India.
| | - V Vipat
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Jadhav
- Bioinformatics Group, Indian Council of Medical Research, National Institute of Virology, Pune, India
| | - U Saha
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Y Jadhav
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Bhardwaj
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - M L Choudhary
- Influenza Group, Indian Council of Medical Research, National Institute of Virology, 20-A Dr Ambedkar Road, Pune, 411001, Maharashtra, India
| | - S Cherian
- Bioinformatics Group, Indian Council of Medical Research, National Institute of Virology, Pune, India
| | - P Abraham
- Indian Council of Medical Research, National Institute of Virology, Pune, India
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16
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Chaturvedi S, Hughes JT, Cherian S, Morris P. EARLY EVALUATION OF A NEWLY COMMENCED PAEDIATRIC NEPHROLOGY SERVICE IN THE NORTHERN TERRITORY OF AUSTRALIA: A CARER'S AND PROVIDER'S PERSPECTIVE. J Paediatr Child Health 2020; 56:1999. [PMID: 33351244 DOI: 10.1111/jpc.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Swasti Chaturvedi
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Jaquilyne T Hughes
- Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Renal Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sajiv Cherian
- Department of Renal Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Peter Morris
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia
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17
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Tiong MK, Thomas S, Fernandes DK, Cherian S. Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia. Intern Med J 2020; 52:288-294. [PMID: 33251718 DOI: 10.1111/imj.14960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indigenous Australians are disproportionately affected by end stage kidney disease. Despite this, they face significant delays being assessed and waitlisted for kidney transplant. AIMS To examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous Australians and non-Indigenous patients, and identify major sources of delay. METHODS We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between-group differences were used to compare the time between commencement of dialysis and completion of each component of assessment. Patients who had more than 1 year between commencement of dialysis and waitlisting were further analysed for major sources of delay. RESULTS Twenty-five patients were included (20 Indigenous Australians and 5 non-Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 vs 264 days, P = 0.032). Indigenous Australian patients waited longer before commencing the transplant assessment process and before completing dental assessment, tissue typing and review by the transplant nephrologist and surgeon. Five patients (two Indigenous Australians, three non-Indigenous) were waitlisted within 1 year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay. CONCLUSION Indigenous Australian patients face significant delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve equity of access to kidney transplantation.
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Affiliation(s)
- Mark K Tiong
- Central Australian Renal Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Aboriginal and Torres Strait Islander Working Group, Adelaide, South Australia, Australia
| | - Sajan Thomas
- Central Australian Renal Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - David K Fernandes
- Central Australian Renal Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sajiv Cherian
- Central Australian Renal Service, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Smile T, Reddy C, Qiao-Guan G, Amarnath S, Stephans K, Woody N, Balagamwala E, AlHilli M, Michener C, Mahdi H, DeBernardo R, Rose P, Cherian S. Stereotactic Body Radiotherapy for the Treatment of Oligometastatic Gynecological Malignancy in the Abdomen and Pelvis: A Single-Institution Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Bauer-Nilsen K, Shah C, Tom M, Tendulkar R, Cherian S, Al-Hilli Z, Arthur D, Vicini F. Impact of Evolving Margin Definitions Following Breast Conserving Surgery on Boost Utilization. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1123] [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: 10/23/2022]
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20
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Humble B, Cherian S, Al-Kaabi A, Hobson J. M069 FIRST REPORTED MANAGEMENT OF A RARE ADVERSE REACTION TO IVIG BY TRANSITION TO SUBCUTANEOUS PRODUCT. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.138] [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: 10/25/2022]
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21
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Campbell S, Magnelli A, Murphy E, Shah C, Hamilton B, Majhail N, Sekeres M, Cherian S. Partial Transmission Kidney Blocks to Reduce Radiation Nephropathy in Patients Receiving Myeloablative Total Body Irradiation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Sharrett J, Shah C, Murphy E, Garcia A, Jagadeesh D, Dean R, Hill B, Pohlman B, Cherian S. Treatment Outcomes and Patterns of Failure in High Grade Lymphoma of the Thyroid Following Combined Modality Therapy: Single Institution Series. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1453] [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: 11/30/2022]
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23
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Obi E, Tom M, Obi B, Suarez E, Naik M, Cherian S, Tendulkar R, Shah C. Initial Outcomes with an Image-Guided Five Fraction Accelerated Partial-Breast Irradiation Regimen Delivered with IMRT. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Sittenfeld S, Pham Y, Reddy C, Obi E, Kruse M, Al-Hilli Z, Cherian S, Shah C, Tendulkar R. Ten Year Outcomes of Locoregional and Distant Recurrence for T1-2N1 Breast Cancer with or Without Post-Mastectomy Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Bhatt K, Cherian S, Agarwal R, Jose S, Cherian KM. Perioperative Management of Sickle Cell Disease in Paediatric Cardiac Surgery. Anaesth Intensive Care 2019; 35:792-5. [DOI: 10.1177/0310057x0703500524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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
In sickle cell disease, cardiopulmonary bypass may induce red cell sickling. Partial exchange transfusion reduces the circulating haemoglobin S level. We report the management of a child with sickle cell disease who required surgical closure of a ventricular septal defect. Preoperative exchange transfusion of 50% of the total blood volume was performed with fresh packed red cells over three days. Further exchange transfusion was performed as cardiopulmonary bypass commenced. The haemoglobin S level was reduced from 76% to 37%. The blood removed from the patient during the exchanges was processed allowing storage and re-infusion of the patient's plasma and platelets. Combined preoperative and intraoperative exchange transfusions, instead of a single stage 50% volume exchange, was effective and potentially avoids larger haemodynamic effects. Cardiopulmonary bypass was conducted at normothermia and cold cardioplegia was avoided (fibrillatory arrest was used during the surgical repair).
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Affiliation(s)
- K. Bhatt
- Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India
- Department of Cardiac Anaesthesiology
| | - S. Cherian
- Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India
- Department of Cardiac Surgery
| | - R. Agarwal
- Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India
- Department of Cardiac Surgery
| | - S. Jose
- Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India
- Department of Perfusion Technology
| | - K. M. Cherian
- Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India
- Chairman and CEO, Chief Cardiac Surgeon, Frontier Lifeline
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26
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Thomas S, Pawar B, Fernandes D, Nayar S, George P, Cherian S. An Unusual Case of Pulmonary Mucormycosis. Transplant Proc 2018; 50:3943-3945. [PMID: 30503525 DOI: 10.1016/j.transproceed.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/01/2018] [Indexed: 01/15/2023]
Abstract
Invasive fungal infections in solid organ transplant recipients are associated with significant morbidity and mortality. Of these fungal infections, mucormycosis presents as an aggressive, frequently fatal angioinvasive infection. Immunocompromised hosts and diabetes are important risk factors. These infections are frequently difficult to diagnose. A high index of suspicion in the appropriate setting and early, aggressive treatment with the newer antifungal agents have altered the previously grave prognosis. We present the first reported case of cavitating pulmonary mucormycosis in a renal transplant recipient caused by an unusual species of Mucorales. The patient was treated with a combination of lobectomy and antifungal treatment comprising of amphotericin B and posaconazole. He remains free of disease recurrence on monotherapy with posaconazole.
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Affiliation(s)
- S Thomas
- Alice Springs Hospital, Northern Territory, Australia.
| | - B Pawar
- Alice Springs Hospital, Northern Territory, Australia
| | - D Fernandes
- Alice Springs Hospital, Northern Territory, Australia
| | - S Nayar
- Alice Springs Hospital, Northern Territory, Australia
| | - P George
- Alice Springs Hospital, Northern Territory, Australia
| | - S Cherian
- Alice Springs Hospital, Northern Territory, Australia
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27
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Fleming C, Kunapareddy G, Yu N, Tendulkar R, Cherian S, Budd G, Colier P, Shah C. Assessment of Cardiac Dosimetry and Additional Cardiac Risk Factors in Patients Undergoing Modern Breast Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Anjaneya A, Singh KP, Cherian S, Saminathan M, Singh R, Ramakrishnan MA, Maan S, Maan NS, Hemadri D, Rao PP, Putty K, Krishnajyothi Y, Mertens PP. Comparative Neuropathology of Major Indian Bluetongue Virus Serotypes in a Neonatal BALB/c Mouse Model. J Comp Pathol 2018; 162:18-28. [PMID: 30060839 DOI: 10.1016/j.jcpa.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 01/15/2023]
Abstract
Bluetongue virus (BTV) is neurotropic in nature, especially in ruminant fetuses and in-utero infection results in abortion and congenital brain malformations. The aim of the present study was to compare the neuropathogenicity of major Indian BTV serotypes 1, 2, 10, 16 and 23 by gross and histopathological lesions and virus distribution in experimentally infected neonatal BALB/c mice. Each BTV serotype (20 μl of inoculum containing 1 × 105 tissue culture infectious dose [TCID]50/ml of virus) was inoculated intracerebrally into 3-day-old mice, while a control group was inoculated with mock-infected cell culture medium. Infection with BTV serotypes 1, 2 and 23 led to 65-70% mortality at 7-9 days post infection (dpi) and caused severe necrotizing encephalitis with neurodegenerative changes in neurons, swelling and proliferation of vascular endothelial cells in the cerebral cortex, cerebellum, midbrain and brainstem. In contrast, infection with BTV serotypes 10 and 16 led to 25-30% mortality at 9-11 dpi and caused mild neuropathological lesions. BTV antigen was detected by immunohistochemistry, direct fluorescence antibody technique and confocal microscopy in the cytoplasm of neuronal cells of the hippocampus, grey matter of the cerebral cortex and vascular endothelial cells in the midbrain and brainstem of BTV-1, -2, -10, -16 and -23 infected groups from 3 to 20 dpi. BTV nucleic acid was detected in the infected brain tissues from as early as 24 h up to 20 dpi by VP7 gene segment-based one-step reverse transcriptase polymerase chain reaction. This study of the relative neurovirulence of BTV serotypes is likely to help design suitable vaccination and control strategies for the disease.
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Affiliation(s)
- A Anjaneya
- Centre for Animal Disease Research and Diagnosis, India
| | - K P Singh
- Centre for Animal Disease Research and Diagnosis, India.
| | - S Cherian
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122, Bareilly, Uttar Pradesh, India
| | - M Saminathan
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122, Bareilly, Uttar Pradesh, India
| | - R Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243 122, Bareilly, Uttar Pradesh, India
| | - M A Ramakrishnan
- ICAR-Indian Veterinary Research Institute, Regional Station, Mukteswar, Uttarkhand, India
| | - S Maan
- LLR University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - N S Maan
- LLR University of Veterinary and Animal Sciences, Hisar, Haryana, India
| | - D Hemadri
- National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - P P Rao
- Ella Foundation, Hyderabad, Telangana, India
| | - K Putty
- SPVNR Telangana Veterinary University, Hyderabad, Telangana, India
| | - Y Krishnajyothi
- Veterinary Biological and Research Institute, Vijayawada, Andhra Pradesh, India
| | - P P Mertens
- School of Veterinary Medicine and Science, The University of Nottingham, UK
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29
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Balagamwala E, Leyrer C, Tom M, Potemin S, Kolar M, Polkowski W, Sperk E, Wenz F, Suh J, Amarnath S, Rose P, Hull T, Chalikonda S, Mahdi H, Stephans K, Cherian S. EP-1534: International multi-institutional study of intraoperative radiotherapy for abdominopelvic tumors. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31843-7] [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: 11/27/2022]
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30
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Guo B, Shah C, Magnelli A, Manyam B, Tendulkar R, Cherian S, Palmison T, McCarthy D, Suh J, Xia P. Surface Guided Radiation Therapy (SGRT): The Sensitivity of the Region of Interest (ROI) Selection on the Translational and Rotational Accuracy for Whole Breast Irradiation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balagamwala E, Leyrer C, Suh J, Berriochoa C, Amarnath S, Rose P, Hull T, Chalikonda S, Mahdi H, Stephans K, Cherian S. Intraoperative Radiation Therapy for the Treatment of Locally Advanced and Recurrent Abdominopelvic Tumors. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.926] [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: 11/28/2022]
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Leyrer C, Balagamwala E, Reddy C, Berriochoa C, Shah C, Cherian S, Donaldson A, Calhoun B, Stewart R, Moore H, Tendulkar R. The Importance of Treatment and Timing in Metaplastic Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.660] [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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Kazzaz F, Demla V, Cherian S. Unilateral Pulmonary Edema, Westermark's Sign and Palla's Sign in Pulmonary Embolism. QJM 2017; 110:459-460. [PMID: 28339667 DOI: 10.1093/qjmed/hcx041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Kazzaz
- Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.134, Houston, TX 77030, USA
| | - V Demla
- Emergency Medicine, Division of Emergency Critical Care Medicine, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 1.434, Houston, TX 77030, USA
| | - S Cherian
- Divisions of Critical Care, Pulmonary and Sleep Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 1.434, Houston, TX 77030, USA
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Mahdi H, Moulton L, Nutter B, Cherian S, Rose P. The Impact of Combined Radiation and Chemotherapy on Outcome in Uterine Clear Cell Carcinoma Compared with Chemotherapy Alone. Clin Oncol (R Coll Radiol) 2016; 28:776-782. [PMID: 27339402 DOI: 10.1016/j.clon.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/25/2015] [Revised: 05/20/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
AIMS To investigate the impact of pelvic radiation on survival in patients with uterine clear cell carcinoma (UCC) who received adjuvant chemotherapy. MATERIALS AND METHODS Patients with stage I-IV UCC who had undergone surgery and chemotherapy were identified from the Surveillance, Epidemiology, and End Results (SEER) programm 2000-2009. Patients were divided into those who received only chemotherapy and those who received both chemotherapy and radiation therapy. Kaplan-Meier curves and Cox regression models were used for analysis. RESULTS Of the 317 patients included, 195 (62%) were in the chemotherapy only group and 122 (38%) were in the chemotherapy and radiation therapy group. Pelvic radiation was associated with significant improvement in overall survival (median 88 versus 25 months, 5 year survival: 58% versus 33%, P<0.001) in the chemotherapy and radiation therapy group compared with the chemotherapy only group for the entire cohort. On subset analysis, chemotherapy and radiation therapy was associated with improved overall survival in late stage disease (III-IV) (5 year 54% versus 22%, P<0.001) compared with the chemotherapy only group, whereas in stage I-II UCC, there was no difference in overall survival between the chemotherapy and radiotherapy group and the chemotherapy only group (5 year 65% versus 67%, P=0.69). In multivariable analysis, pelvic radiation was associated with improved survival in patients with late stage disease (hazard ratio 0.57, 95% confidence interval 0.35-0.94, P=0.03) but not for early stage disease (hazard ratio 0.81, 95% confidence interval 0.33-2.0, P=0.65). Other significant predictors were advanced stage, positive cytology and extensive lymphadenectomy. CONCLUSIONS Radiation was associated with significant improvement in survival in advanced stage UCC, but not in early stage UCC. These data support the beneficial role of radiation therapy in UCC, especially in patients with advanced stage disease.
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Affiliation(s)
- H Mahdi
- Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - L Moulton
- Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - B Nutter
- Quantitative Health Sciences Department, Cleveland Clinic, Cleveland, Ohio, USA
| | - S Cherian
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - P Rose
- Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Maple-Brown LJ, Hughes JT, Ritte R, Barzi F, Hoy WE, Lawton PD, Jones GRD, Death E, Simmonds A, Sinha AK, Cherian S, Thomas MAB, McDermott R, Brown ADH, O'Dea K, Jerums G, Cass A, MacIsaac RJ. Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study. Clin J Am Soc Nephrol 2016; 11:993-1004. [PMID: 27076636 PMCID: PMC4891751 DOI: 10.2215/cjn.09770915] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 09/15/2015] [Accepted: 02/16/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2-4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m(2), progression to RRT, or renal death). RESULTS Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m(2), respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m(2). Stratified by baseline eGFR (≥90, 60-89, <60 ml/min per 1.73 m(2)), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m(2). Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. CONCLUSIONS The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.
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Affiliation(s)
- Louise J Maple-Brown
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Jamieson L, Skilton M, Maple-Brown L, Kapellas K, Askie L, Hughes J, Arrow P, Cherian S, Fernandes D, Pawar B, Brown A, Boffa J, Hoy W, Harris D, Mueller N, Cass A. Periodontal disease and chronic kidney disease among Aboriginal adults; an RCT. BMC Nephrol 2015; 16:181. [PMID: 26520140 PMCID: PMC4628248 DOI: 10.1186/s12882-015-0169-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/14/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study will assess measures of vascular health and inflammation in Aboriginal Australian adults with chronic kidney disease (CKD), and determine if intensive periodontal intervention improves cardiovascular health, progression of renal disease and periodontal health over a 24-month follow-up. METHODS The study will be a randomised controlled trial. All participants will receive the periodontal intervention benefits, with the delayed intervention group receiving periodontal treatment 24 months following baseline. Inclusion criteria include being an Aboriginal Australian, having CKD (a. on dialysis; b. eGFR levels of < 60 mls/min/1.73 m(2) (CKD Stages 3 to 5); c. ACR ≥ 30 mg/mmol irrespective of eGFR (CKD Stages 1 and 2); d. diabetes plus albuminuria (ACR ≥ 3 mg/mmol) irrespective of eGFR), having moderate or severe periodontal disease, having at least 12 teeth, and living in Central Australia for the 2-year study duration. The intervention involves intensive removal of dental plaque biofilms by scaling, root-planing and removal of teeth that cannot be saved. The intervention will occur in three visits; baseline, 3-month and 6-month follow-up. The primary outcome will be changes in carotid intima-media thickness (cIMT). Secondary outcomes will include progression of CKD or death as a consequence of CKD/cardiovascular disease. Progression of CKD will be defined by time to the development of the first of: (1) new development of macroalbuminuria; (2) 30 % loss of baseline eGFR; (3) progression to end stage kidney disease defined by eGFR < 15 mLs/min/1.73 m(2); (4) progression to end stage kidney disease defined by commencement of renal replacement therapy. A sample size of 472 is necessary to detect a difference in cIMT of 0.026 mm (SD 0.09) at the significance criterion of 0.05 and a power of 0.80. Allowing for 20 % attrition, 592 participants are necessary at baseline, rounded to 600 for convenience. DISCUSSION This will be the first RCT evaluating the effect of periodontal therapy on progression of CKD and cardiovascular disease among Aboriginal patients with CKD. Demonstration of a significant attenuation of CKD progression and cardiovascular disease has the potential to inform clinicians of an important, new and widely available strategy for reducing CKD progression and cardiovascular disease for Australia's most disadvantaged population. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trial Registry ANZCTR12614001183673.
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Affiliation(s)
- Lisa Jamieson
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia.
| | | | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas Kapellas
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Lisa Askie
- Clinical Trials Centre, Unversity of Sydney, Sydney, Australia
| | - Jaqui Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Peter Arrow
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Sajiv Cherian
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - David Fernandes
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - Basant Pawar
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - Wendy Hoy
- Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - David Harris
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicole Mueller
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Nicol P, Anthonappa R, King N, Slack-Smith L, Cirillo G, Cherian S. Caries burden and efficacy of a referral pathway in a cohort of preschool refugee children. Aust Dent J 2015; 60:73-9. [PMID: 25721281 DOI: 10.1111/adj.12269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to assess the early caries experience and the efficacy of a community based dental referral pathway in preschool refugees in Western Australia. METHODS Preschool refugee children referred to the Western Australian paediatric hospital Refugee Health Clinic were prospectively screened for caries by a paediatric dentist before being referred to community dental clinics. Dental forms and medical records were audited to assess decayed, missing and filled teeth (dmft), medical data and dental services engagement. Poisson regression analysis determined the contribution of count variables to the final model. RESULTS Among the 105 screened children (54% male, median age 3.2 years, 41% Burmese), community dental clinic engagement was low (46%, n=48). Of the 62% with caries (n=65/105, mean dmft 5.2, SD 4.1), 45% were recommended for specialist dental services and 48% were treated. After adjustment for age, gender and total number of teeth, caries incidence was significantly associated with BMI-for-age Z score (p=0.02). CONCLUSIONS Preschool refugee caries burden was high. The community dental referral pathway was ineffective compared to co-located intersectorial dental screening. Specialist dental service needs are high in this cohort and require a targeted approach.
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Affiliation(s)
- P Nicol
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
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Winstanley A, Sperotto RG, Putnick DL, Cherian S, Bornstein MH, Gattis M. Consistency of maternal cognitions and principles across the first five months following preterm and term deliveries. Infant Behav Dev 2014; 37:760-71. [PMID: 25459794 PMCID: PMC4266449 DOI: 10.1016/j.infbeh.2014.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/12/2014] [Accepted: 09/29/2014] [Indexed: 11/29/2022]
Abstract
Consistency in group level (continuity) and individual level (stability) was examined longitudinally for caregiving principles (structure and attunement) and cognitions (categorical thinking, perspectivist thinking, complexity of thought) in mothers of preterm and term infants from birth to 5 months old. Attunement was continuous and stable in mothers of preterm and term infants. Structure was continuous in both groups but stable only in mothers of term infants. Complexity of thought was continuous in both groups, perspectivist thinking increased in both groups but only for first-time mothers, and categorical thinking increased only in mothers of preterm infants. Categorical thinking, perspectivist thinking, and complexity of thought were stable in mothers of both preterm and term infants.
The aims of this study were to examine and compare the development of parenting cognitions and principles in mothers following preterm and term deliveries. Parenting cognitions about child development, including thinking that is restricted to single causes and single outcomes (categorical thinking) and thinking that takes into account multiple perspectives (perspectivist thinking), have been shown to relate to child outcomes. Parenting principles about using routines (structure) or infant cues (attunement) to guide daily caregiving have been shown to relate to caregiving practices. We investigated the continuity and stability of parenting cognitions and principles in the days following birth to 5 months postpartum for mothers of infants born term and preterm. All parenting cognitions were stable across time. Categorical thinking increased at a group level across time in mothers of preterm, but not term, infants. Perspectivist thinking increased at a group level for first-time mothers (regardless of birth status) and tended to be lower in mothers of preterm infants. Structure at birth did not predict later structure (and so was unstable) in mothers of preterm, but not term, infants and neither group changed in mean level across time. Attunement was consistent across time in both groups of mothers. These results indicate that prematurity has multiple, diverse effects on parenting beliefs, which may in turn influence maternal behavior and child outcomes.
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Affiliation(s)
- A Winstanley
- Department of Psychology, University of Cambridge, Cambridge, UK; School of Psychology, Cardiff University, Cardiff, UK.
| | - R G Sperotto
- School of Psychology, Cardiff University, Cardiff, UK
| | - D L Putnick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - S Cherian
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - M H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - M Gattis
- School of Psychology, Cardiff University, Cardiff, UK.
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Liu H, Cherian S, Stephans K, Videtic G, Qi P, Xia P, Zhuang T. SU-F-BRD-16: Under Dose Regions Recalculated by Monte Carlo Cannot Predict the Local Failure for NSCLC Patients Treated with SBRT. Med Phys 2014. [DOI: 10.1118/1.4889837] [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: 11/07/2022] Open
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Sellappan B, Chakraborty M, Cherian S. Congenital hypothyroidism presenting as pseudo-obstruction in preterm infants. BMJ Case Rep 2014; 2014:bcr2013201082. [PMID: 24832703 PMCID: PMC4025204 DOI: 10.1136/bcr-2013-201082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/03/2022] Open
Abstract
Congenital hypothyroidism (CH) presenting as acute pseudo-obstruction is uncommon. We report two premature infants presenting with acute bowel obstruction subsequently diagnosed to have CH. Both responded well to medical management with thyroid supplementation.
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Affiliation(s)
- B Sellappan
- Neonatal Unit, University Hospital of Wales, Cardiff, UK
| | - M Chakraborty
- Neonatal Unit, University Hospital of Wales, Cardiff, UK
| | - S Cherian
- Neonatal Unit, University Hospital of Wales, Cardiff, UK
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Cherian S, Wai Lam Y, McDaniels I, Struziak M, Delay RJ. Estradiol rapidly modulates odor responses in mouse vomeronasal sensory neurons. Neuroscience 2014; 269:43-58. [PMID: 24680884 DOI: 10.1016/j.neuroscience.2014.03.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 10/23/2013] [Revised: 02/11/2014] [Accepted: 03/09/2014] [Indexed: 11/27/2022]
Abstract
In rodents, many social behaviors are driven by the sense of smell. The vomeronasal organ (VNO), part of the accessory olfactory system mediates many of these chemically driven behaviors. The VNO is heavily vascularized, and is readily accessible to circulating peptide or steroid hormones. Potentially, this allows circulating hormones to alter behavior through modulating the output of the primary sensory neurons in the VNO, the vomeronasal sensory neurons (VSNs). Based on this, we hypothesized that steroid hormones, in particular 17β-estradiol, would modulate activity of VSNs. In this paper, we show that the estrogen receptors, GPR30 and ERα, were present in VSNs and that estradiol may be synthesized locally in the VNO. Our results also showed that 17β-estradiol decreased responses of isolated VSNs to dilute urine, a potent natural stimulus, with respect to current amplitudes and depolarization. Further, 17β-estradiol increased the latency of the first action potential (AP) and the AP amplitude. Additionally, calcium responses to sulfated steroids (present in the low molecular weight fraction of urine) that act as ligands for apical vomeronasal receptors were decreased by 17β-estradiol. In conclusion, we show that estradiol modulates odorant responses mediated by VSNs and hence paves the way for future studies to better understand the mechanisms by which odorant mediated behavior is altered by endocrine status of the animal.
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Affiliation(s)
- S Cherian
- Department of Biology, University of Vermont, United States
| | - Y Wai Lam
- Department of Biology, University of Vermont, United States; Vermont Genetics Network Proteomics Facility, University of Vermont, United States
| | - I McDaniels
- Department of Biology, University of Vermont, United States
| | - M Struziak
- Department of Biology, University of Vermont, United States
| | - R J Delay
- Department of Biology, University of Vermont, United States.
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Liu H, Cherian S, Stephans K, Videtic G, Qi P, Xia P, Zhuang T. Analysis of Local Failure of Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1953] [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: 11/30/2022]
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Balagamwala E, Cherian S, Suh J, Reddy C, Angelov L, Djemil T, Magnelli A, Soeder S, Chao S. Treatment of 3 or More Contiguous Vertebral Bodies With Spine Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kwong S, Djemil T, Vaghefi H, Cherian S, Videtic G, Stephans K. Incidental Mediastinal Nodal Radiation During Stereotactic Radiation for Lung Tumors: Implications for High-dose Treatment of Locally Advanced Disease. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1615] [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: 11/24/2022]
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Cherian S, Djemil T, Abdel-Wahab M, Greskovich J, Fung J, Aucejo F, Miller C, Sanabria J, Menon N, Stephan K. Stereotactic Radiation (SBRT) for Primary Liver Malignancies. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Loo SW, Martin WMC, Smith P, Cherian S, Roques TW. Interobserver variation in parotid gland delineation: a study of its impact on intensity-modulated radiotherapy solutions with a systematic review of the literature. Br J Radiol 2012; 85:1070-7. [PMID: 22815411 DOI: 10.1259/bjr/32038456] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study evaluates the interobserver variation in parotid gland delineation and its impact on intensity-modulated radiotherapy (IMRT) solutions. METHODS The CT volumetric data sets of 10 patients with oropharyngeal squamous cell carcinoma who had been treated with parotid-sparing IMRT were used. Four radiation oncologists and three radiologists delineated the parotid gland that had been spared using IMRT. The dose-volume histogram (DVH) for each study contour was calculated using the IMRT plan actually delivered for that patient. This was compared with the original DVH obtained when the plan was used clinically. RESULTS 70 study contours were analysed. The mean parotid dose achieved during the actual treatment was within 10% of 24 Gy for all cases. Using the study contours, the mean parotid dose obtained was within 10% of 24 Gy for only 53% of volumes by radiation oncologists and 55% of volumes by radiologists. The parotid DVHs of 46% of the study contours were sufficiently different from those used clinically, such that a different IMRT plan would have been produced. CONCLUSION Interobserver variation in parotid gland delineation is significant. Further studies are required to determine ways of improving the interobserver consistency in parotid gland definition.
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Affiliation(s)
- S W Loo
- Department of Clinical Oncology, Norfolk and Norwich University Hospital, Norwich, UK.
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George B, Coates T, McDonald S, Russ G, Cherian S, Nolan J, Brealey J. Disseminated microsporidiosis with Encephalitozoon species in a renal transplant recipient. Nephrology (Carlton) 2012; 17 Suppl 1:5-8. [PMID: 22497646 DOI: 10.1111/j.1440-1797.2012.01580.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To our knowledge, 5 cases of disseminated microsporidiosis with Encephalitozoon species have been reported worldwide in transplant recipients. George et al. present the first such case in Australia, to be reported and treated with good clinical recovery.
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Affiliation(s)
- Bibin George
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, South Australia.
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Patil JA, Cherian S, Walimbe AM, Bhagat A, Vallentyne J, Kakade M, Shah PS, Cecilia D. Influence of evolutionary events on the Indian subcontinent on the phylogeography of dengue type 3 and 4 viruses. Infect Genet Evol 2012; 12:1759-69. [PMID: 22890284 DOI: 10.1016/j.meegid.2012.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 11/19/2022]
Abstract
During 1960-80 dengue disease profile in India was mild despite circulation of all four serotypes of dengue virus (DENV). Increase in disease severity with a concomitant change in the population of DENV-1 and 2 have been reported since then. To determine population dynamics of DENV-3 and 4, the envelope (E) gene sequence was determined for 16 Indian isolates of DENV-3 and 11 of DENV-4 and analyzed together with 97 DENV-3 and 43 DENV-4 global sequences. All Indian DENV-3 isolates belonged to genotype III, lineages C, D, E and F. Lineage F was newly identified and represented non-circulating viruses. Three non-conservative amino acid changes in domain I, II & III were identified during the transition from lineages F/E, associated with mild disease, to A-D, associated with severe disease. For DENV-4, the current viruses clustered in genotype I, lineage C, whilst the isolates from 1960s formed the new genotype V. A 1979 Indian isolate of DENV-4 was found to be an inter-genotypic recombinant of Sri Lankan isolate (1978) of genotype I and Indian isolate (1961) of genotype V. The rates of nucleotide substitution and time to the most recent common ancestor (tMRCA) estimated for DENV-3 (1782-1934) and DENV-4 (1719-1931) were similar to earlier reports. However, the divergence time for genotype III of DENV-3, 1938-1963, was a more accurate estimate with the inclusion of Indian isolates from the 1960s. By phylogeographical analysis it was revealed that DENV-3 GIII viruses emerged from India and evolved through Sri Lanka whilst DENV-4 emerged and dispersed from India. The present study demonstrates the crucial role that India/Sri Lanka have played in the evolution and dispersion of the major genotypes, GIII of DENV-3 and GI of DENV-4 which are more virulent and show higher dissemination potential.
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Affiliation(s)
- J A Patil
- Dengue Group, National Institute of Virology, 20-A, Dr Ambedkar Road, PO Box No 11, Pune 411001, Maharashtra State, India
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Panichpisal K, Omoregie E, Rodriguez A, Sarva H, Law S, Rojas-Soto D, Dardis C, Ramirez-Abreu D, Nguyen C, Sareen A, Kotseva M, Cherian S, Moradiya Y, Antezana A, Bulic S, Jadoo C, Personna-Policard J, Vulkanov V, Emami A, Arya K, Jirasakuldej S, Kozlova O, McIntyre S, Thomas L, Rosenbaum D, Levine S, Baird A. Stroke Risk Factors and Ischemic Subtypes in a Multiethnic Population in Central and East Brooklyn (P07.050). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cikirikcioglu M, Zorman Y, Cherian S, Muller H, Vallee J, Licker M, Kalangos A. VP-020 SURGICAL TREATMENT OF CONSTRICTIVE PERICARDITIS. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70237-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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