1
|
Mohan S, Gnanaraj R, Khan B, Sugathan G. Paracentral acute middle maculopathy as an isolated ocular manifestation of Behçet's disease: A case report. J Fr Ophtalmol 2024; 47:104052. [PMID: 38233263 DOI: 10.1016/j.jfo.2023.104052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 01/19/2024]
Affiliation(s)
- S Mohan
- Medcare Eye Centre, Al Safa, Matloob Building F, Sheikh Zayed Road, Dubai, United Arab Emirates; Rajan Eye Care, No 5, Vidyodaya East 2nd Street, T Nagar 600017, Chennai, India.
| | - R Gnanaraj
- University of Colorado, Colorado, CO, United States
| | - B Khan
- King's College Hospital London, Dubai Hills, Dubai, United Arab Emirates
| | - G Sugathan
- Medcare Eye Centre, Al Safa, Matloob Building F, Sheikh Zayed Road, Dubai, United Arab Emirates
| |
Collapse
|
2
|
Vasantham A, Thanigaimani K, Sudhakaran R, Mohan S, Arumugam N, Almansour AI, Perumal K. Rationally construction of 2D & 3D material on h-BN @ SnO 2/TiO 2 micro-sphere enables for photocatalytic debasement of textile cloth dyes in waste water treatment. Environ Res 2024; 251:118728. [PMID: 38492840 DOI: 10.1016/j.envres.2024.118728] [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] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Affordable and swiftly available h-BN@SnO2/TiO2 photocatalysts are being developed through an easy hydrothermally approach was used urea as boric acid precursors. With their constructed photo catalysts, the effect of h-BN@SnO2/TiO2 has been investigated under the assessment of Adsorption agents utilizing X-ray diffraction pattern (XRD), Scanning electron microscopy, Energy dispersive spectroscopic analysis (SEM/EDS), transmission electron microscopy (TEM), high resolution transmission electron microscopy (HR-TEM), and Burner Emit Teller (BET) isotherm testing methods, which also indicated that SnO2/TiO2 and h-BN have been tightly bound together. Because turquoise blue (TB) and Methyl orange (MO) fabric dyes can be found in the industrial wastewater being processed, the photo catalytic degradation process happens to be applied. According to the advantageous linkages of h-BN@SnO2/TiO2 photocatalysts, fantastic efficacy in breakdown towards hazardous compounds has been found. For the decomposition of Turquoise blue (TB) and Methyl orange (MO), the h-BN@SnO2/TiO2 catalysts proved the best performance stability (0.0386 min-1 and 1.524min-1) but were significantly 22 times quicker. Optical catalysis has additionally demonstrated extraordinary resilience and durability throughout five reprocessed efforts. On top of that, an approach enabling photocatalytic breakdown of harmful substances upon h-BN@SnO2/TiO2 has been presented.
Collapse
Affiliation(s)
- A Vasantham
- PG and Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India
| | - K Thanigaimani
- PG and Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India.
| | - R Sudhakaran
- PG and Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India
| | - S Mohan
- PG and Research Department of Chemistry, Vivekananda College of Arts and Sciences for Women (Autonomous), Elayampalaym, Tiruchengode, 637205, Namakkal-DT, Tamilnadu, India.
| | - Natarajan Arumugam
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdulrahman I Almansour
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Karthikeyan Perumal
- Department of Chemistry and Biochemistry, the Ohio State University, 151 W. Woodruff Ave, Columbus, OH, 43210, USA
| |
Collapse
|
3
|
Ross JE, Mohan S, Zhang J, Sullivan MJ, Bury L, Lee K, Futchi I, Frantz A, McDougal D, Perez Botero J, Cattaneo M, Cooper N, Downes K, Gresele P, Keenan C, Lee AI, Megy K, Morange PE, Morgan NV, Schulze H, Zimowski K, Freson K, Lambert MP. Evaluating the clinical validity of genes related to hemostasis and thrombosis using the Clinical Genome Resource gene curation framework. J Thromb Haemost 2024; 22:645-665. [PMID: 38016518 PMCID: PMC10922649 DOI: 10.1016/j.jtha.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Inherited bleeding, thrombotic, and platelet disorders (BTPDs) are a heterogeneous set of diseases, many of which are very rare globally. Over the past 5 decades, the genetic basis of some of these disorders has been identified, and recently, high-throughput sequencing has become the primary means of identifying disease-causing genetic variants. OBJECTIVES Knowledge of the clinical validity of a gene-disease relationship is essential to provide an accurate diagnosis based on results of diagnostic gene panel tests and inform the construction of such panels. The Scientific and Standardization Committee for Genetics in Thrombosis and Hemostasis undertook a curation process for selecting 96 TIER1 genes for BTPDs. The purpose of the process was to evaluate the evidence supporting each gene-disease relationship and provide an expert-reviewed classification for the clinical validity of genes associated with BTPDs. METHODS The Clinical Genome Resource (ClinGen) Hemostasis/Thrombosis Gene Curation Expert Panel assessed the strength of evidence for TIER1 genes using the semiquantitative ClinGen gene-disease clinical validity framework. ClinGen Lumping and Splitting guidelines were used to determine the appropriate disease entity or entities for each gene, and 101 gene-disease relationships were identified for curation. RESULTS The final outcome included 68 Definitive (67%), 26 Moderate (26%), and 7 Limited (7%) classifications. The summary of each curation is available on the ClinGen website. CONCLUSION Expert-reviewed assignment of gene-disease relationships by the ClinGen Hemostasis/Thrombosis Gene Curation Expert Panel facilitates accurate molecular diagnoses of BTPDs by clinicians and diagnostic laboratories. These curation efforts can allow genetic testing to focus on genes with a validated role in disease.
Collapse
Affiliation(s)
- Justyne E Ross
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shruthi Mohan
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jing Zhang
- KingMed Diagnostics, Guangzhou, Guangdong, China
| | - Mia J Sullivan
- Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Loredana Bury
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Kristy Lee
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Isabella Futchi
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Annabelle Frantz
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dara McDougal
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Juliana Perez Botero
- Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA; Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marco Cattaneo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Nichola Cooper
- Centre for Haematology, Imperial College London, London, UK
| | - Kate Downes
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Catriona Keenan
- Haemostasis Molecular Diagnostic Laboratory, National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Alfred I Lee
- Section of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karyn Megy
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Pierre-Emmanuel Morange
- INSERM, INRAE, C2VN, Aix Marseille University, Marseille, France; Hematology Laboratory, La Timone Hospital, APHM, Marseille, France
| | - Neil V Morgan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Harald Schulze
- Institute of Experimental Biomedicine, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany
| | - Karen Zimowski
- Aflac Cancer and Blood Disorders Center, Emory University/Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kathleen Freson
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium.
| | - Michele P Lambert
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
4
|
Christina B, Thanigaimani K, Sudhakaran R, Mohan S, Arumugam N, Almansour AI, Mahalingam SM. Pyto-Architechture of Ag, Au and Ag-Au bi-metallic nanoparticles using waste orange peel extract for enable carcinogenic Congo red dye degradation. Environ Res 2024; 242:117625. [PMID: 38007079 DOI: 10.1016/j.envres.2023.117625] [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] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
Ecologically inspired to develop silver, gold and silver/gold bimetallic nanoparticles from discarded orange peel extract. The plant-derived compounds included in discarded orange peel extract have been accountable for the development of Ag, Au and Ag-Au bimetallic nanoparticles, that might be used in the biosynthetic process. The qualitative assessment of developed silver, gold and silver/gold bimetallic nanoparticles has been performed by UV-visible, XRD pattern, FT IR analysis, TEM/HRTEM, EDX and BET isotherm analysis. In this investigation, the photocatalytic effect of developed silver, gold and silver/gold bimetallic nanoparticles on Congo red dye breakdown efficiency was achieved at 96%, 94%, and 99.2%, respectively. Due to prolonged electron-hole recombination process was investigated using UV irradiation and reused for up to 5 consecutive runs without significant loss of photocatalytic activity. Moreover, silver, gold, and silver/gold bimetallic nanoparticles manufactured in an environmentally benign manner could potentially contribute to the ecological cleanup.
Collapse
Affiliation(s)
- B Christina
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli, 620 022, Tamilnadu, India
| | - K Thanigaimani
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli, 620 022, Tamilnadu, India.
| | - R Sudhakaran
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli, 620 022, Tamilnadu, India
| | - S Mohan
- PG & Research Department of Chemistry, Vivekananda College of Arts and Sciences for Women (Autonomous), Elayampalaym, Tiruchengode, 637205, Namakkal-DT, Tamilnadu, India.
| | - Natarajan Arumugam
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Abdulrahman I Almansour
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | | |
Collapse
|
5
|
Christina B, Thanigaimani K, Sudhakaran R, Mohan S, Arumugam N, Almansour AI, Karthikeyan Perumal. Green waste immobilized Ag/Cu feather like Bi-matrix on garment dye decomposes and their bio-efficacy. Environ Res 2024; 242:117761. [PMID: 38036214 DOI: 10.1016/j.envres.2023.117761] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
This paper describes a simple phyto-remediation of feather-like silver/copper bi-matrix (BMs) was constructed by employing pommagrant waste peel (PWP) extract as crucial role of reducing agent and chelating agents. Numerous strategies, including UV-Visible, XRD, SEM-EDX, and TEM and BET isotherm were used to analysis the optical, structural, surface area and functional properties. Ag/Cu BPNMs of TEM characterization shows feather-like architectural features with constrained size and shape. The Ag/Cu co-catalytic nanoparticles have a particle size of 34-64 nm. The photocatalytic efficiency of Ag/Cu BMs was investigated using a garment dye, Congo red (CR), at successive time intervals under halogen lamp exposure. For Ag/Cu bimetallic nanoparticles, the photocatalytic degradation rate was recorded to be 100% after 40 min which is caused by adsorption of Congo red dye molecules on Ag/Cu and their degradation by reactive oxygen species (ROS). ROS are free hydroxyl radicals such as •OH and O2• ions that have high oxidizing capacity. The developed Ag/Cu BMs shown effective bacteriostatic action against many infections.
Collapse
Affiliation(s)
- B Christina
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India
| | - K Thanigaimani
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India.
| | - R Sudhakaran
- PG & Research Department of Chemistry, Government Arts College (Affiliated to Bharathidasan University), Tiruchirappalli - 620022, Tamilnadu, India
| | - S Mohan
- PG & Research Department of Chemistry, Vivekananda College of Arts and Sciences for Women (Autonomous), Elayampalaym, Tiruchengode - 637205, Namakkal-DT, Tamilnadu, India.
| | - Natarajan Arumugam
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdulrahman I Almansour
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Karthikeyan Perumal
- Department of Chemistry and Biochemistry, The Ohio State University, 151 W. Woodruff Ave, Columbus, OH, 43210, USA
| |
Collapse
|
6
|
Hasson DC, Mohan S, Rose JE, Merrill KA, Goldstein SL, Benoit SW, Varnell CD. Ionized Magnesium Correlates With Total Blood Magnesium in Pediatric Patients Following Kidney Transplant. Ann Lab Med 2024; 44:21-28. [PMID: 37665282 PMCID: PMC10485856 DOI: 10.3343/alm.2024.44.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Background Abnormal serum magnesium (Mg) concentrations are common and associated with worse mortality in kidney-transplant recipients. Many kidney and transplant-related factors affect Mg homeostasis. The concentration of the active form, ionized Mg (iMg), is not measured clinically, and total Mg (tMg) and iMg correlations have conflicted. We hypothesized that iMg and tMg concentrations show poor categorical agreement (i.e., low, normal, and high) in kidney-transplant recipients but that ionized calcium (iCa) correlates with iMg. Methods We retrospectively evaluated hypomagnesemia in kidney-transplant recipients over a 2-yr period. We prospectively collected blood at 0-28 days post-transplant to measure correlations between iMg and iCa/tMg. iMg and iCa concentrations in the reference ranges of 0.44-0.65 and 1.0-1.3 mmol/L, respectively, were considered normal. Fisher's exact test and unweighted kappa statistics revealed category agreements. Pearson's correlation coefficients and linear regression measured correlations. Results Among 58 retrospective kidney-transplant recipients, 54 (93%) had tMg<0.66 mmol/L, 28/58 (48%) received Mg supplementation, and 20/28 (71%) had tacrolimus dose adjustments during supplementation. In 13 prospective transplant recipients (N=43 samples), iMg and tMg showed strong category agreement (P=0.0003) and correlation (r=0.71, P<0.001), whereas iMg and iCa did not (P=0.7; r=-0.25, P=0.103, respectively). Conclusions tMg and iMg exhibited strong correlation following kidney transplantation. However, iCa may not be an accurate surrogate for iMg. Determining the effect of Mg supplementation and the Mg concentration where supplementation is clinically necessary are important next steps.
Collapse
Affiliation(s)
- Denise C. Hasson
- Division of Pediatric Critical Care, Hassenfeld Children’s Hospital, New York University Langone Health, New York, NY, USA
| | - Shruthi Mohan
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - James E. Rose
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kyle A. Merrill
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stefanie W. Benoit
- Division of Pediatric Critical Care, Hassenfeld Children’s Hospital, New York University Langone Health, New York, NY, USA
| | - Charles D. Varnell
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, USA
| |
Collapse
|
7
|
Choo S, Gonzalez B, Hazelton J, Robinson E, Mohan S, Leach C, Bailey SKT, Latifi K, Hoffe S. Toward Burnout Prevention: Can One Short Virtual Reality Relaxation and Mindfulness Training Session for Staff and Patients Decrease Stress and Improve Subjective Sense of Wellbeing? Int J Radiat Oncol Biol Phys 2023; 117:e507. [PMID: 37785590 DOI: 10.1016/j.ijrobp.2023.06.1759] [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) Mental wellness of healthcare workers has deteriorated recently, increasing burnout rates. Cancer patients are also often highly distressed, reporting fear, pain, and fatigue. Relaxation and mindfulness training have been shown to decrease stress and anxiety. Currently, the use of virtual reality (VR) for relaxation and mindfulness for cancer patients and oncology clinical staff is an ongoing area of research. We aimed to test the preliminary efficacy of incorporating an innovative digital therapeutic (DTx) we developed at our center in this population. MATERIALS/METHODS Cancer patients and clinic staff from one institution's Gastrointestinal and Radiation Oncology departments participated in the immersive VR-enhanced relaxation and mindfulness experience for this IRB-exempt study. Users completed a pre-VR survey via iPad assessing baseline knowledge and practice of stress reduction techniques, baseline stress, and familiarity with VR. In the VR app deployed on an Oculus Quest 2, users chose a relaxing water scene (e.g., stream, beach) and optional soothing background music. Users could also choose a relaxation or mindfulness training audio track. A post-VR survey assessed whether the experience affected their subjective stress and sense of wellbeing ("Yes" or "No") as well as the feasibility of using the app. A binomial test on a single proportion was used to test whether more participants (>50%) indicated their stress was reduced following the VR training than did not. Post-VR qualitative verbal feedback was also collected to identify future changes to the VR app. RESULTS Six patients, a patient's son, and forty-three employees used the VR app. Users were aged ≤ 30 years old (18%), 30-50 years (60%), and 50-70 years (22%). Users completed the VR experience in a median of 14 min (IQR: 11-19 min). In the pre-survey, most (78%) reported they felt stress at this point in their lives. In the post-survey, significantly more than the expected proportion of participants (>50%) reported feeling less stressed after using the VR app (88%, n = 44, p <0.001). Most (90%) reported that the VR app improved their subjective sense of wellbeing. All (100%) users reported it was easy to learn the VR controls. Nearly all (96%) reported they would be interested in using this VR app again, including 30% and 38% who reported they would be "extremely likely" and "very likely," respectively, to use the app again. CONCLUSION These findings suggest our VR relaxation and mindfulness training was well accepted and could be integrated into the hospital setting in short sessions. Further work should be done based on participant feedback to expand the offerings of this VR app to offer a wider range of relaxation experiences and gamified psychological interventions that can help de-stress, recharge, and build resiliency.
Collapse
Affiliation(s)
- S Choo
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - B Gonzalez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - E Robinson
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - S Mohan
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - C Leach
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - S K T Bailey
- University of South Florida Morsani College of Medicine, Tampa, FL; Center for Advanced Medical Learning and Simulation, Tampa, FL
| | - K Latifi
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - S Hoffe
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| |
Collapse
|
8
|
Davis M, Mohan S, Russell T, Feng C, Badillo A, Levitt M, Ho CP, Pohl HG, Varda BK. A prospective cohort study of assisted bladder emptying following primary cloacal repair: The Children's National experience. J Pediatr Urol 2023; 19:371.e1-371.e11. [PMID: 37037763 DOI: 10.1016/j.jpurol.2023.03.017] [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: 11/07/2022] [Revised: 02/20/2023] [Accepted: 03/11/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION/BACKGROUND Although the combination of bladder dysfunction and upper tract anomalies puts patient with cloaca at risk for renal disease, the rarity of this condition makes it difficult to study empirically. As a high-volume center, we uniquely capture bladder function outcomes following our growing number of cloacal repairs. OBJECTIVE 1) Describe the rates of incomplete bladder emptying following primary cloacal repair (at 2-3 months after repair and last follow up), and 2) identify clinical factors associated with assisted bladder emptying. STUDY DESIGN We performed a prospective cohort study of patients undergoing primary cloaca repair by our Children's National Colorectal Center team between 2020 and 2021. The primary outcome was assisted bladder emptying at 2-3 months postoperatively and last visit. Covariables included preoperative characteristics (cloacagram measurements), ARM complexity (moderate = common channel [CC] <3-cm, severe = CC ≥ 3-cm), vesicoureteral reflux (VUR) status, sacral ratio (good ≥0.7, intermediate 0.7-0.4, poor ≤0.4), spinal cord status, means of preoperative bladder emptying, and operative details (age at repair, repair type, & concomitant laparotomy). RESULTS Eighteen participants were eligible. A majority had moderate cloaca (78%), VUR (67%), spinal cord abnormalities (89%), and good sacral ratios (56%). Preoperatively, 10 patients were diapered for urine and 8 had assisted bladder emptying. Surgical repairs were performed at a median age of 8 months (range 4-46). Nine (50%) patients underwent urogenital separation (UGS), eight (44%) total urogenital mobilization, and 1 (6%) perineal sparing posterior sagittal anorectoplasty with introitoplasty. Exploratory laparotomy was performed in 7 (39%) patients. At 2-3 months, 7 patients were voiding and 11 required assisted bladder emptying. Median length of long-term follow up was 12 months (range 5-25), and 8 patients were voiding and 10 required assisted bladder emptying. Postoperative need for assisted bladder emptying was significantly associated with assisted bladder emptying preoperatively, a shorter urethra and increasing common channel length, UGS and exploratory laparotomy. Spinal cord imaging findings were not associated. DISCUSSION Bladder emptying following cloaca repair is likely a result of congenital function and surgical effects. Indeed, increasingly cloaca complexity requiring UGS and laparotomy was associated with both pre- and post-operative assisted bladder emptying. The lack of association with spinal cord imaging may reflect a divergence between anatomy and function. CONCLUSION Approximately half of patients required assisted bladder emptying in this study. Associated factors included urethral and common channel length, the need for assisted bladder emptying preoperatively, the type of surgical approach and additional laparotomy. Being diapered with seemingly normal voiding prior to surgery did not guarantee normal bladder function postoperatively.
Collapse
Affiliation(s)
- Meghan Davis
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Shruthi Mohan
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Teresa Russell
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Christina Feng
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Andrea Badillo
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Marc Levitt
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Christina P Ho
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Hans G Pohl
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Briony K Varda
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA.
| |
Collapse
|
9
|
Giorgi A, Cer AT, Mohan S, Perreault MC. Excitatory and Inhibitory Descending Commissural Interneurons Differentially Integrate Supraspinal and Segmental Sensory Signals. J Neurosci 2023; 43:5014-5029. [PMID: 37286348 PMCID: PMC10324999 DOI: 10.1523/jneurosci.2015-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023] Open
Abstract
The limited information about how descending inputs from the brain and sensory inputs from the periphery use spinal cord interneurons (INs) is a major barrier to understanding how these inputs may contribute to motor functions under normal and pathologic conditions. Commissural interneurons (CINs) are a heterogeneous population of spinal INs that has been implicated in crossed motor responses and bilateral motor coordination (ability to use the right and left side of the body in a coordinated manner) and, therefore, are likely involved in many types of movement (e.g., dynamic posture stabilization, jumping, kicking, walking). In this study, we incorporate mouse genetics, anatomy, electrophysiology, and single-cell calcium imaging to investigate how a subset of CINs, those with descending axons called dCINs, are recruited by descending reticulospinal and segmental sensory signals independently and in combination. We focus on two groups of dCINs set apart by their principal neurotransmitter (glutamate and GABA) and identified as VGluT2+ dCINs and GAD2+ dCINs. We show that VGluT2+ and GAD2+ dCINs are both extensively recruited by reticulospinal and sensory input alone but that VGluT2+ and GAD2+ dCINs integrate these inputs differently. Critically, we find that when recruitment depends on the combined action of reticulospinal and sensory inputs (subthreshold inputs), VGluT2+ dCINs, but not GAD2+ dCINs, are recruited. This difference in the integrative capacity of VGluT2+ and GAD2+ dCINs represents a circuit mechanism that the reticulospinal and segmental sensory systems may avail themselves of to regulate motor behaviors both normally and after injury.SIGNIFICANCE STATEMENT The way supraspinal and peripheral sensory inputs use spinal cord interneurons is fundamental to defining how motor functions are supported both in health and disease. This study, which focuses on dCINs, a heterogeneous population of spinal interneurons critical for crossed motor responses and bilateral motor coordination, shows that both glutamatergic (excitatory) and GABAergic (inhibitory) dCINs can be recruited by supraspinal (reticulospinal) or peripheral sensory inputs. Additionally, the study demonstrates that in conditions where the recruitment of dCINs depends on the combined action of reticulospinal and sensory inputs, only excitatory dCINs are recruited. The study uncovers a circuit mechanism that the reticulospinal and segmental sensory systems may avail themselves of to regulate motor behaviors both normally and after injury.
Collapse
Affiliation(s)
- Andrea Giorgi
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Abishag Tluang Cer
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Shruthi Mohan
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia 30322
| | | |
Collapse
|
10
|
Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
Collapse
|
11
|
Mohan S, Mayers M, Weaver M, Baudet H, De Biase I, Goldstein J, Mao R, McGlaughon J, Moser A, Pujol A, Suchy S, Yuzyuk T, Braverman NE. Evaluating the strength of evidence for genes implicated in peroxisomal disorders using the ClinGen clinical validity framework and providing updates to the peroxisomal disease nomenclature. Mol Genet Metab 2023; 139:107604. [PMID: 37236006 PMCID: PMC10484331 DOI: 10.1016/j.ymgme.2023.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
Peroxisomal disorders are heterogeneous in nature, with phenotypic overlap that is indistinguishable without molecular testing. Newborn screening and gene sequencing for a panel of genes implicated in peroxisomal diseases are critical tools for the early and accurate detection of these disorders. It is therefore essential to evaluate the clinical validity of the genes included in sequencing panels for peroxisomal disorders. The Peroxisomal Gene Curation Expert Panel (GCEP) assessed genes frequently included on clinical peroxisomal testing panels using the Clinical Genome Resource (ClinGen) gene-disease validity curation framework and classified gene-disease relationships as Definitive, Strong, Moderate, Limited, Disputed, Refuted, or No Known Disease Relationship. Subsequent to gene curation, the GCEP made recommendations to update the disease nomenclature and ontology in the Monarch Disease Ontology (Mondo) database. Thirty-six genes were assessed for the strength of evidence supporting their role in peroxisomal disease, leading to 36 gene-disease relationships, after two genes were removed for their lack of a role in peroxisomal disease and two genes were curated for two different disease entities each. Of these, 23 were classified as Definitive (64%), one as Strong (3%), eight as Moderate (23%), two as Limited (5%), and two as No known disease relationship (5%). No contradictory evidence was found to classify any relationships as Disputed or Refuted. The gene-disease relationship curations are publicly available on the ClinGen website (https://clinicalgenome.org/affiliation/40049/). The changes to peroxisomal disease nomenclature are displayed on the Mondo website (http://purl.obolibrary.org/obo/MONDO_0019053). The Peroxisomal GCEP-curated gene-disease relationships will inform clinical and laboratory diagnostics and enhance molecular testing and reporting. As new data will emerge, the gene-disease classifications asserted by the Peroxisomal GCEP will be re-evaluated periodically.
Collapse
Affiliation(s)
- Shruthi Mohan
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Megan Mayers
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Meredith Weaver
- American College of Medical Genetics and Genomics, Bethesda, MD, USA
| | - Heather Baudet
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | | | - Jennifer Goldstein
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Rong Mao
- ARUP Laboratories, Salt Lake City, UT, USA
| | | | - Ann Moser
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Aurora Pujol
- Bellvitge Biomedical Research Institute (IDIBELL Instituto de Investigación Biomédica de Bellvitge), Barcelona, Spain
| | | | | | - Nancy E Braverman
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
12
|
Mohan S, Kasthuri N. Automatic Segmentation of Psoriasis Skin Images Using Adaptive Chimp Optimization Algorithm-Based CNN. J Digit Imaging 2023; 36:1123-1136. [PMID: 36609894 PMCID: PMC10287620 DOI: 10.1007/s10278-022-00765-x] [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] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Psoriasis is a severe skin disease that is surveyed outwardly by dermatologists. In recent years, computer vision is the major solution for diagnosing the psoriasis skin disease by segmenting the infected skin images. Besides, many researchers had presented efficient machine learning techniques for segmenting the psoriasis skin images. Nevertheless, accuracy and time consumption of the model are further to be improved. Thus, in this work, we present adaptive chimp optimization algorithm (AChOA)-based convolutional neural network (CNN) which is introduced for automatic segmentation of psoriasis skin images. After pre-processing, the input images are segmented using AChOA-CNN model where weight and bias values of CNN are optimized with the AChOA. The search ability of ChOA is enhanced by adapting the chaotic sequence based on tent map. At final, from the segmented output images, artifacts are removed by applying the threshold module. From the simulation, we attain 97% of accuracy.
Collapse
Affiliation(s)
- S. Mohan
- Department of ECE, AVS Engineering College, Tamil Nadu Salem, India
| | - N. Kasthuri
- Department of ECE, Kongu Engineering College, Tamil Nadu Kumaran Nagar, India
| |
Collapse
|
13
|
Mohan S, Kumar S, Kumar GP, Maheswari A, Bhatia A, Sagar A. Assessment of the efficacy of olopatadine 0.1% in the treatment of vernal keratoconjunctivitis in terms of clinical improvement based on total ocular symptom score and ocular surface disease index. Indian J Ophthalmol 2023; 71:1822-1827. [PMID: 37203036 PMCID: PMC10391378 DOI: 10.4103/ijo.ijo_2048_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose The main objective of this study is to explore the efficacy of olopatadine 0.1% treatment in the resolution of symptoms of vernal keratoconjunctivitis (VKC) among the Indian population. Methods This single-center, prospective cohort study involved 234 patients with VKC. Patients were treated with olopatadine 0.1%, twice daily for a period of 12 weeks and then followed up in 1st week, 4th week, 3rd month, and 6th month. The extent of relief in the symptoms of VKC was measured using total ocular symptom score (TOSS) and ocular surface disease index (OSDI). Results In the present study, the dropout rate was 5.6%. Total of 136 males and 85 females with a mean age of 37.68 ± 11.35 years completed the study. TOSS score reduced from 58.85 to 5.06 and the OSDI score reduced from 75.41 to 11.2 with statistical significance (P < 0.01) from 1st week to 6th week after olopatadine 0.1% treatment. The data showed relief in subjective symptoms of itching, tearing, and redness, and relief in discomfort in functions related to ocular grittiness, visuals like reading, and environmental like tolerability in dry conditions. Further, olopatadine 0.1% was effective in both males and females, and patients across ages 18-70 years. Conclusion Based on TOSS and OSDI scores, the findings of this study validate safety and tolerability as revealed by low adverse effects and moderate efficacy of olopatadine 0.1% in reducing VKC symptoms in a broader age group (18-70 years) of both genders.
Collapse
Affiliation(s)
- S Mohan
- Command Hospital Airforce, Bengaluru, Karnataka, India
| | - Santosh Kumar
- Command Hospital Airforce, Bengaluru, Karnataka, India
| | - G Pawan Kumar
- Command Hospital Airforce, Bengaluru, Karnataka, India
| | | | - Agrima Bhatia
- Command Hospital Airforce, Bengaluru, Karnataka, India
| | - Anand Sagar
- Command Hospital Airforce, Bengaluru, Karnataka, India
| |
Collapse
|
14
|
Vidhya V, Dominic S, Mohan S, Raneesh KE. Outcome of Management of Mandibular Sub condylar Fractures Based on Classification System Using Cone-Beam Computed Tomography. J Maxillofac Oral Surg 2023; 22:453-459. [PMID: 37122793 PMCID: PMC10130293 DOI: 10.1007/s12663-023-01868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/11/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose The purpose of this study is to determine the amount of ramal height shortening and degree of displacement of sub condylar fracture that should be considered for effective management of mandibular sub condylar fractures using cone-beam computed tomography. Patients and Methods A prospective study of forty-two patients, who presented with unilateral sub condylar fracture was done. All patients were classified into Class I, II and III based on the degree of displacement of fractured segment and amount of ramal height shortening measured using cone-beam computed tomography. The treatment protocol was closed reduction and maxillomandibular fixation for Class I patients and open reduction and internal fixation for Class II and III patients. Outcomes of treatment were measured postoperatively 2 weeks, 1 and 3 months clinically. The variables, such as mouth opening, lateral and protrusive movements, deviation, pain and occlusion were studied. Results Among forty-two patients, twenty had Class I fractures, twelve had Class II fractures and ten had Class III fractures. Overall, no statistically significant differences were found between Class I and Class II groups in terms of functional outcomes and there were statistically significant differences between Class I and III groups. Class I fractures can be considered for closed method and open reduction is recommended for Class II and III fractures. The sample was composed of 42 patients grouped as follows: Class I (n = 20), Class II (n = 12), and Class III (n = 10) for treatment of sub condylar fractures. There were no significant differences between the three groups for the study variables at baseline, except for mouth opening and pain. There was significant difference in mouth opening between Class I and III cases (p 0.001) and insignificant difference in mouth opening in Class I and II cases (p 0.98). Persistent pain was elicited more in surgical Class II and III (n = 5) than non-surgical cases Class I (n = 0) on 3 months follow-up. Conclusion The study emphasises on use of three-dimensional diagnostic modality like cone-beam computed tomography for accurately classifying sub condylar fractures. The results favour closed reduction for mildly displaced Class I cases and surgical management of significantly displaced Class III fractures. The need for open reduction for Class II patients classified using CBCT is negligible assessing risks associated with surgical procedure which is contradictory to our protocol which requires a further comparative evaluation among Class II group.
Collapse
Affiliation(s)
- V. Vidhya
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala 686008 India
| | - Shiney Dominic
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala 686008 India
| | - S. Mohan
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala 686008 India
| | - K. E. Raneesh
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala 686008 India
| |
Collapse
|
15
|
Geoghegan CE, Mohan S, Lynch CP, Cha EDK, Jacob KC, Patel MR, Prabhu MC, Vanjani NN, Pawlowski H, Singh K. Validation of Neck Disability Index Severity among Patients Receiving One or Two-Level Anterior Cervical Surgery. Asian Spine J 2023; 17:86-95. [PMID: 35527536 PMCID: PMC9977990 DOI: 10.31616/asj.2021.0414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. PURPOSE To evaluate the validity of established severity thresholds for Neck Disability Index (NDI) among patients undergoing anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA). OVERVIEW OF LITERATURE Few studies have examined the validity of established NDI threshold values among patients undergoing ACDF or CDA. METHODS A surgical database was reviewed to identify patients undergoing cervical spine procedures. Demographics, operative characteristics, comorbidities, NDI, Visual Analog Scale (VAS), and 12-item Short Form (SF-12) physical and mental composite scores (PCS and MCS) were recorded. NDI severity was categorized using previously established threshold values. Improvement from preoperative scores at each postoperative timepoint and convergent validity of NDI was evaluated. Discriminant validity of NDI was evaluated against VAS neck and arm and SF-12 PCS and MCS. RESULTS All 290 patients included in the study demonstrated significant improvements from baseline values for all patient-reported outcome measures (PROMs) at all postoperative timepoints (p<0.001) except SF-12 MCS at 2 years (p =0.393). NDI showed a moderate- to-strong correlation (r≥0.419) at most timepoints for VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS (p<0.001, all). NDI severity categories demonstrated significant differences in mean VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS at all timepoints (p<0.001, all). Differences between NDI severity groups were not uniform for all PROMs. VAS neck values demonstrated significant intergroup differences at most timepoints, whereas SF-12 MCS showed significantly different values between most severity groups. CONCLUSIONS Neck disability is strongly correlated with neck and arm pain, physical function, and mental health and demonstrates worse outcomes with increasing severity. Previously established severity categories may be more applicable to pain than physical function or mental health and may be more uniformly applied preoperatively for cervical spine patients.
Collapse
Affiliation(s)
- Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
16
|
Mohan S, Navamani P, Dhanalekshmi KI, Jayamoorthy K, Srinivasan N. NMR spectral, DFT and antibacterial studies of triazole derivatives. INORG NANO-MET CHEM 2023. [DOI: 10.1080/24701556.2023.2166069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S. Mohan
- Research and Development Center, Bharathiar University, Coimbatore, Tamil Nadu, India
- Department of Chemistry, Rajalakshmi Engineering College, Thandalam, Tamil Nadu, India
| | - P. Navamani
- Research and Development Center, Bharathiar University, Coimbatore, Tamil Nadu, India
- PG Assistant in Chemistry, GGHSS, Kanchipuram, Tamil Nadu, India
| | - K. I. Dhanalekshmi
- Department of Chemistry, Global Institute of Engineering & Technology, Moinabad, R. R. District, Hyderabad, Telgana, India
| | - K. Jayamoorthy
- Department of Chemistry, St. Joseph’s College of Engineering, Chennai, Tamil Nadu, India
| | - N. Srinivasan
- Research and Development Center, Bharathiar University, Coimbatore, Tamil Nadu, India
- Department of Chemistry, Pachaiyappa’s College for Men, Kanchipuram, Tamil Nadu, India
| |
Collapse
|
17
|
Moni SS, Mohan S, Makeen HA, Alhazmi HA, Basode VK, Rehman Z, Alam MS, Alam MF, Anwer T, Elmobark ME, Abdulhaq A, Alamoudi MUA, Hadi IMH, Amri SAA, Alrithi AMA, Jathmi ZAJ, Kaabi MAA. Spectral characterization and biological evaluation of biomolecules from the peels of three orange fruits: a comparative study. BRAZ J BIOL 2023; 82:e267856. [PMID: 36700593 DOI: 10.1590/1519-6984.267856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
The present work was designed to investigate the presence of bioactive chemicals in the reaction mixtures (RMs) of peels of Valencia, Mandarin, and African navel oranges, through GC-MS and FT-IR studies. Limonene, a unique compound, is present in the RMs of the three orange peels. Moreover, hexadecanoic acid 2-hydroxy-1-(hydroxymethyl) ethyl ester was identified in the RMs of all the three-orange peels. The RM of Mandarin orange exhibited potent cytotoxic effect against MCF-7 ATCC human breast cancer cells (HBC). All the three RMs exhibited moderate antibacterial activity against the human pathogenic bacteria Staphylococcus aureus (ATCC 25923), Staphylococcus epidermidis (ATCC 12228), Enterococcus faecalis (ATCC 29212), Escherichia coli (ATCC 25922), Klebsiella pneumoniae (ATCC 700603), Salmonella choleraesis (ATCC 10708), Pseudomonas aeruginosa (ATCC 27853), and Proteus mirabilis (ATCC 299).
Collapse
Affiliation(s)
- S S Moni
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Saudi Arabia
| | - S Mohan
- Jazan University, Substance Abuse and Toxicology Research Centre, Jazan, Saudi Arabia.,Saveetha University, Saveetha Institute of Medical and Technical Science, Saveetha Dental College, Department of Pharmacology, Center for Transdisciplinary Research, Chennai, India.,University of Petroleum and Energy Studies, School of Health Sciences, Dehradun, Utta-rakhand, India
| | - H A Makeen
- Jazan University, College of Pharmacy, Pharmacy Practice Research Unit, Jazan, Saudi Arabia
| | - H A Alhazmi
- Jazan University, Substance Abuse and Toxicology Research Centre, Jazan, Saudi Arabia.,Jazan University, College of Pharmacy, Department of Pharmaceutical Chemistry and Pharmacognosy, Jazan, Saudi Arabia
| | - V K Basode
- Jazan University, College of Applied Medical Sciences, Unit of Medical Microbiology, Jazan, Saudi Arabia
| | - Z Rehman
- Jazan University, College of Pharmacy, Department of Pharmaceutical Chemistry and Pharmacognosy, Jazan, Saudi Arabia
| | - M S Alam
- Jazan University, College of Pharmacy, Department of Pharmaceutical Chemistry and Pharmacognosy, Jazan, Saudi Arabia
| | - M F Alam
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Saudi Arabia
| | - T Anwer
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Saudi Arabia
| | - M E Elmobark
- Jazan University, College of Pharmacy, Department of Pharmaceutics, Jazan, Saudi Arabia
| | - A Abdulhaq
- Jazan University, College of Applied Medical Sciences, Unit of Medical Microbiology, Jazan, Saudi Arabia
| | - M U A Alamoudi
- Jazan University, College of Pharmacy, Department of Pharmacology and Toxicology, Jazan, Saudi Arabia
| | - I M H Hadi
- Jazan University, College of Pharmacy, Jazan, Saudi Arabia
| | - S A A Amri
- Jazan University, College of Pharmacy, Jazan, Saudi Arabia
| | - A M A Alrithi
- Jazan University, College of Pharmacy, Jazan, Saudi Arabia
| | - Z A J Jathmi
- Jazan University, College of Pharmacy, Jazan, Saudi Arabia
| | - M A A Kaabi
- Jazan University, College of Pharmacy, Jazan, Saudi Arabia
| |
Collapse
|
18
|
Kurtz RM, Babatunde VD, Schmitt JE, Berger JR, Mohan S. Spinal Cord Sarcoidosis Occurring at Sites of Spondylotic Stenosis, Mimicking Spondylotic Myelopathy: A Case Series and Review of the Literature. AJNR Am J Neuroradiol 2023; 44:105-110. [PMID: 36521966 PMCID: PMC9835907 DOI: 10.3174/ajnr.a7724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease, with intramedullary spinal cord involvement seen in <1% of cases. This case series illustrates the clinical presentations and imaging findings of 5 patients with intramedullary spinal neurosarcoidosis occurring at sites of spondylotic spinal canal stenosis, which can be indistinguishable from spondylotic myelopathy with cord enhancement. Both entities are most common in middle-aged men and present with weeks to months of motor and sensory symptoms. On imaging, both can have focal spinal cord enhancement and longitudinally extensive signal abnormality centered at or just below the level of spinal canal stenosis. On the basis of our experience, we suggest that in patients with cord enhancement centered at or just below a site of spinal canal stenosis, consideration should be given to chest imaging and lymph node biopsy when applicable, to assess for the possibility of underlying sarcoidosis before surgical decompression.
Collapse
Affiliation(s)
- R M Kurtz
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - V D Babatunde
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - J E Schmitt
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - J R Berger
- Neurology (J.R.B.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Mohan
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| |
Collapse
|
19
|
Al Gharaibeh FN, Mohan S, Santoro MA, Slagle CL, Goldstein SL. Acute kidney injury and early fluid load in a retrospective cohort of neonatal sepsis. Pediatr Nephrol 2022; 38:1971-1977. [PMID: 36525082 DOI: 10.1007/s00467-022-05840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sepsis and acute kidney injury (AKI) are associated with mortality in the newborn intensive care unit (NICU). There is a paucity of studies that describe AKI and fluid overload in neonatal sepsis and their association with mortality. METHODS Retrospective study of neonates with culture positive sepsis admitted to the NICU between June 2020 and June 2021 was conducted. Primary outcome was in-hospital mortality according to AKI as defined by the neonatal modified Kidney Diseases Improving Outcomes criteria. Secondary outcomes were early fluid overload and vasopressor use. RESULTS Thirty-three percent of neonates had AKI with sepsis, and 57% of cases were severe AKI. AKI was associated with mortality after adjusting for variables that were different between survivors and non-survivors (aOR 5.7 [95% CI 1.1-36], p = 0.04). Early fluid overload occurred in 27% of neonates who were at higher risk of having AKI with sepsis (OR 7.4 [95% CI 1.6-26.0], p = 0.01) and higher risk of mortality (aOR 17.8 [95% CI 2-7545], p = 0.02). CONCLUSIONS AKI and early fluid overload are associated with mortality in sepsis in our retrospective cohort. Mitigating AKI and early fluid overload in sepsis might be a fruitful strategy in reducing mortality with sepsis. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Faris N Al Gharaibeh
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Shruthi Mohan
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Cara L Slagle
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.,College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Stuart L Goldstein
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.,Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
20
|
Joshna EK, Poorna TA, Bobby J, Mohan S. Embedded Foreign Bodies in the Maxillofacial Region: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:4802-4806. [PMID: 36742923 PMCID: PMC9895343 DOI: 10.1007/s12070-022-03111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/09/2022] [Indexed: 02/07/2023] Open
Abstract
Impacted Foreign Bodies (FB) within the maxillofacial region are often inadequately diagnosed during the initial examination. Proper evaluation and management are mandatory to avoid untoward consequences. We depict a series of five cases with impacted FBs, managed case-specifically, along with an algorithm for dealing FBs in the maxillofacial region.
Collapse
Affiliation(s)
- E. K. Joshna
- Department of Oral and Maxillofacial Surgery, Government Medical College, Kottayam, Kerala India
| | - T. Anish Poorna
- Department of Oral and Maxillofacial Surgery, Government Medical College, Kottayam, Kerala India
| | - John Bobby
- Department of Oral and Maxillofacial Surgery, Government Medical College, Kottayam, Kerala India
| | - S. Mohan
- Department of Oral and Maxillofacial Surgery, Government Medical College, Kottayam, Kerala India
| |
Collapse
|
21
|
Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
Collapse
Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Lynch CP, Cha EDK, Jenkins NW, Parrish JM, Nolte MT, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Influence of Preoperative Depressive Burden on Achieving a Minimal Clinically Important Difference Following Lumbar Decompression. Clin Spine Surg 2022; 35:E693-E697. [PMID: 35509017 DOI: 10.1097/bsd.0000000000001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE This study evaluates the association of preoperative mental health with the rate of achieving minimal clinically important difference (MCID) in patient-reported outcomes following lumbar decompression (LD). SUMMARY OF BACKGROUND DATA Research is scarce regarding the influence of preoperative depression on the rate of achieving MCID for mental health, physical function, and pain among LD patients. METHODS A surgical registry was retrospectively reviewed for primary LD surgeries. Patients were grouped by depressive symptom severity according to the preoperative Patient Health Questionnaire 9 score. The association of Patient Health Questionnaire 9 subgroups with demographic and surgical variables was analyzed, and differences among subgroups were assessed. Achievement rates of MCID for physical function, pain, disability, and mental health were compared among groups at each time point using previously established MCID thresholds. RESULTS Of the 321 subjects, 69.8% were male, and 170 subjects had minimal preoperative depressive symptoms, 86 had moderate, and 65 had severe. Patients in moderate and severe groups demonstrated a significantly greater rate of MCID achievement for disability at 6 weeks and 3 months postoperatively. The severe group demonstrated a significantly higher rate of achieving MCID for mental health at the 1-year time point. CONCLUSIONS Patients with any range of preoperative depressive symptom severity had a similar rate of achieving MCID for pain and physical function throughout 1 year following LD. The severe depressive symptom group had a higher rate of MCID achievement with disability at 6 weeks and with mental health at 1 year. This study demonstrates that patients with any preoperative depressive symptom severity have an indistinguishable ability to attain MCID by 1 year following LD. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Geoghegan CE, Jadczak CN, Jacob KC, Patel MR, Cha EDK, Lynch CP, Mohan S, Singh K. History of Prior Lumbar Surgery Does Not Impact Mental Health Outcomes Following Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2022; 35:E737-E742. [PMID: 35696709 DOI: 10.1097/bsd.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to evaluate the impact of undergoing a prior lumbar procedure on mental health outcomes following anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA Revision and reoperations are perceived as risk factors for worse mental health outcomes. METHODS A retrospective review of a surgical database was performed for cervical and lumbar procedures. The mental health measures used were: Short Form 12-Item Mental Composite Score (SF-12 MCS) and Patient Health Questionnaire 9 (PHQ-9). Secondary outcomes of interest were Visual Analogue Scale for neck and arm pain, Neck Disability Index, and Short Form 12-Item Physical Composite Score (SF-12 PCS). All outcomes were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Minimum clinically important difference (MCID) was calculated using established values. Patients were grouped based on the surgical history of an elective lumbar spine procedure and propensity-matched. Differences in postoperative outcome scores and MCID achievement were evaluated using linear and logistic regression respectively. RESULTS A total of 74 patients were included in this study. Mental health outcomes did not demonstrate significant differences between groups for SF-12 MCS and PHQ-9 for all time points except at 6 weeks for PHQ-9 ( P =0.038). MCID achievement was not significantly impacted by surgical history for all outcome measures at all postoperative time points (all P >0.050). The majority of patients achieved an MCID by the 1-year time point for all outcomes for patients without a prior lumbar surgery except for Visual Analogue Scale arm and SF-12 PCS, while those with a surgical history achieved an MCID for all outcomes except SF-12 PCS and PHQ-9. CONCLUSIONS Anterior cervical discectomy and fusion patients with a past history of lumbar surgery demonstrated significant improvements in depression, neck and arm pain, disability, and physical function as those without a past lumbar surgical history. Prior surgery also did not impact MCID achievement for all outcomes.
Collapse
Affiliation(s)
- Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Raghunatha P, Inamdar MN, Asdaq SMB, Almuqbil M, Alzahrani AR, Alaqel SI, Kamal M, Alsubaie FH, Alsanie WF, Alamri AS, Rabbani SI, Attimarad M, Mohan S, Alhomrani M. New Thiazole Acetic Acid Derivatives: A Study to Screen Cardiovascular Activity Using Isolated Rat Hearts and Blood Vessels. Molecules 2022; 27:molecules27196138. [PMID: 36234675 PMCID: PMC9572953 DOI: 10.3390/molecules27196138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular diseases are one of the major causes of mortalities worldwide. In the present research, new synthetic derivatives of thiazole were studied using isolated hearts and blood vessels of rats. The heart and thoracic aorta were tested with six new synthesized thiazole acetic acid derivatives (SMVA-10, SMVA-35, SMVA-40, SMVA-41, SMVA-42 and SMVA-60), and the data obtained were statistically analyzed and compared. Isolated rat hearts were used to record the changes in developed tension and heart rate, while thoracic aortas were used to measure the contractile response, before and after treatments. Analysis of the results indicated a significant (p < 0.01) increase in developed tension with the addition of SMVA-35, SMVA-40, SMVA-41 and SMVA-42, which was augmented in the presence of adrenaline without affecting the heart rate. On the other hand, acetylcholine significantly decreased the developed tension, which was significantly reversed (p < 0.01) in the presence of compounds (SMVA-35 and SMVA-60). However, in the presence of SMVA-35 and SMVA-40, acetylcholine-induced bradycardia was significantly (p < 0.01) reduced. Furthermore, only SMVA-42 induced a dose-dependent contractile response in the isolated blood vessel, which was abolished in the presence of prazosin. Therefore, it can be concluded that some of the new synthesized thiazole derivatives exhibited promising results by raising the developed tension without changing the heart rate or blood vessel function, which could be helpful in failing heart conditions. However, more research is required to fully comprehend the function, mechanism and effectiveness of the compounds.
Collapse
Affiliation(s)
- P. Raghunatha
- Department of Pharmacology, Al-Ameen College of Pharmacy, Bangalore 560027, India
| | - Mohammed Naseeruddin Inamdar
- Department of Pharmacology, Al-Ameen College of Pharmacy, Bangalore 560027, India
- Department of Pharmacology, East West College of Pharmacy, Bangalore 560091, India
| | - Syed Mohammed Basheeruddin Asdaq
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, Riyadh 13713, Saudi Arabia
- Correspondence: or
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah R. Alzahrani
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Al-Abidiyah, P.O. Box 13578, Makkah 21955, Saudi Arabia
| | - Saleh I. Alaqel
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Mehnaz Kamal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Firas Hamdan Alsubaie
- Medical Sale Representative, Jamjoom Pharmaceutical Company, Riyadh 12211, Saudi Arabia
| | - Walaa F. Alsanie
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif 21944, Saudi Arabia
| | - Abdulhakeem S. Alamri
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif 21944, Saudi Arabia
| | - Syed Imam Rabbani
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Mahesh Attimarad
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - S. Mohan
- Faculty of Pharmaceutical Sciences, PES University, Bengaluru 560085, India
| | - Majid Alhomrani
- Department of Clinical Laboratory Sciences, The Faculty of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
- Centre of Biomedical Sciences Research (CBSR), Deanship of Scientific Research, Taif University, Taif 21944, Saudi Arabia
| |
Collapse
|
25
|
Riggs ER, Bingaman TI, Barry CA, Behlmann A, Bluske K, Bostwick B, Bright A, Chen CA, Clause AR, Dharmadhikari AV, Ganapathi M, Gonzaga-Jauregui C, Grant AR, Hughes MY, Kim SR, Krause A, Liao J, Lumaka A, Mah M, Maloney CM, Mohan S, Osei-Owusu IA, Reble E, Rennie O, Savatt JM, Shimelis H, Siegert RK, Sneddon TP, Thaxton C, Toner KA, Tran KT, Webb R, Wilcox EH, Yin J, Zhuo X, Znidarsic M, Martin CL, Betancur C, Vorstman JAS, Miller DT, Schaaf CP. Clinical validity assessment of genes frequently tested on intellectual disability/autism sequencing panels. Genet Med 2022; 24:1899-1908. [PMID: 35616647 PMCID: PMC10200330 DOI: 10.1016/j.gim.2022.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/07/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Neurodevelopmental disorders (NDDs), such as intellectual disability (ID) and autism spectrum disorder (ASD), exhibit genetic and phenotypic heterogeneity, making them difficult to differentiate without a molecular diagnosis. The Clinical Genome Resource Intellectual Disability/Autism Gene Curation Expert Panel (GCEP) uses systematic curation to distinguish ID/ASD genes that are appropriate for clinical testing (ie, with substantial evidence supporting their relationship to disease) from those that are not. METHODS Using the Clinical Genome Resource gene-disease validity curation framework, the ID/Autism GCEP classified genes frequently included on clinical ID/ASD testing panels as Definitive, Strong, Moderate, Limited, Disputed, Refuted, or No Known Disease Relationship. RESULTS As of September 2021, 156 gene-disease pairs have been evaluated. Although most (75%) were determined to have definitive roles in NDDs, 22 (14%) genes evaluated had either Limited or Disputed evidence. Such genes are currently not recommended for use in clinical testing owing to the limited ability to assess the effect of identified variants. CONCLUSION Our understanding of gene-disease relationships evolves over time; new relationships are discovered and previously-held conclusions may be questioned. Without periodic re-examination, inaccurate gene-disease claims may be perpetuated. The ID/Autism GCEP will continue to evaluate these claims to improve diagnosis and clinical care for NDDs.
Collapse
Affiliation(s)
| | | | | | | | | | - Bret Bostwick
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | | | - Chun-An Chen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | | | - Avinash V Dharmadhikari
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Mythily Ganapathi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Claudia Gonzaga-Jauregui
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, Mexico
| | - Andrew R Grant
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA; New York Medical College, Valhalla, NY
| | | | - Se Rin Kim
- National Human Genome Research Institute, Bethesda, MD
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jun Liao
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Aimé Lumaka
- Laboratoire de Génétique Humaine, University of Liège, Liège, Belgium
| | - Michelle Mah
- Trillium Health Partners, Mississauga, Ontario, Canada
| | | | | | - Ikeoluwa A Osei-Owusu
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Emma Reble
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Olivia Rennie
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juliann M Savatt
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA
| | - Hermela Shimelis
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA
| | - Rebecca K Siegert
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Tam P Sneddon
- Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina, Chapel Hill, NC
| | - Courtney Thaxton
- Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina, Chapel Hill, NC
| | - Kelly A Toner
- Drexel University College of Medicine, Philadelphia, PA
| | - Kien Trung Tran
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Ryan Webb
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Emma H Wilcox
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jiani Yin
- Department of Neurology, University of California Los Angeles, Los Angeles, CA
| | - Xinming Zhuo
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Masa Znidarsic
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Catalina Betancur
- Sorbonne Université, INSERM, CNRS, Neuroscience Paris Seine, Institut de Biologie Paris Seine, Paris, France
| | - Jacob A S Vorstman
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David T Miller
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA
| | - Christian P Schaaf
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
26
|
Lynch CP, Cha ED, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Neurospine 2022; 19:533-543. [PMID: 34990539 PMCID: PMC9537840 DOI: 10.14245/ns.2142088.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The American Society of Anesthesiologists (ASA) physical status classification has been used to risk stratify surgical candidates. Our study compares outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures based on preoperative ASA physical status classification. METHODS A surgical registry was reviewed for primary, single-level MIS TLIF patients. Patients were categorized by preoperative ASA physical status classification: ASA I, ASA II, ASA III+. Perioperative complications were compared among groups. Patient-reported outcome measures (PROMs) for back pain, leg pain, physical function, and disability were recorded preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. PROM improvement from baseline (ΔPROM) and minimum clinically important difference (MCID) achievement was calculated for each timepoint and compared among groups. MCID achievement was determined as ΔPROMs that surpassed previously established MCID values. RESULTS Of the 487 patients, 64 had an ASA classification of I, whereas 336 had an ASA of II, and 87 had an ASA of III or greater. Rates of complications were not associated with ASA classification (all p > 0.050). Neither mean PROM scores nor ΔPROM scores were significantly associated with ASA classification at any timepoint (all p > 0.050). MCID achievement was significantly associated with ASA classification for back pain at 1 year only (p = 0.041). Overall MCID achievement was not significantly associated with ASA classification for any PROM (p > 0.050). CONCLUSION While ASA classification has been commonly used to risk stratify surgical candidates for spinal procedures, patients with an ASA of III or greater may be able to achieve similar long-term outcomes following MIS TLIF given proper selection criteria.
Collapse
Affiliation(s)
- Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D.K. Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N. Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,Corresponding Author Kern Singh Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
| |
Collapse
|
27
|
Lynch CP, Cha ED, Patel MR, Jacob KC, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Predicting Acute Changes in Depressive Symptoms Following Lumbar Decompression. Int J Spine Surg 2022; 16:953-959. [PMID: 35908806 PMCID: PMC9807053 DOI: 10.14444/8332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND While depressive symptoms improve for most patients following minimally invasive lumbar decompression (MIS LD), for some, symptoms may worsen. This study aimed to investigate predictors of change in depressive symptoms in the short-term postoperative period following MIS LD. METHODS We retrospectively analyzed a prospective surgical database for patients undergoing primary MIS LD procedures from 2016 to 2020. Preoperative pain (visual analog scale back and leg) scores were recorded, and the 9-Item Patient Health Questionnaire (PHQ-9) was administered at the preoperative and postoperative (6 weeks, 12 weeks, 6 months, and 1 year) timepoints. Patients were grouped into 1 of 3 categories of depression severity based on preoperative PHQ-9 scores: minimal (0-4), mild (5-9), and moderate to severe (10-27). Postoperative change in depressive symptoms was calculated by determining differences from baseline scores to scores at 6 weeks, 12 weeks, and 6 months. Analysis of demographics, perioperative characteristics, and spinal pathologies was conducted using χ 2 test. Significant factors contributing to postoperative changes in depression were analyzed using multiple linear regression analysis. Significance was set at P = 0.05. RESULTS The 216 patients included had a mean age of 48 years, and a majority were men (70.4%). Most patients had a preoperative diagnosis of spinal stenosis (90.3%) or herniated nucleus pulposus (69.9%). Univariate analysis identified age, ethnicity, insurance, and diabetes as significant variables among depression severity groups. Patients demonstrated significant improvements in depressive symptoms at all postoperative timepoints (P < 0.001). Multivariate analysis identified several significant predictors of postoperative change in PHQ-9, which included moderate to severe preoperative depression for all postoperative timepoints (all P ≤ 0.038), mild preoperative depression for 6 weeks and 12 weeks (both P ≤ 0.029), and private insurance (P = 0.002) and smoking status (P = 0.047) at 12 weeks. CONCLUSION Depression improved at all postoperative timepoints following LD. Insurance type, smoking status, and preoperative depression severity were all identified as significant predictors of postoperative changes in depressive symptoms. CLINICAL RELEVANCE This study explores predictors of changes in depressive symptoms following LD. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Conor P. Lynch
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Elliot D.K. Cha
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Madhav R. Patel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Kevin C. Jacob
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Shruthi Mohan
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Cara E. Geoghegan
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Caroline N. Jadczak
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Kern Singh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite #300 Chicago, IL 60612, USA Phone: 312-432-2373 Fax: 708-409-5179;
| |
Collapse
|
28
|
Sullivan TB, Lynch CP, Cha ED, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Impact of Lower Extremity Arthroplasty on Improvement of Quality-of-Life Outcomes Following Lumbar Fusion. Int J Spine Surg 2022; 16:1016-1022. [PMID: 35908807 PMCID: PMC9807040 DOI: 10.14444/8335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Both hip-spine and knee-spine syndromes can significantly impact a patient's quality of life; however, few studies have investigated their effect on postoperative outcomes following lumbar fusion. OBJECTIVE Our study aimed to evaluate the impact of a prior lower extremity arthroplasty on the improvement of patient-reported outcome measures (PROMs) following lumbar fusion surgery. METHODS Patients undergoing primary, single, or multilevel lumbar interbody fusion were retrospectively reviewed. Patients missing preoperative PROMs were excluded. PROMs were collected preoperatively and postoperatively and included the Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary, Patient-Reported Outcomes Measurement Information System Physical Function, and visual analog scale (VAS). A minimum clinically important difference (MCID) was calculated. Patients were categorized based on a history of hip/knee arthroplasty and propensity score matched. Intragroup improvement of PROM scores and intergroup differences in mean scores were evaluated using a paired t test and linear regression. MCID achievement differences were evaluated using logistic regression. RESULTS A total of 335 patients were included, with 25 having a history of hip/knee arthroplasty. Arthroplasty patients were significantly older (P = 0.001) and typically had a higher Charlson Comorbidity Index (P ≤ 0.003, both). Patients differed in spinal pathology of degenerative spondylolisthesis (P = 0.049). Nonarthroplasty patients demonstrated significant improvements in all PROMs by 2 years (P < 0.001, all). The arthroplasty group demonstrated significant improvements in all PROMs by 1 year (P < 0.031, all). Preoperative VAS back was significantly worse for nonarthroplasty patients (P = 0.035). MCID achievement did not significantly differ between groups except at 6 months for ODI (P = 0.035). CONCLUSION Following lumbar fusion, patients with a past surgical history did not demonstrate differences in outcome measures or MCID from those without. These results suggest that comorbid orthopedic conditions requiring surgery do not negatively impact the ability of patients to improve following lumbar fusion. CLINICAL RELEVANCE Prior surgical history of lower extremity arthroplasty should not discourage the use of lumbar fusion when properly indicated, as patients reported clinical improvement regardless of history of hip or knee arthroplasty. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- T. Barrett Sullivan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D.K. Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N. Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite #300, Chicago, IL 60612, USA;
| |
Collapse
|
29
|
Lynch CP, Cha ED, Patel MR, Jacob KC, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Anterior Cervical Discectomy and Fusion Results in Clinically Significant Improvements in Patients With Preoperative Sleep Difficulties. Int J Spine Surg 2022; 16:1046-1053. [PMID: 35835574 PMCID: PMC9807043 DOI: 10.14444/8333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). METHODS A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. MCID achievement was determined by comparing postoperative PROM improvement from baseline to previously established values. Logistic regression assessed responses to each individual question of the preoperative PHQ-9 as predictors of MCID achievement in each other PROMs. RESULTS Sixty-six ACDF patients were included with a mean age of 47.2 years. Herniated nucleus pulposus was the most common preoperative spinal diagnosis (95.6%). The mean operative duration was 50.3 minutes, the mean estimated blood loss was 27.5 mL, and most patients were discharged on postoperative day 0 (81.8%). A majority of patients achieved MCID for all measures except SF-12 PCS. PHQ-9 question 3 significantly predicted MCID achievement for VAS neck (P = 0.045), VAS arm (P = 0.049), and SF-12 PCS (P = 0.037). No other PHQ-9 items or overall PHQ-9 scores significantly predicted MCID achievement. CONCLUSION Question 3 of the PHQ-9 regarding "trouble falling asleep, staying asleep, or sleeping too much" significantly predicted clinically meaningful improvement in neck pain, arm pain, and physical function following ACDF, although overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery. CLINICAL RELEVANCE Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D.K. Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N. Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA, Kern Singh, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Suite #300, Chicago, IL 60612, USA;
| |
Collapse
|
30
|
Nolte MT, Parrish JM, Jenkins NW, Cha EDK, Lynch CP, Jadczak CN, Mohan S, Geoghegan CE, Hrynewycz NM, Singh K. Validation of Veterans RAND 12-Item Physical Function Survey in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Int J Spine Surg 2022; 16:8308. [PMID: 35728833 PMCID: PMC9421278 DOI: 10.14444/8308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Veterans RAND 12-item (VR-12) physical component score (PCS) has been validated in both veteran and US citizen populations; however, its use for spine surgery populations has not been evaluated. This study aims to correlate the VR-12 PCS survey with legacy patient-reported outcome measures (PROMs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS A prospective surgical database was retrospectively assessed for MIS TLIFs performed at 1 level from March 2015 to June 2019. Inclusion criteria were elective procedures for degenerative spinal pathology. Patients were excluded if they had surgery for metastatic, traumatic, or infectious etiologies or had incomplete preoperative 12-item Short Form (SF-12) PCS or Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) survey. Additionally, patients with any incomplete VR-12 PCS surveys through 1 year were excluded. Demographics and perioperative characteristics were recorded. Mean postoperative PROM scores and score difference from preoperative baseline were calculated at each postoperative timepoint through 1 year. The relationship of VR-12-PCS with SF-12-PCS and PROMIS PF was evaluated with a Pearson's correlation coefficient and time-independent partial correlation. RESULTS A total of 59 patients underwent single-level MIS TLIFs. The cohort was 44.1% women with an average age of 53.8 years, and 52.5% were obese (body mass index ≥30 kg/m2). The VR-12 PCS, SF-12 PCS, and PROMIS PF surveys had significant improvements from baseline to the 6 month through 1 year postoperative timepoints (P ≤ 0.001, all). All timepoints revealed strong VR-12-PCS correlations with SF-12-PCS and PROMIS PF (all P ≤ 0.001). CONCLUSION VR-12 PCS, SF-12 PCS, and PROMIS PF scores all indicate statistically significant improvements in physical function for patients following MIS TLIF. VR-12 PCS was strongly correlated with the historically validated SF-12 PCS system as well as with the more recent PROMIS PF survey. Our observations give weight to utilizing the VR-12 PCS survey as a valid measure of physical function among patients undergoing MIS TLIF. CLINICAL RELEVANCE This study validates VR-12 PCS to measure physical function for TLIF patients. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
31
|
Matza M, Dagincourt N, Mohan S, Pavlov A, Han J, Stone JH, Unizony S. POS0267 OUTCOMES DURING AND AFTER LONG-TERM TOCILIZUMAB TREATMENT IN PATIENTS WITH GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on the long-term efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA), including incidence and timing of disease relapse after TCZ discontinuation, is limited.ObjectivesWe aimed to evaluate the long-term outcomes of GCA patients treated with TCZ in a real-world setting.MethodsRetrospective analysis of GCA patients treated with TCZ for >9 months at a single center between 2010-2021. Time to relapse and annualized relapse rate during and after TCZ treatment, prednisone use and safety were assessed. Relapse was defined as the re-appearance of clinical manifestations of GCA that required treatment intensification regardless of the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. The duration of TCZ treatment was determined as per the best clinical judgement of the treating rheumatologist.ResultsA total of 57 GCA patients were followed for a mean (SD) period of 3.4 (1.7) years. Baseline characteristics and treatments received are shown in Table 1. Patients were maintained on their initial TCZ course for a mean (SD) period of 2.0 (1.3) years. The initial TCZ course lasted >12 months in 50 (88%) patients. During the initial TCZ course, 8 (14.0%) patients relapsed. Kaplan-Meier (KM) estimated relapse rates on TCZ were 10.5% and 14.9% at 12 and 18 months, respectively (Figure 1A). TCZ was discontinued due to long-term remission in 37 (64.9%) patients and after an adverse event in 6 (10.5%) patients. Of the 43 patients stopping TCZ due to remission or adverse event, 19 (44.2%) subsequently relapsed. KM estimated relapse rates after TCZ discontinuation were 30.4% and 44.0% at 12 and 18 months, respectively (Figure 1B). Overall, 12 patients received more than one TCZ course. The aggregation of all TCZ courses (mean 2.5 years) and all periods off TCZ following the initial TCZ treatment (mean 0.9 years) showed that 11 (19.3%) patients relapsed while on TCZ and 20 (35.1%) patients relapsed during time off TCZ. An analysis adjusting for age, sex, prednisone dose at initiation of first TCZ course, and disease type (new onset vs. relapsing) at initiation of first TCZ course showed an annualized relapse rate (95% CI) of 0.1 (0.0-0.2) during TCZ treatment and 0.4 (0.3-0.7) off TCZ (rate ratio 0.2, p<0.0001). By the end of follow up, 42 (73.7%) patients were able to wean off prednisone. During the study, 12 serious adverse events occurred in 11 (19.3%) patients. Among those 12 events, 3 (25%) were related or possibly related to TCZ exclusively (i.e., soft tissue infection, bacteremia, and COVID-19), 3 (25%) to prednisone exclusively (i.e., osteoporotic fracture, diabetic ketoacidosis and stroke), and 2 (16.7%) to either TCZ or prednisone (i.e., pneumonia and sepsis).Table 1.Baseline characteristics and treatmentsGCA patients(n = 57)Age, mean (SD)70.1 (9.3)Female sex39 (68.4)New onset disease at TCZ initiation18 (31.6)Initial TCZ treatment 4 mg/Kg intravenously monthly2 (3.5) 8 mg/Kg intravenously monthly13 (22.8) 162 mg subcutaneously every 2 weeks6 (10.5) 162 mg subcutaneously weekly36 (63.2)On prednisone at TCZ initiation57 (100)Prednisone dose (mg) at TCZ initiation, mean (SD)32.3 (21.7)Patients receiving >1 TCZ course12 (21.1)Duration of initial TCZ course (years), mean (SD)2.0 (1.3)Total duration of TCZ treatment (years), mean (SD)2.5 (1.6)*Values represent number and (%) unless otherwise specified. *Aggregated time on tocilizumab (TCZ)for those patients that received more than 1 TCZ course. GCA, giant cell arteritis; SD, standard deviation.ConclusionLong-term TCZ treatment was efficacious in maintaining disease remission and sparing the use of prednisone in patients with GCA. Over 40% of patients stopping TCZ after long-term remission or adverse event relapsed following TCZ discontinuation.AcknowledgementsThis study was sponsored by Genentech, Inc.Disclosure of InterestsMark Matza: None declared, Nicholas Dagincourt Employee of: Working for Genentech, Inc., as employees of Everest Clinical Research, Shalini Mohan Shareholder of: Genentech, Inc., Employee of: Genentech, Inc., Andrey Pavlov Employee of: Working for Genentech, Inc. as an employee of Everest Clinical Research, Jian Han Shareholder of: Genentech, Inc., Employee of: Genentech, Inc., John H. Stone Consultant of: Roche, Grant/research support from: Roche, Sebastian Unizony Grant/research support from: Research funding from Genentech, Inc.
Collapse
|
32
|
Sangeetha J, Mohan S, Hariharasudan A, Nawaz N. Strategic analysis of intimate partner violence (IPV) and cycle of violence in the autobiographical text - When I Hit You. Heliyon 2022; 8:e09734. [PMID: 35761928 PMCID: PMC9233205 DOI: 10.1016/j.heliyon.2022.e09734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/03/2021] [Accepted: 06/10/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives Intimate Partner Violence (IPV) is a globally recognized societal problem that requires intensive research to raise public awareness. Aim Accordingly, the purpose of the study is to analyze IPV at the physical, psychological, and social aspects of abuse. Method The methodology of the study correlates IPV to the personal experiences of notable Indian writer, Meena Kandasamy, according to the autobiographical account of her abusive married life in the award-winning novel When I Hit You, which depicts the horrible treatment of women by their perpetrators within a closed sphere. To substantiate, the selected autobiographical work is compared with Lenore Edna Walker’s prominent Cycle of Violence theory, which best describes why women become victims and also the abuser’s tactics in controlling the women in a violent relationship. Results The study’s findings suggest that IPV, a serious global problem, requires government intervention and severe legal enforcement to protect women’s lives from the clutches of the abuser.
Collapse
Affiliation(s)
- J. Sangeetha
- Research Scholar, Kalasalingam Academy of Research and Education, Anand Nagar, Krishnankoil, 626126, Tamil Nadu, India
| | - S. Mohan
- Faculty of English, Kalasalingam Academy of Research and Education, Anand Nagar, Krishnankoil, 626126, Tamil Nadu, India
| | - A. Hariharasudan
- Faculty of English, Kalasalingam Academy of Research and Education, Anand Nagar, Krishnankoil, 626126, Tamil Nadu, India
- Corresponding author.
| | - Nishad Nawaz
- Department of Business Management, College of Business Administration, Kingdom University, Riffa, 40434, Bahrain
| |
Collapse
|
33
|
Lynch CP, Cha ED, Jacob KC, Patel MR, Jenkins NW, Parrish JM, Jadczak CN, Mohan S, Geoghegan CE, Singh K. The Worldwide Influence of Social Media on Cervical Spine Literature. Int J Spine Surg 2022; 16:264-271. [PMID: 35444034 PMCID: PMC9930660 DOI: 10.14444/8213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Altmetric (Digital Science, Holtzbrinck Publishing) Attention Score (AAS) is an automatically calculated score that accounts for other literary influences, which include academic sources as well as nonacademically focused social media outlets such as Twitter, Facebook, and news articles. This study compares the most popular cervical surgery articles on social media to the most cited articles within peer-reviewed literature and identifies journals that contribute the most articles and geographic trends. METHODS We searched the Altmetric database for cervical spine surgery articles since inception using the search phrase "cervical" and "spine." We ranked journals that contributed the most articles and calculated their AAS, contributing social media outlets (eg, Twitter, Facebook, News, etc) and citation counts. We also ranked the top 100 most popular cervical spine articles on social media and compared them to the most cited articles. Countries were assessed based on their mentions through the most contributing social media platform. RESULTS Of the 527 total journals identified in our search, the top 10 journals were responsible for contributing 60.2% of the total articles. The 3 journals that contributed the most articles were Spine (18.9%), European Spine Journal (11.8%), and The Spine Journal (10.3%). The journals with the highest AAS scores included Journal of Neurosurgery: Spine (11.3), Spine (8.8), and Journal of Manipulative & Physiological Therapeutics (5.8). Social media outlets that contributed the most mentions per article were Twitter (4.4), Facebook (0.5), and news sources (0.3). Among all countries contributing Twitter mentions, the 3 countries with the most cervical spine posts included the United States (23.3%), the United Kingdom (10.3%), and Spain (5.5%). CONCLUSION Our evaluation of cervical spine literature revealed Twitter, Facebook, and news sources are the most common social media outlets influencing title dissemination. Journals contributing the most articles did not necessarily have the highest average AAS. CLINICAL RELEVANCE Spinal surgeons should consider utilization of social media outlets, such as Twitter, Facebook, and news sources, to potentially increase the dissemination of their articles. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Conor P. Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D.K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R. Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nathaniel W. Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James M. Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N. Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E. Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
34
|
Cha EDK, Lynch CP, Hrynewycz NM, Geoghegan CE, Mohan S, Jadczak CN, Parrish JM, Jenkins NW, Singh K. Spine Surgery Complications in the Ambulatory Surgical Center Setting: Systematic Review. Clin Spine Surg 2022; 35:118-126. [PMID: 34183543 DOI: 10.1097/bsd.0000000000001225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/23/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a systematic review study. PURPOSE This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC). BACKGROUND Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates. METHODS This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). The primary outcome was the frequency of complications with respect to various categories. RESULTS Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092). CONCLUSIONS After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Pinsino A, Braghieri L, Nguonly A, Carey M, Mohan S, Kim A, Mondellini G, Jennings D, Naka Y, Takeda K, Faillace R, Sayer G, Uriel N, Colombo P, Yuzefpolskaya M. Cystatin C- versus Creatinine-Based Assessment of Kidney Function in Advanced Heart Failure: Insights from REVIVAL. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.142] [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] Open
|
36
|
Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
Collapse
Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Cha EDK, Lynch CP, Jacob KC, Patel MR, Parrish JM, Jenkins NW, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Workers' Compensation Association With Clinical Outcomes After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2022; 90:322-328. [PMID: 35006206 DOI: 10.1227/neu.0000000000001820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research has suggested that workers' compensation (WC) status can result in poor outcomes after anterior cervical diskectomy and fusion (ACDF). OBJECTIVE To determine the influence WC status has on postoperative clinical outcomes after ACDF. METHODS A surgical database was reviewed for patients undergoing primary or revision single-level ACDF. Patients were grouped into WC vs Non-WC, and differences in baseline characteristics were assessed. Postoperative improvement was assessed for differences in mean scores between WC subgroups for visual analog scale (VAS) arm, VAS neck, 12-item Short Form Physical Composite Score, Patient-Reported Outcomes Measurement Information System physical function (PF), and Neck Disability Index (NDI) at preoperative and postoperative time points. Minimum clinically important difference (MCID) achievement was compared between groups. RESULTS The patient cohort included 44 with WC and 95 without. The cohort was 40% female with an average age of 48 years and mean body mass index of 30. Mean VAS arm, VAS neck, NDI, 12-item Short-Form Physical Composite Score, and Patient-Reported Outcomes Measurement Information System PF scores differed between groups; however, the difference was not sustained at the 1-yr time point. MCID achievement among WC subgroups was different for VAS arm (6 wk through 6 mo, P = .005), VAS neck (3 and 6 mo, P < .01), and NDI (3 and 6 mo, P < .05). No statistically significant difference was noted between cohorts for overall rates of MCID achievement for all patient-reported outcome measures collected. CONCLUSION WC patients reported similar preoperative and 1-yr postoperative neck and arm pain compared with non-WC patients after ACDF. One-yr MCID achievement rates were similar between cohorts for disability and PF scores.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Cha EDK, Lynch CP, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression. Int J Spine Surg 2022; 16:51-61. [PMID: 35177523 DOI: 10.14444/8176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinically important postoperative changes can be best evaluated through the minimal clinically important difference (MCID). Our study aims to evaluate risk factors associated with failure to achieve MCID following lumbar decompression (LD). METHODS Demographics, perioperative characteristics, and patient-reported outcome measures (PROM) for pain, disability, and physical function were retrospectively reviewed and collected for patients undergoing LD. MCID achievement was calculated using established values. Relative risk of demographic and perioperative characteristics with failure to meet MCID for all PROMs was calculated. Least absolute shrinkage and selection operator (LASSO) was used to estimate individual risk factors, and postestimation logistic regression was performed. RESULTS The study cohort included 811 patients. Comorbidity burden was associated with failed MCID for visual analog scale (VAS) back and leg pain and Oswestry Disability Index (ODI). Operative levels or duration was associated with failed MCID for VAS leg pain, 12-item short form physical component summary (SF-12 PCS), and the patient-reported outcomes measurement information system physical function (PROMIS PF). Preoperative spinal pathology was associated with failed MCID for VAS leg pain, ODI, SF-12 PCS, and PROMIS PF. Additional risk factors included the type of operation, insurance, age, and body mass index. LASSO selected insurance, age, comorbidity burden, blood loss, operative duration, and type of spinal pathology as significant risk factors for failure to reach MCID. CONCLUSION Failure to reach MCID was greatest for VAS back. Age, comorbidity burden, and prolonged procedures were significantly associated with risk for failure to reach MCID for a majority of PROMs. Comorbidity burden combined with operative outcomes may place patients at increased risk for failure to reach MCID for pain, disability, and physical function following LD. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Establishes risk factors for failing to reach the threshold of meaningful difference in symptoms after LD surgery.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
39
|
Cha ED, Lynch CP, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Impact of Depression Severity on Patient-Reported Outcome Measures Following Multilevel Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2022; 16:81-87. [DOI: 10.14444/8180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Cha EDK, Lynch CP, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Differences in Clinically Important Physical Function Improvement in Workers' Compensation Population. Int J Spine Surg 2022; 16:176-185. [PMID: 35177529 DOI: 10.14444/8186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients receiving workers' compensation demonstrate a propensity for poorer postoperative outcomes. This study aims to determine rates of minimum clinically important difference (MCID) achievement in patients receiving workers' compensation following transforaminal lumbar interbody fusion (TLIF). METHODS We retrospectively reviewed a prospective surgical database from 2015 to 2020 for primary, single-level TLIFs with posterior instrumentation for degenerative spinal pathologies. Visual analog scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were collected pre- and postoperatively. Patients were separated by workers' compensation (WC) status. Propensity score matching was performed to account for differences in demographic characteristics. Postoperative improvements in patient-reported outcome measures (PROMs) were calculated using paired Student's t test, and intergroup differences were determined by Mann-Whitney U test. Achievement of MCID was determined using established values, and intergroup differences were assessed using χ 2 analysis. RESULTS A total of 121 patients were included in this study with 29 WC and 92 non-WC patients. The mean age was 53.5 years with the majority being men (63.6%) and nonobese (54.5%). WC patients demonstrated significantly poorer PROM values at all timepoints except for preoperative VAS back (P = 0.297) and leg (P = 0.475). Overall achievement of MCID was significantly lower for WC patients for VAS back (P = 0.040), ODI (P = 0.001), SF-12 PCS (P = 0.010), and PROMIS-PF (P = 0.039). CONCLUSION WC patients demonstrated poorer postoperative outcomes at multiple timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed for WC patients. CLINICAL RELEVANCE These results suggest that WC patients may require alternative preoperative counseling about realistic expectations for improvement following lumbar fusion. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
41
|
Parrish JM, Jenkins NW, Cha EDK, Lynch CP, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression. Int J Spine Surg 2022; 16:159-167. [PMID: 35314511 PMCID: PMC9519078 DOI: 10.14444/8184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD. METHODS A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back. RESULTS The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 <5), 94 had moderate (5≤ PHQ-9 ≤10), and 71 had severe (PHQ-9 >10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year. CONCLUSION Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models. CLINICAL RELEVANCE Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.
Collapse
Affiliation(s)
- James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| |
Collapse
|
42
|
Cha EDK, Lynch CP, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Impact of Obesity Severity on Achieving a Minimum Clinically Important Difference Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. Clin Spine Surg 2022; 35:E267-E273. [PMID: 34050042 DOI: 10.1097/bsd.0000000000001205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to determine the impact of obesity on postoperative outcomes and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA Obesity is a proven risk factor for poorer outcomes in MIS TLIF patients. However, few studies have investigated the impact of body mass index (BMI) on achievement of a MCID for Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). METHODS A prospective surgical database was retrospectively reviewed for primary, elective, single level MIS TLIF patients. Patients were categorized into BMI groups: nonobese (<30 kg/m2); obese I (≥30 and <35 kg/m2); severe (≥35 and <40 kg/m2); and morbid (≥40 kg/m2). Demographic, perioperative information, and complication rates were compared between groups. Visual Analog Scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-Item Short Form-12 Physical Composite Score (SF-12 PCS), and PROMIS PF were collected preoperatively and up to 2-year postoperatively. Impact of BMI on outcome measures and MCID achievement at all timepoints was evaluated. RESULTS A total of 162 patients were included with 88 patients categorized as normal weight, 37 obese I, 25 severe, and 12 morbid. SF-12 PCS, and PROMIS PF significantly differed by BMI at all timepoints, but only at 6- and 12-week for VAS back, preoperatively and 12 weeks for VAS leg, and preoperatively to 1-year for ODI. MCID achievement only differed for PROMIS PF and VAS back at 2 years, but did not for overall MCID achievement. CONCLUSIONS BMI is a significant predictor of ODI, SF-12 PCS, and PROMIS PF preoperatively to 1-year postoperatively, but only through 12-week for VAS scores. MCID achievement varied for PROMIS PF and VAS back, suggesting that though BMI may affect postoperative outcome values, obesity may impact a patient's perception of meaningful improvements in pain and physical function.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | | | | | | | | | | |
Collapse
|
43
|
Cha EDK, Lynch CP, Patel MR, Jacob KC, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Preoperative Duration of Symptoms Does Not Affect Outcomes of Anterior Lumbar Interbody Fusion. Neurosurgery 2022; 90:215-220. [PMID: 34995271 DOI: 10.1227/neu.0000000000001782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have examined the impact of preoperative duration of symptoms (DOS) on lumbar spinal surgery outcomes although this has not been explored for anterior lumbar interbody fusion (ALIF). OBJECTIVE To assess the impact of preoperative DOS on patient-reported outcome measures (PROMs) of ALIF with posterior instrumentation. METHODS A database was retrospectively reviewed for ALIFs with posterior instrumentation. PROMs recorded at preoperative, 6-wk, 12-wk, 6-mo, and 1-yr postoperative timepoints included Visual Analog Scale back and leg, Oswestry Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and PROM Information System physical function. Achievement of minimum clinically important difference (MCID) was determined by comparing differences in postoperative PROMs from baseline to established values. Patients were grouped based on preoperative DOS into <1-yr and ≥1-yr groups. Differences in PROMs were compared using a t-test, whereas MCID achievement used a χ2 test. RESULTS Fifty-three patients were included, with 20 in the <1-yr group and 33 in the ≥1-yr group. The most common diagnosis was isthmic spondylolisthesis. No significant preoperative differences were observed in any PROM. DOS groups demonstrated significantly different scores for SF-12 PCS at 6 wk (P = .049). No significant differences in MCID achievement were observed between groups for any PROM. CONCLUSION ALIF patients demonstrated similar levels of pain, disability, and physical function regardless of preoperative DOS, except for back pain and physical function at intermittent timepoints. MCID achievement did not differ based on DOS for all outcome measures.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Cha EDK, Lynch CP, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Impact of Time to Complete PROMIS-PF Surveys on the Scores of Patients Undergoing Lumbar Decompression. Int J Spine Surg 2022; 15:1060-1065. [PMID: 35078877 DOI: 10.14444/8191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used for spinal surgery and may place additional burden in terms of time needed to complete. Few studies address the impact of time to complete (TTC) on PROMs. PURPOSE To determine whether length of TTC Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) surveys impact scores in patients undergoing minimally invasive surgery (MIS) for lumbar decompression (LD). METHODS We conducted a retrospective review of LD patients from 2015 to 2020. Inclusion criterion was primary, single-level MIS LD. Patients undergoing multilevel procedures and patients without preoperative PROMIS-PF survey data were excluded. PROMIS-PF, and visual analog scale (VAS) for back and leg pain were all evaluated at preoperative, 6 weeks, 12 weeks, 6 months, and 1 year time points. A minimum clinically important difference was evaluated for PROMIS-PF and VAS back and leg. TTC was calculated as the difference in start and stop time for completed questionnaires. Improvement in outcome scores was determined using a t test. Differences in mean TTC among time points were assessed using 1-way analysis of variance. Correlation between PROMIS-PF and TTC or VAS back and leg was determined using Pearson correlation and categorized as: 0.1 ≤ |r| < 0.3 = weak; 0.3 ≤ |r| < 0.5 = moderate; |r|≥0.5 = strong. RESULTS The study cohort included 91 patients. Mean age was 47 years, and 64.7% of patients were male. PROMIS-PF, VAS back, and VAS leg significantly improved at all postoperative time points. TTC did not significantly differ at any time point. PROMIS-PF and TTC were not significantly correlated at any time point (all P < 0.05), but PROMIS-PF was correlated with VAS back and leg (P < 0.015). CONCLUSION PROMIS-PF significantly improved through 1 year. TTC did not significantly differ at any time point and was not correlated with PROMIS-PF scores. This suggests PROMIS-PF consistently places relatively low burden on patients and remains a valid measure to evaluate outcomes after LD. CLINICAL RELEVANCE The utility of PROM surveys is increasingly appreciated in the context of spinal surgery; expansion of their use places additional burden on patients to complete surveys accurately and in a timely fashion. Length of TTC PROMIS-PF surveys does not impact scores in patients undergoing LD. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
45
|
Cha EDK, Lynch CP, Parrish JM, Jenkins NW, Mohan S, Geoghegan CE, Jadczak CN, Singh K. Recovery of Physical Function Based on Body Mass Index Following Anterior Cervical Discectomy and Fusion. Int J Spine Surg 2022; 15:1123-1132. [PMID: 35078884 DOI: 10.14444/8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Body mass index (BMI) serves as a risk factor for complications and poorer outcomes following anterior cervical discectomy and fusion (ACDF). This study investigates the association between BMI and Patient Reported Outcomes Measurement Information System physical function (PROMIS-PF) following ACDF. METHODS A prospectively maintained surgical registry was retrospectively reviewed for cervical spine surgeries between 2015 and 2019. Included patients underwent elective primary, single, or multilevel ACDF and were excluded for missing preoperative PROMIS-PF. Patients were stratified into 4 groups based on BMI score. Associations of demographic and perioperative characteristics with BMI groups were analyzed using either χ2 test or t test. PROMIS-PF was evaluated preoperatively and 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively using linear regression. Delta improvement in PROMIS-PF was evaluated at all time points. RESULTS The 128 study cohort had 74 patients the nonobese, 27 in the Obese I, 19 in the Obese II, and 8 in the Obese III groups. The mean age was 50.0 years and 57.0% were male. Gender, diabetic status, and Charlson Comorbidity Index (CCI) significantly differed by BMI groups but did not differ by perioperative characteristics. Preoperative PROMIS-PF did not significantly differ by group. Obese II and III groups had decreased PROMIS-PF compared to Obese I and nonobese groups at 1 year and 2 years. BMI groups had significantly different delta improvement at the 12 weeks (4.1 vs 10.1 vs 1.8 vs 4.3; P = 0.044) and 2 years (9.9 vs 7.1 vs 2.3 vs 3.0; P = 0.048). CONCLUSION Among the assessed BMI subgroups, all experienced similar physical function scores during the preoperative and short-term time points. Patients with higher BMI demonstrated diminished physical function at long-term time points. While this study focused on evaluating obesity, longitudinal tracking of high-risk patients during the postoperative period remains important for optimal rehabilitation. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE High BMI may predispose patients to lengthier recovery of physical function following ACDF.
Collapse
Affiliation(s)
- Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
46
|
Jenkins NW, Parrish JM, Lynch CP, Cha EDK, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Association of Preoperative Physical Function and Changes in Mental Health After Minimally Invasive Transforaminal Lumbar Interbody Fusion. Int J Spine Surg 2022; 15:1115-1122. [PMID: 35078883 DOI: 10.14444/8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few investigations have focused on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores, patient depression measured by the Patient Health Questionnaire-9 (PHQ-9), and their relationship in the setting of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). This study aims to detail the association between preoperative physical function with postoperative change in physical function and in depressive symptoms. METHODS A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to February 2019. Inclusion criteria were primary, single-level MIS TLIF procedures. Multilevel procedures and patients without PROMIS or PHQ-9 were excluded. Patients were grouped by preoperative PROMIS score (<35.0 and ≥35.0), with higher scores indicating greater physical function. A t test analyzed differences between PROMIS subgroups for operative time (skin incision to closure), estimated blood loss, length of stay, and discharge day. A t test also assessed the difference in PROMIS Physical Function (PF) and PHQ-9. Linear regression evaluated the relationship between pre- and postoperative PROMIS and PHQ-9. RESULTS Of 119 patients, 53.8% were male and 47.9% were obese. The mean ± SD age was 52.2 ± 10.7 years. The PROMIS <35.0 group had a larger improvement of PROMIS scores compared to the PROMIS ≥35.0 group at 6 weeks, 12 weeks, and 6 months. There was a negative association between preoperative PROMIS and PROMIS score improvement at 6 weeks, 12 weeks, and 6 months. For all time points, improvement in PHQ-9 was not associated with preoperative PROMIS scores. CONCLUSION From 0 weeks to 6 months after MIS TLIF, patients with lower preoperative physical function had larger improvements in PROMIS PF scores. Preoperative function was not predictive of postoperative changes in PHQ-9. While relationships between mental and physical health cannot be discounted, the lack of PHQ-9 association with physical function demonstrates the impact that MIS TLIF can have, regardless of PROMIS PF score. CLINICAL RELEVANCE Patients demonstrating lower levels of preoperative physical function may be in position for greater improvements in physical function following MIS TLIF surgery. In this study, there was no clear relationship between preoperative physical function levels and postoperative improvement in mental health, suggesting that all patients may achieve similar mental health improvement following MIS TLIF. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| |
Collapse
|
47
|
Oke N, Mohan S. Development of nanoporous textile sludge based adsorbent for the dye removal from industrial textile effluent. J Hazard Mater 2022; 422:126864. [PMID: 34416690 DOI: 10.1016/j.jhazmat.2021.126864] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
The development of a novel textile sludge based activated carbon (TSBAC) adsorbent and its performance for the treatment of textile dyeing effluent, have been explained in this paper. TSBAC was prepared by the thermal treatment of textile effluent treatment sludge followed by the chemical activation using phosphoric acid. Characterization of TSBAC resulted in enhanced specific surface area (123.65 m2/g) along with the presence of active surface functional groups including -OH, -COOH, -CO. TSBAC showed superior adsorption capacity for methylene blue (123.6 mg/g), reactive red 198 (101.4 mg/g), and reactive yellow 145 (96.8 mg/g) individually, and from the synthetic textile effluent (106 mg/g). The pseudo-second order model and Langmuir isotherm model were found to be fitted well with batch experimental data. The results of the continuous column studies showed that adsorption capacity for methylene blue, reactive red 198, reactive yellow 145 are 101.8 mg/g, 76.6 mg/g, and 75.1 mg/g respectively, and the synthetic textile effluent resulted in an adsorption capacity value of 79.1 mg/g. The reuse potential of TSBAC was proved by effective dye removal up to six reuse cycles. The leachability studies proved that the used adsorbent could be safely disposed of without any harmful effect to the environment.
Collapse
Affiliation(s)
- Ninad Oke
- Indian Institute of Technology Madras, Environmental and Water Resources Engineering Division, Department of Civil Engineering, Chennai, Tamil Nadu 600036, India.
| | - S Mohan
- Indian Institute of Technology Madras, Environmental and Water Resources Engineering Division, Department of Civil Engineering, Chennai, Tamil Nadu 600036, India.
| |
Collapse
|
48
|
Lynch CP, Cha EDK, Rush Iii AJ, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Outcomes of Transforaminal Lumbar Interbody Fusion Using Unilateral Versus Bilateral Interbody Cages. Neurospine 2022; 18:854-862. [PMID: 35000341 PMCID: PMC8752695 DOI: 10.14245/ns.2142248.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the impact of bilateral versus unilateral interbody cages on outcomes for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures.
Methods A retrospective review for primary, elective, single-level MIS TLIF procedures with bilateral posterior instrumentation from 2008–2020 was performed. Patients were grouped according to unilateral or bilateral interbody cage use. Procedures performed without static interbody cages or indicated for trauma, infection, malignancy were excluded. Patient-reported outcomes (PROs) included visual analogue scale (VAS), Oswestry Disability Index, 12-item Short Form health survey physical composite score (SF-12 PCS), PatientReported Outcome Measurement Information System physical function (PROMIS-PF). PROs were collected preoperatively and postoperatively. Change in PROs (Δ) was calculated and compared between groups. Achievement of minimum clinically important difference (MCID) was calculated using established values from the literature. Achievement rates were compared between groups using logistic regression.
Results The study included 151 patients, with 111 unilateral and 40 bilateral cage placements. Charlson Comorbidity Index, diabetes, and insurance status differed between groups (p < 0.050). Prevalence of degenerative and isthmic spondylolisthesis (both p ≤ 0.002), operative level (p = 0.003), and postoperative length of stay (p = 0.022) significantly differed between groups. The unilateral group had lower 1-year arthrodesis rates (p = 0.035). Preoperative VAS leg (p = 0.017) and SF-12 PCS (p = 0.045) were worse for the unilateral group. ΔPROMIS-PF was greater for the bilateral group at 2 years (p = 0.001). Majority of patients achieved an overall MCID for all PROs, except VAS leg (bilateral group).
Conclusion While preoperative status and postoperative arthrodesis rates differed, patients achieved an MCID at similar rates regardless of use of unilateral or bilateral cages.
Collapse
Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Augustus J Rush Iii
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
49
|
Nolte MT, Cha EDK, Lynch CP, Jacob KC, Patel MR, Geoghegan CE, Jadczak CN, Mohan S, Singh K. Change in Patient-Reported Outcome Measures as Predictors of Revision Lumbar Decompression Procedures. Neurospine 2022; 18:863-870. [PMID: 35000342 PMCID: PMC8752697 DOI: 10.14245/ns.2142230.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).
Methods Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.
Results The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).
Conclusion LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.
Collapse
Affiliation(s)
- Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
50
|
Lynch CP, Cha EDK, Patel MR, Jadczak CN, Mohan S, Geoghegan CE, Singh K. Effects of Anterior Plating on Achieving Clinically Meaningful Improvement Following Single-Level Anterior Cervical Discectomy and Fusion. Neurospine 2022; 19:315-322. [PMID: 34990538 PMCID: PMC9260542 DOI: 10.14245/ns.2142214.107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2 years following ACDF.
Methods Patients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROMs) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: 12-item Short Form health survey physical component summary (SF-12 PCS) 8.1, visual analogue scale (VAS) neck 2.6, VAS arm 4.1, Neck Disability Index (NDI) 8.5. Rates of MCID achievement were compared between groups.
Results The cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6 weeks. Rates of MCID achievement differed significantly between groups for NDI at 6 weeks, and 12 weeks, and SF-12 PCS overall.
Conclusion Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall.
Collapse
Affiliation(s)
- Conor P Lynch
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elliot D K Cha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Caroline N Jadczak
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shruthi Mohan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Cara E Geoghegan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|