1
|
Xiang HF, Venigalla S, Liang X, Berkenstock K, Copella A, Pai S, Boimel P. Risk-Adapted SABR for Ultra-Central Lung Tumors Attaining High BED 10 to Targets in a Steep Dose-Response Window of 72-105 Gy under Tumor Tracking: A Planning Study. Int J Radiat Oncol Biol Phys 2023; 117:e76. [PMID: 37786173 DOI: 10.1016/j.ijrobp.2023.06.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Higher rate of durable local control in stereotactic ablative radiotherapy (SABR) for ultra-central lung tumors (UCLTs) strongly correlates to a BED10 ≥ 100 Gy to the tumors. However, higher rates of grade 5 toxicities are reported to be directly associated with higher dose to the organs at risk (OARs) abutting or in close distance to the UCLTs, including trachea, proximal bronchial tree (PBT) and esophagus. This study evaluated two risk-adapted SABR schemes in a steep dose-response window of BED10 at 72 -105 Gy with isotoxic optimization and dynamic tumor tracking to safely attain high BED10 to the tumors while keeping dose to the OARs within evidence-based tolerances. MATERIALS/METHODS A total of 12-16 patients are included for planning under two risk-adapted-SABR schemes of 60 Gy in 8 (scheme A) and15 (scheme B) fractions to attain high BED10 of ≥100 Gy to the distal sections of the PTV and yet potent BED10 at 72-84 Gy to the proximal sections of the PTV. Such inhomogeneous dose plans use a 3-5 mm GTV to PTV margins under a scenario that patients have at least one fiducial marker placed in or near the GTV for real-time tumor tracking on a robotic SRS-SABR system. All plans used fixed cone collimators and a planning tool's dose calculation to reach highest BED10 dose coverage achievable to the target volumes while respecting the OAR dose tolerances, including V105 Gy, V100 Gy, V84 Gy and V72 Gy in BED10 for target volumes and the maximum EQD2 dose tolerances (α/β = 3 Gy) in D0.03cc for the trachea/PBT ≤80.5-82.5 Gy and esophagus ≤64.0-77.6 Gy in scheme-A; and trachea/PBT≤97.7 Gy and esophagus ≤64.3 Gy in scheme-B. Median and range of plan dosimetry metrics are compared between the two schemes. RESULTS For scheme-A, mean BED10 to PTV are 118.0 Gy (median) in105.5-133.5 Gy (range), and mean BED10 dose to GTV are 132.2 (118.3-149.4 Gy). EQD2 dose to trachea are 80.5 Gy (68.0-81.7 Gy), PBT 80.5 Gy (49.1-82.2 Gy), esophagus 67.2 Gy (51.6-77.3 Gy). PTV coverage by BED10 of 72 Gy, 84 Gy, 100 Gy and 105 Gy are 98.9% (87.5-100%), 97.1% (81.8-99.8%), 91.9% (72.5-98.6%) and 85.3% (68.5-97.9%). For scheme-B, mean BED10 to PTV are 102.2 Gy (93.4-106.0 Gy), and mean BED10 dose to GTV are 115.4 (103.4-117.3 Gy). EQD2 dose to trachea are 73.3 Gy (67.5-96.3 Gy), PBT 90.9 Gy (74.4-97.2 Gy), esophagus 61.4 Gy (41.9-64.1 Gy). PTV coverage by BED10 of 72 Gy, 84 Gy, 100 Gy and 105 Gy are 100% (94.9-100%), 95.5% (83.9-99.0%), 54.8% (31.2-65.4%) and 42.8% (17.9-53.2%). CONCLUSION Two risk-adapted SABR of 7.5 Gyx8 and 4 Gyx15 are implemented for treating ultra-central lung tumors with BED10 ≥100 Gy to the distal sections of PTV and yet attain potent BED10 ≥72-84 Gy to the proximal sections of PTV that abut or overlap with trachea, proximal bronchial tree or esophagus. Accurate dose calculation by a planning tool and real-time tumor tracking are essential for safe and accurate delivery of such high-risk SABR treatments.
Collapse
Affiliation(s)
- H F Xiang
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - S Venigalla
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - X Liang
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - K Berkenstock
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - A Copella
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - S Pai
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| | - P Boimel
- Department of Radiation Oncology, Penn Medicine Lancaster General Hospital, Lancaster, PA
| |
Collapse
|
2
|
Blane B, Coll F, Raven K, Allen O, Kappeler ARM, Pai S, Floto RA, Peacock SJ, Gouliouris T. Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study. J Hosp Infect 2023; 139:192-200. [PMID: 37451408 DOI: 10.1016/j.jhin.2023.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of nosocomial infection, driven by its ability to spread between patients and persist in the hospital environment. AIM To investigate the impact of a long-established cardiothoracic hospital moving to new premises with close to 100% single-occupancy rooms on the rates of environmental contamination and infection or colonization by VRE. METHODS Prospective environmental surveillance for VRE was conducted at five time-points between April and November 2019, once in the original building, and four times in the new building. Incidence rate ratios (IRRs) of VRE infection/colonization were determined for the one-year period before and after the hospital move, and compared to a nearby hospital. FINDINGS In the original location, the first environmental screen found 29% VRE positivity. The following four screens in the new location showed a significant reduction in positivity (1-6%; P<0.0001). The VRE infection/colonization rates were halved in the new location (IRR: 0.56; 95% confidence interval: 0.38-0.84), compared to the original location, contrasting with an increase in a nearby hospital (1.62; 1.17-2.27) over the same time-period. Genomic analysis of the environmental isolates was consistent with reduced transmission in the new hospital. CONCLUSION The use of single-occupancy rooms was associated with reduced environmental contamination with VRE, and lower transmission and isolation of VRE from clinical samples. The cost-effectiveness of single-occupancy room hospitals in reducing healthcare-associated infections should be reassessed in the context of operational costs of emerging pandemic and increasing antimicrobial resistance threats.
Collapse
Affiliation(s)
- B Blane
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
| | - F Coll
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Raven
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - O Allen
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - A R M Kappeler
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Pai
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R A Floto
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - S J Peacock
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
| | - T Gouliouris
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
3
|
Shenoy NN, Gheewala GK, Kedambadi R, Pai S, Zulfikli KM, Naidu R, Pai R, Daruwala F. Can Serum Magnesium Level and Visual Evoked Potentials (P100) be a Predictive in Migraineurs?: Evidence Based Study. Neurol India 2023; 71:463-466. [PMID: 37322741 DOI: 10.4103/0028-3886.378668] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Background and Objective Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. Materials and Methods After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. Results In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). Conclusions As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks.
Collapse
Affiliation(s)
- Nisha N Shenoy
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
| | - Gaurang K Gheewala
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Rakshith Kedambadi
- First Neuro Brain & Spine Super Speciality, Hospital, Mangaluru, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - K Misri Zulfikli
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Ramesh Naidu
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Rohit Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Feral Daruwala
- Department of Medical Writer, Nephrolife the Complete Kidney Care, Surat, Gujarat, India
| |
Collapse
|
4
|
Rangwalla S, Cortes L, Buckley K, McClelland G, Pai S, Schwartz S, Coste F. 211 Increasing body mass index percentile in cystic fibrosis clinic using novel algorithm. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00901-8] [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: 11/06/2022]
|
5
|
Pai S, Outterson B, Castelan M, Schwartz S. 98 Improving Quarterly Out-Patient Pediatric cystic fibrosis (CF) Clinic Visits. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
6
|
Wang J, Johnson M, Barve M, Pelster M, Chen X, Li Z, Gordon J, Reiss M, Pai S, Falchook G, Tolcher A. Preliminary results from HERKULES-1: a phase 1b/2, open-label, multicenter study of ERAS-007, an oral ERK1/2 inhibitor, in patients with advanced or metastatic solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Schwartz S, Pai S, Beachler D, Fullmer J. 135: Improving cystic fibrosis (CF) patient registry timely data entry. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Long P, Pai S, Beachler D, Gregory K. 279: Resiliency training for maintaining and improving the cystic fibrosis staff’s mental health. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Russian L, Villagomez K, Pai S. 265: Improving home spirometry adherence for out-patient cystic fibrosis clinic. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01690-8] [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: 10/20/2022]
|
10
|
Pai S. 261: Telehealth versus face-to-face annual respiratory education for pediatric outpatient cystic fibrosis clinic visits. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Kaur P, do Rosario MC, Hebbar M, Sharma S, Kausthubham N, Nair K, A S, Bhat Y R, Lewis LES, Nampoothiri S, Patil SJ, Suresh N, Bijarnia Mahay S, Dua Puri R, Pai S, Kaur A, Kc R, Kamath N, Bajaj S, Kumble A, Shetty R, Shenoy R, Kamate M, Shah H, Muranjan MN, Bl Y, Avabratha KS, Subramaniam G, Kadavigere R, Bielas S, Girisha KM, Shukla A. Clinical and genetic spectrum of 104 Indian families with central nervous system white matter abnormalities. Clin Genet 2021; 100:542-550. [PMID: 34302356 PMCID: PMC8918360 DOI: 10.1111/cge.14037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022]
Abstract
Genetic disorders with predominant central nervous system white matter abnormalities (CNS WMAs), also called leukodystrophies, are heterogeneous entities. We ascertained 117 individuals with CNS WMAs from 104 unrelated families. Targeted genetic testing was carried out in 16 families and 13 of them received a diagnosis. Chromosomal microarray (CMA) was performed for three families and one received a diagnosis. Mendeliome sequencing was used for testing 11 families and all received a diagnosis. Whole exome sequencing (WES) was performed in 80 families and was diagnostic in 52 (65%). Singleton WES was diagnostic for 50/75 (66.67%) families. Overall, genetic diagnoses were obtained in 77 families (74.03%). Twenty-two of 47 distinct disorders observed in this cohort have not been reported in Indian individuals previously. Notably, disorders of nuclear mitochondrial pathology were most frequent (9 disorders in 20 families). Thirty-seven of 75 (49.33%) disease-causing variants are novel. To sum up, the present cohort describes the phenotypic and genotypic spectrum of genetic disorders with CNS WMAs in our population. It demonstrates WES, especially singleton WES, as an efficient tool in the diagnosis of these heterogeneous entities. It also highlights possible founder events and recurrent disease-causing variants in our population and their implications on the testing strategy.
Collapse
Affiliation(s)
- Parneet Kaur
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Michelle C do Rosario
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Malavika Hebbar
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Suvasini Sharma
- Department of Paediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Neethukrishna Kausthubham
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Karthik Nair
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shrikiran A
- Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Bhat Y
- Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Leslie Edward S Lewis
- Department of Paediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sheela Nampoothiri
- Department of Paediatric Genetics, Amrita Institute of Medical Sciences and Research Centre, Kochi, India
| | | | - Narayanaswami Suresh
- Department of Paediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Sunita Bijarnia Mahay
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Anupriya Kaur
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakshith Kc
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nutan Kamath
- Department of Paediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Shruti Bajaj
- Jaslok Hospital and Research Centre, Mumbai, India
| | - Ali Kumble
- Department of Paediatrics, Indiana Hospital and Heart Institute, Mangalore, India
| | | | - Rathika Shenoy
- Department of Paediatrics, K.S. Hegde Medical Academy, NITTE University, Mangalore, India
| | - Mahesh Kamate
- Department of Paediatrics, Jawaharlal Nehru Medical College, Belgaum, India
| | - Hitesh Shah
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mamta N Muranjan
- Department of Pediatrics, Genetics Division, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Yatheesha Bl
- Dheemahi Child Neurology and Development Center, Shimoga, India
| | | | | | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Stephanie Bielas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Katta Mohan Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
12
|
Bravo Montenegro G, Vanderwalde A, Raez L, Nieva J, Feldman R, Herrmann A, Nagasaka M, Ikpeazu C, Mamdani H, Pai S, Wozniak A, Spira A, Lopes G, Liu S, Kim C. P76.43 Co-occurring genomic alterations and treatment outcomes in patients with EGFR exon 20 insertion positive NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Shetty N, Samuel SR, Alaparthi GK, Amaravadi SK, Joshua AM, Pai S. Comparison of Diaphragmatic Breathing Exercises, Volume, and Flow-Oriented Incentive Spirometry on Respiratory Function in Stroke Subjects: A Non-randomized Study. Ann Neurosci 2020; 27:232-241. [PMID: 34556964 PMCID: PMC8454997 DOI: 10.1177/0972753121990193] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Abstract. BACKGROUND Reduced respiratory muscle strength leads to reduced pulmonary function, chest wall movements in the affected side, and increased chest infections, which thereby reduces oxygenation and ventilation. Respiratory muscle training can be used in acute stroke subjects to increase their pulmonary function. PURPOSE To compare the short-term effects of diaphragmatic breathing exercise, flow, and volume-oriented incentive spirometry on respiratory function following stroke. METHODS A non-randomized hospital-based study was conducted at Kasturba Medical College Hospitals, Mangalore, India. Forty-two sub-acute subjects of either gender, with the first episode of stroke within six months, were assigned to three groups by the consultant, i.e., diaphragmatic breathing group (DBE), Flow oriented-incentive spirometry group (FIS), and volume oriented-incentive spirometry group (VIS; N = 14) each. All subjects received intervention thrice daily, along with conventional stroke rehabilitation protocols throughout the study period. Pre- and post-intervention values were taken on alternate days until day 5 for all the three groups. RESULTS The pulmonary function and maximal respiratory pressures were found to be significantly increased by the end of intervention in all three groups, but FIS and DBE groups had better results than VIS (FVC = FIS group, 13.71%; VIS group, 14.89%; DBE group, 21.27%, FEV1 = FIS group, 25.97%; VIS group, 22.52%; DBE group, 19.38%, PEFR = FIS group, 38.76%; VIS group,9.75%; DBE group, 33.16%, MIP = FIS group, 28.23%; VIS group, 19.36%; DBE group, 52.14%, MEP = FIS group, 43.00%; VIS group, 22.80%; DBE group, 28.68%). CONCLUSION Even though all interventions had positive outcomes in all variables, flow incentive spirometry had better results across all outcomes (pulmonary function and maximal respiratory pressures) when compared to the other two interventions making it a valuable tool for stroke rehabilitation.
Collapse
Affiliation(s)
- Natasha Shetty
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Sampath Kumar Amaravadi
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| |
Collapse
|
14
|
Rutledge E, Pai S, Muir T, Antosh D. 19: Modified Manchester-Fothergill procedure for pelvic organ prolapse in a patient with spina bifida. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Naing A, Bauer T, Papadopoulos K, Rahma O, Tsai F, Garralda E, Naidoo J, Pai S, Gibson M, Rybkin I, Wang D, McDermott D, Fasolo A, de Miguel M, Shaheen M, Jenkins Y, Kallender H, Gogov S, Kuriakose E, Pishvaian M. Phase I study of the arginase inhibitor INCB001158 (1158) alone and in combination with pembrolizumab (PEM) in patients (Pts) with advanced/metastatic (adv/met) solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Pai S, Bamodu O, Lin C, Chu P, Chien M, Wang L, Hsiao M, Yeh C, Tsai J. The integrin-associated signal transducer cd47 modulates radiosensitivity by cancer stem cell regulation and emt deactivation in oral squamous cell carcinoma cells. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Nawaz S, Goyal A, Farooqi M, Pai S, Snapper S, Raje N, Field M. A CASE OF VERY EARLY ONSET INFLAMMATORY BOWEL DISEASE, CHRONIC LUNG DISEASE, AND RECURRENT INFECTIONS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
18
|
Haehn D, Prada G, Chamorro Pareja N, Carrillo-Martin I, Irizarry-Alvarado J, Pai S, Gonzalez-Estrada A. ALEMTUZUMAB SKIN TESTING: TO DILUTE OR NOT TO DILUTE; IRRITANT OR NON-IRRITANT. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Pai S, Melamed G, Yurteri-Kaplan L, Grimes C, Muir T, Antosh D. 88: Rate of post-operative urinary tract infection with use of 50% dextrose versus 20% mannitol for intraoperative cystoscopy during surgery for pelvic organ prolapse. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
20
|
Chae Y, Iams W, Pai S, Costa R, Taxter T, Mohindra N, Villaflor V, Pro B, Giles F. P1.04-004 Phase I/Ib Study of Nivolumab and Veliparib in Advanced Solid Tumors and Lymphoma with and without Alterations in Selected DNA Repair Genes. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Pai S, Cohen E, Lin D, Fountzilas G, Kim E, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Lawrence D, Khaliq A, Melillo G, Shire N. RetroSpective cohort stUdy of PD-L1 expression in REcurrent and/or MEtastatic squamous cell carcinoma of the head and neck (SUPREME-HN). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Affiliation(s)
- Saumya H Mittal
- Department of Neurology, KMC Hospital, Mangalore, Karnataka, India
| | - K C Rakshith
- Department of Neurology, KMC Hospital, Mangalore, Karnataka, India
| | - Z K Misri
- Department of Neurology, KMC Hospital, Mangalore, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, KMC Hospital, Mangalore, Karnataka, India
| | - Nisha Shenoy
- Department of Neurology, KMC Hospital, Mangalore, Karnataka, India
| |
Collapse
|
23
|
Chowdhary KN, Rao R, Priya P, Valiathan M, Shetty S, Pai S. Cutaneous Sarcoidosis Misdiagnosed as Leprosy. Report of Two Cases and Review of Literature. Indian J Lepr 2016; 88:177-183. [PMID: 30207442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cutaneous sarcoidosis may occasionally be mistaken and treated for leprosy. We present two cases of sarcoidosis of the skin which were initially treated as leprosy based on the histopathological features. Histological study in one patient showed perineural and perivascular granuloma adding on to the diagnostic confusion. It is very important for the clinicians to consider sarcoidosis as a possible diagnosis in a patient with clinical features that are not typical of leprosy. Histopathology along with appropriate in -situ techniques can help in arriving at an appropriate diagnosis.
Collapse
|
24
|
Kumar S, Puttegowda D, Kamate P, Pai S. AB0511 Minor Salivary Gland (MSG) Biopsy Findings in Indian Patients with Sjögren's Syndrome and Their Correlation with Extra-Glandular Manifestations. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
25
|
Bhat R, Pai S. Immature platelet fraction: a significant platelet parameter in asymptomatic constitutional macrothrombocytopenia. Int J Lab Hematol 2016; 38:e45-7. [DOI: 10.1111/ijlh.12471] [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] [Indexed: 11/29/2022]
Affiliation(s)
- R. Bhat
- Department of Laboratory Medicine; Manipal Hospital; Bengaluru India
| | - S. Pai
- Department of Laboratory Medicine; Manipal Hospital; Bengaluru India
| |
Collapse
|
26
|
Pai S, Bedford L, Ruramayi R, Aliyu SH, Sule J, Maslin D, Enoch DA. Pseudomonas aeruginosa meningitis/ventriculitis in a UK tertiary referral hospital. QJM 2016; 109:85-9. [PMID: 25991873 DOI: 10.1093/qjmed/hcv094] [Citation(s) in RCA: 16] [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] [Received: 11/10/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa is a rare cause of meningitis and ventriculitis but is generally associated with significant morbidity and mortality. AIM We sought to determine the epidemiology, risk factors and outcome of meningitis and ventriculitis due to P. aeruginosa at our institution in order to inform preventive strategies and treatment guidelines. METHODS Retrospective study of all patients with a positive cerebrospinal fluid (CSF) culture admitted to a tertiary care hospital over 18 years. Clinical details, demographic, microbiological and antibiotic data were obtained from laboratory and medical records. RESULTS Twenty-four episodes occurred in 21 patients over 18 years. Pyrexia (75%), fluctuating mental status (50%) and headache (41%) were the most frequent presenting symptoms. Nineteen of the 21 patients had previously undergone a neurosurgical procedure and seven had extra-ventricular devices in situ. Twelve (57%) patients had P. aeruginosa isolated from another site prior to their episode. Most (89%) CSF samples demonstrated a neutrophilia; the CSF protein, when measured, was raised in all cases. Gram-negative bacilli were visible on CSF microscopy in only three isolates. There were relatively low rates of resistance to most antimicrobials tested and combination treatment of intravenous with intrathecal antibiotics was often used. No patients died within 28 days. CONCLUSION Pseudomonas aeruginosa meningitis and ventriculitis are predominantly nosocomial and related to prior neurosurgery. It can be difficult to diagnose as CSF Gram-film and meningism are insensitive markers. Appropriate empirical treatment, neurosurgical prophylaxis and surveillance can aid in managing this infection.
Collapse
Affiliation(s)
- S Pai
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - L Bedford
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - R Ruramayi
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - S H Aliyu
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - J Sule
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - D Maslin
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - D A Enoch
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| |
Collapse
|
27
|
Mittal S, Pai S, Rakshith KC, Misri ZK. A forgotten cause of bilateral wrist drop. Neurol India 2016; 64:800-2. [DOI: 10.4103/0028-3886.185407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Affiliation(s)
- S Shetty
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, India
| | - R Rao
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, India
| | - A Jindal
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, India
| | - S Pai
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, India
| |
Collapse
|
29
|
Pai S, Hsu W, Lin T, Lee F, Lo C. Reconstruction of maxillary and mandibular defects with free fibular flaps: clinical experience review. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
30
|
Liu Z, Larsen E, Bahamondes S, Choi M, Li J, Cranford K, Hayes C, Grow A, Zheng Y, Wu X, Pai S, Kennedy A. SU-E-J-244: Development and Validation of a Knowledge Based Planning Model for External Beam Radiation Therapy of Locally Advanced Non-Small Cell Lung Cancer. Med Phys 2015. [DOI: 10.1118/1.4924330] [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: 11/07/2022] Open
|
31
|
Pai S. SU-F-BRA-09: New Efficient Method for Xoft Axxent Electronic Brachytherapy Source Calibration by Pre-Characterizing Surface Applicators. Med Phys 2015. [DOI: 10.1118/1.4925220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
32
|
Pai S, Ayyalasomayajula S, Lee S. SU-E-P-05: Electronic Brachytherapy: A Physics Perspective On Field Implementation. Med Phys 2015. [DOI: 10.1118/1.4923939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
33
|
Pai S, Koretomo R, Tamaki S, Berg J, Marbury T, Galloway C, Preston R. FP658JTZ-951, A NOVEL HIF-PHD INHIBITOR, DEMONSTRATES INCREASES IN HEMOGLOBIN, IRON MOBILIZATION, REPRODUCIBLE PHARMACOKINETICS, AND SAFETY FOLLOWING ONCE DAILY ADMINISTRATION FOR 15 DAYS IN PATIENTS WITH ANEMIA RECEIVING HEMODIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv182.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
34
|
de Graaf H, Pai S, Burns DA, Karas JA, Enoch DA, Faust SN. Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature. Eur J Clin Microbiol Infect Dis 2015; 34:1281-7. [PMID: 25926302 DOI: 10.1007/s10096-015-2367-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/19/2015] [Indexed: 12/29/2022]
Abstract
Although Clostridium difficile is a major cause of antibiotic-associated diarrhoea in adults, the incidence and severity of C. difficile infection (CDI) in children is unclear. One complicating factor in assessing the role of CDI in children is the possibility of co-infection with other gastrointestinal pathogens. In this review, we summarise the literature concerning C. difficile co-infections in young children, in an attempt to discuss the rate of co-infections and their potential role in the severity of CDI clinical presentation. We identified 31 studies where co-infections were analysed, comprising 1,718 patients with positive C. difficile tests. The pooled percentage of reported co-infections was 20.7% (range 0-100%). Viral co-infections were most commonly reported (46%), with bacteria and parasites accounting for 14.9% and 0.01% of cases, respectively. However, the panel of co-infections tested for varied considerably among studies and 38% of stated co-infections did not have a pathogen reported. Substantial variation in how and when tests for gastrointestinal co-infections are carried out, small sample sizes and a lack of clear CDI case definitions preclude meaningful conclusions on the true rate of co-infections in this patient population. This review suggests that co-infections may be common in children with diarrhoea who tested positive for C. difficile. Given a lack of CDI case definitions, especially in young children under the age of 5 years, a broad panel of pathogens should be tested for to exclude other microbiological causes. However, the summarised poor quality of the available literature on this subject highlights a need for further studies.
Collapse
Affiliation(s)
- H de Graaf
- Faculty of Medicine, University of Southampton and Southampton NIHR Wellcome Trust Clinical Research Facility C Level, West Wing, Mailpoint 218, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | | | | | | | | | | |
Collapse
|
35
|
Pai S, Gouliouris T, Kappeler ARM, Gillham MI. Disinfection of dynamic mattresses: highlighting an infection control issue. J Hosp Infect 2015; 90:172-3. [PMID: 25862312 DOI: 10.1016/j.jhin.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Affiliation(s)
- S Pai
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK.
| | - T Gouliouris
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - A R M Kappeler
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - M I Gillham
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
36
|
Pai S, Smith D, Peng S, Ishida E, Akpeng B, Hung C, Wu T. OC-015: Therapeutic HPV vaccine increases sensitivity of poorly immunogenic tumor to anti-PD-1 monotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34775-7] [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: 10/23/2022]
|
37
|
Mittal S, Rakshith KC, Misri ZK, Pai S, Shenoy N, Gundabolu G. Hypertrophic olivary degeneration due to the presence of pontine cavernomas. Neurol India 2015; 63:981-3. [DOI: 10.4103/0028-3886.170089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
38
|
Rai S, Madi D, Pai S, Baliga S. Unusual Larva in the CSF and Unique MRI Findings in a Case of Eosinophilic Meningitis. J Clin Imaging Sci 2014; 4:76. [PMID: 25806134 PMCID: PMC4286823 DOI: 10.4103/2156-7514.148303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 10/20/2014] [Accepted: 12/27/2014] [Indexed: 11/13/2022] Open
Abstract
Eosinophilic meningitis may be caused by non-infectious and infectious agents. Angiostrongylus cantonensis is the commonest causative agent of eosinophilic meningitis. Rats are the primary hosts of this parasite. Humans get infected by ingestion of raw or inadequately cooked hosts (snails or monitor lizard) or food contaminated with the infective third-stage larvae. A 16-year-old boy was admitted to our hospital with history of fever, headache, and altered sensorium. Magnetic resonance imaging of the brain showed unique findings. Cerebrospinal fluid (CSF) examination showed eosinophilia and the CSF wet mount identified a larva. Patient history revealed ingestion of monitor lizard 2 weeks prior to onset of symptoms. Hence, a diagnosis of eosinophilic meningitis caused by A. cantonensis was made. He was treated with oral albendazole and steroids, resulting in gradual improvement. A. cantonensis as a cause of eosinophilic meningitis is a possibility in patients who present with headache and vomiting after eating raw meat (monitor lizard). To the best of our knowledge, this is a very rare case being reported from India where the larva was identified during the microscopic examination of the CSF.
Collapse
Affiliation(s)
- Santosh Rai
- Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Deepak Madi
- Department of Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| |
Collapse
|
39
|
Streppel MM, Lata S, DelaBastide M, Montgomery EA, Wang JS, Canto MI, Macgregor-Das AM, Pai S, Morsink FHM, Offerhaus GJ, Antoniou E, Maitra A, McCombie WR. Next-generation sequencing of endoscopic biopsies identifies ARID1A as a tumor-suppressor gene in Barrett's esophagus. Oncogene 2014; 33:347-57. [PMID: 23318448 PMCID: PMC3805724 DOI: 10.1038/onc.2012.586] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/28/2012] [Accepted: 10/29/2012] [Indexed: 12/24/2022]
Abstract
The incidence of Barrett's esophagus (BE)-associated esophageal adenocarcinoma (EAC) is increasing. Next-generation sequencing (NGS) provides an unprecedented opportunity to uncover genomic alterations during BE pathogenesis and progression to EAC, but treatment-naive surgical specimens are scarce. The objective of this study was to establish the feasibility of using widely available endoscopic mucosal biopsies for successful NGS, using samples obtained from a BE 'progressor'. Paired-end whole-genome NGS was performed on the Illumina platform using libraries generated from mucosal biopsies of normal squamous epithelium (NSE), BE and EAC obtained from a patient who progressed to adenocarcinoma during endoscopic surveillance. Selective validation studies, including Sanger sequencing, immunohistochemistry and functional assays, were performed to confirm the NGS findings. NGS identified somatic nonsense mutations of AT-rich interactive domain 1A (SWI like) (ARID1A) and PPIE and an additional 37 missense mutations in BE and/or EAC, which were confirmed by Sanger sequencing. ARID1A mutations were detected in 15% (3/20) high-grade dysplasia (HGD)/EAC patients. Immunohistochemistry performed on an independent archival cohort demonstrated ARID1A protein loss in 0% (0/76), 4.9% (2/40), 14.3% (4/28), 16.0% (8/50) and 12.2% (12/98) of NSE, BE, low-grade dysplasia, HGD and EAC tissues, respectively, and was inversely associated with nuclear p53 accumulation (P=0.028). Enhanced cell growth, proliferation and invasion were observed on ARID1A knockdown in EAC cells. In addition, genes downstream of ARID1A that potentially contribute to the ARID1A knockdown phenotype were identified. Our studies establish the feasibility of using mucosal biopsies for NGS, which should enable the comparative analysis of larger 'progressor' versus 'non-progressor' cohorts. Further, we identify ARID1A as a novel tumor-suppressor gene in BE pathogenesis, reiterating the importance of aberrant chromatin in the metaplasia-dysplasia sequence.
Collapse
Affiliation(s)
- MM Streppel
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Lata
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Woodbury, NY, USA
| | - M DelaBastide
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Woodbury, NY, USA
| | - EA Montgomery
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - JS Wang
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - MI Canto
- Department of Medicine (Division of Gastroenterology and Hepatology), John Hopkins Medical Institutions, Baltimore, MD, USA
| | - AM Macgregor-Das
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, MD, USA
- Pathobiology Program, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - S Pai
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - FHM Morsink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - GJ Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Antoniou
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Woodbury, NY, USA
| | - A Maitra
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, John Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Genetic Medicine, John Hopkins Medical Institution, Baltimore, MD, USA
| | - WR McCombie
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Woodbury, NY, USA
| |
Collapse
|
40
|
Pandit L, Mustafa S, Kunder R, Shetty R, Misri Z, Pai S, Shetty R. Optimizing the management of neuromyelitis optica and spectrum disorders in resource poor settings: Experience from the Mangalore demyelinating disease registry. Ann Indian Acad Neurol 2013; 16:572-6. [PMID: 24339582 PMCID: PMC3841603 DOI: 10.4103/0972-2327.120474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 05/12/2013] [Revised: 06/23/2013] [Accepted: 06/29/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In resource-poor settings, the management of neuromyelitis optica (NMO) and NMO spectrum (NMOS) disorders is limited because of delayed diagnosis and financial constraints. AIM To device a cost-effective strategy for the management of NMO and related disorders in India. MATERIALS AND METHODS A cost-effective and disease-specific protocol was used for evaluating the course and treatment outcome of 70 consecutive patients. RESULTS Forty-five patients (65%) had a relapse from the onset and included NMO (n = 20), recurrent transverse myelitis (RTM; n = 10), and recurrent optic neuritis (ROPN; n = 15). In 38 (84.4%) patients presenting after multiple attacks, the diagnosis was made clinically. Only 7 patients with a relapsing course were seen at the onset and included ROPN (n = 5), NMO (n = 1), and RTM (n = 1). They had a second attack after a median interval of 1 ± 0.9 years, which was captured through our dedicated review process. Twenty-five patients had isolated longitudinally extensive transverse myelitis (LETM), of which 20 (80%) remained ambulant at follow-up of 3 ± 1.9 years. Twelve patients (17%) with median expanded disability status scale (EDSS) of 8.5 at entry had a fatal outcome. Serum NMO-IgG testing was done in selected patients, and it was positive in 7 of 18 patients (39%). Irrespective of the NMO-IgG status, the treatment compliant patients (44.4%) showed significant improvement in EDSS (P ≤ 0.001). CONCLUSIONS Early clinical diagnosis and treatment compliance were important for good outcome. Isolated LETM was most likely a post-infectious demyelinating disorder in our set-up. NMO and NMOS disorders contributed to 14.9% (45/303) of all demyelinating disorders in our registry.
Collapse
Affiliation(s)
- Lekha Pandit
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Sharik Mustafa
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Ramya Kunder
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Rajesh Shetty
- Department of Neurology, AJ Institute of Medical Sciences, Mangalore, Karnataka, India
| | - Zulkifly Misri
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Rakshith Shetty
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| |
Collapse
|
41
|
Swarnalatha G, Pai S, Ram R, Dakshinamurty KV. Fulminant hepatic failure following marijuana drug abuse: Molecular adsorbent recirculation system therapy. Indian J Nephrol 2013; 23:384-6. [PMID: 24049281 PMCID: PMC3764719 DOI: 10.4103/0971-4065.116335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Marijuana is used for psychoactive and recreational purpose. We report a case of fulminant hepatic failure following marijuana drug abuse who recovered following artificial support systems for acute liver failure. There is no published literature of management of marijuana intoxication with molecular adsorbent recirculation system (MARS). MARS is effective and safe in patients with fulminant hepatic failure following marijuana intoxication.
Collapse
Affiliation(s)
- G Swarnalatha
- Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
| | | | | | | |
Collapse
|
42
|
Raphael B, Lautenschlager M, Kahler A, Pai S, Parks B, Kalb S, Maslanka S, Shah S, Magnuson M, Hill V. Recovery and detection of botulinum toxin type A from drinking water. Toxicon 2013. [DOI: 10.1016/j.toxicon.2012.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Pai S, Madi D, Achappa B, Mahalingam S, Kendambadi R. An interesting case of eosinophilic meningitis. J Clin Diagn Res 2013; 7:734-5. [PMID: 23730662 DOI: 10.7860/jcdr/2013/4743.2897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/26/2012] [Indexed: 11/24/2022]
Abstract
Angiostrongylus cantonensis is one of the causative agents of eosinophilic meningitis. Humans get infected when they ingest raw or partially cooked snails or monitor lizards (Varanus bengalensis). There is a popular belief that the tongue and the liver of the monitor lizard has aphrodisiac properties. A 20-year-old man was admitted to our hospital with a history of fever, headache and vomiting. His cerebrospinal fluid revealed eosinophilia. He gave a history of the ingestion of a monitor lizard, ten days prior to the onset of the symptoms. So, a diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis was made. He was treated with oral albendazole and prednisolone. His symptoms improved gradually within two weeks from his admission.
Collapse
Affiliation(s)
- Shivanand Pai
- Assistant Professor, Department of Neurology, Kasturba Medical College , Mangalore (affiliated to Manipal University)
| | | | | | | | | |
Collapse
|
44
|
Kaminsky Z, Tochigi M, Jia P, Pal M, Mill J, Kwan A, Ioshikhes I, Vincent JB, Kennedy JL, Strauss J, Pai S, Wang SC, Petronis A. A multi-tissue analysis identifies HLA complex group 9 gene methylation differences in bipolar disorder. Mol Psychiatry 2012; 17:728-40. [PMID: 21647149 DOI: 10.1038/mp.2011.64] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [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: 12/14/2022]
Abstract
Epigenetic studies of DNA and histone modifications represent a new and important activity in molecular investigations of human disease. Our previous epigenome-wide scan identified numerous DNA methylation differences in post-mortem brain samples from individuals affected with major psychosis. In this article, we present the results of fine mapping DNA methylation differences at the human leukocyte antigen (HLA) complex group 9 gene (HCG9) in bipolar disorder (BPD). Sodium bisulfite conversion coupled with pyrosequencing was used to interrogate 28 CpGs spanning ∼700 bp region of HCG9 in 1402 DNA samples from post-mortem brains, peripheral blood cells and germline (sperm) of bipolar disease patients and controls. The analysis of nearly 40 000 CpGs revealed complex relationships between DNA methylation and age, medication as well as DNA sequence variation (rs1128306). Two brain tissue cohorts exhibited lower DNA methylation in bipolar disease patients compared with controls at an extended HCG9 region (P=0.026). Logistic regression modeling of BPD as a function of rs1128306 genotype, age and DNA methylation uncovered an independent effect of DNA methylation in white blood cells (odds ratio (OR)=1.08, P=0.0077) and the overall sample (OR=1.24, P=0.0011). Receiver operating characteristic curve A prime statistics estimated a 69-72% probability of correct BPD prediction from a case vs control pool. Finally, sperm DNA demonstrated a significant association (P=0.018) with BPD at one of the regions demonstrating epigenetic changes in the post-mortem brain and peripheral blood samples. The consistent multi-tissue epigenetic differences at HCG9 argue for a causal association with BPD.
Collapse
Affiliation(s)
- Z Kaminsky
- The Krembil Family Epigenetics Laboratory, Neuroscience Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Sanguineti G, Pai S, Westra W, Forastiere A, Califano J. Defining the Risk of Involvement for Each Neck Nodal Level in Patients with Early T-Stage/Node-positive/HPV-related Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.033] [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: 10/15/2022]
|
46
|
Kamijo T, Milart P, Wojcik K, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Landolsi H, Yacoubi MT, Stita W, Gribaa M, Hmissa S, Molenaar N, van Besouw NH, Steegers EAP, Visser W, de Kuiper P, de Krijger R, Exalto N, Lagrand R, Kaandorp SP, Mellink CHM, van Wely M, Redeker EJW, Knegt AC, Goddijn M, Vidal C, Giles J, Meseguer M, Zuzuarregui JL, Bosch E, Pellicer A, Schust D, Sugimoto M, Sugimoto J, Reus AD, Stephenson MD, Steegers EAP, Krijger de RR, Dunne van FM, Exalto N, Exacoustos C, Vaquero E, Di Giovanni A, Romeo V, Lazzarin N, Arduini D, Brahem S, Mehdi M, Atig F, Ghedir H, Ibala S, Ajina M, Saad A, Chang C, Wang H, Huang S, Pai S, Soong Y, Papanikolaou E, Pantos G, Grimbizis G, Bili E, Polyzos N, Karastefanou K, Humaidan P, Esteves S, Tarlatzis B, McNamee K, Topping A, Farquharson RG, Dawood F, Ruiz Galdon M, Lendinez AM, Palomares AR, Martinez F, Perez-Nevot B, Jimenez Fernandez A, Reyes-Engel A, Horcajadas JA, Savaris RF, Kovac V, Reljic M, Vlaisavljevic V, Colicchia A, Pergolini I, Gilio B, Rampini MR, Alfano P, Marconi D, Verlengia C, Alviggi E, Bellver J, Cruz F, Martinez MC, Ramirez J, Ferro J, Garrido N, Brown JK, Lauer KB, Inglis NF, Critchley HOD, Horne AW, Samli H, Cetinkaya Demir B, Ozgoz A, Atalay MA, Uncu G, Yan Y, Cai-hong MA, Jie QIAO, Xin-na CHEN, Weimar CHE, Kavelaars A, Gellersen B, Brosens JJ, de Vreeden-Elbertse JMT, Heijnen CJ, Macklon NS, Castillo JC, Dolz M, Caballero O, Abad L, Perez-Panades J, Bonilla-Musoles F, Eggert - Kruse W, Scholz S, Klopsch I, Strowitzki T. POSTER VIEWING SESSION - EARLY PREGNANCY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Pai S, Brown N. P21.01 Clostridium difficile diagnosis in the East of England – A re-audit of laboratory methods. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
48
|
Abstract
Formaldehyde has long been the fixative of choice for histological examination of tissue. The use of alternatives to formaldehyde has grown, however, owing to the serious hazards associated with its use. Companies have striven to maintain the morphological characteristics of formaldehyde-fixed tissue when developing alternatives. Glyoxal-based fixatives now are among the most popular formaldehyde alternatives. Although there are many studies that compare staining quality and immunoreactivity, there have been no studies that quantify possible structural differences. Histomorphometric analysis commonly is used to evaluate diseased tissue. We compared fixation with formaldehyde and glyoxal with regard to the histomorphological properties of plantar foot tissue using a combination of stereological methods and quantitative morphology. We measured skin thickness, interdigitation index, elastic septa thickness, and adipocyte area and diameter. No significant differences were observed between formaldehyde and glyoxal fixation for any feature measured. The glyoxal-based fixative used therefore is a suitable fixative for structural evaluation of plantar soft tissue. Measurements obtained from the glyoxal-fixed tissue can be combined with data obtained from formalin-fixed for analysis.
Collapse
Affiliation(s)
- Y N Wang
- Department of Veterans Affairs, RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | | | | | | |
Collapse
|
49
|
|
50
|
Abstract
There has always been the temptation to take prohibited substances in the struggle for an athlete to gain the ‘higher ground’ above the rest of the competitors which allow goals to be attained easier than by the conventional training methods. The problem of drugs in sport has existed for a long time and is underestimated in its prevalence. This paper deals with the reasons of why athletes take such drugs, which drugs are available and the testing employed to detect their use. Among the issues discussed will be the future of drugs in sport and what measures can be taken to combat their use.
Collapse
Affiliation(s)
- S Pai
- Department of Sport Medicine, University Hospital of Hartlepool, UK
| | - G R McLatchie
- Department of Sport Medicine, University Hospital of Hartlepool, UK
| |
Collapse
|