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Naidu A, Garg V, Balakrishnan D, C R V, Sundararajan V, Lulu S S. Systems and Computational Screening identifies SRC and NKIRAS2 as Baseline Correlates of Risk (CoR) for Live Attenuated Oral Typhoid Vaccine (TY21a) associated Protection. Mol Immunol 2024; 169:99-109. [PMID: 38552286 DOI: 10.1016/j.molimm.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
AIM We investigated the molecular underpinnings of variation in immune responses to the live attenuated typhoid vaccine (Ty21a) by analyzing the baseline immunological profile. We utilized gene expression datasets obtained from the Gene Expression Omnibus (GEO) database (accession number: GSE100665) before and after immunization. We then employed two distinct computational approaches to identify potential baseline biomarkers associated with responsiveness to the Ty21a vaccine. MAIN METHODS The first pipeline (knowledge-based) involved the retrieval of differentially expressed genes (DEGs), functional enrichment analysis, protein-protein interaction network construction, and topological network analysis of post-immunization datasets before gauging their pre-vaccination expression levels. The second pipeline utilized an unsupervised machine learning algorithm for data-driven feature selection on pre-immunization datasets. Supervised machine-learning classifiers were employed to computationally validate the identified biomarkers. KEY FINDINGS Baseline activation of NKIRAS2 (a negative regulator of NF-kB signalling) and SRC (an adaptor for immune receptor activation) was negatively associated with Ty21a vaccine responsiveness, whereas LOC100134365 exhibited a positive association. The Stochastic Gradient Descent (SGD) algorithm accurately distinguished vaccine responders and non-responders, with 88.8%, 70.3%, and 85.1% accuracy for the three identified genes, respectively. SIGNIFICANCE This dual-pronged novel analytical approach provides a comprehensive comparison between knowledge-based and data-driven methods for the prediction of baseline biomarkers associated with Ty21a vaccine responsiveness. The identified genes shed light on the intricate molecular mechanisms that influence vaccine efficacy from the host perspective while pushing the needle further towards the need for development of precise enteric vaccines and on the importance of pre-immunization screening.
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Affiliation(s)
- Akshayata Naidu
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Varin Garg
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Deepna Balakrishnan
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Vinaya C R
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Vino Sundararajan
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India..
| | - Sajitha Lulu S
- Integrative Multi Omics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India..
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Grant M, McCarthy D, Kearney C, Collins A, Sundararajan V, Rhee J, Philip J, Emery J. Primary care usage at the end of life: a retrospective cohort study of cancer patients using linked primary and hospital care data. Support Care Cancer 2024; 32:273. [PMID: 38587665 PMCID: PMC11001688 DOI: 10.1007/s00520-024-08458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Health service use is most intensive in the final year of a person's life, with 80% of this expenditure occurring in hospital. Close involvement of primary care services has been promoted to enhance quality end-of-life care that is appropriate to the needs of patients. However, the relationship between primary care involvement and patients' use of hospital care is not well described. This study aims to examine primary care use in the last year of life for cancer patients and its relationship to hospital usage. METHODS Retrospective cohort study in Victoria, Australia, using linked routine care data from primary care, hospital and death certificates. Patients were included who died related to cancer between 2008 and 2017. RESULTS A total of 758 patients were included, of whom 88% (n = 667) visited primary care during the last 6 months (median 9.1 consultations). In the last month of life, 45% of patients were prescribed opioids, and 3% had imaging requested. Patients who received home visits (13%) or anticipatory medications (15%) had less than half the median bed days in the last 3 months (4 vs 9 days, p < 0.001, 5 vs 10 days, p = 0.001) and 1 month of life (0 vs 2 days, p = 0.002, 0 vs 3 days, p < 0.001), and reduced emergency department presentations (32% vs 46%, p = 0.006, 31% vs 47% p < 0.001) in the final month. CONCLUSION This study identifies two important primary care processes-home visits and anticipatory medication-associated with reduced hospital usage and intervention at the end of life.
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Affiliation(s)
- M Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia.
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia.
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands.
| | - D McCarthy
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - C Kearney
- Dept of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - A Collins
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - V Sundararajan
- La Trobe University, Public Health, Melbourne, Australia
| | - J Rhee
- Discipline of General Practice, School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - J Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - J Emery
- Centre of Expertise in Palliative Care Utrecht, Department of General Practice, Julius Centre, UMC Utrecht, Universiteitsweg 100, 3584CG, Utrecht, The Netherlands
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Sasikumar DSN, Thiruselvam P, Sundararajan V, Ravindran R, Gunasekaran S, Madathil D, Kaliamurthi S, Peslherbe GH, Selvaraj G, Sudhakaran SL. Insights into dietary phytochemicals targeting Parkinson's disease key genes and pathways: A network pharmacology approach. Comput Biol Med 2024; 172:108195. [PMID: 38460310 DOI: 10.1016/j.compbiomed.2024.108195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/26/2024] [Accepted: 02/18/2024] [Indexed: 03/11/2024]
Abstract
Parkinson's disease (PD) is a complex neurological disease associated with the degeneration of dopaminergic neurons. Oxidative stress is a key player in instigating apoptosis in dopaminergic neurons. To improve the survival of neurons many dietary phytochemicals have gathered significant attention recently. Thus, the present study implements a comprehensive network pharmacology approach to unravel the mechanisms of action of dietary phytochemicals that benefit disease management. A literature search was performed to identify ligands (i.e., comprising dietary phytochemicals and Food and Drug Administration pre-approved PD drugs) in the PubMed database. Targets associated with selected ligands were extracted from the search tool for interactions of chemicals (STITCH) database. Then, the construction of a gene-gene interaction (GGI) network, analysis of hub-gene, functional and pathway enrichment, associated transcription factors, miRNAs, ligand-target interaction network, docking were performed using various bioinformatics tools together with molecular dynamics (MD) simulations. The database search resulted in 69 ligands and 144 unique targets. GGI and subsequent topological measures indicate histone acetyltransferase p300 (EP300), mitogen-activated protein kinase 1 (MAPK1) or extracellular signal-regulated kinase (ERK)2, and CREB-binding protein (CREBBP) as hub genes. Neurodegeneration, MAPK signaling, apoptosis, and zinc binding are key pathways and gene ontology terms. hsa-miR-5692a and SCNA gene-associated transcription factors interact with all the 3 hub genes. Ligand-target interaction (LTI) network analysis suggest rasagiline and baicalein as candidate ligands targeting MAPK1. Rasagiline and baicalein form stable complexes with the Y205, K330, and V173 residues of MAPK1. Computational molecular insights suggest that baicalein and rasagiline are promising preclinical candidates for PD management.
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Affiliation(s)
- Devi Soorya Narayana Sasikumar
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, TN, 632014, India
| | - Premkumar Thiruselvam
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, TN, 632014, India
| | - Vino Sundararajan
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, TN, 632014, India
| | - Radhika Ravindran
- Department of Biotechnology, Indian Institute of Technology (Madras), Chennai, TN, 600036, India
| | - Shoba Gunasekaran
- Department of Biotechnology, Dwaraka Doss Goverdhan Doss Vaishnav College, Chennai, TN, 600106, India
| | - Deepa Madathil
- Jindal Institute of Behavioral Sciences, O.P Jindal Global University, Sonipat, Haryana, 131001, India
| | - Satyavani Kaliamurthi
- Centre for Research in Molecular Modeling (CERMM), Department of Chemistry and Biochemistry, Concordia University, Loyola Campus, Montreal, QC, H4B 1R6, Canada
| | - Gilles H Peslherbe
- Centre for Research in Molecular Modeling (CERMM), Department of Chemistry and Biochemistry, Concordia University, Loyola Campus, Montreal, QC, H4B 1R6, Canada
| | - Gurudeeban Selvaraj
- Centre for Research in Molecular Modeling (CERMM), Department of Chemistry and Biochemistry, Concordia University, Loyola Campus, Montreal, QC, H4B 1R6, Canada; Bioinformatics Unit, Department of Biomaterials, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS) University, Chennai, TN, 600077, India.
| | - Sajitha Lulu Sudhakaran
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, TN, 632014, India.
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Nag S, Mitra O, Tripathi G, Adur I, Mohanto S, Nama M, Samanta S, Gowda BHJ, Subramaniyan V, Sundararajan V, Kumarasamy V. Nanomaterials-assisted photothermal therapy for breast cancer: State-of-the-art advances and future perspectives. Photodiagnosis Photodyn Ther 2024; 45:103959. [PMID: 38228257 DOI: 10.1016/j.pdpdt.2023.103959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
Breast cancer (BC) remains an enigmatic fatal modality ubiquitously prevalent in different parts of the world. Contemporary medicines face severe challenges in remediating and healing breast cancer. Due to its spatial specificity and nominal invasive therapeutic regime, photothermal therapy (PTT) has attracted much scientific attention down the lane. PTT utilizes a near-infrared (NIR) light source to irradiate the tumor target intravenously or non-invasively, which is converted into heat energy over an optical fibre. Dynamic progress in nanomaterial synthesis was achieved with specialized visual, physicochemical, biological, and pharmacological features to make up for the inadequacies and expand the horizon of PTT. Numerous nanomaterials have substantial NIR absorption and can function as efficient photothermal transducers. It is achievable to limit the wavelength range of an absorbance peak for specific nanomaterials by manipulating their synthesis, enhancing the precision and quality of PTT. Along the same lines, various nanomaterials are conjugated with a wide range of surface-modifying chemicals, including polymers and antibodies, which may modify the persistence of the nanomaterial and diminish toxicity concerns. In this article, we tend to put forth specific insights and fundamental conceptualizations on pre-existing PTT and its advances upon conjugation with different biocompatible nanomaterials working in synergy to combat breast cancer, encompassing several strategies like immunotherapy, chemotherapy, photodynamic therapy, and radiotherapy coupled with PTT. Additionally, the role or mechanisms of nanoparticles, as well as possible alternatives to PTT, are summarized as a distinctive integral aspect in this article.
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Affiliation(s)
- Sagnik Nag
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; Integrative Multiomics Lab, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences (JCSMHS), Monash University Malaysia, Bandar Sunway 47500 Selangor Darul Ehsan, Malaysia.
| | - Oishi Mitra
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; Integrative Multiomics Lab, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Garima Tripathi
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Israrahmed Adur
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Sourav Mohanto
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka 575018, India
| | - Muskan Nama
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Souvik Samanta
- Department of Bio-Sciences, School of Bio-Sciences & Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - B H Jaswanth Gowda
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka 575018, India; School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
| | - Vetriselvan Subramaniyan
- Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences (JCSMHS), Monash University Malaysia, Bandar Sunway 47500 Selangor Darul Ehsan, Malaysia.
| | - Vino Sundararajan
- Integrative Multiomics Lab, School of Bio-Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India.
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
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Sundararajan V, Devi C, Jayalakshmi R, Chockkalingam U, Sumathi M. EFFECTIVENESS OF ICE APPLICATION AT SELECTED ACUPOINT (LI-4) PRIOR TO INTRAMUSCULAR INJECTION ON LEVEL OF PAIN AMONG CHILDREN IN A SELECTED HOSPITAL, CHENNAI, TAMIL NADU, INDIA. Georgian Med News 2024:21-26. [PMID: 38501616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Immunization is an effective and safest way to prevent vaccine-preventable diseases and thereby reduce morbidity and mortality in children. Injections given for immunization are the most usual ground in order to abstract agony or pain, which is the fifth vital sign leading to long-term physically and psychologically detrimental effects. A basic experimental (control group only for post-test) design using the technique of probability of simple random sampling in order to obtain sample size 105 was conducted in an Immunization Clinic at a selected PHC, Tamil Nadu, India. Ice cube was applied for about 30 seconds that is enfolded with gauze and then injected intramuscularly to administer the IM vaccine. In order to assess the pain level, an observation checklist based on Children's Hospital Eastern Ontario pain scale and Wong Baker's Faces pain scale was used. The study results manifest the higher statistical difference in the level of children's pain between the control groups and the experimental groups at a significance level of p<0.001. In order to reduce the pain level, the application of ice at LI-4 acupoint is effective. The children who are being vaccinated pass through stressful events through the application of an intramuscular injection. The findings revealed that ice application at LI-4 acupoint was very effective in pain reduction, which is a simple, safe, non-invasive, very efficient, easy-to-administer intervention and cost-effective without side effects than any other pharmacological pain intervention.
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Affiliation(s)
- V Sundararajan
- 1Department of Pediatric and Neonatal Nursing, Institute of Health Sciences, Wollega University, Ethiopia
| | - C Devi
- 2College of Nursing, Government Medical College, Tirwa, Kannauj, Uttarpradesh, India
| | | | | | - M Sumathi
- 4Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
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Nag S, Mitra O, Tripathi G, Samanta S, Bhattacharya B, Chandane P, Mohanto S, Sundararajan V, Malik S, Rustagi S, Adhikari S, Mohanty A, León‐Figueroa DA, Rodriguez‐Morales AJ, Barboza JJ, Sah R. Exploring the theranostic potentials of miRNA and epigenetic networks in autoimmune diseases: A comprehensive review. Immun Inflamm Dis 2023; 11:e1121. [PMID: 38156400 PMCID: PMC10755504 DOI: 10.1002/iid3.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Autoimmune diseases (AD) are severe pathophysiological ailments that are stimulated by an exaggerated immunogenic response towards self-antigens, which can cause systemic or site-specific organ damage. An array of complex genetic and epigenetic facets majorly contributes to the progression of AD, thus providing significant insight into the regulatory mechanism of microRNA (miRNA). miRNAs are short, non-coding RNAs that have been identified as essential contributors to the post-transcriptional regulation of host genome expression and as crucial regulators of a myriad of biological processes such as immune homeostasis, T helper cell differentiation, central and peripheral tolerance, and immune cell development. AIMS This article tends to deliberate and conceptualize the brief pathogenesis and pertinent epigenetic regulatory mechanism as well as miRNA networks majorly affecting five different ADs namely rheumatoid arthritis (RA), type 1 diabetes, multiple sclerosis (MS), systemic lupus erythematosus (SLE) and inflammatory bowel disorder (IBD) thereby providing novel miRNA-based theranostic interventions. RESULTS & DISCUSSION Pertaining to the differential expression of miRNA attributed in target tissues and cellular bodies of innate and adaptive immunity, a paradigm of scientific expeditions suggests an optimistic correlation between immunogenic dysfunction and miRNA alterations. CONCLUSION Therefore, it is not astonishing that dysregulations in miRNA expression patterns are now recognized in a wide spectrum of disorders, establishing themselves as potential biomarkers and therapeutic targets. Owing to its theranostic potencies, miRNA targets have been widely utilized in the development of biosensors and other therapeutic molecules originating from the same.
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Affiliation(s)
- Sagnik Nag
- Department of Bio‐SciencesSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
- Integrative Multiomics LabSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
| | - Oishi Mitra
- Department of Bio‐SciencesSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
- Integrative Multiomics LabSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
| | - Garima Tripathi
- Department of Bio‐SciencesSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
| | - Souvik Samanta
- Department of Bio‐SciencesSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
| | - Bikramjit Bhattacharya
- Integrative Multiomics LabSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
- Department of Applied MicrobiologyVellore Institute of Technology (VIT)Tamil NaduIndia
| | - Priti Chandane
- Department of BiochemistrySchool of Life SciencesUniversity of HyderabadHyderabadTelanganaIndia
| | - Sourav Mohanto
- Department of PharmaceuticsYenepoya Pharmacy College & Research CentreYenepoya (Deemed to be University)MangaluruKarnatakaIndia
| | - Vino Sundararajan
- Integrative Multiomics LabSchool of Bio‐Sciences & Technology, Vellore Institute of TechnologyVelloreTamil NaduIndia
| | - Sumira Malik
- Amity Institute of BiotechnologyAmity University JharkhandRanchiJharkhandIndia
- University Centre for Research and DevelopmentUniversity of Biotechnology, Chandigarh University, GharuanMohaliPunjab
| | - Sarvesh Rustagi
- School of Applied and Life SciencesUttaranchal UniversityDehradunUttarakhandIndia
| | | | - Aroop Mohanty
- Department of Clinical MicrobiologyAll India Institute of Medical SciencesGorakhpurUttar PradeshIndia
| | | | - Alfonso J. Rodriguez‐Morales
- Clinical Epidemiology and Biostatistics, School of MedicineUniversidad Científica del SurLimaPeru
- Gilbert and Rose‐Marie Chagoury School of MedicineLebanese American UniversityBeirutLebanon
| | | | - Ranjit Sah
- Department of Clinical MicrobiologyInstitute of Medicine, Tribhuvan University Teaching HospitalKathmanduNepal
- Department of Clinical MicrobiologyDr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil VidyapeethPuneIndia
- Department of Public Health DentistryDr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil VidyapeethPuneMaharashtraIndia
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T P, Katta B, Lulu S S, Sundararajan V. Gene expression analysis reveals GRIN1, SYT1, and SYN2 as significant therapeutic targets and drug repurposing reveals lorazepam and lorediplon as potent inhibitors to manage Alzheimer's disease. J Biomol Struct Dyn 2023:1-22. [PMID: 37691428 DOI: 10.1080/07391102.2023.2256878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/02/2023] [Indexed: 09/12/2023]
Abstract
Alzheimer's disease (AD) is a slowly progressive neurodegenerative disease and a leading cause of dementia. We aim to identify key genes for the development of therapeutic targets and biomarkers for potential treatments for AD. Meta-analysis was performed on six microarray datasets and identified the differentially expressed genes between healthy and Alzheimer's disease samples. Thereafter, we filtered out the common genes which were present in at least four microarray datasets for downstream analysis. We have constructed a gene-gene network for the common genes and identified six hub genes. Furthermore, we investigated the regulatory mechanisms of these hub genes by analysing their interaction with miRNAs and transcription factors. The gene ontology analysis results highlighted the enriched terms significantly associated with hub genes. Through an extensive literature survey, we found that three of the hub genes including GRIN1, SYN2, and SYT1 were critically involved in disease development. To leverage existing drugs for potential repurposing, we predicted drug-gene interaction using the drug-gene interaction database, and performed molecular docking studies. The docking results revealed that the drug compounds had strong interactions and favorable binding with selected hub genes. Lorazepam exhibits a binding energy of -7.3 kcal/mol with GRIN1, Lorediplon exhibits binding energies of -7.7 kcal/mol and -6.3 kcal/mol with the SYT1, and SYN2 respectively. In addition, 100 ns molecular dynamics simulations were carried out for the top complexes and apo protein as well. Furthermore, the MM-PBSA free energy calculations also revealed that these complexes are stable and had favorable energies. According to our study, the identified hub gene could serve as a biomarker as well as a therapeutic target for AD, and the proposed repurposed drug molecules appear to have promising efficacy in treating the disease.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Premkumar T
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Bhavana Katta
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Sajitha Lulu S
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Vino Sundararajan
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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Ali A M MT, Narayana S DS, Lulu S S, Nag S, Sundararajan V. Targeting NF-κB pathway for the anti-inflammatory potential of Bhadradarvadi kashayam on stimulated RAW 264.7 macrophages. Heliyon 2023; 9:e19270. [PMID: 37664699 PMCID: PMC10469766 DOI: 10.1016/j.heliyon.2023.e19270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Macrophage-arbitrated inflammation is associated with the regulation of rheumatoid arthritis (RA). Low risk and better efficiency are steered herbal drugs more credible than conventional medicines in RA management. Bhadradarvadi (BDK) concoction has been traditionally used for rheumatism in Ayurveda. However, the mechanisms at the molecular level are still elusive. This study was designed to inspect the process of immunomodulation and anti-inflammatory properties of BDK in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages for the first time. BDK concoction was prepared and evaluated with the stimulated murine macrophage-like RAW 264.7 cell lines. TNF-α, IL6, and PGE2 were quantified by ELISA. The normalization of the fold change in the expression of the target gene mRNA was done by comparing the values of the β-actin housekeeping gene using the 2-ΔΔCt comparative cycle threshold. The expression of TNF-α, IL6, iNOS, and COX-2 in the RAW 264.7 macrophage cells was analyzed using flow cytometry. Our results showed that BDK (150-350 μl/ml) treatment significantly decreased the inflammatory cytokines (TNF-α, and IL-6) and inflammatory mediators (PGE2) in LPS-stimulated RAW 264.7 macrophage cells. The pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) expression, inflammatory enzymes (iNOS and COX-2), and NF-κBp65 were significantly downregulated at transcriptome level in LPS-stimulated RAW 264.7 macrophage cells. The flow cytometry analysis revealed that BDK treatment diminished the TNF-α, IL-6, iNOS, and COX-2 expression at the proteome level, as well as obstruction of NF-κB-p65 nuclear translocation was observed by immunofluorescence analysis in LPS-stimulated RAW 264.7 macrophage cells. Collectively, BDK can intensely augment the anti-inflammatory activities via inhibiting the NF-κB signaling pathway trigger for treating autoimmune disorders including RA.
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Affiliation(s)
- Mohamed Thoufic Ali A M
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Devi Soorya Narayana S
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Sajitha Lulu S
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Sagnik Nag
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Vino Sundararajan
- Integrative Multiomics Lab, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
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Naidu A, Nayak SS, Lulu S S, Sundararajan V. Advances in computational frameworks in the fight against TB: The way forward. Front Pharmacol 2023; 14:1152915. [PMID: 37077815 PMCID: PMC10106641 DOI: 10.3389/fphar.2023.1152915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Around 1.6 million people lost their life to Tuberculosis in 2021 according to WHO estimates. Although an intensive treatment plan exists against the causal agent, Mycobacterium Tuberculosis, evolution of multi-drug resistant strains of the pathogen puts a large number of global populations at risk. Vaccine which can induce long-term protection is still in the making with many candidates currently in different phases of clinical trials. The COVID-19 pandemic has further aggravated the adversities by affecting early TB diagnosis and treatment. Yet, WHO remains adamant on its "End TB" strategy and aims to substantially reduce TB incidence and deaths by the year 2035. Such an ambitious goal would require a multi-sectoral approach which would greatly benefit from the latest computational advancements. To highlight the progress of these tools against TB, through this review, we summarize recent studies which have used advanced computational tools and algorithms for-early TB diagnosis, anti-mycobacterium drug discovery and in the designing of the next-generation of TB vaccines. At the end, we give an insight on other computational tools and Machine Learning approaches which have successfully been applied in biomedical research and discuss their prospects and applications against TB.
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Affiliation(s)
| | | | | | - Vino Sundararajan
- Department of Biotechnology, School of Bio Sciences and Technology, VIT University, Vellore, India
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Nayak SS, Sundararajan V. Robust anti-inflammatory activity of genistein against neutrophil elastase: a microsecond molecular dynamics simulation study. J Biomol Struct Dyn 2023; 41:11612-11628. [PMID: 36705087 DOI: 10.1080/07391102.2023.2170919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/26/2022] [Indexed: 01/28/2023]
Abstract
Human Neutrophil Elastase (HNE) is one of the major causes of tissue destruction in numerous chronic and inflammatory disorders and has been reported as a therapeutic target for inflammatory diseases. Overexpression of this enzyme plays a critical role in the pathogenesis of rheumatoid arthritis (RA). The focus of this study is to identify potent natural inhibitors that could target the active site of the HNE through the use of computational methods. The molecular structure of small molecules was retrieved from several natural compound databases. This was followed by structure-based virtual screening, molecular docking, ADMET property predictions and molecular dynamic simulation studies to screen potential HNE inhibitors. In total, 1881 natural compounds were extracted and subjected to molecular docking studies, and 10 compounds were found to have good interactions, exhibiting the best docking scores. Genistein showed higher binding efficacy (-10.28 Kcal/mol) to HNE in comparison to other natural compounds. The conformational stability of the docked complex of the ELANE gene (HNE) with genistein was assessed using 1-microsecond molecular dynamic simulation (MDs), which reliably revealed the unique stereochemical alteration of the complex, indicating its conformational stability and flexibility. Alterations in the enzyme structure upon complex formation were further characterized through clustering analysis and linear interaction energy (LIE) calculation. The outcomes of this research propose novel potential candidates against target HNE.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Smruti Sudha Nayak
- Department of Bio-Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamilnadu, India
| | - Vino Sundararajan
- Department of Bio-Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamilnadu, India
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Poy SY, Bashir S, Omar FS, Saidi NM, Farhana NK, Sundararajan V, Ramesh K, Ramesh S. Poly (1-vinylpyrrolidone-co-vinyl acetate) (PVP-co-VAc) based gel polymer electrolytes for electric double layer capacitors (EDLC). J Polym Res 2020. [DOI: 10.1007/s10965-020-2016-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kiburg KV, Ward GM, Vogrin S, Steele K, Mulrooney E, Loh M, McLachlan SA, Sundararajan V, MacIsaac RJ. Impact of type 2 diabetes on hospitalization and mortality in people with malignancy. Diabet Med 2020; 37:362-368. [PMID: 31559651 DOI: 10.1111/dme.14147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
AIM To compare the characteristics of and outcomes for people with malignancies with and without a co-diagnosis of diabetes. METHODS Emergency department and hospital discharge data from a single centre for the period between 1 January 2015 and 31 December 2017 were used to identify people with a diagnosis of a malignancy and diabetes. Multivariate Cox regression models were used to estimate the effect of diabetes on all-cause mortality. A truncated negative binomial regression model was used to assess the impact of diabetes on length of hospital inpatient stay. Prentice-Williams-Peterson total time models were used to assess the effect of diabetes on number of emergency department re-presentations and inpatient re-admissions. RESULTS Of 7004 people identified with malignancies, 1195 (17.1%) were also diagnosed with diabetes. A diagnosis of diabetes was associated with a greater number of inpatient re-admissions [adjusted hazard ratio 1.13 (95% CI 1.03, 1.24)], a greater number of emergency department re-presentations [adjusted hazard ratio 1.13 (95% CI 1.05, 1.22)] and longer length of stay [adjusted incidence rate ratio 1.14 (95% CI 1.04, 1.25)]. A co-diagnosis of diabetes was also associated with a 48% increased risk of all-cause mortality [adjusted hazard ratio 1.48 (95% CI 1.22-1.76)]. CONCLUSIONS People with malignancies and diabetes had significantly more emergency department presentations, more inpatient admissions, longer length of hospital stay and higher rates of all-cause mortality compared to people with a malignancy without diabetes.
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Affiliation(s)
- K V Kiburg
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- St Vincent's Institute of Medical Research, Fitzroy, Australia
| | - G M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Clinical Biochemistry, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - S Vogrin
- Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - K Steele
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - E Mulrooney
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - M Loh
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - S A McLachlan
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - V Sundararajan
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - R J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Australia
- St Vincent's Institute of Medical Research, Fitzroy, Australia
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Andrew NE, Kim J, Cadilhac DA, Sundararajan V, Thrift AG, Churilov L, Lannin NA, Nelson M, Srikanth V, Kilkenny MF. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study. Int J Popul Data Sci 2019; 4:1097. [PMID: 34095531 PMCID: PMC8142961 DOI: 10.23889/ijpds.v4i1.1097] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AIM To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. METHODS Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken. ANALYSIS The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective. CONCLUSION Completion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.
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Affiliation(s)
- NE Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - DA Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - V Sundararajan
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - AG Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - L Churilov
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - NA Lannin
- School of Allied Health, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - M Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Victoria, Australia
| | - V Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - MF Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
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Sundararajan V, Selvaraj G, Ng H, Ramesh S, Ramesh K, Wilfred C, Bashir S. Exploring the effect of novel N-butyl-6-methylquinolinium bis(trifluoromethylsulfonyl)imide ionic liquid addition to poly(methyl methacrylate-co-methacrylic) acid electrolyte system as employed in gel-state dye sensitized solar cells. Electrochim Acta 2017. [DOI: 10.1016/j.electacta.2017.04.097] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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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Clay TD, Russell PA, Do H, Sundararajan V, Conron M, Wright GM, Dobrovic A, Moore MM, McLachlan SA. Associations between the IASLC/ATS/ERS lung adenocarcinoma classification and EGFR and KRAS mutations. Pathology 2015; 48:17-24. [PMID: 27020204 DOI: 10.1016/j.pathol.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
Abstract
We sought to investigate the frequency of mutations in epidermal growth factor receptor (EGFR) and Kirsten-RAS (KRAS) by each pathological subtype for patients with resected pulmonary adenocarcinoma as defined by the IASLC/ATS/ERS classification. Histological examination determined the predominant subtype according to the IASLC/ATS/ERS classification. EGFR and KRAS mutations were determined by high-resolution melting and Sanger sequencing. Clinical data were collected from medical records and clinicians. The 178 consecutive patients consisted of 48% males, median age 68 years (range 20-87) and smoking history 78%. The tumour stage was I in 62%, II in 18% and III in 20%. The mutation rates were: EGFR 30%; KRAS 28%. The rate of EGFR mutations in the acinar predominant reference group (n=76), was 37%. The solid predominant subtype showed significantly fewer EGFR mutations [3/33 (9%), odds ratio 0.17 (0.05-0.61), p=0.007]. No differences in mutation rate were observed in other subtypes. No association was found between KRAS mutations and predominant histological subtype. Advanced stage and solid predominant subtype were negative prognostic factors. EGFR mutations can be present in adenocarcinoma of any predominant subtype, however rarely in solid predominant tumours. No association was found between KRAS mutation and the predominant histological subtype.
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Affiliation(s)
- T D Clay
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia.
| | - P A Russell
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - H Do
- University of Melbourne, Australia; Translational Genomics and Epigenetics Laboratory, Olivia Newton John Cancer Research Institute, Heidelberg Australia; School of Cancer Medicine, La Trobe University, Australia
| | | | - M Conron
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - G M Wright
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - A Dobrovic
- University of Melbourne, Australia; Translational Genomics and Epigenetics Laboratory, Olivia Newton John Cancer Research Institute, Heidelberg Australia; School of Cancer Medicine, La Trobe University, Australia
| | - M M Moore
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
| | - S A McLachlan
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Australia
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Sundararajan V, Romano PS, Quan H, Burnand B, Drösler SE, Brien S, Pincus HA, Ghali WA. Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety. Int J Qual Health Care 2015; 27:328-33. [PMID: 26045514 DOI: 10.1093/intqhc/mzv037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. METHODS As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. RESULTS The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. CONCLUSIONS As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.
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Affiliation(s)
- V Sundararajan
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - P S Romano
- Departments of Internal Medicine and Pediatrics, and Center for Healthcare Policy and Research, University of California Davis, Davis, CA, USA
| | - H Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - B Burnand
- Institut Universitaire de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - S E Drösler
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - S Brien
- Health Council of Canada, Toronto, Canada
| | - H A Pincus
- Department of Psychiatry, Division of Clinical Phenomenology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - W A Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada Department of Medicine, University of Calgary, Calgary, Canada
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Quan H, Moskal L, Forster AJ, Brien S, Walker R, Romano PS, Sundararajan V, Burnand B, Henriksson G, Steinum O, Droesler S, Pincus HA, Ghali WA. International variation in the definition of 'main condition' in ICD-coded health data. Int J Qual Health Care 2014; 26:511-5. [PMID: 24990594 DOI: 10.1093/intqhc/mzu064] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hospital-based medical records are abstracted to create International Classification of Disease (ICD) coded discharge health data in many countries. The 'main condition' is not defined in a consistent manner internationally. Some countries employ a 'reason for admission' rule as the basis for the main condition, while other countries employ a 'resource use' rule. A few countries have recently transitioned from one of these approaches to the other. The definition of 'main condition' in such ICD data matters when it is used to define a disease cohort to assign diagnosis-related groups and to perform risk adjustment. We propose a method of harmonizing the international definition to enable researchers and international organizations using ICD-coded health data to aggregate or compare hospital care and outcomes across countries in a consistent manner. Inter-observer reliability of alternative harmonization approaches should be evaluated before finalizing the definition and adopting it worldwide.
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Affiliation(s)
- H Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - L Moskal
- Canadian Institute for Health Information, Ottawa, Canada
| | - A J Forster
- Ottawa Hospital Research Institute and Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - S Brien
- Health Council of Canada, Toronto, Canada
| | - R Walker
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - P S Romano
- Departments of Internal Medicine and Pediatrics, and Center for Healthcare Policy and Research, University of California Davis, Davis, USA
| | - V Sundararajan
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia
| | - B Burnand
- Institut Universitaire de Médecine Sociale et Préventive, Centre, Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - G Henriksson
- Nordic WHO FIC Collaborating Centre, Oslo, Norway
| | - O Steinum
- Nordic WHO FIC Collaborating Centre, Oslo, Norway
| | - S Droesler
- Faculty of Industrial Engineering and Health Care, Niederrhein University of Applied Sciences, Reinarzstrasse 49, Krefeld, Germany
| | - H A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York, NY, USA
| | - W A Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada Department of Medicine, University of Calgary, Calgary, Canada
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Philip J, Lowe A, Gold M, Brand C, Miller B, Douglass J, Sundararajan V. Palliative care for patients with chronic obstructive pulmonary disease: exploring the landscape. Intern Med J 2014; 42:1053-7. [PMID: 24020345 DOI: 10.1111/j.1445-5994.2012.02830.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with chronic obstructive pulmonary disease experience a substantial symptom burden, high levels of psychosocial need and significant mortality. This epidemiological study reveals that the majority of patients are cared for in the public hospital system (64%) and generally die in hospital (72%) with a number of identifiable predictors of 6-month mortality. Our results suggest that palliative care services need to be redirected from a community-based admission focus to a model that is responsive to emergency and acute care hospital systems.
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Affiliation(s)
- J Philip
- Centre for Palliative Care, St Vincent's Hospital and University of Melbourne Palliative Medicine, St Vincent's Hospital School of Population Health, University of Melbourne Murdoch Childrens Research Institute, Royal Children's Hospital Palliative Care Service Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital Centre for Research Excellence in Patient Safety (CREPS) Department of Clinical Epidemiology, Biostatistics and Health Services Research, Melbourne University and Melbourne HealthDepartments of Medicine Medicine, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
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Ghali WA, Pincus HA, Southern DA, Brien SE, Romano PS, Burnand B, Drosler SE, Sundararajan V, Moskal L, Forster AJ, Gurevich Y, Quan H, Colin C, Munier WB, Harrison J, Spaeth-Rublee B, Kostanjsek N, Ustun TB. ICD-11 for quality and safety: overview of the who quality and safety topic advisory group. Int J Qual Health Care 2013; 25:621-5. [DOI: 10.1093/intqhc/mzt074] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Philip J, Gold M, Brand C, Douglass J, Miller B, Sundararajan V. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J 2013; 42:816-22. [PMID: 22152049 DOI: 10.1111/j.1445-5994.2011.02641.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The information needs of patients with chronic obstructive pulmonary disease (COPD) towards the end of life are poorly understood. AIM This study explored the views of patients with COPD and healthcare professionals, focusing upon information needs and treatment preferences. METHOD In-depth, semi-structured interviews were held with patients with COPD following admission to hospital with respiratory failure, and focus groups held with healthcare professionals from hospital and community settings. RESULTS Ten patients were interviewed, who had a median 4 previous hospital admissions, and had smoked for median 47 years. Five focus groups were held with 31 healthcare professionals (18 nurses, 7 doctors, 6 allied health). The theme underpinning all discussions was of tension between maintaining hope and negotiating the reality of the illness and its consequences. Within this theme, patients tended to be optimistic, viewed acute exacerbations as separate from their underlying chronic illness, and were keen for intensive treatments, including intubation if acutely unwell. They had little understanding of the complexities of decision-making around treatment escalation. Both patients and health workers believed that information around end of life should be offered routinely, but delivered in a manner that recognises and maintains a form of hope. CONCLUSION Patients and healthcare professionals believe information around illness course, future goals and treatment is important to care. An expanded view of hope may assist when providing such information, including when discussing goals of care in the setting of advanced illness.
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Affiliation(s)
- J Philip
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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Brand C, Tropea J, Gorelik A, Jolley D, Scott I, Sundararajan V. An adverse event screening tool based on routinely collected hospital-acquired diagnoses. Int J Qual Health Care 2012; 24:266-78. [DOI: 10.1093/intqhc/mzs007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Januel JM, Couris CM, Luthi JC, Halfon P, Trombert-Paviot B, Quan H, Drosler S, Sundararajan V, Pradat E, Touzet S, Wen E, Shepheard J, Webster G, Romano P, So L, Moskal L, Tournay-Lewis L, Sundaresan L, Kelley E, Klazinga N, Ghali W, Colin C, Burnand B. Adaptation au codage CIM-10 de 15 indicateurs de la sécurité des patients proposés par l’Agence étasunienne pour la recherche et la qualité des soins de santé (AHRQ). Rev Epidemiol Sante Publique 2011; 59:341-50. [DOI: 10.1016/j.respe.2011.04.004] [Citation(s) in RCA: 3] [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] [Received: 04/17/2009] [Revised: 02/10/2011] [Accepted: 04/01/2011] [Indexed: 10/17/2022] Open
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Bohensky MA, Jolley D, Sundararajan V, Pilcher DV, Evans S, Brand CA. Empirical aspects of linking intensive care registry data to hospital discharge data without the use of direct patient identifiers. Anaesth Intensive Care 2011; 39:202-8. [PMID: 21485667 DOI: 10.1177/0310057x1103900208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In the field of intensive care, clinical data registries are commonly used to support clinical audit and develop evidence-based practice. However, they are often restricted to the intensive care unit episode only, limiting their ability to follow long-term patient outcomes and identify patient readmissions. Data linkage can be used to supplement existing data, but a lack of unique patient identifiers may compromise the accuracy of the linkage process. The aim of this study was to assess the quality of linking the Australia/New Zealand critical care registry to a state financial claims database using a method without direct patient identifiers and to identify possible sources of bias from this method. We used a linkage method relying on indirect patient identifiers and compared the accuracy of this method to one that also included the patient medical record number and date of birth. The overall linkage rate using the method with indirect identifiers was 92.3% compared to 94.5% using the method with direct identifiers. Factors most strongly associated with not being a correct link in the first method included patients at one study hospital, admissions in 2002 and 2003 and having a hospital length of stay of 20 days or more. Linking the Australia/New Zealand critical care without direct patient identifiers is a valid linkage method that will enable the measurement of long-term patient survival and readmissions. While some sources of bias have been identified, this method provides sufficient quality linkage that will support broad analyses designed to signal future in-depth research.
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Affiliation(s)
- M A Bohensky
- Centre for Research Excellence and Patient Safety, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Brand CA, Sundararajan V. A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Qual Saf Health Care 2010; 19:e51. [PMID: 20558479 DOI: 10.1136/qshc.2009.038273] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To document the burden of in-hospital falls and fractures, and to identify factors that may increase the risk of these events. DESIGN A retrospective cohort analysis. SETTING The study was set in the State of Victoria, Australia. PARTICIPANTS Hospital episode data collected in the Victoria Admitted Episodes Dataset, for all multiday-stay patients 18 years or more admitted to Victorian public hospitals; 1 July 1998 to 30 June 2008. Diagnoses were defined by the International Classification of Disease, 10th Revision, Australian Modification (ICD-10-AM), which includes an in-hospital diagnostic timing code. Outcome measures included rates of in-hospital falls and fractures, length of hospital stay and mortality. Variables included in risk adjustment included financial year, individual demographic and comorbidity data, and hospital characteristics. RESULTS There were 3,345,415 episodes: 21,250 (0.64%) in-hospital falls and 4559 (0.14%) fractures. In-hospital fall (IHF) episode rates increased over the study period, but fracture episode rates were stable. Mortality (HR 1.3, CI 1.3 to 1.5) and length of stay (median 19 days vs 5 days, p<0.0001) were increased with IHF. Risk factors for IHF included dementia (rate ratio 1.7, CI 1.6 to 1.8) and delirium (rate ratio 1.8, CI 1.6 to 2.0). CONCLUSIONS Routinely collected data that include a hospital diagnostic timing code offer a standard method of quantifying in-hospital falls and fractures. Unselected in-hospital falls data may be subject to reporting and documentation bias. The utility of using robust selected injuries such as IHF-related fracture as a quality-of-care indicator requires further investigation.
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Affiliation(s)
- C A Brand
- Centre of Research Excellence in Patient Safety, Department of Preventive Medicine, Monash University, 89 Commercial Road Melbourne, Victoria 3004, Australia.
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Dudeja S, Sundararajan V, Kumar R, Shamsi M, Kumar R, Dada R. Ultrastructural defects in spermatozoa of men attending the infertility clinic. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.423] [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: 10/21/2022]
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Kumar R, Dada R, Kumar M, Pathak D, Shamsi M, Sundararajan V. Diagnostic and prognostic implications of nuclear and mitochondrial mutations in couples opting for ART. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.1053] [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: 10/21/2022]
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Januel JM, Couris CM, Quan H, Luthi JC, Drosler S, Sundararajan V, Trombert-Paviot B, Pradat E, Touzet S, Halfon P, Wen E, Shepheart J, Webster G, Romano P, So L, Moskal L, Tournay-Lewis L, Sundaresan L, Kelley E, Klazinga N, Ghali W, Burnand B, Colin C. Adaptation à la classification CIM-10 d’indicateurs de la sécurité des soins à l’hôpital développés à partir des données médico-administratives : le projet PSI. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.02.063] [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] Open
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New PW, Sundararajan V. Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review. Spinal Cord 2007; 46:406-11. [DOI: 10.1038/sj.sc.3102152] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Clothier HJ, Vu T, Sundararajan V, Andrews RM, Counahan M, Tallis GF, Lambert SB. Invasive pneumococcal disease in Victoria: a better measurement of the true incidence. Epidemiol Infect 2007; 136:225-31. [PMID: 17359564 PMCID: PMC2870793 DOI: 10.1017/s0950268807008187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Invasive pneumococcal disease (IPD) notifications are used to monitor IPD vaccination programmes. We conducted sequential deterministic data-linkage between IPD notifications and hospitalization data in Victoria, Australia, in order to determine whether all diagnosed cases were being reported. The proportion of each relevant hospital admission ICD-10-AM code that could be linked to notified cases was calculated. Total and age-specific annual rates were calculated and compared for notified and non-notified cases. Total incidence was estimated using data-linkage results and application of a two-source capture-recapture method. The first 2 years of IPD surveillance in Victoria missed at least one-sixth of laboratory-confirmed IPD cases. Estimated annual IPD rate increased from 9.0 to 10.7/100,000 and rose even higher, to 11.5/100,000, with age-specific rates possibly reaching 90.0/100,000 children aged <2 years, when using capture-recapture. Strategies to improve notification and coding of hospitalized cases of IPD are required.
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Affiliation(s)
- H J Clothier
- Communicable Diseases Section, Rural and Regional Health and Aged Care Services Division, Department of Human Services, Melbourne, Victoria, Australia.
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Van Doornum S, Brand C, King B, Sundararajan V. Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2006; 54:2061-8. [PMID: 16802340 DOI: 10.1002/art.21932] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Among patients with rheumatoid arthritis (RA), cardiovascular mortality is increased compared with the rate among unaffected peers. In this study, 30-day mortality rates following a first acute cardiovascular event (myocardial infarction or stroke) were compared between RA patients and the general population. METHODS All cases of a first acute cardiovascular event between July 1, 2001 and November 30, 2003 in Victoria, Australia were identified from hospital discharge data. Individuals were classified as having RA when an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification code for RA was recorded at the index admission or during the previous 5 years. Thirty-day mortality rates were determined from linkage to the state death registry. RESULTS A total of 29,924 patients experienced a first cardiovascular event during the study period, 359 (1.2%) of whom had RA. Thirty-day cardiovascular mortality was 17.6% in RA patients versus 10.8% in non-RA patients. In fully adjusted models, the odds ratio (OR) for cardiovascular death in RA patients following a first acute cardiovascular event was 1.6 (95% confidence interval [95% CI] 1.2-2.2). Analysis of index event subgroups revealed that this increased case fatality rate in patients with RA was accounted for almost entirely by excess deaths following myocardial infarction. The adjusted ORs for cardiovascular death in RA after myocardial infarction and stroke were 1.9 (95% CI 1.3-2.7) and 1.2 (95% CI 0.7-2.0), respectively. CONCLUSION RA patients have a substantially increased risk of 30-day case fatality following myocardial infarction, but not stroke, compared with non-RA patients. This higher case fatality rate is likely to contribute to the observed overall excess of cardiovascular deaths in RA populations.
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Affiliation(s)
- S Van Doornum
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Post Office Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Brand C, Sundararajan V, Jones C, Hutchinson A, Campbell D. Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis. Intern Med J 2005; 35:296-9. [PMID: 15845113 DOI: 10.1111/j.1445-5994.2005.00816.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).
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Affiliation(s)
- C Brand
- Clinical Epidemiology and Health Services Evaluation Unit, Royal Melbourne Hospital, Victoria, Australia.
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Sundararajan V, Grann VR, Jacobson JS, Ahsan H, Neugut AI. Variations in the use of adjuvant chemotherapy for node-positive colon cancer in the elderly: a population-based study. Cancer J 2001; 7:213-8. [PMID: 11419029] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Since 1990, the recommended adjuvant therapy for patients with surgically resected node-positive colon cancer has been 5-fluorouracil (5-FU), usually in combination with leucovorin or levamisole. The purpose of this study is to assess the distribution of adjuvant 5-FU treatment in the elderly. METHODS The Surveillance, Epidemiology and End Results-Medicare database provides population-based information on cancer patients, representing approximately 14% of the United States population, along with health care utilization data from Medicare claims files. We studied patients with node-positive colon cancer diagnosed between 1992 and 1996 who survived at least 120 days beyond diagnosis (N = 4998). RESULTS About 50% of elderly patients received 5-FU within 4 months of diagnosis. The proportion of patients treated with 5-FU increased by about 10% from 1992 to 1996. In a multiple logistic regression model, 5-FU treatment was less likely to be given to older patients (compared with those aged 65-69 years, the odds ratio (OR) [95% CI] was 0.82 [0.67-1.00] for ages 70 to 74 years, 0.47 [0.39-0.57] for ages 75 to 79, 0.17 [0.13-0.20] for ages 80 to 84, and 0.04 [0.03-0.05] for ages 85 to 88 years. Non-Hispanic black patients were less likely to be treated than non-Hispanic white patients (OR 0.46 [0.36-0.59]); patients with more than three positive lymph nodes were more likely to be treated than those with three or less, and those with comorbid conditions were less likely to be treated than those without such conditions. CONCLUSIONS Despite its proven efficacy in reducing colon cancer mortality, 5-FU-based chemotherapy is not widely used among apparently eligible patients over age 65. Efforts are needed to ensure that elderly and non-Hispanic black patients receive appropriate treatment.
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Affiliation(s)
- V Sundararajan
- Division of Epidemiology, Joseph L. Mailman School of Public Health, PH-18-127, 630 West 168th Street, New York, NY 10032, USA
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Majoor JW, Loff B, Sundararajan V, Ibrahim JE. Managed care. Med J Aust 2000; 173:557-8. [PMID: 11194746 DOI: 10.5694/j.1326-5377.2000.tb139337.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hariprasad P, Sundararajan V, Srimathi G. Mechanical ventilation: our experience. Indian Pediatr 2000; 37:1285-6. [PMID: 11086323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Grann VR, Sundararajan V, Jacobson JS, Whang W, Heitjan DF, Antman KH, Neugut AI. Decision analysis of tamoxifen for the prevention of invasive breast cancer. Cancer J 2000; 6:169-78. [PMID: 10882333] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE The recent Breast Cancer Prevention Trial has shown that tamoxifen may prevent invasive breast cancer. We used a Markov model to estimate the long-term effects of chemoprevention with tamoxifen on survival, quality-adjusted survival, and health care costs. METHODS We used a hypothetical cohort of women with breast-cancer risk similar to that of participants in the Breast Cancer Prevention Trial, and a computer-based decision analysis (Markov model and 500 Monte Carlo simulations) to model the outcomes of interest. Survival calculations were from Surveillance, Epidemiology, and End-Results (SEER) data; preference ratings from a time trade-off questionnaire administered to a group of average-risk women; and cost estimates from the Group Health Cooperative of Puget Sound and the Health Care Financing Administration. We obtained utility measures for quality-adjustment by administering a time trade-off questionnaire to a group of community-based women. RESULTS Use of tamoxifen prolonged the average survival of cohort members by 69 days (95% probability interval [PI] 27 to 117) for those who started use at age 35 years; 40 days (95% PI 16 to 67) for those who started use at age 50 years; and 27 days (95% PI 14 to 40) for those who started use at age 60 years. Tamoxifen extended quality-adjusted survival by 38 days (95% PI 0.1 to 82) at age 35, 25 days (95% PI 0 to 50) at age 50, and 22 days (95% PI 5 to 39) days at age 60. Chemoprevention with tamoxifen cost $46,619 (95% PI $27,928 to $98,796) per life year life saved for women who started at age 35; for women over age 50, it cost more than $50,000 per life year saved. DISCUSSION Tamoxifen use may improve long-term survival and quality-adjusted survival among women who are at increased risk of breast cancer, but this benefit diminishes with age. Tamoxifen is cost-effective in comparison with other cancer treatment strategies for younger women only.
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Affiliation(s)
- V R Grann
- Herbert Irving Comprehensive Cancer Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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Grann VR, Jacobson JS, Sundararajan V, Albert SM, Troxel AB, Neugut AI. The quality of life associated with prophylactic treatments for women with BRCA1/2 mutations. Cancer J Sci Am 1999; 5:283-92. [PMID: 10526669] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE This study was conducted to obtain and compare the preferences assigned to cancer states and prevention measures by women who had breast cancer, were at high risk for breast cancer, or had neither condition. PATIENTS AND METHODS We administered a time trade-off questionnaire to 21 breast cancer patients, 28 women with a personal history of multiple breast biopsies or a family history of breast cancer, and 135 women without these conditions (the reference group). We stratified the reference group into two groups aged 20 to 32 years and 33 to 50 years, respectively. RESULTS All four groups assigned higher preference to breast cancer than to ovarian cancer. Both reference groups preferred using a tamoxifen-like drug to having mastectomy or oophorectomy for cancer prevention; the high-risk and breast cancer groups did not. None of the four groups had a preference between prophylactic mastectomy and breast cancer. All the groups were willing to subtract more years from their life expectancy to protect offspring from genetic risk than to protect themselves. Reference group members in the 33- to 50-year age range had lower mean ratings than the breast cancer group for almost all the health states, and breast cancer patients were less willing than other respondents to trade time for health. Most of these differences were not statistically significant. The high-risk group was similar to the older reference group in time trade-off ratings. DISCUSSION The time trade-off-based preferences of healthy women may be used to predict the treatment preferences of women with BRCA1/2 mutations. Obtaining healthy women's ratings of treatment outcomes may help health care policy makers envision the consequences of the difficult choices that high-risk women face.
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Affiliation(s)
- V R Grann
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA
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Abstract
In this study, 187 consecutive neonates suspected of having septicaemia were investigated for isolation of micro organisms. Two samples of blood were collected for isolation of aerobes and anaerobes. Cultures were positive in 75 (40%) cases. Aerobic bacteria were the major etiological agent, accounting for 93% of positives including the 8% cases showing polymicrobial etiology. Anaerobic bacteria and Candida species were isolated in 6.6% and 8% of positive cases respectively. Bacteroides fragilis (amongst anaerobic) and Staphylococcus aureus (amongst aerobic) were the predominant organisms isolated. Clinical presentations were not specifically different to distinguish aerobic from anaerobic bacteria. In the present study, 6.6% of bacteremias were due to anaerobes, hence possibility of some of the bactermias being due to anaerobes should be kept in mind while treating cases of neonatal septicaemia. For a complete microbial profile both aerobic and anaerobic cultures should be done.
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Affiliation(s)
- M Thomas
- Department of Microbiology, PSGIMS and R, Coimbatore
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Jackson JC, Vinluan CC, Dragland CJ, Sundararajan V, Yan B, Gounarides JS, Nirmala NR, Topiol S, Ramage P, Blume JE, Aicher TD, Bell PA, Mann WR. Heterologously expressed inner lipoyl domain of dihydrolipoyl acetyltransferase inhibits ATP-dependent inactivation of pyruvate dehydrogenase complex. Identification of important amino acid residues. Biochem J 1998; 334 ( Pt 3):703-11. [PMID: 9729480 PMCID: PMC1219741 DOI: 10.1042/bj3340703] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The activity of the pyruvate dehydrogenase multienzyme complex (PDC), which catalyses the oxidation of pyruvate to acetyl-CoA within the mitochondrion, is diminished in animal models of diabetes. Studies with purified PDC components have suggested that the kinases responsible for inactivating the decarboxylase catalytic subunits of the complex are most efficient in their regulatory role when they are bound to dihydrolipoyl acetyltransferase (E2) subunits, which form the structural core of the complex. We report that the addition of an exogenous E2 subdomain (inner lipoyl domain) to an intact PDC inhibits ATP-dependent inactivation of the complex. By combining molecular modelling, site-directed mutagenesis and biophysical characterizations, we have also identified two amino acid residues in this subdomain (Ile229 and Phe231) that largely determine the magnitude of this effect.
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Affiliation(s)
- J C Jackson
- Metabolic and Cardiovascular Diseases Research, Novartis Institute for Biomedical Research, 556 Morris Avenue, Summit, NJ 07901-1398, USA
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Abstract
OBJECTIVE To describe the patterns of provider use associated with an acute episode of nonspecific low back pain and their impact on cost. METHODS The analysis is based on a prospective cohort study of patients with acute low back pain followed until they recovered completely or to 6 months. Patients were followed after an initial visit to one of four provider types: private primary care physician, chiropractor, orthopedic surgeon, or HMO primary care physician. Follow-up interviews were conducted at baseline, 2, 4, 8, 12, and 24 weeks; 1,580 (97%) of the participants completed the 6-month follow-up. MAIN RESULTS Seventy-nine percent of patients saw only the initial provider who began their care for low back pain. Logistic regression revealed that duration of pain prior to initial visit, sciatica, higher Roland disability score, days to functional recovery, interval to complete recovery, referral by initial provider, disk attribution, satisfaction, and the type of index provider were significantly (p < .05) associated with seeking care from multiple provider types. Age, race, gender, and education were not significant. The adjusted proportions of multiple provider type use were 14% (95% confidence interval [CI] 11%, 17%) for the private primary care provider stratum; 19% (95% CI 16%, 23%) for the chiropractic stratum; 30% (95% CI 23%, 37%) for the orthopedic stratum; and 9% (95% CI 5%, 14%) for the HMO primary care physician stratum. Cost of seeing only the index provider was $439 (95% CI $404, $475), and cost of seeing multiple provider types was $1,137 (95% CI $1,064, $1,211) based on the adjusted model. CONCLUSIONS Use of multiple provider types, is associated with several factors, one of which is the initial provider type. The cost of such use is significant.
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Affiliation(s)
- V Sundararajan
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7590, USA
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Abstract
The care of the febrile neutropenic patient has undergone a shift in the last 10 years with the realization that neutropenic patients presenting with fever do not constitute a homogeneous group. Strategies of risk assessment have allowed the testing of novel therapies including outpatient treatment with oral and intravenous antibiotics, either in combination regimens or as monotherapy; the addition of growth factors to hasten the return of the absolute neutrophil count; and the possibility of self-initiation of antibiotics by cancer patients when they develop fever. The clinical trials data regarding these new approaches will be reviewed, and areas requiring further research will be discussed.
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Affiliation(s)
- V Sundararajan
- Ambulatory and Supportive Care Oncology Research Program (ASCORP), University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Sundararajan V, Kanhere DG, Singru RM. Momentum distribution in vanadium: Compton scattering and positron annihilation. Phys Rev B Condens Matter 1992; 46:7857-7863. [PMID: 10002527 DOI: 10.1103/physrevb.46.7857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sundararajan V, Cooper DK, Muchmore J, Manion CV, Liguori C, Zuhdi N, Novitzky D, Chen PN, Bourne DW, Corder CN. Interaction of cyclosporine and probucol in heart transplant patients. Transplant Proc 1991; 23:2028-32. [PMID: 2063476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- V Sundararajan
- Oklahoma Medical Research Foundation, Oklahoma City 73104
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Asokamani R, Rajagopalan M, Suvasini MB, Sundararajan V. Band structure and superconductivity in Lu at high pressures. Phys Rev B Condens Matter 1986; 33:7556-7561. [PMID: 9938120 DOI: 10.1103/physrevb.33.7556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Govindarajan S, Sundararajan V. Elasto-plastic behaviour of a thin cylinder under thermal stress cycling. Nuclear Engineering and Design 1983. [DOI: 10.1016/0029-5493(83)90082-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sundararajan V, Thakur S. Public Investment, Crowding out, and Growth: A Dynamic Model Applied to India and Korea (Investissement public, "effet de refoulement" et croissance: un modele dynamique applique a l'Inde et a la Coree) (Inversion publica, desplazamiento de la inversion privada y crecimiento: Un modelo dinamico aplicado a India y Corea). ACTA ACUST UNITED AC 1980. [DOI: 10.2307/3866958] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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