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McNeil AL, Al-Shibli NK, Fuller ME, Goldstein SA, Habib AS, Dotters-Katz SK, Shah SH, Meng ML. Pregnancy-related outcomes in obstetric patients with pulmonary hypertension: a single-center retrospective cohort study. Int J Obstet Anesth 2024; 57:103964. [PMID: 38103941 DOI: 10.1016/j.ijoa.2023.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Affiliation(s)
- A L McNeil
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - N K Al-Shibli
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - M E Fuller
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - S A Goldstein
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - A S Habib
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - S K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - S H Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - M-L Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
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Karki KB, Towbin JA, Shah SH, Philip RR, West AN, Tadphale SD, Saini A. Elevated Copeptin Levels Are Associated with Heart Failure Severity and Adverse Outcomes in Children with Cardiomyopathy. Children (Basel) 2023; 10:1138. [PMID: 37508636 PMCID: PMC10377870 DOI: 10.3390/children10071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
In children with cardiomyopathy, the severity of heart failure (HF) varies. However, copeptin, which is a biomarker of neurohormonal adaptation in heart failure, has not been studied in these patients. In this study, we evaluated the correlation of copeptin level with functional HF grading, B-type natriuretic peptide (BNP), and echocardiography variables in children with cardiomyopathy. Furthermore, we determined if copeptin levels are associated with adverse outcomes, including cardiac arrest, mechanical circulatory support, heart transplant, or death. In forty-two children with cardiomyopathy with a median (IQR) age of 13.1 years (2.5-17.2) and a median follow-up of 2.5 years (2.2-2.7), seven (16.7%) children had at least one adverse outcome. Copeptin levels were highest in the patients with adverse outcomes, followed by the patients without adverse outcomes, and then the healthy children. The copeptin levels in patients showed a strong correlation with their functional HF grading, BNP level, and left ventricular ejection fraction (LVEF). Patients with copeptin levels higher than the median value of 25 pg/mL had a higher likelihood of experiencing adverse outcomes, as revealed by Kaplan-Meier survival analysis (p = 0.024). Copeptin level was an excellent predictor of outcomes, with an area under the curve of 0.861 (95% CI, 0.634-1.089), a sensitivity of 86%, and a specificity of 60% for copeptin level of 25 pg/mL. This predictive value was superior in patients with dilated and restrictive cardiomyopathies (0.97 (CI 0.927-1.036), p < 0.0001, n = 21) than in those with hypertrophic and LV non-compaction cardiomyopathies (0.60 (CI 0.04-1.16), p = 0.7, n = 21).
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Affiliation(s)
- Karan B Karki
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Jeffrey A Towbin
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Samir H Shah
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Ranjit R Philip
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Alina N West
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Sachin D Tadphale
- Division of Pediatric Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Arun Saini
- Section of Pediatric, Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Affiliated Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
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Hamilton H, West AN, Ammar N, Chinthala L, Gunturkun F, Jones T, Shaban-Nejad A, Shah SH. Analyzing Relationships Between Economic and Neighborhood-Related Social Determinants of Health and Intensive Care Unit Length of Stay for Critically Ill Children With Medical Complexity Presenting With Severe Sepsis. Front Public Health 2022; 10:789999. [PMID: 35570956 PMCID: PMC9099028 DOI: 10.3389/fpubh.2022.789999] [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: 10/05/2021] [Accepted: 03/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Of the Social Determinants of Health (SDoH), we evaluated socioeconomic and neighborhood-related factors which may affect children with medical complexity (CMC) admitted to a Pediatric Intensive Care Unit (PICU) in Shelby County, Tennessee with severe sepsis and their association with PICU length of stay (LOS). We hypothesized that census tract-level socioeconomic and neighborhood factors were associated with prolonged PICU LOS in CMC admitted with severe sepsis in the underserved community. Methods This single-center retrospective observational study included CMC living in Shelby County, Tennessee admitted to the ICU with severe sepsis over an 18-month period. Severe sepsis CMC patients were identified using an existing algorithm incorporated into the electronic medical record at a freestanding children's hospital. SDoH information was collected and analyzed using patient records and publicly available census-tract level data, with ICU length of stay as the primary outcome. Results 83 encounters representing 73 patients were included in the analysis. The median PICU LOS was 9.04 days (IQR 3.99–20.35). The population was 53% male with a median age of 4.1 years (IQR 1.96–12.02). There were 57 Black/African American patients (68.7%) and 85.5% had public insurance. Based on census tract-level data, about half (49.4%) of the CMC severe sepsis population lived in census tracts classified as suffering from high social vulnerability. There were no statistically significant relationships between any socioeconomic and neighborhood level factors and PICU LOS. Conclusion Pediatric CMC severe sepsis patients admitted to the PICU do not have prolonged lengths of ICU stay related to socioeconomic and neighborhood-level SDoH at our center. A larger sample with the use of individual-level screening would need to be evaluated for associations between social determinants of health and PICU outcomes of these patients.
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Affiliation(s)
- Hunter Hamilton
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Alina N West
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Nariman Ammar
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Lokesh Chinthala
- Clinical Trials Network of Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Fatma Gunturkun
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Tamekia Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States.,Children's Foundation Research Institute Biostatistics Core, Memphis, TN, United States
| | - Arash Shaban-Nejad
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Samir H Shah
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
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Di Nardo M, Ahmad AH, Merli P, Zinter MS, Lehman LE, Rowan CM, Steiner ME, Hingorani S, Angelo JR, Abdel-Azim H, Khazal SJ, Shoberu B, McArthur J, Bajwa R, Ghafoor S, Shah SH, Sandhu H, Moody K, Brown BD, Mireles ME, Steppan D, Olson T, Raman L, Bridges B, Duncan CN, Choi SW, Swinford R, Paden M, Fortenberry JD, Peek G, Tissieres P, De Luca D, Locatelli F, Corbacioglu S, Kneyber M, Franceschini A, Nadel S, Kumpf M, Loreti A, Wösten-Van Asperen R, Gawronski O, Brierley J, MacLaren G, Mahadeo KM. Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement. Lancet Child Adolesc Health 2022; 6:116-128. [PMID: 34895512 PMCID: PMC9372796 DOI: 10.1016/s2352-4642(21)00336-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) in children receiving haematopoietic cell transplantation (HCT) and immune effector cell therapy is controversial and evidence-based guidelines have not been established. Remarkable advancements in HCT and immune effector cell therapies have changed expectations around reversibility of organ dysfunction and survival for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (HCT and cancer immunotherapy subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC), and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT and immune effector cell therapy. These are the first international, multidisciplinary consensus-based recommendations on the use of ECMO in this patient population. This Review provides a clinical decision support tool for paediatric haematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations can represent a base for future research studies focused on ECMO selection criteria and bedside management.
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Affiliation(s)
- Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Ali H Ahmad
- Department of Pediatrics, Pediatric Critical Care, Houston, TX, USA
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matthew S Zinter
- Department of Pediatrics, Divisions of Critical Care and Bone Marrow Transplantation, University of California, San Francisco, CA, USA
| | - Leslie E Lehman
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Courtney M Rowan
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Marie E Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Sangeeta Hingorani
- Department of Pediatrics, Division of Nephrology, University of Washington School of Medicine, and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Transplantation and Cell Therapy Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sajad J Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basirat Shoberu
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer McArthur
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Samir H Shah
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hitesh Sandhu
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen Moody
- CARTOX Program, and Department of Pediatrics, Supportive Care, Houston, TX, USA
| | - Brandon D Brown
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Diana Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor Olson
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Lakshmi Raman
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian Bridges
- Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christine N Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Sung Won Choi
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI, USA; Department of Pediatrics, Ann Arbor, MI, USA
| | - Rita Swinford
- Department of Pediatrics, Division of Pediatric Nephrology, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Matt Paden
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - James D Fortenberry
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - Giles Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Pierre Tissieres
- Division of Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospital, Le Kremlin-Bicetre, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Paris, France
| | - Daniele De Luca
- Division of Pediatrics, Transportation and Neonatal Critical Care Medicine, APHP, Paris Saclay University Hospital, "A.Beclere" Medical Center and Physiopathology and Therapeutic Innovation Unit-INSERM-U999, Paris Saclay University, Paris, France
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Martin Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, Groningen, Netherlands; Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Alessio Franceschini
- Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simon Nadel
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Matthias Kumpf
- Interdisciplinary Pediatric Intensive Care Unit, Universitäetsklinikum Tuebingen, Tuebingen, Germany
| | - Alessandra Loreti
- Medical Library, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roelie Wösten-Van Asperen
- Department of Pediatric Intensive Care, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Joe Brierley
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - Graeme MacLaren
- Director of Cardiothoracic ICU, National University Health System, Singapore, Singapore; Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Muranjan SN, Singhal DD, Shah SH, Shah AK. Bilateral idiopathic temporal bone meningoencephaloceles - An unusual presentation. J Postgrad Med 2021; 67:228-231. [PMID: 34845891 PMCID: PMC8706532 DOI: 10.4103/jpgm.jpgm_566_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Meningoencephaloceles (MECs) occur due to herniation of brain tissue through a bony defect in the skull base. They can be spontaneous or acquired. These are secondary to trauma, infection or neoplasia. Adult-onset spontaneous or idiopathic MECs are rare. Temporal bone MECs can present with watery discharge from the ear, conductive hearing loss or symptoms of meningitis like headache, fever, vomiting or seizures. These symptoms mimic chronic suppurative or serous otitis media. Computed tomography scan and magnetic resonance imaging differentiate between them. Awareness of this disease entity is necessary for early detection to avoid complications. We report a case of bilateral idiopathic temporal bone MECs with a rare presentation of autophony as the chief complaint. The differentiating features on computed tomography scan and magnetic resonance imaging and the surgical management are discussed.
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Affiliation(s)
- S N Muranjan
- Department of ENT, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - D D Singhal
- Department of ENT, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - S H Shah
- Department of Radiology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - A K Shah
- Department of ENT, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
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Avinashsingh Eswarsingh AS, Bose AB, Islam TS, Shah SH, Alampoondi Venkataramanan SAI, Muthyala AM, Manohar SM, Rupendu SR, Shah NS. Effect of statin on progression of degenerative aortic root dilatation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic root dilatation (ARD) is the most common thoracic aortic aneurysm (TAA). Causes of TAA include congenital and heritable disorders, degenerative disorders, inflammatory and infectious etiologies (1.) Hypertension management and smoking cessation are the two most important risk factor modification strategies to prevent rapid progression (>2 mm/year) of TAAs. Beta blockers and angiotensin receptor blockers are the preferred agents to treat HTN (5,6). Statin use is associated with a lower rate of progression of ascending arch and thoracoabdominal aortic aneurysms (2,3,4). However, their role in the progression of degenerative ARD remains unclear.
Purpose
To evaluate the association between statin use and progression of ARD.
Methods
A retrospective chart analysis was performed on 340 patients with a known diagnosis of degenerative ARD. Aortic root measurements were followed by serial transthoracic echocardiograms from the time of first diagnosis for a total of 10 years. The study population was dichotomized based on statin use. The mean change in ARD was calculated for each patient in millimeters. Baseline characteristics were compared between the groups. Multivariate adjusted linear regression models were used to estimate unit change in mean ARD change based on statin use.
Results
Patients in the statin group were older, more obese, with a higher prevalence of comorbidities and medication use compared to patients not on statin. Over a 10-year follow up, the mean increase in ARD was comparable for statin vs. non-statin users (0.83 mm vs. 0.73 mm, p=0.53). On a multivariate regression model adjusted for baseline demographics, risk factors and medication use, the statin group showed a 0.16 mm reduction in ARD compared to non-statin group but this decrease was not statistically significant (Table 1, p=0.47)
Conclusion
In patients with degenerative ARD on a pre-existing regimen of statin, there was no statistically significant change in ARD.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
| | - A B Bose
- Saint Vincent Hospital, Cardiology, Worcester, United States of America
| | - T S Islam
- Geisinger Medical Center, Internal medicine, Danville, United States of America
| | - S H Shah
- Saint Vincent Hospital, Internal medicine, Worcester, United States of America
| | | | - A M Muthyala
- Saint Vincent Hospital, Internal medicine, Worcester, United States of America
| | - S M Manohar
- Saint Vincent Hospital, Internal medicine, Worcester, United States of America
| | - S R Rupendu
- Saint Vincent Hospital, Internal medicine, Worcester, United States of America
| | - N S Shah
- Saint Vincent Hospital, Cardiology, Worcester, United States of America
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Hussain Z, Sun Y, Shah SH, Khan H, Ali S, Iqbal A, Zia MA, Ali SS. The dynamics of genome size and GC contents evolution in genus Nicotiana. BRAZ J BIOL 2021; 83:e245372. [PMID: 34669791 DOI: 10.1590/1519-6984.245372] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 05/11/2021] [Indexed: 11/22/2022] Open
Abstract
Hybridization and Polyploidization are most common of the phenomenon observed in plants, especially in the genus Nicotiana leading to the duplication of genome. Although genomic changes associated with these events has been studied at various levels but the genome size and GC content variation is less understood because of absence of sufficient genomic data. In this study the flow cytometry technique was used to uncover the genome size and GC contents of 46 Nicotiana species and we compared the genomic changes associated with the hybridization events along evolutionary time scale. The genome size among Nicotiana species varied between 3.28 pg and 11.88 pg whereas GC contents varied between 37.22% and 51.25%. The tetraploid species in genus Nicotiana including section Polydiclae, Repandae, Nicotiana, Rustica and Sauveolentes revealed both up and downsizing in their genome sizes when compared to the sum of genomes of their ancestral species. The genome sizes of three homoploid hybrids were found near their ancestral species. Loss of large genome sequence was observed in the evolutionary more aged species (>10 Myr) as compared to the recently evolved one's (<0.2 Myr). The GC contents were found homogenous with a mean difference of 2.46% among the Nicotiana species. It is concluded that genome size change appeared in either direction whereas the GC contents were found more homogenous in genus Nicotiana.
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Affiliation(s)
- Z Hussain
- Chinese Academy of Agricultural Sciences, Qingdao, Shandong, China
- University of Swat, Centre for Biotechnology and Microbiology, Mingora, Swat, Khyber Pukhtunkhwa, Pakistan
| | - Y Sun
- Chinese Academy of Agricultural Sciences, Qingdao, Shandong, China
| | - S H Shah
- Allama Iqbal Open University, Faculty of Sciences, Department of Agricultural Sciences, Islamabad, Pakistan
| | - H Khan
- Quid-e-Azam University, Department of Biotechnology, Islamabad, Pakistan
| | - S Ali
- University of Swat, Centre for Biotechnology and Microbiology, Mingora, Swat, Khyber Pukhtunkhwa, Pakistan
| | - A Iqbal
- University of Swat, Centre for Biotechnology and Microbiology, Mingora, Swat, Khyber Pukhtunkhwa, Pakistan
| | - M A Zia
- National Agricultural Research Centre - NARC, National Institute for Genomics and Advanced Biotechnology - NIGAB, Islamabad, Pakistan
| | - S S Ali
- University of Swat, Centre for Biotechnology and Microbiology, Mingora, Swat, Khyber Pukhtunkhwa, Pakistan
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8
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Shafqat N, Shahzad A, Shah SH, Mahmood Z, Sajid M, Ullah F, Islam M, Masood R, Jabeen N, Zubair K. Characterization of wheat-Thinopyrum bessarabicum genetic stock for stripe rust and Karnal bunt resistance. BRAZ J BIOL 2021; 83:e246440. [PMID: 34550282 DOI: 10.1590/1519-6984.246440] [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] [Received: 12/10/2020] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
Utilization of modern breeding techniques for developing high yielding and uniform plant types ultimately narrowing the genetic makeup of most crops. Narrowed genetic makeup of these crops has made them vulnerable towards disease and insect epidemics. For sustainable crop production, genetic variability of these crops must be broadened against various biotic and abiotic stresses. One of the ways to widen genetic configuration of these crops is to identify novel additional sources of durable resistance. In this regard crops wild relatives are providing valuable sources of allelic diversity towards various biotic, abiotic stress tolerance and quality components. For incorporating novel variability from wild relative's wide hybridization technique has become a promising breeding method. For this purpose, wheat-Th. bessarabicum amphiploid, addition and translocation lines have been screened in field and screen house conditions to get novel sources of yellow rust and Karnal bunt resistant. Stripe rust screening under field conditions has revealed addition lines 4JJ and 6JJ as resistant to moderately resistant while addition lines 3JJ, 5JJ, 7JJ and translocation lines Tr-3, Tr-6 as moderately resistant wheat-Thinopyrum-bessarabicum genetic stock. Karnal bunt screening depicted addition lines 5JJ and 4JJ as highly resistant genetic stock. These genetic stocks may be used to introgression novel stripe rust and Karnal bunt resistance from the tertiary gene pool into susceptible wheat backgrounds.
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Affiliation(s)
- N Shafqat
- Hazara University, Department of Agriculture, Mansehra, Pakistan
| | - A Shahzad
- National Institute for Genomics and Advanced Biotechnology - NIGAB, National Agricultural Research Centre - NARC, Islamabad, Pakistan
| | - S H Shah
- Allama Iqbal Open University, Faculty of Sciences, Department of Agricultural Sciences, Islamabad, Pakistan
| | - Z Mahmood
- National Agricultural Research Centre - NARC, Wheat Program, Islamabad, Pakistan
| | - M Sajid
- Hazara University, Department of Agriculture, Mansehra, Pakistan
| | - F Ullah
- Hazara University, Department of Agriculture, Mansehra, Pakistan
| | - M Islam
- Hazara University Mansehra, Department of Genetics, Mansehra, Pakistan
| | - R Masood
- Hazara University Mansehra, Department of Botany, Mansehra, Pakistan
| | - N Jabeen
- Hazara University, Department of Agriculture, Mansehra, Pakistan
| | - K Zubair
- Hazara University Mansehra, Department of Genetics, Mansehra, Pakistan
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Khan SU, Ali S, Shah SH, Zia MA, Shoukat S, Hussain Z, Shahzad A. Impact of nitrogen and phosphorus fertilizers on Cry1Ac protein contents in transgenic cotton. BRAZ J BIOL 2021; 83:e246436. [PMID: 34495159 DOI: 10.1590/1519-6984.246436] [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] [Received: 12/10/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Application of different fertilizers to check the efficiency of expression of Bt (Bacillus thuringiensis) gene in one of the leading commercialized crops (cotton) against Lepidopteran species is of great concern. The expression of Cry protein level can be controlled by the improvement of nutrients levels. Therefore, the myth of response of Cry toxin to different combinations of NP fertilizers was explored in three Bt cotton cultivars. Combinations include three levels of nitrogen and three levels of phosphorus fertilizers. Immunostrips and Cry gene(s) specific primer based PCR (Polymerase Chain Reaction) analysis were used for the presence of Bt gene that unveiled the presence of Cry1Ac gene only. Further, the ELISA (enzyme-linked immunosorbent assay) kit was used to quantify the expression of Cry1Ac protein. Under various NP fertilizers rates, the level of toxin protein exhibited highly significant differences. The highest toxin level mean was found to be 2.3740 and 2.1732 µg/g under the treatment of N150P75 kg ha-1 combination while the lowest toxin level mean was found to be 0.9158 and 0.7641 µg/g at the N50P25 kg ha-1 level at 80 and 120 DAS (Days After Sowing), respectively. It was concluded from the research that the usage of NP fertilizers has a positive relation with the expression of Cry1Ac toxin in Bt cotton. We recommend using the N150P50 kg ha-1 level as the most economical and practicable fertilizer instead of the standard dose N100P50 kg ha-1 to get the desired level of Cry1Ac level for long lasting plant resistance (<1.5). The revised dose of fertilizer may help farmers to avoid the cross-resistance development in contradiction of insect pests.
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Affiliation(s)
- S U Khan
- PARC Institute of Advanced Studies in Agriculture - PIASA, National Agricultural Research Centre - NARC, Islamabad, Pakistan
| | - S Ali
- National Institute for Genomics & Advanced Biotechnology - NIGAB, National Agricultural Research Centre - NARC, Islamabad, Pakistan
| | - S H Shah
- Department of Agricultural Sciences, Faculty of Sciences, Allama Iqbal Open University, Islamabad, Pakistan
| | - M A Zia
- National Institute for Genomics & Advanced Biotechnology - NIGAB, National Agricultural Research Centre - NARC, Islamabad, Pakistan
| | - S Shoukat
- PARC Institute of Advanced Studies in Agriculture - PIASA, National Agricultural Research Centre - NARC, Islamabad, Pakistan
| | - Z Hussain
- Centre for Biotechnology and Microbiology, University of Swat, Swat, Khyber Pukhtunkhwa, Pakistan
| | - A Shahzad
- National Institute for Genomics & Advanced Biotechnology - NIGAB, National Agricultural Research Centre - NARC, Islamabad, Pakistan
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10
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Liaquat M, Ali I, Ahmad S, Malik AM, Ashraf HMQ, Parveen N, Tareen MJ, Saeed T, Shah SH, Zulfiqar B. Efficiency of exogenous zinc sulfate application reduced fruit drop and improved antioxidant activity of 'Kinnow' mandarin fruit. BRAZ J BIOL 2021; 83:e244593. [PMID: 34468512 DOI: 10.1590/1519-6984.244593] [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] [Received: 10/15/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
‘ Kinnow' mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of 'Kinnow' mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the "Kinnow" fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-1) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar spray of ZnSO4 (0.6%) four months prior to harvest reduced pre-harvest fruit drop, increase yield with improved quality of 'Kinnow' mandarin fruit.
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Affiliation(s)
- M Liaquat
- PMAS Arid Agriculture University, Institute of Hydroponic Agriculture, Rawalpindi, Pakistan
| | - I Ali
- PMAS-Arid Agriculture University, Deparment of Horticulture, Rawalpindi, Pakistan
| | - S Ahmad
- University of Agriculture, Institute of Horticultural Sciences, Faisalabad, Pakistan
| | - A M Malik
- PMAS Arid Agriculture University, Institute of Hydroponic Agriculture, Rawalpindi, Pakistan
| | - H M Q Ashraf
- University of Agriculture, Institute of Horticultural Sciences, Faisalabad, Pakistan
| | - N Parveen
- University of Agriculture, Department of Plant Breeding and Genetics, Faisalabad, Pakistan
| | - M J Tareen
- Agriculture Research Institute, Balochistan, Pakistan
| | - T Saeed
- Government of Azad Jammu and Kashmir, Department of Agriculture, Muzaffarabad, Pakistan
| | - S H Shah
- Allama Iqbal Open University, Faculty of Sciences, Department of Agricultural Sciences, Islamabad, Pakistan
| | - B Zulfiqar
- Scientific Officer Horticulture Soil and Water Conservation Research Institute, Chakwal, Pakistan
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11
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Zia MA, Shah SH, Shoukat S, Hussain Z, Khan SU, Shafqat N. Physicochemical features, functional characteristics, and health benefits of cottonseed oil: a review. BRAZ J BIOL 2021; 82:e243511. [PMID: 34378680 DOI: 10.1590/1519-6984.243511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Vegetable oils have their specific physicochemical properties due to which they are playing vital role in human nutritional diet for health benefits. Cottonseed oil is obtained from various species of cotton seeds that are famous to be grown mainly for their fiber quality. The most prominently used specie is Gossypium hirsutum. It is obvious that the seeds of different variety of cotton vary as grown in diverse agroclimatic conditions with respect to oil, fats and protein contents. Cottonseed oil is routinely used for cooking and food manufacturing products. Cottonseed oil obtained after proper extraction/processing steps from crude state to refined oil in a variety of ways. Cotton crop is considered for their dual-use purpose, for fiber quality and oil production to promote health benefits in the world. Keeping in view the above facts, this review clearly demonstrated an overview about physicochemical and functional properties of cottonseed oil to promote health benefits associated with the use of this oil. The overall characteristics and all concerned health benefits of CSO will further improve their usefulness is a compact way. We have summarized a brief multi-dimensional features of CSO in all aspects up to the best of our knowledge for the end researchers who can further research in the respective aspect.
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Affiliation(s)
- M A Zia
- National Agricultural Research Centre - NARC, National Institute for Genomics and Advanced Biotechnology - NIGAB, Islamabad, Pakistan.,Quaid-i-Azam University, Department of Biotechnology, Islamabad, Pakistan
| | - S H Shah
- Allama Iqbal Open University, Faculty of Sciences, Department of Agricultural Sciences, Islamabad, Pakistan
| | - S Shoukat
- National Agricultural Research Centre - NARC, National Institute for Genomics and Advanced Biotechnology - NIGAB, Islamabad, Pakistan
| | - Z Hussain
- University of Swat, Centre for Biotechnology and Microbiology, Khyber Pukhtunkhwa, Pakistan
| | - S U Khan
- Chinese Academy of Agricultural Sciences - CAAS, Biotechnology Research Institute, Biotechnology Research Institute, Beijing, P.R. China
| | - N Shafqat
- Hazara University, Department of Agricultural Sciences, Mansehra, Pakistan
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12
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Arif M, Hussain N, Yasmeen A, Naz S, Anwar A, Mushtaq S, Iqbal J, Shaheen A, Aziz M, Bukhari SAH, Shah SH. Exogenous application of bio-stimulant and growth retardant improved the productivity of cotton cultivars under different planting arrangement. BRAZ J BIOL 2021; 82:e238812. [PMID: 34161424 DOI: 10.1590/1519-6984.238812] [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] [Received: 05/24/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
Optimum planting arrangement is an important attribute for efficient utilization of available resources and to obtain high yield of cotton. Application of plant growth promoter and retardant on cotton in improved planting density are the innovative techniques in the establishment of more productive cotton crop. Therefore, we planned a field study to assess the role of bio-stimulant and growth retardant in the resource utilization efficiency of cotton cultivars planted under variable row spacing at Agronomic Research Area Bahauddin Zakariya University and Usmania Agricultural Farm Shujabad during Kharif 2012. Experimental treatments consisted of cotton genotypes viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and ultra-narrow row spacing (25 cm) with foliar spray of bio-stimulant (moringa leaf extract) and growth retardant (mepiquate chloride), either sole or in combination, keeping distilled water as a control. Exogenously applied MLE alone and MLE + MC significantly enhanced the number of squares, flowers and green bolls per plant leading to higher cotton seed and lint yield of CIM 598 cultivar cultivated under conventional row spacing. While application of MC alone and MLE + MC produced maximum micronaire value, fiber strength and fiber uniformity ratio of CIM 573 cultivar cultivated under conventional row spacing. The results suggested that application of MLE is a possible approach to enhance the cotton productivity and the use of MC to enhance the fiber quality attributes under conventional row spacing.
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Affiliation(s)
- M Arif
- Bahauddin Zakariya University, Multan, Punjab, Pakistan.,Directorate of Land Reclamation, Irrigation Department Punjab, Lahore, Pakistan
| | - N Hussain
- Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Yasmeen
- Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - S Naz
- Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Anwar
- Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Punjab, Pakistan
| | - S Mushtaq
- University of Wisconsin, Madison, USA
| | - J Iqbal
- The Ismia University of Bahawalpur, Punjab, Pakistan
| | - A Shaheen
- Govt. Sadiq College Women University Bahawalpur, Punjab, Pakistan
| | - M Aziz
- Barani Agricultural Research Institute, Chakwal, Punjab, Pakistan
| | - S A H Bukhari
- Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - S H Shah
- Allama Iqbal Open University, Islamabad, Pakistan
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13
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McGarrah RW, Ferencik M, Giamberardino SN, Coles A, Hoffmann U, Ginsburg GS, Kraus WE, Douglas PS, Shah SH. 170Lipoprotein subclasses associated with high-risk coronary atherosclerotic plaque: insights from the PROMISE clinical trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Greater than half of major adverse cardiovascular events (MACE) occur in individuals with non-obstructive coronary artery disease (CAD) and may be related to the presence of high-risk coronary atherosclerotic plaque (HRP). HRP can be detected by coronary computed tomographic angiography (CTA) and is associated with increased MACE risk. Biomarkers associated with HRP may therefore aid in risk stratification in individuals with chest pain and provide insight into the biology of HRP.
Purpose
To determine whether nuclear magnetic resonance (NMR)-measured lipoprotein particles are associated with HRP independent of risk factors.
Methods
This study included 1755 stable symptomatic outpatients enrolled in the PROMISE trial who had coronary CTA performed. Thirty-seven lipoprotein particle parameters were measured in plasma using NMR. Principal components analysis was used to reduce the number of correlated lipoproteins into a smaller number of uncorrelated factors. HRP cases (N=277) were defined as presence of HRP features (positive remodeling, low CT attenuation or napkin-ring sign) with or without obstructive CAD; controls had no HRP and no obstructive CAD (N=1478). Multivariable logistic regression models adjusting for age, sex, diabetes, hypertension, BMI, smoking status and statin use were used to test for association of lipoprotein factors with HRP case/control status; lipoproteins loaded within significant factors (p<0.05) were tested individually. Finally, because event rates in PROMISE were too low, we used a separate study (CATHGEN, a study of individuals undergoing coronary angiography; N=8707) to test for association of lipoproteins with MACE using multivariable Cox proportional hazard models.
Results
HRP cases were less likely to be female than controls (36.8% vs. 56.6%) and were more likely to have diabetes (23.5% vs 19.6%), but were of similar age (60.1 vs 60.4 years [SD±8]) and with similar statin use (45.2% vs 44.4%). In multivariable models, two lipoprotein factors were associated with HRP: an HDL factor (OR 1.29 [95% CI, 1.10–1.52], p=0.002) and a triglyceride (TG) factor (OR 1.19 [1.03–1.36], p=0.01). Within these two factors, H6P (a large HDL subclass; OR 0.67 [0.54–0.82], p<0.001), HDL size (OR 0.78 [0.66–0.92], p=0.003) and small TG-rich lipoproteins (OR 1.22 [1.07–1.39], p=0.002) were associated with HRP. H6P (HR 1.1 [1.07–1.13], p<0.0001) and HDL size (HR 1.28 [1.24–1.32], p<0.0001) were also associated with time to death or MI in CATHGEN, but in the opposite direction.
Conclusions
In a cohort of low-risk patients from the PROMISE trial, large HDL and small TG particles were associated with CTA-defined HRP independent of risk factors. Large HDL particles were also associated with incident MACE in a separate high-risk cohort. The discordant direction of association of HDL subclasses with HRP and MACE is likely due to underlying HDL biology and requires further study.
Acknowledgement/Funding
The PROMISE trial was funded by the National Heart, Lung, and Blood Institute (grants R01HL098237, R01HL098236, R01HL98305, and R01HL098235)
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Affiliation(s)
- R W McGarrah
- Duke University Medical Center, Durham, United States of America
| | - M Ferencik
- Oregon Health & Science University, Portland, United States of America
| | | | - A Coles
- Duke Clinical Research Institute, Durham, United States of America
| | - U Hoffmann
- Massachusetts General Hospital, Boston, United States of America
| | - G S Ginsburg
- Duke University Medical Center, Durham, United States of America
| | - W E Kraus
- Duke University Medical Center, Durham, United States of America
| | - P S Douglas
- Duke Clinical Research Institute, Durham, United States of America
| | - S H Shah
- Duke University Medical Center, Durham, United States of America
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14
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Weiner GA, Shah SH, Angelopoulos CM, Bartakova AB, Pulido RS, Murphy A, Nudleman E, Daneman R, Goldberg JL. Cholinergic neural activity directs retinal layer-specific angiogenesis and blood retinal barrier formation. Nat Commun 2019; 10:2477. [PMID: 31171770 PMCID: PMC6554348 DOI: 10.1038/s41467-019-10219-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 04/26/2019] [Indexed: 12/16/2022] Open
Abstract
Blood vessels in the central nervous system (CNS) develop unique features, but the contribution of CNS neurons to regulating those features is not fully understood. We report that inhibiting spontaneous cholinergic activity or reducing starburst amacrine cell numbers prevents invasion of endothelial cells into the deep layers of the retina and causes blood-retinal-barrier (BRB) dysfunction in mice. Vascular endothelial growth factor (VEGF), which drives angiogenesis, and Norrin, a Wnt ligand that induces BRB properties, are decreased after activity blockade. Exogenous VEGF restores vessel growth but not BRB function, whereas stabilizing beta-catenin in endothelial cells rescues BRB dysfunction but not vessel formation. We further identify that inhibiting cholinergic activity reduces angiogenesis during oxygen-induced retinopathy. Our findings demonstrate that neural activity lies upstream of VEGF and Norrin, coordinating angiogenesis and BRB formation. Neural activity originating from specific neural circuits may be a general mechanism for driving regional angiogenesis and barrier formation across CNS development. During retinal development, waves of cholinergic neural activity play a role in retinal circuit development. Here, the authors show that this activity also contributes to layer-specific angiogenesis and formation of the blood-retinal barrier.
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Affiliation(s)
- G A Weiner
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, 92037, USA.,Medical Scientist Training Program, University of California, San Diego, La Jolla, CA, 92037, USA
| | - S H Shah
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, 92037, USA.,Medical Scientist Training Program, University of California, San Diego, La Jolla, CA, 92037, USA.,Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA
| | - C M Angelopoulos
- Department of Pharmacology, University of California, San Diego, La Jolla, CA, 92037, USA
| | - A B Bartakova
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, 92037, USA
| | - R S Pulido
- Department of Pharmacology, University of California, San Diego, La Jolla, CA, 92037, USA
| | - A Murphy
- Department of Pharmacology, University of California, San Diego, La Jolla, CA, 92037, USA
| | - E Nudleman
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, 92037, USA
| | - R Daneman
- Department of Pharmacology, University of California, San Diego, La Jolla, CA, 92037, USA.
| | - J L Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, 94303, USA.,Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, 92037, USA
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15
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Moler FW, Silverstein FS, Nadkarni VM, Meert KL, Shah SH, Slomine B, Christensen J, Holubkov R, Page K, Dean JM. Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation 2018; 135:88-97. [PMID: 30572071 DOI: 10.1016/j.resuscitation.2018.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 01/11/2023]
Abstract
AIM Although recent out-of-hospital cardiac arrest (CA) trials found no benefits of hypothermia versus normothermia targeted temperature management, preclinical models suggest earlier timing of hypothermia improves neuroprotective efficacy. This study investigated whether shorter time to goal temperature was associated with better one-year outcomes in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial. METHODS Patients were classified by tertiles of time to attain assigned goal temperature range (32-34°C or 36-37.5°C) following ROSC. Outcomes in the first tertile ("earlier") Group 1 were compared with second and third tertiles ("later") Group 2. Separate analyses were, additionally, completed for hypothermia and normothermia intervention groups. Three one-year outcomes were examined: survival; Vineland Adaptive Behavior Scale (VABS-II) score≥70; and decrease in VABS-II≤15 points from baseline. RESULTS In the entire cohort (n=281), median time from ROSC to goal temperature was 7.4 [IQR 6.2-9.7] hours: Group 1, 5.8 [IQR 5.2, 6.2] and Group 2, 8.8 [IQR 7.4, 10.4] h. Outcomes did not differ between these groups. For hypothermia subgroup, survival was lower in Group 1 than 2, [10/49(20%) versus 47/99(47%), p<0.002], with a trend toward fewer with VABS-II scores≥70 and change in VABS-II≤15 points (p=0.07-0.08). For normothermia subgroup, there was a trend toward higher survival in Group 1 than 2 [18/42(43%) versus 21/83(25%), p=0.065], but no differences in VABS-II-related measures. In multivariable logistic regression models, no difference in earlier and later groups or temperature intervention was observed. CONCLUSION We found no evidence that earlier time to goal temperature was associated with better outcomes.
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Affiliation(s)
- Frank W Moler
- University of Michigan Medical School, Ann Arbor, MI, United States.
| | | | - Vinay M Nadkarni
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kathleen L Meert
- Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States
| | - Samir H Shah
- University of Tennessee Health Sciences Center, United States
| | - Beth Slomine
- Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD, United States
| | - James Christensen
- Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD, United States
| | | | - Kent Page
- University of Utah, Salt Lake City, UT, United States
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16
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Shah SH, Goel A, Selvakumar V, Garg S, Siddiqui K, Kumar K. Role of pneumonectomy for lung cancer in current scenario: An Indian perspective. Indian J Cancer 2018; 54:236-240. [PMID: 29199698 DOI: 10.4103/0019-509x.219569] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surgical treatment for lung cancer has evolved from pneumonectomy to lobectomy/sleeve resection around the world. Although condemned for poor outcomes, pneumonectomy may still be required in a select group of patients in developing countries. With the better patient selection, optimization of medical comorbidities, better perioperative care; pneumonectomy may show better results. Thus, there is a need to reconsider the role of pneumonectomy in patients with locally advanced lung cancer in the current scenario. PATIENTS AND METHODS The aim of this study was to analyze the demographic and clinicopathologic profile of lung cancer patients and the role of pneumonectomy at a tertiary cancer center in India. The records of patients, who underwent surgery for lung cancer at our institute from January 2011 to April 2014, were analyzed retrospectively, and various parameters in pneumonectomy were compared to lobectomy patients. RESULTS Out of 48 patients undergoing major lung resections, nearly 80% patients were symptomatic at presentation and were mostly in advanced stages, thus requiring neoadjuvant chemotherapy in 45.8% cases and pneumonectomy in 41.6% patients. There was no difference in morbidity and mortality in pneumonectomy (25%, 5%) versus lobectomy (21.2%, 3.5%). Disease-free survival at 1, 2, and 3 years after pneumonectomy (71.8%, 51.4%, and 42.8%) was comparable to lobectomy (73.3%, 66.1%, and 55.6%). After neoadjuvant therapy, survival was not affected by the type of surgery. CONCLUSIONS In the Indian scenario, as the majority of lung cancer patients present at an advanced stage, pneumonectomy still plays a major role, and the acceptable postoperative outcome can be achieved with aggressive perioperative management.
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Affiliation(s)
- S H Shah
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - A Goel
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
| | - Vpp Selvakumar
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Garg
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - K Siddiqui
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - K Kumar
- Department of Surgical Oncology, BLK Cancer Centre, BLK Super Speciality Hospital, New Delhi, India
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17
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Asch E, Shah SH, Berkowitz S, Mehta S, Eisenberg RL, Jayadevan R, Connolly C, Slanetz PJ. Resident Idea System: A Novel Tool to Engage Trainees in Quality Improvement at the Institutional Level. J Am Coll Radiol 2016; 14:256-261. [PMID: 27815057 DOI: 10.1016/j.jacr.2016.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Elizabeth Asch
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
| | | | - Seth Berkowitz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sahil Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ronald L Eisenberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rashmi Jayadevan
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Caitlin Connolly
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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18
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Parajuli R, Ao Z, Shah SH, Sengul TK, Lippman ME, Datar R, El-Ashry D. Abstract P2-02-10: Circulating cells from the tumor microenvironment as liquid biopsy biomarkers alongside circulating tumor cells in metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-02-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Metastasis is a multistep process that involves the shedding of tumor cells in the peripheral circulation. These Circulating Tumor Cells (CTCs) have prognostic implications in patients with metastatic breast cancer (MBC). Cancer Associated Fibroblasts (CAFs) are a major component of the breast tumor microenvironment. The reciprocal signaling between tumor cells and its microenvironment promotes carcinogenesis, invasion, and metastasis. Studies in mouse models have shown that metastatic cells can bring their own stromal components from the primary site to the site of metastasis, and that these cotraveling stromal cells provide an early growth advantage to the accompanying metastatic cancer cells. CAFs have not been identified in the peripheral circulation. Using a microfilter capture technique, we discovered non-tumor, non-immune cells in the blood of metastatic patients and identified these cells as circulating CAFs (cCAFs). The purpose of this study is to demonstrate the presence of cCAFs as a biomarker of metastasis simultaneously with CTCs in patients with MBC.
Materials and Methods: We identified 20 patients with MBC (Metastatic/MET Group) and 10 patients with cured breast cancer (Ductal carcinoma in situ or Stage I post definitive treatment with >5 years of disease free survival i.e. Localized/LOC Group). A total of 7.5 ml of peripheral blood was obtained from each patient. The enumeration of CTCs and cCAFs was carried out by the microfilter capture technique. Identification of these cells was done by a triple immunofluorescence staining for pan-CK (cytokeratin), FAP (Fibroblast Activated Protein) and CD45. cCAFs were identified as CK-, FAP+, CD45- cells and CTCs as CK+, CD45- cells. Identification and confirmation of cCAF was also carried out in parallel samples by a simultaneous FAP/α-Smooth Muscle Actin staining.
Results: cCAFs were detected in 17/20 (85%) MET patients but in only 2/10 (20%) LOC patients. CTCs were detected in 20/20 (100%) MET patients and in 8/10 (80%) LOC patients. The counts of CTCs and cCAFs in MET group ranged between 1-98 (median 13.5) and 0-117 (median 4), respectively. The counts of CTCs and cCAFs in the LOC group ranged between 1-14 (median 6) and 0-2 (median 0), respectively. For patients with exhibited cCAFs, 2/10 LOC and 5/17 MET patients had cCAFs counts of 2 or less. Although the sample size was small, patients exhibiting cCAFs (odds ratio=22.67, 95% CI: 3.14-163.63, p=0.002) were more likely to be in MET group than LOC group.
Conclusion: This is the first demonstration that CAFs, the predominant mesenchymal cell in the breast tumor microenvironment, are shed into the circulation and can be identified and enumerated as cCAFs in MBC patients along with CTCs. There was a clear difference in the numbers of CTCs and cCAFs levels between the MET and the LOC groups suggesting that CTCs and cCAFs are associated with advanced stage disease. While most patients, both in the LOC and MET group, exhibited CTCs, very few LOC patients exhibited cCAFs. We suggest that cCAFs could independently or along with CTCs serve as liquid biopsy biomarkers of metastasis. Validation of these findings in a larger cohort of patients will be presented during the meeting.
Citation Format: Parajuli R, Ao Z, Shah SH, Sengul TK, Lippman ME, Datar R, El-Ashry D. Circulating cells from the tumor microenvironment as liquid biopsy biomarkers alongside circulating tumor cells in metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-02-10.
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Affiliation(s)
- R Parajuli
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - Z Ao
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - SH Shah
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - TK Sengul
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - ME Lippman
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - R Datar
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
| | - D El-Ashry
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL; Sheila and David Fuente Graduate Program in Cancer Biology, University of Miami Miller School of Medicine, Miami, FL; University of Miami Miller School of Medicine, Miami, FL
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Abstract
Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation.
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Affiliation(s)
- Samir H Shah
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - Jack A Porrino
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - John R Green
- Department of Orthopaedics, University of Washington, Seattle, WA, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
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Anand KJS, Sepanski RJ, Giles K, Shah SH, Juarez PD. Pediatric intensive care unit mortality among Latino children before and after a multilevel health care delivery intervention. JAMA Pediatr 2015; 169:383-90. [PMID: 25706478 DOI: 10.1001/jamapediatrics.2014.3789] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care. OBJECTIVE To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention. DESIGN, SETTING, AND PARTICIPANTS Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatric intensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179). INTERVENTIONS Multilevel health care intervention to address the increased odds of mortality among Latino children. MAIN OUTCOMES AND MEASURES The odds of mortality were analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery. RESULTS Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009 were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortality were observed between white children and African American children (odds ratio [OR], 1.0; 95% CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95% CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary intervention was launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino children were 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95% CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95% CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95% CI, 0.73-1.43; P = .90). CONCLUSIONS AND RELEVANCE Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy.
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Affiliation(s)
- Kanwaljeet J S Anand
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis
| | - Robert J Sepanski
- Decision Support Department, Le Bonheur Children's Hospital, Memphis, Tennessee3currently at Department of Performance Improvement and Patient Safety, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Kimberley Giles
- Decision Support Department, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Samir H Shah
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis
| | - Paul D Juarez
- Research Center on Health Disparities, Equity, and the Exposome, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
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Shah SH, West AN, Sepanski RJ, Hannah D, May WN, Anand KJS. Clinical risk factors for central line-associated venous thrombosis in children. Front Pediatr 2015; 3:35. [PMID: 26000265 PMCID: PMC4419679 DOI: 10.3389/fped.2015.00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/08/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying risk factors related to central venous line (CVL) placement could potentially minimize central line-associated venous thrombosis (CLAVT). We sought to identify the clinical factors associated with CLAVT in children. METHODS Over a 3-year period, 3733 CVLs were placed at a tertiary-care children's hospital. Data were extracted from the electronic medical records of patients with clinical signs and symptoms of venous thromboembolism, diagnosed using Doppler ultrasonography and/or echocardiography. Statistical analyses examined differences in CLAVT occurrence between groups based on patient and CVL characteristics (type, brand, placement site, and hospital unit). RESULTS Femoral CVL placement was associated with greater risk for developing CLAVT (OR 11.1, 95% CI 3.9-31.6, p < 0.0001). CVLs placed in the NICU were also associated with increased CLAVT occurrence (OR 5.3, 95% CI 2.1-13.2, p = 0.0003). CVL brand was also significantly associated with risk of CLAVT events. CONCLUSION Retrospective analyses identified femoral CVL placement and catheter type as independent risk factors for CLAVT, suggesting increased risks due to mechanical reasons. Placement of CVLs in the NICU also led to an increased risk of CLAVT, suggesting that small infants are at increased risk of thrombotic events. Alternative strategies for CVL placement, thromboprophylaxis, and earlier diagnosis may be important for reducing CLAVT events.
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Affiliation(s)
- Samir H Shah
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA
| | - Alina Nico West
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA ; Children's Foundation Research Institute, Le Bonheur Children's Hospital , Memphis, TN , USA
| | - Robert J Sepanski
- Department of Performance Improvement and Patient Safety, Children's Hospital of The King's Daughters , Norfolk, VA , USA
| | - Debbie Hannah
- Department of Quality Improvement, Le Bonheur Children's Hospital , Memphis, TN , USA
| | | | - Kanwaljeet J S Anand
- Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital Memphis , Memphis, TN , USA
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Li T, Murtaza G, Azhar S, Nasir B, Raza H, Shah SH, Farzana K, Khan AK, Mir S, Li Y, Nisa ZU, Xu X. Assessment of the determinant of choice of ‘over the counter’ analgesics among students of a university in Abbottabad, Pakistan. TROP J PHARM RES 2014. [DOI: 10.4314/tjpr.v13i10.21] [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: 11/17/2022] Open
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Drago B, Shah NS, Shah SH. Acute permethrin neurotoxicity: Variable presentations, high index of suspicion. Toxicol Rep 2014; 1:1026-1028. [PMID: 28962315 PMCID: PMC5598406 DOI: 10.1016/j.toxrep.2014.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/06/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022] Open
Abstract
Permethrin is a synthetic Type I pyrethroidal neurotoxic pesticide that has been responsible for accidental animal deaths. Despite its widespread use, there are no published case reports on pediatric intensive care unit admissions due to permethrin exposure. We report the unusual and varied presentations of permethrin toxicity in three siblings presenting to a tertiary care pediatric intensive care unit (PICU). While there is no standard clinical diagnostic test for permethrin, accurate diagnosis was obtained by rapidly analyzing the offending agent. In the absence of a known antidote for permethrin, supportive management was initiated and resulted in a favorable outcome for all three siblings.
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Affiliation(s)
- Bonny Drago
- Department of Pediatrics, State University of New York at Stony Brook, New York, NY 11790, USA
| | - Namrata S Shah
- Department of Pediatric Neurology, Le Bonheur Children's Hospital and The University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Samir H Shah
- Department of Pediatric Critical Care Medicine, Le Bonheur Children's Hospital and The University of Tennessee Health Science Center, Memphis, TN 38103, USA
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Abstract
We sought to create a screening tool with improved predictive value for pediatric severe sepsis (SS) and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric emergency department (ED). "Gold standard" SS cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over 2 months. The tool's identification of SS was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS) parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool's predictive value based on receiver operating characteristics (ROC). Age-specific normal and abnormal values for heart rate (HR) and respiratory rate (RR) were empirically derived from 143,603 children seen in a second pediatric ED over 3 years. Univariate analyses were performed for each measure in the tool to assess its association with SS and to characterize it as an "early" or "late" indicator of SS. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool's positive predictive value was 48.7%, a significant, nearly threefold improvement over the original ICCPS tool. False positive systemic inflammatory response syndrome identifications were nearly sixfold lower.
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Affiliation(s)
- Robert J Sepanski
- Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA
| | - Sandip A Godambe
- Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA ; Department of Pediatrics, Eastern Virginia Medical School , Norfolk, VA , USA ; Department of Pediatrics, University of Tennessee Health Science Center , Memphis, TN , USA
| | - Christopher D Mangum
- Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA
| | - Christine S Bovat
- Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA
| | - Arno L Zaritsky
- Department of Performance Improvement, Children's Hospital of The King's Daughters , Norfolk, VA , USA ; Department of Pediatrics, Eastern Virginia Medical School , Norfolk, VA , USA
| | - Samir H Shah
- Department of Pediatrics, University of Tennessee Health Science Center , Memphis, TN , USA
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Chan K, Patel RS, Newcombe P, Nelson CP, Qasim A, Epstein SE, Burnett S, Vaccarino VL, Zafari AM, Shah SH, Anderson JL, Carlquist JF, Hartiala J, Allayee H, Hinohara K, Lee BS, Erl A, Ellis KL, Goel A, Schaefer AS, Mokhtari NE, Goldstein BA, Hlatky MA, Go AS, Shen GQ, Gong Y, Pepine C, Laxton RC, Wittaker JC, Tang WHW, Johnson JA, Wang QK, Assimes TL, Nöthlings U, Farrall M, Watkins H, Richards AM, Cameron VA, Muendlein A, Drexel H, Koch W, Park JE, Kimura A, Shen WF, Simpson IA, Hazen SL, Horne BD, Hauser ER, Quyyumi AA, Reilly MP, Samani NJ, Ye S. 126 CHROMOSOME 9P21 LOCUS AND ANGIOGRAPHIC CORONARY ARTERY DISEASE BURDEN: A COLLABORATIVE META-ANALYSIS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Udupa AS, Nahar PS, Shah SH, Kshirsagar MJ, Ghongane BB. Study of comparative effects of antioxidants on insulin sensitivity in type 2 diabetes mellitus. J Clin Diagn Res 2013; 6:1469-73. [PMID: 23285432 DOI: 10.7860/jcdr/2012/4464.2535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/18/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study intended to assess the effects of the antioxidants; Alpha Lipoic Acid (ALA), omega 3 fatty acids and vitamin E on the parameters of insulin sensitivity, oxidative stress, lipid metabolism and glycaemic control in patients of type 2 diabetes mellitus. METHODS This was a prospective, randomized, double blind, placebo controlled, single centred study. One hundred four patients with type 2 diabetes mellitus with insulin resistance were recruited for the study. They were given ALA, omega 3 fatty acids, vitamin E or placebo. Their weight, Body Mass Index (BMI) and Waist circumference were measured. The investigations which were fasting glucose and fasting total cholesterol. The insulin resistance was calculated on the basis of the BMI and the waist circumference. RESULTS In the intra group analysis at the baseline (V1) vs at the end of the treatment period (V5), we observed a significant decrease in the BMI, waist circumference and the total cholesterol in the three treatment groups. In the intergroup analysis at V5, ALA, omega 3 fatty acids and vitamin E showed a significant improvement in the total cholesterol as compared to the placebo and vitamin E showed the maximum improvement. CONCLUSION ALA, omega 3 fatty acids and vitamin E showed the improvement in insulin sensitivity. Since they differ in improving different parameters all of these three can be used as an add on therapy in patients with type 2 diabetes mellitus to improve their insulin sensitivity and lipid metabolism.
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Affiliation(s)
- A S Udupa
- Resident, Department of Pharmacology, B J Medical College, Pune, India
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Tareen AM, Rafique M, Wadood A, Qasim M, Rahman H, Shah SH, Khan K, Pirkani GS. Malaria burden in human population of Quetta, Pakistan. Eur J Microbiol Immunol (Bp) 2012; 2:201-4. [PMID: 24688766 DOI: 10.1556/eujmi.2.2012.3.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/21/2012] [Indexed: 11/19/2022] Open
Abstract
Malaria is a serious global health challenge, which is responsible for more than one million deaths a year. Malarial infection is more prevalent in developing countries including Pakistan. Significant efforts have been made to control malaria; however, due to socio-environmental factors, it remains a frequent problem in Quetta. The present study was undertaken to determine the malarial incidence, species prevalence, and its demographic evaluation in human population of Quetta, Pakistan. A total of 1831 subjects, comprising 1072 male and 759 female presenting symptoms of malaria, were included in this study. Blood samples from clinically suspected individuals were subjected to the standard immunochromatographic and malaria parasite smear analysis for malaria diagnosis. Out of 1831 subjects, 338 (18.45%) patients were positive for malarial parasite while the species prevalence was found as 276 (81.66%) and 62 (18.34%) for Plasmodium vivax, and Plasmodium falciparum, respectively. Furthermore, seasonal variations gradual increase in the prevalence rate. The age group of 21-30 years (30.47%) was found more prone to malaria. The suspected malaria cases were found more frequent in rural (72.1%) as compared to urban (27.9%). In addition, the malaria burden was high in urban area (22.89%) population as compared to the rural area (16.74%) population. It was observed that the highest disease occurrence was caused by P. vivax, which reflects a serious threat for public health. The current findings will be helpful to plan effective strategies to prevent and control malaria in this area.
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Shah SH, Crosslin DR, Haynes CS, Nelson S, Turer CB, Stevens RD, Muehlbauer MJ, Wenner BR, Bain JR, Laferrère B, Gorroochurn P, Teixeira J, Brantley PJ, Stevens VJ, Hollis JF, Appel LJ, Lien LF, Batch B, Newgard CB, Svetkey LP. Branched-chain amino acid levels are associated with improvement in insulin resistance with weight loss. Diabetologia 2012; 55:321-30. [PMID: 22065088 PMCID: PMC3667157 DOI: 10.1007/s00125-011-2356-5] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/28/2011] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance (IR) improves with weight loss, but this response is heterogeneous. We hypothesised that metabolomic profiling would identify biomarkers predicting changes in IR with weight loss. METHODS Targeted mass spectrometry-based profiling of 60 metabolites, plus biochemical assays of NEFA, β-hydroxybutyrate, ketones, insulin and glucose were performed in baseline and 6 month plasma samples from 500 participants who had lost ≥4 kg during Phase I of the Weight Loss Maintenance (WLM) trial. Homeostatic model assessment of insulin resistance (HOMA-IR) and change in HOMA-IR with weight loss (∆HOMA-IR) were calculated. Principal components analysis (PCA) and mixed models adjusted for race, sex, baseline weight, and amount of weight loss were used; findings were validated in an independent cohort of patients (n = 22). RESULTS Mean weight loss was 8.67 ± 4.28 kg; mean ∆HOMA-IR was -0.80 ± 1.73, range -28.9 to 4.82). Baseline PCA-derived factor 3 (branched chain amino acids [BCAAs] and associated catabolites) correlated with baseline HOMA-IR (r = 0.50, p < 0.0001) and independently associated with ∆HOMA-IR (p < 0.0001). ∆HOMA-IR increased in a linear fashion with increasing baseline factor 3 quartiles. Amount of weight loss was only modestly correlated with ∆HOMA-IR (r = 0.24). These findings were validated in the independent cohort, with a factor composed of BCAAs and related metabolites predicting ∆HOMA-IR (p = 0.007). CONCLUSIONS/INTERPRETATION A cluster of metabolites comprising BCAAs and related analytes predicts improvement in HOMA-IR independent of the amount of weight lost. These results may help identify individuals most likely to benefit from moderate weight loss and elucidate novel mechanisms of IR in obesity.
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Affiliation(s)
- S H Shah
- Department of Medicine, DUMC, Duke University Medical Center, Box 3445, Durham, NC 27710, USA.
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Abstract
Using first principles calculations and atomistic thermodynamics the bulk and defect properties of orthorhombic bismuth titanate (Bi₄Ti₃O₁₂) and bismuth lanthanum titanate (Bi₃.₂₅La₀.₇₅Ti₃O₁₂) have been investigated. Heats of formation, valid chemical conditions for synthesis, lanthanum substitution energies and oxygen and bismuth vacancy formation energies have been computed. The study improves our understanding of how native point defects and substitutional impurities influence the ferroelectric properties of these layered perovskite materials. It is found that lanthanum incorporation could occur on either of the two distinct bismuth sites in the structure and that the effect of substitution is to increase the formation energy of nearby native oxygen vacancies. The results provide direct atomistic evidence over a range of chemical conditions supporting the suggestion that lanthanum incorporation reduces the oxygen vacancy concentration. Oxygen vacancies contribute to ferroelectric fatigue by interacting strongly with domain walls, and therefore a decrease in their concentration is beneficial. The conditions that favor the greatest reduction in oxygen vacancy concentration are described.
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Affiliation(s)
- S H Shah
- Department of Materials Science and Metallurgy, University of Cambridge, Pembroke Street, Cambridge CB23QZ, UK.
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Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL, Zheng DD, Abolian AM, Kim D, Ali LK, Shah SH, Towfighi A, Ovbiagele B, Kidwell CS, Tateshima S, Jahan R, Duckwiler GR, Viñuela F, Salamon N, Villablanca JP, Vinters HV, Marder VJ, Saver JL. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke 2011; 42:1237-43. [PMID: 21393591 DOI: 10.1161/strokeaha.110.605576] [Citation(s) in RCA: 377] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to provide the first correlative study of the hyperdense middle cerebral artery sign (HMCAS) and gradient-echo MRI blooming artifact (BA) with pathology of retrieved thrombi in acute ischemic stroke. METHODS Noncontrast CT and gradient-echo MRI studies before mechanical thrombectomy in 50 consecutive cases of acute middle cerebral artery ischemic stroke were reviewed blinded to clinical and pathology data. Occlusions retrieved by thrombectomy underwent histopathologic analysis, including automated quantitative and qualitative rating of proportion composed of red blood cells (RBCs), white blood cells, and fibrin on microscopy of sectioned thrombi. RESULTS Among 50 patients, mean age was 66 years and 48% were female. Mean (SD) proportion was 61% (±21) fibrin, 34% (±21) RBCs, and 4% (±2) white blood cells. Of retrieved clots, 22 (44%) were fibrin-dominant, 13 (26%) RBC-dominant, and 15 (30%) mixed. HMCAS was identified in 10 of 20 middle cerebral artery stroke cases with CT with mean Hounsfield Unit density of 61 (±8 SD). BA occurred in 17 of 32 with gradient-echo MRI. HMCAS was more commonly seen with RBC-dominant and mixed than fibrin-dominant clots (100% versus 67% versus 20%, P=0.016). Mean percent RBC composition was higher in clots associated with HMCAS (47% versus 22%, P=0.016). BA was more common in RBC-dominant and mixed clots compared with fibrin-dominant clots (100% versus 63% versus 25%, P=0.002). Mean percent RBC was greater with BA (42% versus 23%, P=0.011). CONCLUSIONS CT HMCAS and gradient-echo MRI BA reflect pathology of occlusive thrombus. RBC content determines appearance of HMCAS and BA, whereas absence of HMCAS or BA may indicate fibrin-predominant occlusive thrombi.
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Shah SH, Bristowe PD. First-principles density functional study of polarization-strain coupling in bismuth titanate. J Phys Condens Matter 2010; 22:385902. [PMID: 21386559 DOI: 10.1088/0953-8984/22/38/385902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The influence of uniaxial and biaxial strain (± 3%) on the spontaneous polarization of orthorhombic bismuth titanate (Bi(4)Ti(3)O(12)) is investigated using a first-principles density functional approach. Born effective charges are obtained using linear response theory. In unstrained bismuth titanate the calculated principal component of polarization along the a axis (P(a)) is 0.46 C m(-2), which is close to the experimental measurement of 0.50 C m(-2). Uniaxial strain along this axis is more effective than along the c axis in improving this component of polarization, by up to 17% for a tensile strain of 3%. Compressive strain along the c axis also enhances P(a) but to a lesser degree. Biaxial strain has a more significant effect on P(a) than uniaxial strain. A simultaneous uniform tensile strain of 3% along the a and b axes enhances the principal component of polarization by 39% while a similar strain along the c and b axes produces an enhancement of 8%. These effects are explained in terms of the off-centre displacements of ions and have implications for device applications of bismuth titanate which use epitaxially strained thin-film heterostructures.
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Affiliation(s)
- S H Shah
- Department of Materials Science and Metallurgy, University of Cambridge, Pembroke Street, Cambridge CB2 3QZ, UK.
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Shah SH. Gastroretentive floating drug delivery systems with potential herbal drugs for Helicobacter pylori eradication: a review. ACTA ACUST UNITED AC 2009; 7:976-82. [DOI: 10.3736/jcim20091012] [Citation(s) in RCA: 4] [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: 11/11/2022]
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Shah MM, Khalid Q, Khan UW, Shah SAH, Shah SH, Hassan A, Pervez A. Variation in genotypic responses and biochemical analysis of callus induction in cultivated wheat. Genet Mol Res 2009; 8:783-93. [PMID: 19681030 DOI: 10.4238/vol8-3gmr513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M M Shah
- Department of Environmental Sciences, COMSATS (Commission on Science and Technology for Sustainable Development in the South) Institute of Information Technology, Abbottabad, Pakistan.
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Bang OY, Saver JL, Alger JR, Shah SH, Buck BH, Starkman S, Ovbiagele B, Liebeskind DS. Patterns and predictors of blood-brain barrier permeability derangements in acute ischemic stroke. Stroke 2008; 40:454-61. [PMID: 19038915 DOI: 10.1161/strokeaha.108.522847] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [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
BACKGROUND AND PURPOSE MRI permeability imaging is a promising approach to identify patients with acute ischemic stroke with an increased propensity for hemorrhagic transformation (HT). Permeability imaging provides direct visualization of blood-brain barrier derangements in ischemic fields. METHODS We retrospectively analyzed clinical and MRI data on patients with acute cerebral ischemia within the middle cerebral artery territory to identify the frequency, patterns, and predictors of permeability derangements and their association with HT types. RESULTS A total of 179 permeability scans was obtained in 127 patients (59 men; mean age, 66.8 years). Among 179 image sets (82 pre-/no treatment and 97 posttreatment), permeability derangements were present in 29 images, frequently at the basal ganglia (n=23) and rarely at the juxta-cortical area (n=6). After adjusting for covariates, diastolic pressure (OR, 1.12, per 1-mm Hg increase; 95% CI, 1.02 to 1.22) and s-glucose (OR, 1.04, per 1-mg/dL increase; 95% CI, 1.01 to 1.07) were independently associated with pretreatment permeability derangements, whereas low-density lipoprotein cholesterol (OR, 0.97, per 1-mg/dL increase; 95% CI, 0.94 to 0.99), malignant MRI profile (OR, 24.84; 95% CI, 1.50 to 412.93), and time from onset to recanalization therapy (OR, 1.47, per 1-hour increase; 95% CI, 1.10 to 1.96) were independently associated with permeability derangements after recanalization therapy. Types of HT varied among the patients with permeability derangements (no HT, 4; hemorrhagic infarct type, 12; and parenchymal hematoma, 13) and transient derangements (without subsequent HT) and normalization of derangements (in the presence of HT) on permeability images was observed in several cases. CONCLUSIONS Permeability derangements, a dynamic process associated with ischemic stroke pathophysiology and recanalization therapy, vary in pattern and evolution toward HT. Several prognostic and therapeutic predictors for HT are independently associated with pre- and posttreatment permeability derangements.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, South Korea
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Shah SH, Engelhardt R, Ovbiagele B. Patterns of complementary and alternative medicine use among United States stroke survivors. J Neurol Sci 2008; 271:180-5. [DOI: 10.1016/j.jns.2008.04.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/28/2008] [Accepted: 04/10/2008] [Indexed: 11/28/2022]
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Wang L, Hauser ER, Shah SH, Seo D, Sivashanmugam P, Exum ST, Gregory SG, Granger CB, Haines JL, Jones CJH, Crossman D, Haynes C, Kraus WE, Freedman NJ, Pericak-Vance MA, Goldschmidt-Clermont PJ, Vance JM. Polymorphisms of the tumor suppressor gene LSAMP are associated with left main coronary artery disease. Ann Hum Genet 2008; 72:443-53. [PMID: 18318786 DOI: 10.1111/j.1469-1809.2008.00433.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous association mapping on chromosome 3q13-21 detected evidence for association at the limbic system-associated membrane protein (LSAMP) gene in individuals with late-onset coronary artery disease (CAD). LSAMP has never been implicated in the pathogenesis of CAD. We sought to thoroughly characterize the association and the gene. Non-redundant single nucleotide polymorphisms (SNPs) across the gene were examined in an initial dataset (168 cases with late-onset CAD, 149 controls). Stratification analysis on left main CAD (N = 102) revealed stronger association, which was further validated in a validation dataset (141 cases with left main CAD, 215 controls), a third control dataset (N = 255), and a family-based dataset (N = 2954). A haplotype residing in a novel alternative transcript of the LSAMP gene was significant in all independent case-control datasets (p = 0.0001 to 0.0205) and highly significant in the joint analysis (p = 0.00004). Lower expression of the novel alternative transcript was associated with the risk haplotype (p = 0.0002) and atherosclerosis burden in human aortas (p = 0.0001). Furthermore, silencing LSAMP expression in human aortic smooth muscle cells (SMCs) substantially augmented SMC proliferation (p<0.01). Therefore, the risk conferred by the LSAMP haplotype appears to be mediated by LSAMP down-regulation, which may promote SMC proliferation in the arterial wall and progression of atherosclerosis.
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Affiliation(s)
- L Wang
- Miami Institute of Human Genomics, University of Miami, Miami, FL 33101, USA
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Pineda S, Bang OY, Saver JL, Starkman S, Yun SW, Liebeskind DS, Kim D, Ali LK, Shah SH, Ovbiagele B. Association of serum bilirubin with ischemic stroke outcomes. J Stroke Cerebrovasc Dis 2008; 17:147-52. [PMID: 18436156 DOI: 10.1016/j.jstrokecerebrovasdis.2008.01.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 12/20/2007] [Accepted: 01/08/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Higher levels of serum bilirubin may offer a therapeutic advantage in oxidative stress-mediated diseases, but may also simply reflect intensity of oxidative stress. Little is known about the role of bilirubin in stroke. We assessed the relation of serum bilirubin levels with clinical presentation and outcomes among patients hospitalized with ischemic stroke. METHODS Data were collected prospectively during a 5-year period on consecutive ischemic stroke admissions to a university hospital. Serum bilirubin levels, total (Tbil) and direct (Dbil), were measured on admission. Presenting stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Functional outcome at discharge was assessed using the modified Rankin scale. RESULTS Among 743 patients, mean age was 67.3 years and 47.5% were women. Median presenting NIHSS score was 4, and 24% had a poor (modified Rankin scale 4-6) functional outcome at discharge. Higher Dbil levels were associated with greater stroke severity (P = .001) and poorer discharge outcome (P = .034). Multivariable regression analyses showed that those with higher Dbil levels (> or =0.4 mg/dL) had significantly greater admission NIHSS scores compared with those with lower levels (< or =0.1 mg/dL) (odds ratio 2.79, 95% confidence interval 1.25-6.20, P = .012), but no independent relationship was confirmed between Dbil and discharge outcome. Although higher admission Tbil was associated with greater stroke severity in crude analyses (P = .003), no independent relationship between Tbil versus stroke severity or outcome was noted after adjusting for confounders. CONCLUSIONS Higher Dbil level is associated with greater stroke severity but not outcome among ischemic stroke patients, possibly reflecting the intensity of initial oxidative stress. Further study into the underlying pathophysiology of this relationship is needed.
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Affiliation(s)
- Sandra Pineda
- Stroke Center and Department of Neurology, University of California at Los Angeles Medical Center, CA 90095, USA
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Ghafoor S, Shah MM, Ahmad H, Swati ZA, Shah SH, Pervez A, Farooq U. Molecular characterization of Ephedra species found in Pakistan. Genet Mol Res 2007; 6:1123-1130. [PMID: 18273806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ephedra, also known as "ma huang", is a dioecious, drought- and frost-resistant, perennial, evergreen shrub with compelling medicinal value. The genus is represented by 42 species around the world, 9 of which were provisionally reported from Pakistan. Species of the genus have a controversial taxonomy due to their overlapping morphological features. Conventional tools alone are not sufficient for characterizing the species. The objective of present study was to assess the genetic variability present in different biotypes of Ephedra growing in Pakistan using molecular markers. A total of six genotypes collected from diverse geographic zones of Pakistan were used. The DNA of all genotypes was amplified using nine randomly amplified polymorphic DNA (RAPD) primers to study genetic variability at the molecular level. The dissimilarity coefficient matrix based on the data of 9 RAPD primers was used to construct a dendrogram which was then used to group the genotypes in clusters. Based on the dendrogram and dissimilarity coefficient matrix, the RAPD markers used here revealed a moderate to high level of genetic polymorphism (6 to 49%) among the genotypes. It was found that the collection of genotype accessions from Swat Valley in northwestern Pakistan was most distantly related to the other five collections. More molecular markers including functional genes and ribosomal spacer regions are suggested to find a better estimate of the genetic diversity present in Ephedra growing in Pakistan. The information provided here is useful for identifying valuable Ephedra variants which will be used for medicinal purposes and earning foreign currency.
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Affiliation(s)
- S Ghafoor
- Department of Genetics, Hazara University, Dhodial Mansehra, Pakistan
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Sanossian N, Ances BM, Shah SH, Kim D, Saver JL, Liebeskind DS. FLAIR vascular hyperintensity may predict stroke after TIA. Clin Neurol Neurosurg 2007; 109:617-9. [PMID: 17602831 PMCID: PMC4294545 DOI: 10.1016/j.clineuro.2007.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 04/30/2007] [Accepted: 05/12/2007] [Indexed: 11/30/2022]
Abstract
FLAIR vascular hyperintensities (FVH) are frequently encountered in acute ischemic stroke. We report two cases presenting with transient ischemic attack (TIA) with isolated FVH on MRI who went on to have a stroke during hospitalization. Isolated FVH may be an important imaging correlate in acute ischemia, and may suggest proximal occlusion with the presence of slow flow through retrograde leptomeningeal collaterals. Recognition of these subtle correlates may complement clinical predictors of stroke after TIA.
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Affiliation(s)
- Nerses Sanossian
- Department of Neurology, University of Southern California, Los Angeles, CA 90033, United States.
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Shah SH, Kraus WE, Crossman DC, Granger CB, Haines JL, Jones CJH, Mooser V, Huang L, Haynes C, Dowdy E, Vega GL, Grundy SM, Vance JM, Hauser ER. Serum lipids in the GENECARD study of coronary artery disease identify quantitative trait loci and phenotypic subsets on chromosomes 3q and 5q. Ann Hum Genet 2006; 70:738-48. [PMID: 17044848 DOI: 10.1111/j.1469-1809.2006.00288.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Coronary artery disease (CAD) and dyslipidemia have strong genetic components. Heterogeneity complicates evaluating genetics of complex diseases such as CAD; incorporating disease-related phenotypes may help reduce heterogeneity. We hypothesized that incorporating lipoproteins in a study of CAD would increase the power to map genes, narrow linkage peaks, identify phenotypic subsets, and elucidate the contribution of established risk factors to genetic results. We performed ordered subset analysis (OSA) and quantitative trait linkage (QTL) using serum lipoproteins and microsatellite markers in 346 families with early-onset CAD. OSA defined homogeneous subsets and calculated lod scores across a chromosome after ranking families by mean lipoprotein values. QTL used variance components analysis. We found significantly increased linkage to chromosome 3q13 (LOD 5.10, p = 0.008) in families with higher HDL cholesterol, lower LDL and total cholesterol, lower triglycerides, and fewer CAD risk factors, possibly due to a concentrated non-lipoprotein-related genetic effect. OSA identified linkage on chromosome 5q34 in families with higher cholesterol, possibly representing a hereditary lipoprotein phenotype. Multiple QTLs were identified, with the strongest for: total cholesterol on chromosome 5q14 (LOD 4.3); LDL on 20p12 (LOD 3.97); HDL on 3p14 (LOD 1.65); triglycerides on 18q22 (LOD 1.43); and HDL/TC ratio on 3q27-28 (LOD 2.06). Our findings suggest the presence of etiologic heterogeneity in families with early-onset CAD, potentially due to differential effects of lipoprotein phenotypes. Candidate genes are under investigation.
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Affiliation(s)
- S H Shah
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Shah SH, Liebeskind DS, Saver JL, Starkman S, Vinuela F, Duckwiler G, Jahan R, Kim D, Sanossian N, Vespa P, Ovbiagele B. Influence of gender on outcomes after intra-arterial thrombolysis for acute ischemic stroke. Neurology 2006; 66:1745-6. [PMID: 16769954 DOI: 10.1212/01.wnl.0000218208.31305.84] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recent data suggest that women obtain greater benefit than men from IV fibrinolysis for acute ischemic stroke. It is unknown whether this gender-thrombolysis advantage extends to those treated with intra-arterial (IA) thrombolysis. The authors evaluated the independent effect of gender among ischemic stroke patients treated with IA fibrinolysis and found no differences in short-term clinical and angiographic outcomes between men and women who received IA thrombolysis for acute ischemic stroke.
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Affiliation(s)
- S H Shah
- Department of Neurology, UCLA Medical Center, USA.
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Sinha SN, Kulkarni PK, Shah SH, Desai NM, Patel GM, Mansuri MM, Saiyed HN. Environmental monitoring of benzene and toluene produced in indoor air due to combustion of solid biomass fuels. Sci Total Environ 2006; 357:280-7. [PMID: 16140361 DOI: 10.1016/j.scitotenv.2005.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 07/25/2005] [Accepted: 08/04/2005] [Indexed: 05/04/2023]
Abstract
Exposure to benzene and toluene from the combustion of solid biomass fuels is one of the important causes of morbidity and mortality in developing countries. In this study, we assessed the exposure of cooks to benzene and toluene from biomass fuel combustion in 55 rural homes. The GC-MS was used for quantification while a personnel sampler was used for environmental monitoring. The benzene exposure differed significantly (p < 0.0001) across different types of indoor kitchen fuel combinations. The geometrical mean (GM) of benzene exposure for cooks during cooking hours in an indoor kitchen using mixed fuel was 75.3 microg/m3 (with partition) and 63.206 microg/m3 (without partition), while the exposure was 11.7 microg/m3 for open type. The benzene exposure was significantly higher (p < 0.05) in an indoor kitchen with respect to open type using mixed fuels. Concentration of benzene (114.1 microg/m3) for cooks in an indoor kitchen with partition using dung fuel was significantly higher in comparison to non-cooks (5.1 microg/m3) for open type. Benzene exposure was not significantly different for kitchen with ventilation (31.2 microg/m3) and without ventilation (45.0 microg/m3) using wood fuel. However, this value was significantly (p < 0.05) lower than in indoor kitchens with or without partition. An almost similar trend was observed for toluene but the difference was statistically non-significant. This study may be helpful in developing a regional exposure database and in the facilitation of health risk assessment due to volatile organic pollutants in our day-to-day environment.
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Affiliation(s)
- Sukesh Narayan Sinha
- Air Pollution Division, National Institute of Occupational Health (ICMR), Meghaninagar, Ahmedabad-38 0016, India.
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Sinha SN, Patel TS, Shah SH, Desai NM, Patel GM, Mansuri MM, Saiyed HN. A correlation of secondary aerosol (nitrate and sulfate) with respirable particulate matter (RPM) in ambient air at different traffic junctions of Vadodara city. J Environ Biol 2005; 26:187-90. [PMID: 16161971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The correlation study of secondary aerosol (nitrate and sulfate) with RPM in ambient air at different traffic junctions of Vadodara city is reported. RPM was analyzed using Ion Chromatography technique and measured the level of nitrate and sulfate in ambient air. The correlation studies of these particulates with RPM have been established. The average concentration of sulfate and nitrate in ambient air was found 35.74 microg/m3 and 24.22 microg/m3, which ranged of 5.33-84.69 and 1.93-77.86 microg/m3 respectively. The correlation of RPM and SO4 (r = 0.813, P<0.01), RPM-NO3 (r = 0.5549, P<0.01) and SO4-NO3 (r = 0.6133, P<0.01) were found significant. The presence of sulfate and nitrate in RPM is 8.25% and 5.60% . The pH of water extract of RPM averaged 6.81, which ranged 6.17-7.28. Regression analysis result showed that the relationship between RPM-SO4 was significantly (R2=0.66215) correlated. This indicate that probably the secondary aerosols such as nitrate and sulfate in excess may cause irritation and increasing lung disease.
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Affiliation(s)
- S N Sinha
- National Institute of Occupational Health, Meghani Nagar, Ahmedabad 380 016, India.
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Sinha SN, Kulkarni PK, Desai NM, Shah SH, Patel GM, Mansuri MM, Parikh DJ, Saiyed HN. Gas chromatographic–mass spectroscopic determination of benzene in indoor air during the use of biomass fuels in cooking time. J Chromatogr A 2005; 1065:315-9. [PMID: 15782977 DOI: 10.1016/j.chroma.2004.12.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A gas chromatography-mass spectroscopic method in electron ionization (EI) mode with MS/MS ion preparation using helium at flow rate 1 ml min(-1) as carrier gas on DB-5 capillary column (30 m x 0.25 mm i.d. film thickness 0.25 microm) has been developed for the determination of benzene in indoor air. The detection limit for benzene was 0.002 microg ml(-1) with S/N: 4 (S: 66, N: 14). The benzene concentration for cooks during cooking time in indoor kitchen using dung fuel was 114.1 microg m(-3) while it was 6.6 microg m(-3) for open type kitchen. The benzene concentration was significantly higher (p < 0.01) in indoor kitchen with respect to open type kitchen using dung fuels. The wood fuel produces 36.5 microg m(-3) of benzene in indoor kitchen. The concentration of benzene in indoor kitchen using wood fuel was significantly (p < 0.01) lower in comparison to dung fuel. This method may be helpful for environmental analytical chemist dealing with GC-MS in confirmation and quantification of benzene in environmental samples with health risk exposure assessment.
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Affiliation(s)
- Sukesh Narayan Sinha
- National Institute of Occupational Health (ICMR), Ahmedabad 380016, Gujarat, India.
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Idris M, Shah SH, Fareed J, Gul N. An experience with sixty cases of haematological malignancies; a clinico haematological correlation. J Ayub Med Coll Abbottabad 2004; 16:51-4. [PMID: 15762065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Haematological malignancies are not uncommon in our area. Due to inadequate diagnostic facilities and lack of health education they are diagnosed at an advanced stage when treatment is either impossible or very difficult. In our study, sixty patients with haematological malignancies were studied from 1-1-1999 to 1-1-2001, at Ayub Teaching Hospital. Abbottabad. METHODS Patients were interviewed in detail, a thorough physical examination and blood tests including haemoglobin estimation, total and differential leukocyte count, platelets count, reticulocyte count and blood film examination was done on each patient. Bone marrow examination for routine giemsa staining and cytochemistry was also done in each case. Trephine biopsy was done in selected cases. RESULTS About 35.9% patients had acute myeloid leukemia, while 19.15% patients had acute lymphoblastic leukemia. Non Hodgkin's lymphoma was seen in 15.39% cases. Among chronic leukemias, chronic lymphocytic leukemia outnumbered chronic myeloid leukemia (13.91% against 10.76%). Multiple myeloma was seen in 4.61% patients while a single patient had Hodgkin's disease. Male to female ratio in haematological malignancies was 1.4:1 and majority of the patients (66.66) belonged to two districts (i.e. Mansehra and Abbottabad). Low grade fever, progressive pallor, weakness and body aches were the commonest symptoms (70% cases) while pallor was the frequently observed sign. Medium age for acute myeloid and acute lymphoblastic leukemia was 26 years and 7 years respectively. For chronic myeloid and chronic lymphocytic leukemia it was 22 years and 56 years respectively. In case of non Hodgkin's lymphoma it was 22.5 years. CONCLUSION In our study acute myeloid leukemia was the commonest type of haematological malignancy. Males were affected more than the females. Majority of the patients belonged to districts Mansehra and Abbottabad. Non specific symptoms like low grade fever, progressive pallor and bodyaches were the commonest symptoms while pallor was the most frequently observed sign.
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Affiliation(s)
- Muhammad Idris
- Department of Pathology, Ayub Medical College, Abbottahad, Pakistan.
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Ahangar AG, Dar AM, Bhat MA, Lone GN, Mir IA, Shah SH. Limb salvage in vascular trauma: review of 300 cases. Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Iqbal M, Patel IK, Shah SH, Ain Q, Barney N, Kiani Q, Rabbani KZ, Zaidi G, Mehdi B. Susceptibility patterns of Escherichia coli: prevalence of multidrug-resistant isolates and extended spectrum beta-lactamase phenotype. J PAK MED ASSOC 2002; 52:407-11. [PMID: 12532575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To study Escherichia coli (E. coli) susceptibility, prevalence of multidrug-resistant isolates and possible role of extended spectrum beta-lactamases (ESBL) in E. coli resistance. SETTING Department of Medicine, Shifa College of Medicine, Islamabad. METHODS Three hundred and seventy eight E. coli isolates from different sources were identified during six-month period. Susceptibility to various antibiotics was checked using standard methods. Multidrug-resistant isolates were separated. Isolates resistant to cefpodoxime and aztreonam were considered as ESBL phenotype, indicating ESBL production. RESULTS Most of isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Overall resistance to ciprofloxacin, ceftriaxone, cefotaxime and cefpodoxime was 49%, 34%, 36% and 38% respectively. Resistance to fourth generation cephalosporins was lower. Almost all Isolates were sensitive to amikacin, imipenem and tazobactam. Aztreonam resistance was found in 25% isolates. Similar pattern was observed for urinary E. coli isolates; 45% E. coli isolates were found to be multidrug-resistant. Nitrofurantoin showed low-level resistance both to multidrug-resistant as well as urinary isolates. Resistance to both cefpodoxime and aztreonam was found in 25% isolates suggesting ESBL production. CONCLUSION E. coli resistance in Pakistan is much higher than reported from western literature. Multidrug-resistant isolates, including third generation cephalosporins and quinolones, are very common. ESBL production may contribute to this high level resistance against beta-lactams.
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Affiliation(s)
- M Iqbal
- Department of Medicine, Shifa College of Medicine and International Hospital, Islamabad
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Khan MT, Shah SH. Comparison of aztreonam against other antibiotics used in urinary tract infections. J Ayub Med Coll Abbottabad 2001; 13:22-4. [PMID: 11873424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Urinary tract infection is a very common problem in adults as well as in children. There is always need for the right antibiotic to be chosen for treatment. METHODS This study was conducted at Microbiology section in Pathology department of Ayub Medical College, Abbottabad, Pakistan. In this study the aztronam which is only effective against gram negative bacilli has been compared with other conventionally used antibiotics, ampicillin, cotrimoxazole, minocyclin, pipemedic acid, nalidixic acid, norfloxacin, ciprofloxacin, gentamicin and ceftriaxon. RESULTS Total gram negative isolates were 342. Out of this 76.6% (262) were E. coli, klebsiella pneumoniae 14.3% (49), proteus species 5.2%(18) and pseudomonas aeruginosa were 3.8% (13). The aztreonam showed 78% sensitivity against gram negative bacilli which is better than norfloxacin which showed 62.2% sensitivity.
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Affiliation(s)
- M T Khan
- Department of Pathology, Ayub Medical College, Abbottabad
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49
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Ghosh SK, Patel TS, Doctor PB, Kulkarni PK, Shah SH, Desai NM, Derasari A. Study on indoor air pollutants: toxicity screening of suspended particulate matter. Bull Environ Contam Toxicol 2001; 67:149-154. [PMID: 11381325 DOI: 10.1007/s001280103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2000] [Accepted: 04/15/2001] [Indexed: 05/23/2023]
Affiliation(s)
- S K Ghosh
- National Institute of Occupational Health, Meghani Nagar, Ahmedabad 380 016, India
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50
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Shah MK, Shah SH, Fruchtman PK. Helicobacter pylori. A view from a primary care perspective. N C Med J 2001; 62:198-202. [PMID: 11468982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- M K Shah
- Rowan Primary Care, Salisbury, NC, USA.
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