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Spartz EJ, DeDecker LC, Fansiwala KM, Noorian S, Roney AR, Hakimian S, Sauk JS, Chen PH, Limketkai BN. Recent trends and risk factors associated with Clostridioides difficile infections in hospitalized patients with inflammatory bowel disease. Aliment Pharmacol Ther 2024; 59:89-99. [PMID: 37873878 DOI: 10.1111/apt.17777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/22/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Clostridioides difficile infections (CDIs) are common among patients with inflammatory bowel disease (IBD) and can mimic and exacerbate IBD flares, thus warranting appropriate testing during flares. AIMS To examine recent trends in rates of CDI and associated risk factors in hospitalized IBD patients, which may better inform targeted interventions to mitigate the risk of infection. METHODS This is a retrospective analysis using the Nationwide Readmissions Database from 2010 to 2020 of hospitalized individuals with Crohn's disease (CD) or ulcerative colitis (UC). Longitudinal changes in rates of CDI were evaluated using International Classification of Diseases codes. Multivariable logistic regression evaluated the association between patient- and hospital-related factors and CDI. RESULTS There were 2,521,935 individuals with IBD who were hospitalized at least once during the study period. Rates of CDI in IBD-related hospitalizations increased from 2010 to 2015 (CD: 1.64%-3.32%, p < 0.001; UC: 4.15%-5.81%, p < 0.001), followed by a steady decline from 2016 to 2020 (CD: 3.15%-2.27%, p < 0.001; UC: 5.04%-4.27%, p < 0.001). In multivariable models, CDI was associated with the Charlson-Deyo comorbidity index, public insurance, and hospital size. CDI was associated with increased mortality. CONCLUSIONS Rates of CDI among hospitalized patients with IBD had initially increased, but have declined since 2015. Increased comorbidity, large hospital size, public insurance, and urban teaching hospitals were associated with higher rates of CDI. CDI was associated with increased mortality in hospitalized patients with IBD. Continued vigilance, infection control, and treatment of CDI can help continue the trend of declining infection rates.
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Affiliation(s)
- Ellen J Spartz
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Lauren C DeDecker
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Kush M Fansiwala
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Shaya Noorian
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Andrew R Roney
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Shahrad Hakimian
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Jenny S Sauk
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Po-Hung Chen
- Division of Gastroenterology & Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Berkeley N Limketkai
- Center for Inflammatory Bowel Diseases, UCLA School of Medicine, Los Angeles, California, USA
- Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
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Hanscom M, Anders S, Hakimian S, Dudekala A, Rau P, Singh A, Zivny J, Churrango G, Bhattacharya K, Marshall C, Marya NB. Novel dilation technique and stent selection to reduce periprocedural adverse events in left hepaticogastrostomy. VideoGIE 2021; 6:460-463. [PMID: 34667912 PMCID: PMC8505228 DOI: 10.1016/j.vgie.2021.06.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Video 1Video demonstration of left hepaticogastrostomy with the assistance of an angioplasty balloon.
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Affiliation(s)
- Mark Hanscom
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephen Anders
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Shahrad Hakimian
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anwar Dudekala
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Prashanth Rau
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anupam Singh
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jaroslav Zivny
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gustavo Churrango
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kanishka Bhattacharya
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher Marshall
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Neil B Marya
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, Massachusetts
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Hakimian S, Raines D, Reed G, Hanscom M, Stefaniwsky L, Petersile M, Rau P, Foley A, Cave D. Assessment of Video Capsule Endoscopy in the Management of Acute Gastrointestinal Bleeding During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2118796. [PMID: 34328500 PMCID: PMC8325069 DOI: 10.1001/jamanetworkopen.2021.18796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Evaluation of acute gastrointestinal (GI) bleeding using invasive endoscopic procedures comprising the standard of care (SOC)-upper endoscopy and colonoscopy-can expose the endoscopy staff to SARS-CoV-2. Video capsule endoscopy (VCE) does not generate aerosols and only requires 1 person to manage the procedure. OBJECTIVE To examine the safety of VCE for the initial evaluation of GI bleeding at the peak of the COVID-19 pandemic to identify signs of active bleeding while minimizing patient and personnel exposure, saving personal protective equipment, and avoiding invasive or unnecessary procedures. DESIGN, SETTING, AND PARTICIPANTS A multicenter (UMass Memorial Medical Center and Louisiana State University Health Sciences Center) retrospective cohort study including 146 patients with COVID-19 who received VCE as the first-line diagnostic modality was conducted from March 15 to June 15, 2020, compared with SOC in January 2020 for evaluation of GI bleeding. The association between treatment and outcomes was estimated using multivariable regression adjusting for potential confounders. Propensity score matching was used to verify the results. MAIN OUTCOMES AND MEASURES The primary end point was detection of active bleeding or stigmata of recent bleeding. Secondary end points included the number of patients requiring any invasive procedures, number of additional procedures, rates of rebleeding and rehospitalization, transfusion requirements, and mortality. RESULTS Among 146 patients, 92 (63.0%) were men; mean (SD) age was 64.93 (14.13) years in the COVID-19 group and 61.33 (13.39) years in the SOC group. Active bleeding or stigmata of recent bleeding was observed in 44 (59.5%) patients in the COVID-19 group compared with 18 (25.0%) in the SOC group (adjusted odds ratio, 5.23; 95% CI, 2.23 to 12.27). Only 36 patients (48.7%) in the COVID-19 group required any invasive procedure during the hospitalization compared with 70 (97.2%) in the SOC group (adjusted odds ratio, 0.01; 95% CI, 0.001 to 0.08). The mean (SD) number of invasive procedures was 0.59 (0.77) per patient in the COVID-19 group compared with 1.18 (0.48) per patient in the SOC group (adjusted difference, -0.54; 95% CI, -0.77 to -0.31). Both approaches appeared to be safe and there was no significant difference in transfusion requirements, rebleeding, rehospitalization, or in-hospital mortality. No mortality was attributed to GI bleeding in either group. CONCLUSIONS AND RELEVANCE In this cohort study, first-line diagnostic evaluation of acute GI bleeding using VCE appeared to be a safe and useful alternative to the traditional approach of upper endoscopy and colonoscopy. Use of VCE was associated with increased detection of active bleeding and a reduced number of invasive procedures and unnecessary exposure of personnel to SARS-CoV-2 and use of personal protective equipment.
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Affiliation(s)
- Shahrad Hakimian
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
- now with Department of Medicine, Division of Digestive Diseases, University of California, Los Angeles
| | - Daniel Raines
- Section of Gastroenterology, Louisiana State University Health Sciences Center, New Orleans
| | - George Reed
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
| | - Mark Hanscom
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
| | - Lilia Stefaniwsky
- Section of Gastroenterology, Louisiana State University Health Sciences Center, New Orleans
| | - Matthew Petersile
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
| | - Prashanth Rau
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
| | - Anne Foley
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
| | - David Cave
- Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester
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Lui JK, Spaho L, Hakimian S, Devine M, Bui R, Touray S, Holzwanger E, Patel B, Ellis D, Fridlyand S, Ogunsua AA, Mahboub P, Daly JS, Bozorgzadeh A, Kopec SE. Pleural Effusions Following Liver Transplantation: A Single-Center Experience. J Intensive Care Med 2020; 36:862-872. [PMID: 32527176 DOI: 10.1177/0885066620932448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. RESULTS In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. CONCLUSIONS In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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Affiliation(s)
- Justin K Lui
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Lidia Spaho
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Shahrad Hakimian
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Michael Devine
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosa Bui
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Sunkaru Touray
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA.,Carlsbad Medical Center, NM, USA
| | - Erik Holzwanger
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Boskey Patel
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Ellis
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Svetlana Fridlyand
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Adedotun A Ogunsua
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiology, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Paria Mahboub
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Daly
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Division of Infectious Diseases, 3354University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott E Kopec
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA
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Abstract
Bleeding from the small intestine remains a clinically challenging diagnostic and therapeutic problem. It may be minor, requiring only supplemental iron treatment, to patients who have severe overt bleeding that requires multimodal intervention. This article provides an up-to-date review of the state-of-the-art of diagnosis and treatment of small intestinal bleeding.
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Affiliation(s)
- Shahrad Hakimian
- Division of Gastroenterology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Ave. N., Worcester, MA, 01655, USA
| | - Krunal Patel
- Division of Gastroenterology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Ave. N., Worcester, MA, 01655, USA
| | - David Cave
- Division of Gastroenterology, Department of Medicine, UMass Memorial Medical Center, 55 Lake Ave. N., Worcester, MA, 01655, USA.
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Hakimian S, Jawaid S, Guilarte-Walker Y, Mathew J, Cave D. Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit. Endosc Int Open 2018; 6:E989-E993. [PMID: 30083589 PMCID: PMC6075946 DOI: 10.1055/a-0590-3940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Video capsule endoscopy (VCE) is a minimally invasive tool that helps visualize the gastrointestinal tract from the esophagus to the right colon without the need for sedation or preparation. VCE is safe with very few contraindications. However, its role and safety profile in the intensive care unit (ICU) population have not been reported. The aim of this study is to evaluate the safety, efficacy, and feasibility of VCE use in ICU patients. PATIENTS AND METHODS We conducted a single-center retrospective observational study of patients who underwent VCE for evaluation of obscure overt gastrointestinal bleeding in the ICU between 2008 and 2016. RESULTS This study included 48 patients who were admitted to the UMass Memorial Medical Center ICUs for gastrointestinal bleeding. VCE was successfully completed in 43/48 (90 %) patients. The entire length of small bowel could be evaluated in 75 % and the source of bleeding was identified in 44 % of the patients. The most commonly identified source of bleeding included small bowel angioectasias, duodenal erosions/ulcers, and small bowel polyps. No major complications could be attributed to the VCE. Only 1 capsule was retained after 2 wk; however, there was no incidence of bowel obstruction, perforation, or capsule aspiration. CONCLUSIONS This observational retrospective study demonstrates that VCE may be a safe, feasible, and effective diagnostic tool in evaluation of gastrointestinal bleeding in the ICU population with few complications. VCE may be a safe diagnostic prelude and be a guide to the correct therapeutic procedure if needed, in the context of patients who are seriously ill.
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Affiliation(s)
- Shahrad Hakimian
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA,Corresponding author Shahrad Hakimian, MD UMass Memorial Medical CenterDepartment of Internal Medicine55 Lake Avenue NorthWorcesterMA 01655United States+1-508-8563981
| | - Salmaan Jawaid
- Division of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
| | - Yurima Guilarte-Walker
- Division of Data Sciences and Technology, Information Technology, UMass Medical School, Worcester, MA
| | - Jomol Mathew
- Division of Data Sciences and Technology, Information Technology, UMass Medical School, Worcester, MA
| | - David Cave
- Division of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
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Hakimian S, Popov Y, Rupawala AH, Salomon-Escoto K, Hatch S, Pellish R. The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation. Biologics 2018. [PMID: 29520131 PMCID: PMC5834167 DOI: 10.2147/btt.s150958] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Tumor necrosis factor alpha (TNFα) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFα medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI. Methods We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications. Results We included 107 and 89 patients with IBD and RA, respectively. We found that a higher proportion of IBD patients had indeterminate QFT-GIT result compared to RA patients. Furthermore, we found that the majority of patients with indeterminate results were tested during an acute flare of IBD (88%) and while taking corticosteroids. Of all patients receiving ≥20 mg equivalent prednisone dose (n=32), 63% resulted in indeterminate QFT-GIT, compared to only 6% indeterminate testing in patients receiving <20 mg of equivalent prednisone dose (n=164, P<0.001). There was no correlation between indeterminate results and age, gender, disease duration, or distribution, or smoking status within each population. Conclusion We observed that high-dose corticosteroids may affect QFT-GIT outcomes leading to a high proportion of indeterminate results. We propose that IBD patients should be tested prior to initiation of corticosteroids to avoid equivocal results and prevent potential delays in initiation of anti-TNF medications.
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Affiliation(s)
| | | | | | | | - Steven Hatch
- Division of Infectious Disease, UMass Memorial Medical Center, Worcester, MA, USA
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Hakimian S, Kheder J, Arum S, Cave DR, Hyatt B. Re-evaluating osteoporosis and fracture risk in Crohn's disease patients in the era of TNF-alpha inhibitors. Scand J Gastroenterol 2018; 53:168-172. [PMID: 29235392 DOI: 10.1080/00365521.2017.1416161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patients with Crohn's disease (CD) are at increased risk for osteoporosis and fractures as compared to the general population. Recently, various cytokines including tumor necrosis factor (TNF)-alpha are found to play a major role in bone health. In this study, we aimed to gain a better understanding of the risk factors for osteoporosis and vitamin D deficiency in the era of TNF-alpha inhibitors. METHODS We conducted a retrospective review of 464 consecutive patients with CD in our GI clinic between 2008 and 2015. Statistical analysis was performed using the student t-test and chi-square test. RESULTS CD patients treated with TNF-alpha inhibitors (TNF) and those who are anti-TNF naïve (NB) had similar rates of vitamin D deficiency, insufficiency and normal vitamin D-25-OH levels. Similarly, rates of osteoporosis (16% vs 18%), osteopenia (53% vs 57%) and normal bone density (31% vs 25%) were comparable between the TNF and NB groups respectively. However, Z-scores at the spine (-0.47 vs -0.05) were significantly lower in the TNF group (p = .03). Interestingly, rates of osteoporosis in the NB group were drastically different before and after age 60 (3.6% vs 30%) with no major difference in the TNF group (15% vs 18%). Bone density was positively correlated with BMI (Pearson's R = 0.39) and negatively correlated with age and smoking status (R= -0.25). CONCLUSIONS TNF group patients were diagnosed with osteoporosis from an earlier age compared to NB group but with a smaller increase in osteoporosis after menopause. Further prospective studies are necessary to further determine the role of anti-TNF medications in osteoporosis.
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Affiliation(s)
- Shahrad Hakimian
- a Department of Medicine , UMass Memorial Medical Center , Worcester , MA , USA
| | - Joan Kheder
- b Division of Gastroenterology , UMass Memorial Medical Center , Worcester , MA , USA
| | - Seth Arum
- c Division of Endocrinology , UMass Memorial Medical Center , Worcester , MA , USA
| | - David R Cave
- b Division of Gastroenterology , UMass Memorial Medical Center , Worcester , MA , USA
| | - Benjamin Hyatt
- b Division of Gastroenterology , UMass Memorial Medical Center , Worcester , MA , USA
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Economopoulos KP, Ward NL, Phillips CD, Teshager A, Patel P, Mohamed MM, Hakimian S, Cox SB, Ahmed R, Moaven O, Kaliannan K, Alam SN, Haller JF, Goldstein AM, Bhan AK, Malo MS, Hodin RA. Prevention of antibiotic-associated metabolic syndrome in mice by intestinal alkaline phosphatase. Diabetes Obes Metab 2016; 18:519-27. [PMID: 26876427 PMCID: PMC5110215 DOI: 10.1111/dom.12645] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 08/10/2015] [Revised: 02/02/2016] [Accepted: 02/09/2016] [Indexed: 12/20/2022]
Abstract
AIMS To examine whether co-administration of intestinal alkaline phosphatase (IAP) with antibiotics early in life may have a preventive role against metabolic syndrome (MetS) in mice. METHODS A total of 50 mice were allocated to four treatment groups after weaning. Mice were treated with azithromycin (AZT) ± IAP, or with no AZT ± IAP, for three intermittent 7-day cycles. After the last treatment course, the mice were administered a regular chow diet for 5 weeks and subsequently a high-fat diet for 5 weeks. Body weight, food intake, water intake, serum lipids, glucose levels and liver lipids were compared. 16S rRNA gene pyrosequencing was used to determine the differences in microbiome composition. RESULTS Exposure to AZT early in life rendered mice susceptible to MetS in adulthood. Co-administration of IAP with AZT completely prevented this susceptibility by decreasing total body weight, serum lipids, glucose levels and liver lipids to the levels of control mice. These effects of IAP probably occur as a result of changes in the composition of specific bacterial taxa at the genus and species levels (e.g. members of Anaeroplasma and Parabacteroides). CONCLUSIONS Co-administration of IAP with AZT early in life prevents mice from susceptibility to the later development of MetS. This effect is associated with alterations in the composition of the gut microbiota. IAP may represent a novel treatment against MetS in humans.
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Affiliation(s)
- K. P. Economopoulos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - N. L. Ward
- Departments of Molecular Biology and Botany, University of Wyoming, WY 82071, USA
| | - C. D. Phillips
- Research and Testing Laboratory, Lubbock, TX 79407
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409
| | - A. Teshager
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - P. Patel
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - M. M. Mohamed
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - S. Hakimian
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - S. B. Cox
- Research and Testing Laboratory, Lubbock, TX 79407
| | - R. Ahmed
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - O. Moaven
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - K. Kaliannan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - S. N. Alam
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - J. F. Haller
- Lipid Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - A. M. Goldstein
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - A. K. Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - M. S. Malo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - R. A. Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Corresponding author: Richard A. Hodin, MD, Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114; Telephone: (617) 724-2570; Fax: (617) 724-2574;
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Economopoulos K, Van Der Wilden G, Teshager A, Hakimian S, Muhammad N, Tantillo T, Mohamed M, Gul S, Hamarneh S, Karas A, Tao Q, Morrison S, Malo M, Fagenholz P, Hodin R. Perioperative Fasting Reduces Intestinal Alkaline Phosphatase in Humans. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Economopoulos KP, Martinou E, Hakimian S, Schizas D, Georgopoulos S, Tsigris C, Bakoyiannis CN. An overview of laparoscopic techniques in abdominal aortic aneurysm repair. J Vasc Surg 2013; 58:512-20. [PMID: 23890444 DOI: 10.1016/j.jvs.2013.04.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/12/2013] [Accepted: 04/28/2013] [Indexed: 02/05/2023]
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Kaliannan K, Hamarneh SR, Economopoulos KP, Nasrin Alam S, Moaven O, Patel P, Malo NS, Ray M, Abtahi SM, Muhammad N, Raychowdhury A, Teshager A, Mohamed MMR, Moss AK, Ahmed R, Hakimian S, Narisawa S, Millán JL, Hohmann E, Warren HS, Bhan AK, Malo MS, Hodin RA. Intestinal alkaline phosphatase prevents metabolic syndrome in mice. Proc Natl Acad Sci U S A 2013; 110:7003-8. [PMID: 23569246 PMCID: PMC3637741 DOI: 10.1073/pnas.1220180110] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Metabolic syndrome comprises a cluster of related disorders that includes obesity, glucose intolerance, insulin resistance, dyslipidemia, and fatty liver. Recently, gut-derived chronic endotoxemia has been identified as a primary mediator for triggering the low-grade inflammation responsible for the development of metabolic syndrome. In the present study we examined the role of the small intestinal brush-border enzyme, intestinal alkaline phosphatase (IAP), in preventing a high-fat-diet-induced metabolic syndrome in mice. We found that both endogenous and orally supplemented IAP inhibits absorption of endotoxin (lipopolysaccharides) that occurs with dietary fat, and oral IAP supplementation prevents as well as reverses metabolic syndrome. Furthermore, IAP supplementation improves the lipid profile in mice fed a standard, low-fat chow diet. These results point to a potentially unique therapy against metabolic syndrome in at-risk humans.
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Affiliation(s)
- Kanakaraju Kaliannan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Sulaiman R. Hamarneh
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | | | - Sayeda Nasrin Alam
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Omeed Moaven
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Palak Patel
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Nondita S. Malo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Madhury Ray
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Seyed M. Abtahi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Nur Muhammad
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Atri Raychowdhury
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Abeba Teshager
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Mussa M. Rafat Mohamed
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Angela K. Moss
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Rizwan Ahmed
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Shahrad Hakimian
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Sonoko Narisawa
- Sanford Children's Health Research Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037; and
| | - José Luis Millán
- Sanford Children's Health Research Center, Sanford-Burnham Medical Research Institute, La Jolla, CA 92037; and
| | | | - H. Shaw Warren
- Infectious Disease Unit, Department of Medicine and Pediatrics, and
| | - Atul K. Bhan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Madhu S. Malo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
| | - Richard A. Hodin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
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Ezra N, Goltche NB, Hakimian S, Afari A. CTLA4-induced splenomegaly and a review of the literature pertaining to autoimmune complications of therapy. J Drugs Dermatol 2010; 9:1432-1436. [PMID: 21061768] [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: 05/30/2023]
Abstract
CTLA4-blocking antibodies induce tumor regression in a subset of patients with metastatic melanoma by optimizing T-cell activity to fight the malignant cells. In addition to therapeutic benefits, CTLA4 therapy may induce immune-related adverse events (irAE). Studies on CTLA4 knockout and other CTLA4 deficient mice have resulted in splenomegaly, lymphoproliferation and fatal multi-organ destruction. The authors present a case of a 68-year-old patient who has developed splenomegaly following CTLA4 therapy. CTLA4 therapy's risks and benefits should be weighed carefully in the treatment of malignant melanoma. Larger prospective multi-center trials are needed to gauge the efficacy and complication rate of CTLA4 therapy. The authors propose that patients should get short-term surveillance imaging (CT or PET/CT) to exclude the multiple abdominopelvic complications and quickly terminate therapy if clinically warranted. It is also necessary for clinicians to carefully monitor for the number of possible complications associated with this immunotherapy.
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Affiliation(s)
- Navid Ezra
- Department of Radiology, Los Angeles, CA 90095-1712, USA
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Tchieu J, Kuoy E, Chin MH, Trinh H, Patterson M, Sherman SP, Aimiuwu O, Lindgren A, Hakimian S, Zack JA, Clark AT, Pyle AD, Lowry WE, Plath K. Female human iPSCs retain an inactive X chromosome. Cell Stem Cell 2010; 7:329-42. [PMID: 20727844 DOI: 10.1016/j.stem.2010.06.024] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/27/2010] [Accepted: 06/17/2010] [Indexed: 11/16/2022]
Abstract
Generating induced pluripotent stem cells (iPSCs) requires massive epigenome reorganization. It is unclear whether reprogramming of female human cells reactivates the inactive X chromosome (Xi), as in mouse. Here we establish that human (h)iPSCs derived from several female fibroblasts under standard culture conditions carry an Xi. Despite the lack of reactivation, the Xi undergoes defined chromatin changes, and expansion of hiPSCs can lead to partial loss of XIST RNA. These results indicate that hiPSCs are epigenetically dynamic and do not display a pristine state of X inactivation with two active Xs as found in some female human embryonic stem cell lines. Furthermore, whereas fibroblasts are mosaic for the Xi, hiPSCs are clonal. This nonrandom pattern of X chromosome inactivation in female hiPSCs, which is maintained upon differentiation, has critical implications for clinical applications and disease modeling, and could be exploited for a unique form of gene therapy for X-linked diseases.
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Affiliation(s)
- Jason Tchieu
- Department of Biological Chemistry, Jonsson Comprehensive Cancer Center, Molecular Biology Institute, David Geffen School of Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA 90024, USA
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Zackowski KM, Bastian AJ, Hakimian S, Mink JW, Perlmutter JS, Koller WC, Thach WT. Thalamic stimulation reduces essential tremor but not the delayed antagonist muscle timing. Neurology 2002; 58:402-10. [PMID: 11839839 DOI: 10.1212/wnl.58.3.402] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
BACKGROUND Electrical stimulation of the thalamus dramatically reduces essential tremor (ET). It has been hypothesized that the cerebellum and inferior olive are involved in the generation of ET, and thalamic stimulation is presumed to dampen ET through interactions with cerebellar output to the thalamus. Evidence suggests that abnormal timing of agonist and antagonist muscle responses contribute to cerebellar tremor (CbT); however, this relationship has not been investigated for ET. The mechanisms of the tremor and improvement are unknown. OBJECTIVE To measure the effect of ventral intermediate thalamic stimulation in controlling the ET response to sudden stretch of an agonist muscle and to determine whether, in ET, the timing relationships between the initial agonist and antagonist electromyography (EMG) responses show abnormalities similar to those seen in CbT. METHODS The authors studied ET subjects (with implanted thalamic stimulators turned off and on) and normal controls as they responded to mechanical torque pulses given at the wrist joint. The wrist joint angle, wrist agonist, and antagonist EMG were recorded. RESULTS Like CbT, patients with ET showed delayed onsets of antagonist EMG and excessive rebound. Thalamic stimulation reduced the tremor but did not alter the antagonist delay or the rebound. CONCLUSIONS In ET, antagonist muscle responses to a torque pulse are similar to that in CbT. However, benefit from thalamic stimulation did not alter these EMG responses; therefore, suppression of tremor must be caused by mechanisms other than the re-establishment of normal agonist-antagonist timing.
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Affiliation(s)
- K M Zackowski
- Program in Physical Therapy, Department of Anatomy and Neurobiology, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63110, USA
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Gierada DS, Hakimian S, Slone RM, Yusen RD. MR analysis of lung volume and thoracic dimensions in patients with emphysema before and after lung volume reduction surgery. AJR Am J Roentgenol 1998; 170:707-14. [PMID: 9490958 DOI: 10.2214/ajr.170.3.9490958] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [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: 02/06/2023]
Abstract
OBJECTIVE This study was performed to assess the accuracy of determining lung volume in patients with emphysema using MR imaging and then to investigate changes in thoracic dimensions after lung volume reduction surgery. SUBJECTS AND METHODS Fast gradient-echo breath-hold MR imaging through the entire thorax at full inspiration and expiration was performed in 21 patients with severe emphysema and was performed again in nine of the patients who underwent surgery. Lung volumes were determined using a semiautomated computerized method of delineating the lungs and summing cross-sectional areas. These summed areas were compared with volumes measured on plethysmography and CT. Postoperative changes in thoracic structure were determined by measuring anteroposterior and transverse lung dimensions and lung height before and after surgery. RESULTS The correlation coefficients and SEM for determining inspiratory lung volume were MR imaging versus plethysmography, r = .77, SEM = -12% (volume measured as less on MR imaging); CT versus plethysmography, r = .86, SEM = -13% (volume measured as less on CT); and MR imaging versus CT, r = .87, SEM = 4% (volume measured as greater on MR imaging). The correlation coefficients and SEM for determining expiratory volume on MR imaging versus plethysmography were r = .77, SEM = 6% (volume measured as greater on MR imaging). After surgery, decreases were found in all thoracic dimensions, and such decreases were greatest at expiration. CONCLUSION MR measurements of lung volume are comparable with those of CT and differ from those of plethysmography. Changes in thoracic dimensions after lung volume reduction surgery are consistent with improved respiratory mechanics.
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Affiliation(s)
- D S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA
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