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Agrawal S. Considerations for Creating the Next Generation of RNA Therapeutics: Oligonucleotide Chemistry and Innate Immune Responses to Nucleic Acids. Nucleic Acid Ther 2024; 34:37-51. [PMID: 38578231 DOI: 10.1089/nat.2024.29009.sud] [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] [Indexed: 04/06/2024] Open
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Pillai R, Chheda A, Agrawal S, Ravat S, Sankhe S, Muzumdar D. Skull-base temporal encephalocele: Hidden cause of temporal lobe epilepsy. J Postgrad Med 2023; 0:382956. [PMID: 37555423 DOI: 10.4103/jpgm.jpgm_354_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: 08/10/2023] Open
Abstract
In the present study patients with previously diagnosed MRI-negative temporal lobe epilepsy (TLE) on long-term video electroencephalography (VEEG) monitoring were re-evaluated with high resolution 3T MRI brain to look out for a skull base temporal lobe encephalocoele (TE). A total of 234 VEEGs were analyzed. TLE had been diagnosed in 104 patients based on semiology, ictal, interictal EEG data, and brain positron emission tomography (PET) studies. Of these, 99 patients had temporal lobe abnormality (78 had mesial temporal sclerosis, 8 had tumor, 3 had focal cortical dysplasia, and 10 had mixed pathology). Out of the five 1.5T MRI-negative TLE patients, two patients were diagnosed with TE on subsequent 3T MRI brain scans and one patient underwent electrocorticography-guided tailored resection for complete removal of epileptogenic tissue; with Engels class I seizure freedom at one year follow-up. We propose that TE should be carefully searched for, as a cause of refractory TLE, using high-resolution MRI sequences.
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Affiliation(s)
- R Pillai
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - A Chheda
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - S Agrawal
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - S Ravat
- Department of Neurology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - S Sankhe
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - D Muzumdar
- Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India
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Kalathia J, Patel K, Vala G, Agrawal S, Chipde S, Valiya A, Khetarpal A. Supine percutaneous nephrolithotomy under segmental epidural block in high risk compromised cardiovascular patients: A prospective analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Kadian S, Mallikarjuna S, Jamir T, Agrawal S. Dexmedetomidine-induced polyuria in a patient with a vestibular schwannoma. Anaesth Rep 2023; 11:e12222. [PMID: 36941948 PMCID: PMC10023669 DOI: 10.1002/anr3.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- S. Kadian
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - S. Mallikarjuna
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - T. Jamir
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - S. Agrawal
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
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Raja Thinagaran JK, James PA, Agrawal S. Efficacy of outpatient surveillance in post-intravesical BCG management of high-risk bladder cancer. Journal of Clinical Urology 2022. [DOI: 10.1177/20514158221139897] [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: 12/13/2022]
Abstract
Background: Intravesical Bacillus Calmette–Guérin (BCG) instillation is an established form of immunotherapy for intermediate and high-risk bladder cancers. Mandatory cystoscopic surveillance is commonly performed under general anaesthesia (GA) to facilitate biopsy or other procedures. However, it is resource-intensive with unclear clinical benefit. Methods and patients: We performed a two-cycle audit, before and after changing post-BCG surveillance policy, from GA cystoscopy to local anaesthetic flexible cystoscopy (LAFC) on trans urethral laser ablation (TULA) lists, where patients may undergo a tumour biopsy or laser ablation. In the first cycle, we audited 53 patients undergoing 114 post-BCG rigid cystoscopies from January 2018 to December 2019. In the second cycle, there were 56 patients undergoing 99 post-BCG LAFCs on TULA lists in 2020. Results: In the first audit cycle cohort, the mean patient age was 72.29 ± 8.98 years and 48 were men; malignant histology was identified only on five occasions (three grade progressions). Fourteen patients required overnight admission. In the second audit cycle cohort, the mean patient age was 70.44 ± 9.17 years and 47 were men. Four had a grade progression, while another a stage progression. Out of 99 LAFCs, 47 confirmed normal bladder appearance. A biopsy was taken during other 52 cystoscopies: 17 (33%) confirmed malignancy. Fifteen patients showed findings that were labelled as recurrence, but only two required a further GA procedure to deal with recurrence. One patient was admitted for post-procedure bleeding, which settled with irrigation. Conclusion: Local anaesthetic TULA procedure is a safe and effective alternative for a GA rigid cystoscopy to survey bladders of patients on intravesical BCG therapy. Level of evidence: 3
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Affiliation(s)
| | - PA James
- Department of Urology, St. Peter’s Hospital, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Chertsey, UK
| | - S Agrawal
- Department of Urology, St. Peter’s Hospital, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Chertsey, UK
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Meshram S, Gupta S, Alexander A, Agrawal S, Lanjewar N, Meshram K, Patel A, More A, Yadav R, Muley S, Shamkuwar C, Singh A. Sleep quality in COVID-19 patients and its association with severity of COVID. Sleep Med 2022. [PMCID: PMC9300259 DOI: 10.1016/j.sleep.2022.05.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Agrawal S, Tipre D, Dave S. Biodegradation of Sulphonated Triazo Acid Black 210 Dye by Thermohalotolerant Bacillus pumilus SRS83: Kinetic, Metabolite and Toxicity Analysis. APPL BIOCHEM MICRO+ 2022. [DOI: 10.1134/s0003683822050027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Agrawal S, Pradhan S. Treatment of Infrabony Defects by Open Flap Debridement with or without Diode Laser. Kathmandu Univ Med J (KUMJ) 2022; 20:461-466. [PMID: 37795725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Periodontitis is the common oral condition which affects the periodontium of the teeth that leads to destruction of periodontal ligaments and alveolar bone. Open flap debridement is the surgical procedure which provides access and visibility of the site, application of laser as an adjunct has various advantanges. Objective To compare clinical outcomes after open flap debridement with or without diode laser. Method Patients aged 25-45 years diagnosed with infrabony defect ≥ 5 mm visiting Department of Dental Surgery, Bir Hospital. Control group sites were treated with open flap debridement alone, whereas test-groups were treated with Open flap debridement with diode laser. Various parameters like Plaque index, Gingival index, Pocket depth and Clinical attachment level were assessed and compared between groups at baseline, 3 and 6 months. Result The mean plaque and gingival scores improved in both the control and test groups at 3 and 6 months follow up as compared to baseline and was statistically nonsignificant between two groups. Open flap debridement with or without diode laser in the treatment of periodontal intrabony defects did not produce significant reduction in pocket depth and gain in clinical attachment level. Conclusion There was no significant differences in the clinical parameters were seen in the surgical flap debridement of infrabony pocket with and without diode laser. Diode laser can be used safely as an adjunct. However, long-term, multicentric, histologic and microbial studies are required.
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Affiliation(s)
- S Agrawal
- Department of Periodontology and oral Implantology, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - S Pradhan
- Periodontology and Oral Implantology Unit, Department of Dental Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Williams LA, Gerber DJ, Elder A, Tseng WC, Baru V, Delaney-Busch N, Ambrosi C, Mahimkar G, Joshi V, Shah H, Harikrishnan K, Upadhyay H, Rajendran SH, Dhandapani A, Meier J, Ryan SJ, Lewarch C, Black L, Douville J, Cinquino S, Legakis H, Nalbach K, Behrends C, Sato A, Galluzzi L, Yu TW, Brown D, Agrawal S, Margulies D, Kopin A, Dempsey GT. Developing antisense oligonucleotides for a TECPR2 mutation-induced, ultra-rare neurological disorder using patient-derived cellular models. Mol Ther Nucleic Acids 2022; 29:189-203. [PMID: 35860385 PMCID: PMC9287140 DOI: 10.1016/j.omtn.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
Mutations in the TECPR2 gene are the cause of an ultra-rare neurological disorder characterized by intellectual disability, impaired speech, motor delay, and hypotonia evolving to spasticity, central sleep apnea, and premature death (SPG49 or HSAN9; OMIM: 615031). Little is known about the biological function of TECPR2, and there are currently no available disease-modifying therapies for this disease. Here we describe implementation of an antisense oligonucleotide (ASO) exon-skipping strategy targeting TECPR2 c.1319delT (p.Leu440Argfs∗19), a pathogenic variant that results in a premature stop codon within TECPR2 exon 8. We used patient-derived fibroblasts and induced pluripotent stem cell (iPSC)-derived neurons homozygous for the p.Leu440Argfs∗19 mutation to model the disease in vitro. Both patient-derived fibroblasts and neurons showed lack of TECPR2 protein expression. We designed and screened ASOs targeting sequences across the TECPR2 exon 8 region to identify molecules that induce exon 8 skipping and thereby remove the premature stop signal. TECPR2 exon 8 skipping restored in-frame expression of a TECPR2 protein variant (TECPR2ΔEx8) containing 1,300 of 1,411 amino acids. Optimization of ASO sequences generated a lead candidate (ASO-005-02) with ∼27 nM potency in patient-derived fibroblasts. To examine potential functional rescue induced by ASO-005-02, we used iPSC-derived neurons to analyze the neuronal localization of TECPR2ΔEx8 and showed that this form of TECPR2 retains the distinct, punctate neuronal expression pattern of full-length TECPR2. Finally, ASO-005-02 had an acceptable tolerability profile in vivo following a single 20-mg intrathecal dose in cynomolgus monkeys, showing some transient non-adverse behavioral effects with no correlating histopathology. Broad distribution of ASO-005-02 and induction of TECPR2 exon 8 skipping was detected in multiple central nervous system (CNS) tissues, supporting the potential utility of this therapeutic strategy for a subset of patients suffering from this rare disease.
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Affiliation(s)
- Luis A Williams
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - David J Gerber
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Amy Elder
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Wei Chou Tseng
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Valeriya Baru
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | | | | | - Gauri Mahimkar
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Vaibhav Joshi
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Himali Shah
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | | | - Hansini Upadhyay
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | | | | | - Joshua Meier
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Steven J Ryan
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Caitlin Lewarch
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Lauren Black
- Charles River Laboratories, Montreal, QC, Canada
| | | | | | | | - Karsten Nalbach
- Munich Cluster for Systems Neurology, Ludwig-Maximilians-Universität München, Germany
| | - Christian Behrends
- Munich Cluster for Systems Neurology, Ludwig-Maximilians-Universität München, Germany
| | - Ai Sato
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Timothy W Yu
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Duncan Brown
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Sudhir Agrawal
- University of Massachusetts Medical School, Department of Medicine, Worcester, MA 01655, USA.,Arnay Sciences LLC, Shrewsbury, MA 01545, USA
| | - David Margulies
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
| | - Alan Kopin
- Tufts University School of Medicine, Boston, MA, USA.,Luke Heller TECPR2 Foundation, Swampscott, MA, USA
| | - Graham T Dempsey
- Q-State Biosciences, 179 Sidney Street, Cambridge, MA 02139, USA
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Li D, Parvez W, Tiwari M, Jones M, Tufail M, Agrawal S, Bennett J, Sudhir R. EP13.01-001 The Burden of Incidental Extra-thoracic Positron Emission Tomography-CT (PET-CT) Findings in Thoracic Malignancies. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.921] [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: 10/14/2022]
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Maharjan J, Agrawal S, Marahatta S. Hirsutism and Quality of Life of Women in Tertiary Care Center in Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2022; 20:268-272. [PMID: 37042364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Background Hirsutism is excess terminal hair growth in women at androgen-dependent sites of the body and it has great impact on psychological and social aspects of their lives, thus affecting their quality of life (QoL). Several studies assessing the quality of life in hirsute women could be found in world literature but none in Nepalese literature. So, this study was undertaken for the assessment of the impact of hirsutism on the quality of life in Nepalese women. Objective To assess the effect of hirsutism on quality of life of women in a tertiary center of Eastern Nepal and its association with various socio-demographic and clinical parameters. Method A cross-sectional questionnaire-based study was conducted in 49 participants aged 10 to 49 years at the Department of Dermatology, B.P. Koirala Institute of Health Sciences. Clinically diagnosed hirsute females with modified Ferriman-Gallwey (mFG) score > 8, were enrolled and asked to fill Dermatology Life Quality Index (DLQI) questionnaire in the Nepalese version. Result More than 57.2% of the study population was of age 20 to 29 years with a mean of 27.76±8.08 years. The mean Dermatology Life Quality Index score was 7.78±4.95. The moderate effect was seen in the majority of participants (36.7%) with a predominant effect upon aspects of life like daily activities and symptoms and feelings. Participants with higher mF-G score (22.15±3.82) had a very large effect on their quality of life. Younger unmarried women with a school education and having a longer duration of hirsutism were found to have a higher effect upon their quality of life. However, the association was not statistically significant. Conclusion Hirsutism had affected the quality of life moderately with predominant effect upon aspects like daily activities and symptoms and feelings. No significant association was elicited between severity of hirsutism and its effect on quality of life from our study.
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Affiliation(s)
- J Maharjan
- Department of Dermatology and STD, Meditouch Skin and Hair Clinic, Pokhara, Nepal
| | - S Agrawal
- Department of Dermatology and Venereology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Marahatta
- Department of Dermatology and Venereology, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Kumar V, Agrawal S. Urban modelling and forecasting of landuse using SLEUTH model. Int J Environ Sci Technol (Tehran) 2022; 20:6499-6518. [PMID: 35765368 PMCID: PMC9223261 DOI: 10.1007/s13762-022-04331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 05/24/2023]
Abstract
The present study performs landcover modelling using the SLEUTH model. The urban land use changing factors are calibrated to predict the Land Use Land Cover (LULC) for a densely populated and developing smart city, Prayagraj, India. This research aims to use the SLEUTH model for simulating the future urban growth with the help of historical LULC (1990-2020), road network and elevation data. The influence of road gravity and slope resistant coefficients is very significant in this study's outcome. The built-up area of the region increased from 40.22 km2 (5.10% of total area) in 1990 to 85.89 km2 (10.89%) in 2020. According to prediction results, in the next 20 years, the built-up growth rate would be 1.9% and approximated built-up area would be 118.66 km2 (14.98%) in the year 2040. The quality of the result has been quantified in terms of best fit value of Optimal SLEUTH Metric (OSM) and validated against the existing LULC. The study utilises a spatially explicit urban growth model with 30 m resolution remote sensing data and provides future landuse of Prayagraj city.
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Affiliation(s)
- V. Kumar
- GIS Cell, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, Uttar Pradesh 211004 India
| | - S. Agrawal
- GIS Cell, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, Uttar Pradesh 211004 India
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Agrawal S, Al-Refai A, Abbasi N, Kulkarni AV, Pruthi V, Drake J, Ryan G, Van Mieghem T. Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida. Ultrasound Obstet Gynecol 2022; 59:799-803. [PMID: 34523765 DOI: 10.1002/uog.24767] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Open spina bifida is a common cause of hydrocephalus in the postnatal period. In-utero closure of the fetal spinal defect decreases the need for postnatal cerebrospinal fluid (CSF) diversion surgery. Good prenatal predictors of the need for postnatal CSF diversion surgery are currently lacking. In this study, we aimed to assess the association of fetal ventriculomegaly and its progression over the course of pregnancy with the rate of postnatal hydrocephalus requiring intervention. METHODS In this retrospective study, fetuses with a prenatal diagnosis of open spina bifida were assessed longitudinally. Ventricular diameter, as well as other potential predictors of the need for postnatal CSF diversion surgery, were compared between fetuses undergoing prenatal closure and those undergoing postnatal repair. RESULTS The diameter of the lateral ventricle increased significantly throughout gestation in both groups, but there was no difference in maximum ventricular diameter at first or last assessment between fetuses undergoing prenatal closure and those undergoing postnatal repair. There was no significant difference in the rate of progression of ventriculomegaly between the two groups, with a mean progression rate of 0.83 ± 0.5 mm/week in the prenatal-repair group and 0.6 ± 0.6 mm/week in the postnatal-repair group (P = 0.098). Fetal repair of open spina bifida was associated with a lower rate of postnatal CSF diversion surgery (P < 0.001). In all subjects, regardless of whether they had prenatal or postnatal surgery, the severity of ventriculomegaly at first and last assessments was associated independently with the need for postnatal CSF diversion surgery (P = 0.005 and P = 0.001, respectively), with a greater need for surgery in fetuses with larger ventricular size, even after controlling for gestational age at assessment. CONCLUSIONS In fetuses with open spina bifida, fetal ventricular size increases regardless of whether spina bifida closure is performed prenatally or postnatally, but the need for CSF diversion surgery is significantly lower in those undergoing prenatal repair. Ventriculomegaly is associated independently with the need for postnatal CSF diversion in fetuses with open spina bifida, irrespective of timing of closure. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Agrawal
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - A Al-Refai
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences - Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - N Abbasi
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - A V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - V Pruthi
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - J Drake
- Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - G Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - T Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
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Syed H, Aljoe J, China Z, Malhi G, James P, Agrawal S. ‘Tech’ towards a greener future - the impact and benefits of outpatient bladder cancer management using next generation scopes and lasers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kim JW, Vella C, Parvez W, Verma R, Majid M, Woltmann G, Pareek M, Bennett J, Agrawal S, Sudhir R, Ahyow L, Tufail M, Haldar P. Impact of COVID-19 on the diagnosis and management of lung cancer and TB. Int J Tuberc Lung Dis 2022; 26:372-374. [PMID: 35351244 DOI: 10.5588/ijtld.22.0045] [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: 11/10/2022] Open
Affiliation(s)
- J W Kim
- Department of Respiratory Sciences, University of Leicester, Leicester, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - C Vella
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - W Parvez
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - R Verma
- Department of Respiratory Sciences, University of Leicester, Leicester, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - M Majid
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - G Woltmann
- Department of Respiratory Sciences, University of Leicester, Leicester, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - M Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester
| | - J Bennett
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - S Agrawal
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - R Sudhir
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - L Ahyow
- UK Health Security Agency, London, UK
| | - M Tufail
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
| | - P Haldar
- Department of Respiratory Sciences, University of Leicester, Leicester, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester
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Ish S, Agrawal S, Ish P. Subretinal abscess-a rare presentation of tuberculosis. QJM 2022; 115:94-95. [PMID: 34273174 DOI: 10.1093/qjmed/hcab203] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Ish
- Department of Ophthalmology, Theia Eye Care Clinic, New Delhi 110029, India
| | - S Agrawal
- Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - P Ish
- Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
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Syed H, James P, Abboudi H, Shamsuddin A, Agrawal S. Outpatient Transurethral Laser Ablation (TULA) for non-muscle invasive bladder cancer; results from a multi-centre prospective 1 year EORTC risk matched study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doan P, Counter W, Sheehan-Dare G, Papa N, Ho B, Lee J, Liu V, Thompson J, Agrawal S, Roberts M, Algharzo O, Buteau J, Hofman M, Moon D, Murphy D, Stricker P, Emmett L. Diagnostic accuracy, concordance and certainty with 68Ga-PSMA-11 PET/MRI fusion compared to mpMRI and 68Ga-PSMA-11 PET/CT alone for prostate cancer diagnosis: A PRIMARY trial sub-study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Geboers B, Gondoputro W, Thompson J, Reesink D, Van Riel L, Zhang D, Blazevski A, Doan P, Agrawal S, Mathews J, Haynes AM, Liu Z, Delprado W, Shnier R, De Reijke T, Lawrentschuk N, Stijns P, Yaxley J, Scheltema M, Stricker P. Multicenter validation of the diagnostic accuracy of multiparametric magnetic resonance imaging to detect residual prostate cancer in the follow-up of focal therapy with irreversible electroporation. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Alam M, Agrawal S, Rastogi N, Saxena R. Chemotherapy or chemotherapy followed by consolidation chemoradiation in postoperative (simple cholecystectomy) gall bladder cancer with residual disease, unsuitable for revision surgery? Risk stratification and outcomes. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_1161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Singhal D, Kanodia N, Singh R, Singh SK, Agrawal S. Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases. Malays Orthop J 2021; 15:71-77. [PMID: 34966498 PMCID: PMC8667253 DOI: 10.5704/moj.2111.011] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. Materials and methods: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot. Results: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6-8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases. Conclusion: Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.
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Affiliation(s)
- D Singhal
- Department of Orthopaedic, Sir Ganga Ram Hospital, New Delhi, India
| | - N Kanodia
- Department of Orthopaedic, Sir Ganga Ram Hospital, New Delhi, India
| | - R Singh
- Department of Orthopaedic and Traumatology, Mayo Institute of Medical Sciences, Barabanki, India
| | - S K Singh
- Department of Orthopaedics, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - S Agrawal
- Department of Orthopaedic, Sir Ganga Ram Hospital, New Delhi, India
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Ramalingam S, Balli D, Ciuleanu TE, Pluzanski A, Lee JS, Schenker M, Bernabe Caro R, Lee K, Bartolucci R, Audigier-Valette C, Hellmann M, Paz-Ares L, Reck M, Borghaei H, Brahmer J, O’Byrne K, Tran P, Spires T, Geese W, Agrawal S. 4O Nivolumab (NIVO) + ipilimumab (IPI) versus chemotherapy (chemo) as first-line (1L) treatment for advanced NSCLC (aNSCLC) in CheckMate 227 part 1: Efficacy by KRAS, STK11, and KEAP1 mutation status. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zhang Y, Quraishi IH, McClure H, Williams LA, Cheng Y, Kale S, Dempsey GT, Agrawal S, Gerber DJ, McManus OB, Kaczmarek LK. Suppression of Kv3.3 channels by antisense oligonucleotides reverses biochemical effects and motor impairment in spinocerebellar ataxia type 13 mice. FASEB J 2021; 35:e22053. [PMID: 34820911 DOI: 10.1096/fj.202101356r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022]
Abstract
Mutations in KCNC3, the gene that encodes the Kv3.3 voltage dependent potassium channel, cause Spinocerebellar Ataxia type 13 (SCA13), a disease associated with disrupted motor behaviors, progressive cerebellar degeneration, and abnormal auditory processing. The Kv3.3 channel directly binds Hax-1, a cell survival protein. A disease-causing mutation, Kv3.3-G592R, causes overstimulation of Tank Binding Kinase 1 (Tbk1) in the cerebellum, resulting in the degradation of Hax-1 by promoting its trafficking into multivesicular bodies and then to lysosomes. We have now tested the effects of antisense oligonucleotides (ASOs) directed against the Kv3.3 channel on both wild type mice and those bearing the Kv3.3-G592R-encoding mutation. Intracerebroventricular infusion of the Kcnc3-specific ASO suppressed both mRNA and protein levels of the Kv3.3 channel. In wild-type animals, this produced no change in levels of activated Tbk1, Hax-1 or Cd63, a tetraspanin marker for late endosomes/multivesicular bodies. In contrast, in mice homozygous for the Kv3.3-G592R-encoding mutation, the same ASO reduced Tbk1 activation and levels of Cd63, while restoring the expression of Hax-1 in the cerebellum. The motor behavior of the mice was tested using a rotarod assay. Surprisingly, the active ASO had no effects on the motor behavior of wild type mice but restored the behavior of the mutant mice to those of age-matched wild type animals. Our findings indicate that, in mature intact animals, suppression of Kv3.3 expression can reverse the deleterious effects of a SCA13 mutation while having little effect on wild type animals. Thus, targeting Kv3.3 expression may prove a viable therapeutic approach for SCA13.
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Affiliation(s)
- Yalan Zhang
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Imran H Quraishi
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Heather McClure
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | | | | - Leonard K Kaczmarek
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
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Agarwal A, Karnatak R, Asnani M, Agrawal S, Singh R, Das V. P–638 Status of insulin resistance in infertile women and its effect on ovulation induction. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.637] [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: 11/13/2022] Open
Abstract
Abstract
Study question
Is insulin resistance ( IR) a confounding variable in infertile women, other than those those having polycystic ovarian syndrome (PCOS)
Summary answer
IR was identified in 20.5% of infertile women. The presence of IR did not affect response to ovulation induction but reduced chances of conception
What is known already
Obesity is strongly correlated with insulin resistance. Obesity also has an adverse effect on fertility. In 2008 Steeg et al reported 5% reduction in chances of spontaneous conception with each unit increase in body mass index (BMI). Tetsurou Sakumoto et al (2010) reported hyperinsulinemia to affect granulose cells in small follicles inducing early response to luteinising hormone and anovulation. Adverse effect on endometrial function and implantation was also postulated. Insulin resistance has been studied in cases of PCOS but has not been studied in infertile women not fulfilling criteria for diagnosis of PCOS . So the present study was planned
Study design, size, duration
A prospective cohort study was conducted in infertility unit, King George Medical University, Lucknow, India over a period of one year from August 2018 to July 2019. Total 102 women with unexplained infertility were enrolled. Ethical clearance was obtained from institutional ethical committee
Participants/materials, setting, methods
Women with PCOS; diminished ovarian reserve documented by antral follicle count <7 and anti Mullerian hormone < 1.1ng/ml; bilateral tubal block; abnormal semen analysis; untreated hypothyroidism, hyperprolactinaemia; known diabetes were excluded. All women underwent ovulation induction with clomiphene citrate followed by single intrauterine insemination. Homeostasis model assessment insulin resistance index (HOMA IR) was calculated
HOMA-IR = Fasting S. Glucose (mg/dl) x Fasting insulin (µlU) / 405.
Value ≥ 2 denoted insulin resistance
Main results and the role of chance
: IR was identified in 21/102 (20.5%) cases. Fasting insulin levels were in the range of 5 – 9.9 mIU/ml in 53/102 women; <5mIU/ml in 29 and >10mIU/ml in 20. Fasting insulin > 9.45mIU/ml was found to have 90.5% sensitivity and 96.3% specificity in predicting insulin resistance. None of the cases had abnormal fasting and post prandial plasma glucose levels. IR was seen to be significantly correlated with BMI > 25kg/m2 (p = 0.0018) and waist hip ratio of > 0.85 (p = 0.0024).All women had follicular development and follicle rupture irrespective of presence of IR. Women with IR were more likely to have monofollicular development (17/21 IR cases). Correlation of endometrial thickness with IR was not seen. Mean endometrial thickness was 8.9mm. There were 6 pregnancies among the 102 women studied. None of the women with IR conceived.
So IR was found to be affecting one fifth of women with unexplained infertility. Failure of any woman with IR to conceive was significant but the finding needs to be further studied.
Limitations, reasons for caution
: It was a small study with only 102 cases and the women were followed for only one cycle of ovulation induction and intrauterine insemination so results need to be validated in a larger study with a longer follow up.
Wider implications of the findings: If further larger studies corroborate the role of IR in women with unexplained infertility it could elucidate the possibility of using insulin sensitisers in management of such cases. IR may emerge as an important gamechanger in management of unexplained infertility.
Trial registration number
Not applicable
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Affiliation(s)
- A Agarwal
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
| | - R Karnatak
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
| | - M Asnani
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
| | - S Agrawal
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
| | - R Singh
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
| | - V Das
- King George Medical University- Lucknow- India, Obstetrics and Gynaecology, Lucknow, India
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Haymaker C, Johnson DH, Murthy R, Bentebibel SE, Uemura MI, Hudgens CW, Safa H, James M, Andtbacka RHI, Johnson DB, Shaheen M, Davies MA, Rahimian S, Chunduru SK, Milton DR, Tetzlaff MT, Overwijk WW, Hwu P, Gabrail N, Agrawal S, Doolittle G, Puzanov I, Markowitz J, Bernatchez C, Diab A. Tilsotolimod with Ipilimumab Drives Tumor Responses in Anti-PD-1 Refractory Melanoma. Cancer Discov 2021; 11:1996-2013. [PMID: 33707233 PMCID: PMC8544022 DOI: 10.1158/2159-8290.cd-20-1546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/26/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
Many patients with advanced melanoma are resistant to immune checkpoint inhibition. In the ILLUMINATE-204 phase I/II trial, we assessed intratumoral tilsotolimod, an investigational Toll-like receptor 9 agonist, with systemic ipilimumab in patients with anti-PD-1- resistant advanced melanoma. In all patients, 48.4% experienced grade 3/4 treatment-emergent adverse events. The overall response rate at the recommended phase II dose of 8 mg was 22.4%, and an additional 49% of patients had stable disease. Responses in noninjected lesions and in patients expected to be resistant to ipilimumab monotherapy were observed. Rapid induction of a local IFNα gene signature, dendritic cell maturation and enhanced markers of antigen presentation, and T-cell clonal expansion correlated with clinical response. A phase III clinical trial with this combination (NCT03445533) is ongoing. SIGNIFICANCE: Despite recent developments in advanced melanoma therapies, most patients do not experience durable responses. Intratumoral tilsotolimod injection elicits a rapid, local type 1 IFN response and, in combination with ipilimumab, activates T cells to promote clinical activity, including in distant lesions and patients not expected to respond to ipilimumab alone.This article is highlighted in the In This Issue feature, p. 1861.
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Affiliation(s)
- Cara Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel H Johnson
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Salah-Eddine Bentebibel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc I Uemura
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney W Hudgens
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Houssein Safa
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marihella James
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert H I Andtbacka
- Surgical Oncology Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Douglas B Johnson
- Division of Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Montaser Shaheen
- Department of Medicine and Cancer Center, University of Arizona, Tucson, Arizona
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Willem W Overwijk
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick Hwu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nashat Gabrail
- Department of Oncology, Gabrail Cancer Center, Canton, Ohio
| | - Sudhir Agrawal
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Gary Doolittle
- Department of Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Joseph Markowitz
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Chantale Bernatchez
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Agrawal S, Satapathy S, Gupta V, Sreenivas V, Khaitan BK, Ramam M. Family vitiligo impact scale: A scale to measure the quality-of-life of family members of patients with vitiligo. Indian J Dermatol Venereol Leprol 2021; 88:32-39. [PMID: 34379960 DOI: 10.25259/ijdvl_928_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 04/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vitiligo places a significant psycho-social burden on caregivers and family members. AIMS The aim of the study was to develop and preliminarily validate a scale to measure the psychosocial impact of vitiligo on adult family members. METHODS Themes that emerged from qualitative interviews and a focus group discussion with family members were used to generate items for a preliminary scale, followed by pre-testing and scale development. The new scale was then tested with two comparator scales and a global question. RESULTS A preliminary scale with 32 items was pilot tested on 30 participants. Following this, the scale was condensed to 16 items in 12 domains that were administered to 159 participants. Scale scores ranged from 0 to 48 with a mean of 19.75 ± 12.41. The scale had excellent internal consistency with Cronbach's alpha coefficient of 0.92 (0.70-0.95) and also showed good test-retest reliability at two weeks (r = 0.946). The scale showed criterion, convergent and known group validity. LIMITATIONS It was conducted in a large teaching hospital which may have resulted in selection of patients with persistent or progressive disease and more worried family members. Vitiligo is highly stigmatized in our country and the performance of the scale may need to be evaluated in other communities and cultures as well where stigma is less oppressive. CONCLUSION Family Vitiligo Impact Scale appears to be an easy-to-complete, reliable and valid instrument to measure the psychosocial impact of vitiligo in family members of patients. It may be useful as an outcome measure in both clinical and research settings.
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Affiliation(s)
- S Agrawal
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - S Satapathy
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - V Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - B K Khaitan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Cameron M, Ashikodi E, Wang I, Dhir N, Junejo S, Agrawal S, Baig M. Ct Coronary Angiography Guides Management Of Patients With Stable Angina Irrespective Of Pre-test Probability (PTP) According To NICE/ESC Guidelines. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Over the last four decades, tremendous progress has been made in use of synthetic oligonucleotides as therapeutics. This has been possible largely by introducing chemical modifications to provide drug like properties to oligonucleotides. In this article I have summarized twists and turns on use of chemical modifications and their road to success and highlight areas of future directions.
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Affiliation(s)
- Sudhir Agrawal
- ARNAY Sciences LLC, Shrewsbury, MA 01545, USA; or
- Department of Medicine, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
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Ducoli L, Agrawal S, Sibler E, Kouno T, Tacconi C, Hon C, Berger S, Müllhaupt D, He Y, Kim J, D’Addio M, Dieterich L, Carninci P, de Hoon M, Shin J, Detmar M. 152 LETR1 is a lymphatic endothelial-specific lncRNA governing cell proliferation and migration through KLF4 and SEMA3C. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bista M, Agrawal S, Agrawal Y. Dyschromatosis Universalis Hereditaria. Kathmandu Univ Med J (KUMJ) 2021; 19:146-147. [PMID: 34812175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Dyschromatosis universalis hereditaria (DUH) is a rare pigmentary genodermatosis usually inherited in autosomal dominant fashion characterized by multiple pinpoint to pea-sized hypo- and hyper-pigmented macules arranged in reticulate pattern that develops within the first few years of life. An 11 years old boy presented with multiple gradually progressive asymptomatic hypopigmented macules on hyperpigmented background on trunk, extremities and face since 2 years of age. Family history was absent. Punch biopsies revealed increased number of melanocytes in the epidermis with basal cell vacuolar alteration and pigmentary incontinence and perivascular infiltration by lymphocytes and melanophages in the dermis. We herein present a sporadic case of dyschromatosis universalis hereditaria.
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Affiliation(s)
- M Bista
- Department of Dermatology and Venerology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - S Agrawal
- Department of Dermatology and Venerology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Y Agrawal
- Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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31
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Agrawal S, Gaikwad S, Patel R, Shinde L, Deshmukh A. Synthesis and Formulation Development of Phenytoin by Inclusion Complexation. Indian J Pharm Sci 2021. [DOI: 10.36468/pharmaceutical-sciences.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Agrawal S, Pestell CF, Granich J, Rao S, Nathan E, Wray JA, Whitehouse AJO, Patole S. Difficulties in developmental follow-up of preterm neonates in a randomised-controlled trial of Bifidobacterium breve M16-V - Experience from Western Australia. Early Hum Dev 2020; 151:105165. [PMID: 32871454 DOI: 10.1016/j.earlhumdev.2020.105165] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/20/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Probiotics may be neuroprotective for preterm neonates due to their anti-inflammatory effects and ability to facilitate nutrition. AIM To assess long-term effects of early probiotic supplementation on neuropsychological development in preterm infants. STUDY DESIGN Follow up study. SUBJECTS Children at age 3 to 5 years who had participated as preterm infants (<33 week) in the randomised controlled trial. OUTCOMES Primary: Continuous early learning composite measure derived from the Mullen's Scale of Early Learning (MSEL). Other outcomes were assessed by the Developmental, Dimensional and Diagnostic Interview, Developmental NEuroPSYchological assessment-2nd Edition, Parental questionnaires using children's communication checklist-2nd edition, social responsiveness scale, and Vineland Adaptive Behavioural Scales-2nd edition. MEASURES Continuous scores derived from all the measures. RESULTS 67 children of the 159 participants (42%) (Probiotic: 36/79, Placebo: 31/80) were followed-up for at least one neuropsychological assessment. All six assessments were completed in 18/31 (58.1%) of the control vs. 11/36 (30.6%) probiotic group children. Multivariable analysis of MSEL composite score showed no evidence of probiotic effect univariately, or after adjustment for gestation, intrauterine growth restriction, Apgar <7 at 5 min and age at assessment (adjusted mean effect in probiotic group: -2.7, 95% CI -8.5-3.0, p = 0.349). CONCLUSION There was no significant effect on neurodevelopment of children assessed at the age of 3 to 5 years who participated as preterm neonates in the RCT of B. breve M-16V. The validity of these results is limited by the reduced sample size due to high rate of loss to follow up.
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Affiliation(s)
- S Agrawal
- Neonatal Directorate, KEM Hospital for Women, 374 Bagot Road, Subiaco, WA, Australia.
| | - C F Pestell
- School of Psychological Science, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - J Granich
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - S Rao
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Neonatal Pediatrics, Perth Children Hospital, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - E Nathan
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital for Women, 374, Bagot Road, Subiaco, Perth, WA, Australia
| | - J A Wray
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Child Development Centre, 4/16 Rheola St, West Perth, WA 6005, Australia
| | - A J O Whitehouse
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - S Patole
- Neonatal Directorate, KEM Hospital for Women, 374 Bagot Road, Subiaco, WA, Australia; School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia
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Saini S, Agrawal S, Stockford B, Bruce R, Amin R, Shaikh S, Katato G, Pansare M. P406 SURVEY EXPLORING BARRIERS TO ALLERGY CLINIC VISITS IN AN URBAN PEDIATRIC SUBSPECIALTY CENTER. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
RNA therapeutics are finally taking their place as a main drug category alongside small molecules and proteins. Here, we follow the twists and turns on their road to success and highlight areas of ongoing research.
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Affiliation(s)
- Sudhir Agrawal
- University of Massachusetts Medical School, Department of Medicine, Worcester, MA 01655, USA; Arnay Sciences LLC, Shrewsbury, MA 01545, USA.
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Shinar S, Blaser S, Chitayat D, Selvanathan T, Chau V, Shannon P, Agrawal S, Ryan G, Pruthi V, Miller SP, Krishnan P, Van Mieghem T. Long-term postnatal outcome of fetuses with prenatally suspected septo-optic dysplasia. Ultrasound Obstet Gynecol 2020; 56:371-377. [PMID: 32196785 PMCID: PMC7496228 DOI: 10.1002/uog.22018] [Citation(s) in RCA: 4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Septo-optic dysplasia (SOD) is a clinical syndrome characterized by varying combinations of optic nerve hypoplasia, pituitary gland hypoplasia and abnormal cavum septi pellucidi. It is suspected on prenatal imaging when there is non-visualization or hypoplasia of the septal leaflets. Long-term postnatal outcomes of fetuses with prenatally suspected SOD have been documented poorly. The aims of this study were to describe the natural history of deficient septal leaflets, to quantify the incidence of postnatally confirmed SOD and to document the visual, endocrine and long-term neurodevelopmental outcomes of these infants. METHODS This was an observational retrospective study of all fetuses with prenatal imaging showing isolated septal agenesis, assessed at a single tertiary center over an 11-year period. Pregnancy, delivery and neonatal outcomes and pre- and postnatal imaging findings were reviewed. Neonatal evaluations or fetal autopsy reports were assessed for confirmation of SOD. Ophthalmologic, endocrine, genetic and long-term developmental evaluations were assessed. Imaging findings and outcome were compared between infants with and those without postnatally confirmed SOD. RESULTS Of 214 fetuses presenting with septal absence on prenatal ultrasound and magnetic resonance imaging (MRI), 18 (8.4%) were classified as having suspected isolated septal agenesis suspicious for SOD. Uniform prenatal MRI findings in cases with suspected SOD included remnants of the leaflets of the cavum septi pellucidi, fused forniceal columns, normal olfactory bulbs and tracts and a normal optic chiasm. Twelve fetuses were liveborn and five (27.8%) had postnatally confirmed SOD. Only two of these five fetuses had additional prenatal imaging features (pituitary cyst, microphthalmia and optic nerve hypoplasia) supporting a diagnosis of SOD. The other three confirmed SOD cases had no predictive prenatal or postnatal imaging findings that reliably differentiated them from cases without confirmed SOD. Visual and endocrine impairments were present in two (40%) and four (80%) cases with confirmed SOD, respectively. In those with visual and/or endocrine impairment, developmental delay (median age at follow-up, 2.5 (interquartile range, 2.5-7.0) years) was common (80%) and mostly severe. Neonates with isolated septal agenesis and a lack of visual or endocrine abnormalities to confirm SOD had normal development. CONCLUSIONS Only a quarter of fetuses with isolated septal agenesis suggestive of SOD will have postnatal confirmation of the diagnosis. Clinical manifestations of SOD are variable, but neurodevelopmental delay may be more prevalent than thought formerly. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. Shinar
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - S. Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical ImagingUniversity of TorontoTorontoONCanada
| | - D. Chitayat
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
- Division of Clinical and Metabolic Genetics, Hospital for Sick ChildrenUniversity of TorontoTorontoONCanada
| | - T. Selvanathan
- Department of PaediatricsHospital for Sick Children and University of TorontoTorontoONCanada
| | - V. Chau
- Department of PaediatricsHospital for Sick Children and University of TorontoTorontoONCanada
| | - P. Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - S. Agrawal
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - G. Ryan
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - V. Pruthi
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
| | - S. P. Miller
- Department of PaediatricsHospital for Sick Children and University of TorontoTorontoONCanada
| | - P. Krishnan
- Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical ImagingUniversity of TorontoTorontoONCanada
| | - T. Van Mieghem
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai HospitalUniversity of TorontoTorontoONCanada
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Abstract
PURPOSE OF REVIEW Current bariatric surgical practice has developed from early procedures, some of which are no longer routinely performed. This review highlights how surgical practice in this area has developed over time. RECENT FINDINGS This review outlines early procedures including jejuno-colic and jejuno-ileal bypass, initial experience with gastric bypass, vertical banded gastroplasty and biliopancreatic diversion with or without duodenal switch. The role laparoscopy has played in the widespread utilization of surgery for treatment of obesity will be described, as will the development of procedures which form the mainstay of current bariatric surgical practice including gastric bypass, sleeve gastrectomy and adjustable gastric banding. Endoscopic therapies for the treatment of obesity will be described. By outlining how bariatric surgical practice has developed over time, this review will help practicing surgeons understand how individual procedures have evolved and also provide insight into potential future developments in this field.
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Affiliation(s)
- T Wiggins
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - M S Majid
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - S Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Cho J, Mak A, Agrawal S, Dhanasekaran P, Teoh LK, Cheung P, Lahiri M. FRI0033 ANTI-CARBAMYLATED PROTEIN POSITIVITY PREDICTS DAS28-REMISSION AT 12 MONTHS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: RESULTS FROM THE SINGAPORE EARLY ARTHRITIS COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3039] [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
Background:Anti-carbamylated protein antibody (anti-carp) positivity has been associated with poorer outcomes in Western cohorts of early rheumatoid arthritis; however, it is unknown if this applies to Asians.Objectives:We determined whether anti-carp predicted DAS28-remission, disability and radiographic progression in a multi-ethnic Asian ERA cohort.Methods:Patients with physician diagnosed ERA (symptom duration ≤1 year) were recruited from the Singapore Early Arthritis Cohort (n= 317) by convenience sampling. Serum anti-carp was measured cross-sectionally using a commercial ELISA (SincereBio). The test was repeated in 40 healthy individuals to establish the optimal sensitivity and specificity for the diagnosis of RA via a receiver operating curve. Disease activity (DAS28-ESR or DAS28-CRP) was recorded at baseline, 3, 6 and 12 months. Two independent accessors quantified the radiographic damage at baseline and at follow-up using the modified Sharp van der Heijde score (mSS). We used multivariable logistic regression to determine whether anti-carp predicted the following outcomes; (i) DAS-28 remission at 12 months, (ii) any disability (mHAQ>0) at 12 months and (iii) radiographic progression (any increase in the mSS). In each regression model, we chose covariates known to influence the dependent variable in our cohort or from literature.Results:One hundred patients were recruited, of mean age (SD) 49.8 (12.5) years, median (IQR) disease duration 10.2 (6.9-15.1) weeks at cohort entry and baseline median DAS-28 4.5 (2.9-5.9) (Table 1). The anti-carp assay was performed after a median (IQR) disease duration of 2.24 (1.82-3.14) years. 93 patients had baseline hand radiographs and 66 had follow-up hand radiographs after ≥ 12 months. Receiver operating characteristics curve yielded optimal sensitivity (95%) and specificity (60%) for the diagnosis of RA at 1.60OD. Therefore, 60 patients were anti-carp positive and 35 patients (37.2%) were positive for RF, ACPA and anti-carp (Figure 1). Anti-carp positivity independently predicted DAS28-remission at 12 months (OR 3.41, 95% CI 1.08-10.7,p=0.04) (Table 2). Anti-carp positivity did not predict disability at 12 months (OR 0.61, 95% CI 0.18-2.07,p=0.43) or radiographic progression (OR 0.23, 95% CI 0.03-2.03,p=0.18).Table 1.Predictors of DAS28-remission at 12 monthsVariableN (%)Univariable Logistic RegressionMultivariable Logistic RegressionORpOR (CI)SEpAnti-carp60 (60)3.0 (1.31−6.88)0.013.41 (1.08−10.7)1.990.04SerologyRF and ACPA negative31 (33.0)RefEither RF or ACPA positive11 (11.7)0.99 (0.25−3.93)0.991.10 (0.17−7.04)1.040.92RF and ACPA positive52 (55.3)1.12 (0.45−2.75)0.800.89 (0.28−2.81)0.520.84Baseline DAS28Remission17 (17.4)RefLow DA10 (10.2)0.50 (0.05−4.67)0.540.13 (0.01−1.67)0.170.12Mod DA32 (32.7)0.29 (0.05−1.65)0.160.10 (0.02−0.68)0.100.02High DA39 (39.8)0.18 (0.04−0.90)0.040.06 (0.01−0.41)0.06<0.01Combination csDMARDs or biologic DMARD74 (74)1.13 (0.46−2.76)0.801.97 (0.58−6.67)1.230.28Radiographic damage at baseline11 (20)1.79 (0.65−4.95)0.261.27 (0.33-4.95)0.880.73Tertiary education23 (38.3)0.77 (0.34-1.77)0.540.42 (0.12-1.45)0.270.17EthnicityChinese42 (70)RefMalay39 (68.4)0.61 (0.22-1.71)0.350.56 (0.14-2.25)0.400.41Indian8 (13.3)0.60 (0.20-1.77)0.350.79 (0.20-3.13)0.560.74Females46 (76.7)0.43 (0.17-1.11)0.080.48 (0.13-1.85)0.330.29Conclusion:Contrary to previous studies done on Western cohorts where anti-carp predicted worse outcomes, anti-carp positivity predicted DAS28-remission at 12 months in our multi-ethnic Asian cohort. This suggests that different genetic and environmental determinants account for anti-carp expression in patients with RA.Disclosure of Interests:Jiacai Cho: None declared, Anselm Mak Speakers bureau: Professor Anselm Mak has been paid as a speaker for Johnson & Johnson., Sachin Agrawal: None declared, Preeti Dhanasekaran: None declared, Lay Kheng Teoh: None declared, Peter Cheung: None declared, Manjari Lahiri Grant/research support from: Manjari Lahiri is the site principal investigator for the Singapore National Biologics Register, which is a multi-pharmaceutical funded register, in which industry sponsors provide support through the Chapter of Rheumatologists, Singapore. Dr Lahiri does not personally receive any remuneration.
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Thapa S, Agrawal S, Kryger M. 0707 “What We’Ve Got Here Is Failure To Communicate”: Apnea Patients And Their DME Suppliers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.703] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Successful treatment of obstructive sleep apnea requires adherence to positive airway pressure (PAP) therapy. A key factor is the relationship between the DME provider and the patient so that treatment can be initiated and continued in a timely manner. Our quality improvement project aims to empower and enable patients towards active participation in their sleep apnea care. Our goal is to ultimately increase patients’ knowledge of their Durable Medical Equipment (DME) supplies company, and thus improve their treatment. The first step was to determine patients’ familiarity with their DME.
Methods
Forty-one patients with sleep apnea on PAP therapy volunteered to be questioned about their DME company during clinic visits at the Yale North Haven Sleep Center, Connecticut, starting November 2019. Patients were asked if they knew the name or the contact of their DME; whether they received adequate training on PAP therapy initiation; if they were receiving timely and correct PAP therapy supplies. They were asked to rate their satisfaction with the DME on a scale of 1 to 5; one being very dissatisfied and five being very satisfied.
Results
Only 12 out of 41 patients (29.3 percent) knew the names of their DME companies. The average satisfaction rating was 3 (neutral); 44% of patients were dissatisfied, or very dissatisfied with the performance of their DME. Detailed comments were mostly related to poor contact and communication with the DME.
Conclusion
Most apnea patients had difficulty identifying and contacting their DME. As the next step of this quality improvement project we plan to intervene to ensure that the patients have the name and contact information of their DME available and attached to their PAP machine equipment. We plan to repeat this questionnaire after this intervention to study the impact of this quality improvement project.
Support
None
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Affiliation(s)
- S Thapa
- Yale University, New Haven, CT
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Rohani SA, Allen D, Gare B, Zhu N, Agrawal S, Ladak H. High-resolution imaging of the human incudostapedial joint using synchrotron-radiation phase-contrast imaging. J Microsc 2020; 277:61-70. [PMID: 31989597 DOI: 10.1111/jmi.12864] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
The incudostapedial joint (ISJ) of the middle ear is important for proper transmission of sound energy to the cochlea. Recently, the biomechanics of the ISJ have been investigated using finite-element (FE) modelling, using simplified geometry. The objective of the present study was to investigate the feasibility of synchrotron-radiation phase-contrast imaging (SR-PCI) in visualising the ISJ ultrastructure. Three human cadaveric ISJs were dissected and scanned using SR-PCI at 0.9 µm isotropic voxel size. One of the samples was previously scanned at 9 µm voxel size. The images were visually compared and contrast-to-noise ratios (CNRs) were calculated (of both bone and soft tissues) for quantitative comparisons. The ISJ ultrastructure as well as adjacent bone and soft tissues were clearly visible in images with a 0.9 µm voxel size. The CNRs of the 0.9 µm images were relatively lower than those of the 9 µm scans, while the ratio of bone to soft tissue CNRs were higher, indicating better discernibility of bone from soft tissue in the 0.9 µm scans. This study was the first known attempt to image the ISJ ultrastructure using an SR-PCI scanner at submicron voxel size and results suggest that this method was successful. Future studies are needed to optimise the contrast and test the feasibility of imaging the ISJ in situ. LAY DESCRIPTION: The human middle ear consists of the eardrum, three small bones (the malleus, incus and stapes) and two joints connecting the bones (the incudostapedial joint and the incudomallear joint). The role of the middle ear is to amplify and transfer sound energy to the cochlea, the end organ of hearing. The incudostapedial joint (ISJ) of the middle ear is a synovial joint which is important for proper transmission of sound energy to the cochlea. Similar to other synovial joints it consists of meniscus, fluid and articulating surfaces. Recently, the biomechanics of the ISJ have been investigated using computational models, using grossly simplified geometry. Synchrotron radiation phase contrast imaging (SR-PCI) is a high-resolution imaging technique used to visualise small structures in three dimensions. The objective of the present study was to investigate the feasibility of using SR-PCI in visualising the ISJ ultrastructure. Three human cadaveric ISJs were dissected and scanned using SR-PCI at 0.9 µm isotropic voxel size. One of the samples was previously scanned at 9 µm voxel size. The images were both qualitatively and quantitatively compared. This study was the first known attempt to image the ISJ ultrastructure using an SR-PCI scanner at submicron voxel size and results suggest that this method was successful. Future studies are needed to optimise the contrast and feasibility of imaging the ISJ in situ.
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Affiliation(s)
- S A Rohani
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - D Allen
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - B Gare
- Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - N Zhu
- Bio-Medical Imaging and Therapy Facility, Canadian Light Source Inc., University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - H Ladak
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.,Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
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Dey D, Jingar P, Agrawal S, Shrivastava V, Bhattacharya A, Manhas J, Garg B, Ansari MT, Mridha AR, Sreenivas V, Khurana A, Sen S. Symphytum officinale augments osteogenesis in human bone marrow-derived mesenchymal stem cells in vitro as they differentiate into osteoblasts. J Ethnopharmacol 2020; 248:112329. [PMID: 31672526 DOI: 10.1016/j.jep.2019.112329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/05/2019] [Revised: 10/11/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mesenchymal stem cells (MSCs) are multipotent stem cells possessing regenerative potential. Symphytum officinale (SO) is a medicinal plant and in homoeopathic literature, believed to accelerate bone healing. AIM OF THE STUDY This study aimed to determine if homoeopathic doses of SO could augment osteogenesis in MSCs as they differentiate into osteoblasts in vitro. MATERIALS AND METHODS Bone marrow samples were obtained from patients who underwent bone grafting procedures (n = 15). MSCs were isolated, expanded and characterized by flow cytometry (CD90, CD105). Cytotoxicity of SO was evaluated by MTT assay. Osteogenic differentiation was induced in MSCs with β-glycerophosphate, ascorbic acid and dexamethasone over 2 weeks. Different homoeopathic doses of SO (MT, 3C, 6C, 12C and 30C) were added to the basic differentiation medium (BDM) and efficiency of MSCs differentiating into osteoblasts were measured by evaluating expression of Osteocalcin using flow cytometry, and alkaline phosphatase activity using ELISA. Gene expression analyses for osteoblast markers (Runx-2, Osteopontin and Osteocalcin) were evaluated in differentiated osteoblasts using qPCR. RESULTS Flow cytometry (CD90, CD105) detected MSCs isolated from bone marrow (93-98%). MTT assay showed that the selected doses of SO did not induce any cytotoxicity in MSCs (24 hours). The efficiency of osteogenic differentiation (2 weeks) for different doses of Symphytum officinale was determined by flow cytometry (n = 10) for osteoblast marker, Osteocalcin, and most doses of Symphytum officinale enhanced osteogenesis. Interestingly, gene expression analysis for Runx-2 (n = 10), Osteopontin (n = 10), Osteocalcin (n = 10) and alkaline phosphatase activity (n = 8) also showed increased osteogenesis with the addition of Symphytum officinale to BDM, specially mother tincture. CONCLUSIONS Our findings suggest that homoeopathic dose (specially mother tincture) of Symphytum officinale has the potential to enhance osteogenesis.
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Affiliation(s)
- D Dey
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - P Jingar
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - S Agrawal
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - V Shrivastava
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - A Bhattacharya
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - J Manhas
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - B Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - M T Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - A Khurana
- Central Council for Research in Homoeopathy, New Delhi, India
| | - S Sen
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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Wiggins T, Majid MS, Markar SR, Loy J, Agrawal S, Koak Y. Benefits of barbed suture utilisation in gastrointestinal anastomosis: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:153-159. [PMID: 31508982 PMCID: PMC6996435 DOI: 10.1308/rcsann.2019.0106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Accepted: 06/09/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Anastomosis formation constitutes a critical aspect of many gastrointestinal procedures. Barbed suture materials have been adopted by some surgeons to assist in this task. This systematic review and meta-analysis compares the safety and efficacy of barbed suture material for anastomosis formation compared with standard suture materials. METHODS An electronic search of Embase, Medline, Web of Science and Cochrane databases was performed. Weighted mean differences were calculated for effect size of barbed suture material compared with standard material on continuous variables and pooled odds ratios were calculated for discrete variables. FINDINGS There were nine studies included. Barbed suture material was associated with a significant reduction in overall operative time (WMD: -12.87 (95% CI = -20.16 to -5.58) (P = 0.0005)) and anastomosis time (WMD: -4.28 (95% CI = -6.80 to -1.75) (P = 0.0009)). There was no difference in rates of anastomotic leak (POR: 1.24 (95% CI = 0.89 to 1.71) (P = 0.19)), anastomotic bleeding (POR: 0.80 (95% CI = 0.29 to 2.16) (P = 0.41)), or anastomotic stricture (POR: 0.72 (95% CI = 0.21 to 2.41) (P = 0.59)). CONCLUSIONS Use of barbed sutures for gastrointestinal anastomosis appears to be associated with shorter overall operative times. There was no difference in rates of complications (including anastomotic leak, bleeding or stricture) compared with standard suture materials.
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Affiliation(s)
- T Wiggins
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - MS Majid
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - SR Markar
- Department of Surgery and Cancer, Imperial College London, UK
| | - J Loy
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - S Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
| | - Y Koak
- Department of Bariatric Surgery, Homerton University Hospital, London, UK
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Shaw E, Majid M, Hope J, Savory S, Perkins T, White J, Boulger A, Halst S, Agrawal S, Bennett J, Tufail M. A patients’ satisfaction survey on speed of the Leicester optimal lung cancer pathway. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stockbridge A, Majid M, Dulloo S, Hope J, Bolger A, Young C, Knight K, Thiagarajan S, Agrawal S, Bronnert R, Bennett J, Ahmed S, Richards C, Tufail M. Early warning alert system for small cell lung cancer reduces time from diagnosis to treatment. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stockbridge A, Agarwal S, Sudhir R, Perkins T, Savory S, Pinglay P, Rao P, Das I, Brozik J, Machin R, Deshpande A, Bajaj A, Barnes D, Agrawal S, Bennett J, Tufail M. Optimal lung cancer pathway implementation in a tertiary care centre and its impact on reducing emergency presentations. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zhao X, Shen J, Ivaturi V, Gopalakrishnan M, Feng Y, Schmidt BJ, Statkevich P, Goodman V, Gobburu J, Bello A, Roy A, Agrawal S. Model-based evaluation of the efficacy and safety of nivolumab once every 4 weeks across multiple tumor types. Ann Oncol 2019; 31:302-309. [PMID: 31959348 DOI: 10.1016/j.annonc.2019.10.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 02/01/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nivolumab 480 mg every 4 weeks (Q4W) is approved in the European Union, United States, and several other markets across multiple tumor types. Its approval was supported by quantitative efficacy/safety analyses bridging to 3 mg/kg every 2 weeks (Q2W). PATIENTS AND METHODS The benefit-risk profile of nivolumab 480 mg Q4W relative to 3 mg/kg Q2W was evaluated using population pharmacokinetic modeling and exposure-response (E-R) analyses for safety and efficacy. Pharmacokinetic exposures were predicted for 3203 patients with melanoma, non-small-cell lung cancer (NSCLC), renal cell carcinoma (RCC), squamous cell carcinoma of the head and neck, urothelial carcinoma, or classical Hodgkin lymphoma. Quantitative models analyzed E-R to predict 480-mg Q4W safety across all indications and efficacy for melanoma, NSCLC, and RCC. Intratumoral receptor occupancy (RO) was predicted for parameters representing different tumor types. RESULTS Time-averaged concentrations for 480 mg Q4W versus 3 mg/kg Q2W were higher during the first 28 days (26.8%) and similar at steady state (5.2%). The maximum concentration (Cmax) after the first dose was higher (110.4%), and the trough concentration at day 28 was lower (-22.1%) with 480 mg Q4W versus 3 mg/kg Q2W. The Cmax achieved with 480 mg Q4W was lower than the previously established safe dose of 10 mg/kg Q2W. The probability of adverse events for key safety end points was similar for 480 mg Q4W and 3 mg/kg Q2W. The predicted overall survival and objective response rates with 480 mg Q4W were comparable to 3 mg/kg Q2W. The predicted high intratumoral RO provided additional evidence to support 480 mg Q4W across tumor types. CONCLUSIONS The benefit-risk profile for nivolumab 480 mg Q4W was predicted to be similar to that of 3 mg/kg Q2W across tumor types while providing a convenient and flexible option for patients and their caregivers.
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Affiliation(s)
- X Zhao
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - J Shen
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - V Ivaturi
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, USA
| | - M Gopalakrishnan
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, USA
| | - Y Feng
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - B J Schmidt
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - P Statkevich
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - V Goodman
- Oncology Clinical Development, Bristol-Myers Squibb, Princeton, USA
| | - J Gobburu
- Center for Translational Medicine, School of Pharmacy, University of Maryland, Baltimore, USA
| | - A Bello
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - A Roy
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton, USA
| | - S Agrawal
- Oncology Clinical Development, Bristol-Myers Squibb, Princeton, USA.
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Long GV, Tykodi SS, Schneider JG, Garbe C, Gravis G, Rashford M, Agrawal S, Grigoryeva E, Bello A, Roy A, Rollin L, Zhao X. Assessment of nivolumab exposure and clinical safety of 480 mg every 4 weeks flat-dosing schedule in patients with cancer. Ann Oncol 2019; 29:2208-2213. [PMID: 30215677 PMCID: PMC6290887 DOI: 10.1093/annonc/mdy408] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background A nivolumab monotherapy flat-dosing regimen of 480 mg every 4 weeks (Q4W) has been approved in several markets, including the United States, Canada, and European Union, as an alternative dosing regimen for several indications. Approvals of this Q4W regimen were based on population pharmacokinetic (PK) analyses, established flat exposure–response relationships, and clinical safety. The objective of this study was to compare the PK exposure of 480 mg Q4W with 3 mg/kg every 2 weeks (Q2W) and 240 mg Q2W using modeling and simulation, and to evaluate clinical safety of the Q4W regimen. Patients and methods Nivolumab PK exposure for the 480 mg Q4W schedule was simulated for 3817 patients across multiple tumor types and compared with those for the 3 mg/kg Q2W and 240 mg Q2W schedules. The safety profile of the Q4W schedule was assessed by analysis of clinical data from 61 patients who transitioned to nivolumab 480 mg Q4W from 3 mg/kg Q2W during four phase III clinical trials. Results Compared with 3 mg/kg Q2W, nivolumab 480 mg Q4W produced similar time-averaged concentration, approximately 16% lower trough concentration, and 45% higher peak concentration at steady state. The peak concentration for 480 mg Q4W was significantly lower than that of 10 mg/kg Q2W, a dose previously shown to have an acceptable tolerability and safety profile. Treatment-related adverse events (TRAEs) that started after transitioning from 3 mg/kg Q2W to 480 mg Q4W were reported in 14.8% of patients, with 1.6% of patients reporting grades 3–4 TRAEs. Pooled safety data for these patients are consistent with those for the 3 mg/kg Q2W schedules, and no new safety signals were identified. Conclusions The time-averaged steady-state exposure and safety profile of nivolumab 480 mg Q4W are consistent with that of 3 mg/kg Q2W across multiple tumor types. Nivolumab 480 mg Q4W represents a new dosing schedule option, and in addition to 240 mg Q2W, provides convenience and flexibility for patient care. Clinical trial numbers NCT01721772, NCT01668784, NCT01673867, NCT01642004
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Affiliation(s)
- G V Long
- Department of Medicine, Melanoma Institute Australia, The University of Sydney, Sydney; Department of Medical Oncology, Royal North Shore Hospital, Sydney; Department of Medical Oncology, Mater Hospital, Sydney, Australia.
| | - S S Tykodi
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle
| | - J G Schneider
- Department of Hematology and Oncology, NYU Winthrop Hospital, Mineola, USA
| | - C Garbe
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - G Gravis
- Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille, INSERM UMR 1068, Marseille; Department of Medical Oncology, Centre National de la Recherche Scientifique UMR 7258, Marseille; Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - M Rashford
- Oncology Clinical Development, Bristol-Myers Squibb, Princeton
| | - S Agrawal
- Oncology Clinical Development, Bristol-Myers Squibb, Princeton
| | - E Grigoryeva
- Oncology Clinical Development, Bristol-Myers Squibb, Princeton
| | - A Bello
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton
| | - A Roy
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton
| | - L Rollin
- Global Biometric Sciences, Bristol-Myers Squibb, Princeton, USA
| | - X Zhao
- Clinical Pharmacology & Pharmacometrics, Bristol-Myers Squibb, Princeton
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Pandey D, Agrawal S, Pokharel S. Acute Primary Tuberculous Ulcer of Glans Penis. Kathmandu Univ Med J (KUMJ) 2019; 17:344-346. [PMID: 33311047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute primary tuberculous ulcer of glans penis is a rare entity even in the endemic region. We present a 55 year old male with multiple undermined ulcers for short duration of 4 weeks with raised erythrocyte sedimentation rate, negative Mantoux test and histopathology revealed a diagnosis of tuberculous ulcer which responded well to antitubercular therapy.
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Affiliation(s)
- D Pandey
- Department of Dermatology and Venereology, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S Agrawal
- Department of Dermatology and Venereology, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S Pokharel
- Department of Pathology, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Abstract
Recently, it has become clear that the tumour microenvironment (TME) is important in cancer immunotherapy. While immune checkpoint inhibitors are effective for some patients, the heterogeneous nature and status of the TME (‘cold’ tumours) play a critical role in suppressing antitumour immunity in non-responding patients. Converting ‘cold’ to ‘hot’ tumours through modulation of the TME may enable expansion of the therapeutic efficacy of immunotherapy to a broader patient population. This paper describes advances in intratumoural immunotherapy, specifically activation of nucleic acid sensing pattern recognition receptors to modulate the TME. Intratumoural immunotherapy to modulate the tumour microenvironment. Use of novel immunostimulatory agents which activate nucleic acid sensing pattern recognition receptors. Harnessing innate and adaptive immunity induced by receptor-mediated immune cascade. Intratumoural therapy leads to local and anenestic tumour responses.
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Affiliation(s)
- Sudhir Agrawal
- University of Massachusetts Medical School, Department of Medicine, Worcester, USA
- ARNAY Sciences LLC, Shrewsbury, USA
- Corresponding author. Sudhir Agrawal, University of Massachusetts Medical School, Department of Medicine, 55 N Lake Ave, Worcester, MA 01655, USA.
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Spain L, Gallegos L, Tippu Z, Hill S, Litchfield K, Au L, Gilchrist A, Primus V, Barhoumi A, Stanislaw S, Agrawal S, Shaikh N, Patel N, Mendoza MF, Noel-Storr G, Larkin J, Alexander N, Turajlic S. Homogenisation of leftover surgical tissue across multiple cancer types: A feasibility study (HoLST-F). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Campbell S, Agrawal S, Tom M, Efstathiou J, Zietman A, Michalski J, Abramowitz M, Pollack A, Spratt D, Hearn J, Stephans K, Tendulkar R. Impact of Post-Prostatectomy Prostate Specific Antigen (PSA) Kinetics on Outcomes of Salvage Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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